Bruno Martinelli

Aquatic Exercise is as Effective as dry Land Training to Blood Pressure Reduction in Postmenopausal Hypertensive Women

BACKGROUND AND PURPOSE The evidence of the benefits from regular physical activity to hypertensives is based on dry land training studies. Therefore, the aim of this study is to compare the effect of aquatic exercise with dry land training on hypertensive women. METHODS This is a randomized controlled study with 52 post-menopausal hypertensive women. The patients were randomly allocated in three groups: water aerobic training group (n = 19), dry land aerobic training group (n = 19) and a non-intervention control group (n = 14). The training protocol was performed by 12 weeks. RESULTS There were no differences among the three groups concerning basal blood pressure (BP) and biochemical variables. In water group, there was a statistically significant reduction of systolic BP from 136 ± 16 mm Hg at zero week to 124 ± 18 mm Hg at 11th week and 124 ± 15 mm Hg at 12th week. In dry land training group, there was a statistically significant reduction of systolic BP from 138 ± 15 mm Hg at zero week to 125 ± 10 mm Hg at 7th week, 127 ± 10 mm Hg at 10th week and 126 ± 9 mm Hg at 12th week. The control group presented no change in any of the assessed variables. No changes were carried out in any antihypertensive medications during study. DISCUSSION This is a randomized controlled study that demonstrates the antihypertensive efficacy of aerobic aquatic exercise.

Influência do exercício aeróbio na renina de portadores de hipertensão arterial com sobrepeso

BACKGROUND The activity of the renin-angiotensin-aldosterone system (RAAS) is directly related to overweight and sedentary lifestyles, both of which are associated with hypertension. Aerobic exercise helps control blood pressure (BP) by acting on mechanisms of blood pressure regulation, such as plasma renin activity (PRA). OBJECTIVE To assess the effect of aerobic exercise on plasma renin activity in overweight hypertensive patients. METHODS Blood pressure, serum biochemistry and anthropometric parameters of twenty subjects were measured before and after a 16-week exercise training program, three days a week, at 60-80% of maximal heart rate. Data were expressed as mean +/- standard deviation or median and interquartile range and analyzed using the students t-test, Mann-Whitney test, and ANOVA (p < 0.05). RESULTS Mean age of the study population was 57 +/- 7.0, and mean body mass index was 30 +/- 3.5 kg/m(2). The aerobic training decreased body fat (35 +/- 7.8 to 30 +/- 5.6 %), heart rate (HR) (80 +/- 10.4 to 77 +/- 8.5 bpm), and pulse pressure (PP) (50 +/- 11.8 to 46 +/- 10.0 mmHg) (p < 0.05), but not plasma renin activity, which ranged from 0.8 (0.45-2.0) to 1.45 (0.8-2.15) etag/ml/h (p = 0.055). The group that achieved a reduction in waist circumference (WC) (n = 8) experienced also a reduction in systolic BP and PP (p < 0.05). In the group without reduction in WC, none of the BP variables changed. Plasma renin activity (PRA) was not associated with any variable studied. Aerobic training was associated with a decrease in PP in the study group as a whole and with a decrease in systolic BP in the subgroup who experienced a decrease in waist circumference. CONCLUSION The aerobic exercise training failed to reduce plasma renin activity in overweight hypertensive patients.Correspondencia: Bruno Martinelli • Rua Emilio Carlos, 215 Santa Tereza 14940-000 Ibitinga, SP Brasil E-mail: bnomartinelli@yahoo.com.br Articulo recibido el 18/11/08; revisado recibido el 21/12/09; aceptado el 25/02/10. Resumen Fundamento: La actividad del sistema renina-angiotensina-aldosterona tiene relacion directa con sobrepeso y sedentarismo, y esas variables se asocian a la hipertension arterial (HA). El ejercicio aerobico propicia mejor control de la presion arterial (PA) por actuar en los mecanismos de la regulacion presorica, entre ellos, la actividad de renina plasmatica (ARP).

Association of pre and intraoperative variables with postoperative complications in coronary artery bypass graft surgery

Objective To associate the pre- and intraoperative variables with postoperative complications of patients undergoing coronary artery bypass graft surgery. Methods The pre- and intraoperative risk factors of individuals of both genders with diagnosis of coronary insufficiency undergoing coronary artery bypass graft have been studied. Results Fifty-eight individuals with median age 62 ± 10 year-old were included in the study, 67% of whom were male. Fourteen (24.1%) patients were smokers, 39 (67.2%) had previous myocardial infarction history, 11 (19%) had undergone coronary angioplasty, 74% had hypertension, 27% had diabetes mellitus, 64% had dyslipidemia and 15.5% had chronic obstructive pulmonary disease. Eighteen (31%) patients presented postoperative complications, most frequent being: infection in surgical incision, difficulties in deambulation, dyspnea, urinary infection and generalized weakness. Male patients had fewer complications than females (P=0.005). Patients with chronic obstructive pulmonary disease remained hospitalized for longer time periods (P=0.019). Postoperative complications occurred in 50% of the patients with creatinine increased, while only 27.1% of the patients with normal value of creatinine had complications (P=0.049). In addition, complications occurred in 50% of the patients with diabetes mellitus, while only 23.8% of patients without diabetes mellitus had complications (P=0.032). The intraoperative factors showed no statistically significant differences. Conclusion The preoperative factors are associated with postoperative complications in patients undergoing coronary artery bypass graft surgery.

Effect of aerobic exercise on plasma renin in overweight patients with hypertension

BACKGROUND The activity of the renin-angiotensin-aldosterone system (RAAS) is directly related to overweight and sedentary lifestyles, both of which are associated with hypertension. Aerobic exercise helps control blood pressure (BP) by acting on mechanisms of blood pressure regulation, such as plasma renin activity (PRA). OBJECTIVE To assess the effect of aerobic exercise on plasma renin activity in overweight hypertensive patients. METHODS Blood pressure, serum biochemistry and anthropometric parameters of twenty subjects were measured before and after a 16-week exercise training program, three days a week, at 60-80% of maximal heart rate. Data were expressed as mean +/- standard deviation or median and interquartile range and analyzed using the students t-test, Mann-Whitney test, and ANOVA (p < 0.05). RESULTS Mean age of the study population was 57 +/- 7.0, and mean body mass index was 30 +/- 3.5 kg/m(2). The aerobic training decreased body fat (35 +/- 7.8 to 30 +/- 5.6 %), heart rate (HR) (80 +/- 10.4 to 77 +/- 8.5 bpm), and pulse pressure (PP) (50 +/- 11.8 to 46 +/- 10.0 mmHg) (p < 0.05), but not plasma renin activity, which ranged from 0.8 (0.45-2.0) to 1.45 (0.8-2.15) etag/ml/h (p = 0.055). The group that achieved a reduction in waist circumference (WC) (n = 8) experienced also a reduction in systolic BP and PP (p < 0.05). In the group without reduction in WC, none of the BP variables changed. Plasma renin activity (PRA) was not associated with any variable studied. Aerobic training was associated with a decrease in PP in the study group as a whole and with a decrease in systolic BP in the subgroup who experienced a decrease in waist circumference. CONCLUSION The aerobic exercise training failed to reduce plasma renin activity in overweight hypertensive patients.Correspondencia: Bruno Martinelli • Rua Emilio Carlos, 215 Santa Tereza 14940-000 Ibitinga, SP Brasil E-mail: bnomartinelli@yahoo.com.br Articulo recibido el 18/11/08; revisado recibido el 21/12/09; aceptado el 25/02/10. Resumen Fundamento: La actividad del sistema renina-angiotensina-aldosterona tiene relacion directa con sobrepeso y sedentarismo, y esas variables se asocian a la hipertension arterial (HA). El ejercicio aerobico propicia mejor control de la presion arterial (PA) por actuar en los mecanismos de la regulacion presorica, entre ellos, la actividad de renina plasmatica (ARP).

Comprometimento sensório-motor dos membros inferiores em diabéticos do tipo 2

INTRODUCTION: The high incidence of diabetes mellitus (DM) in the population becomes this pathology subject of much research. One complication of diabetes is peripheral neuropathy characterized by chronic atrophy and axonal degeneration and/or alteration of the Schwann cell. The physiotherapy works in the stimulation of regeneration of the nerve fiber, which reduces the risk of developing diabetic foot. OBJECTIVE: To identify the sensitivity disorders in the lower limbs (LL) in diabetics patients and verify factors that contribute to the development the diabetic foot as glicemic level, glycosylated hemoglobin (GH), time of the diagnostic, blood pressure, anthropometry and life habits. MATERIALS AND METHODS: The diabetics patients were valued in Bauru Diabect Association and submitted the interview, anthropometry, blood pressure, by the Toronto Clinical Scoring System avaliation (TCSS - sensorial test, reflexes e symptoms). RESULTS: The 68 enrolled patients, 61.76% female and 38.23% male, with 62.93 ± 9.64 years-old, showed systolic blood pressure of 132.54 ± 17.95 mmHg and diastolic blood pressure of 80.39 ± 11,35 mmHg; body mass index, 30,34 ± 5,80 kg/m2; glicemic level, 149,20 ± 60,37mg/dL; GH, 7,72 ± 1,4%; time of the diagnostic, one to 34 years; 80,88% had overweight, 72,06%, hypertension; 42,64%, dyslipidemia; 14,7%, kidney; and 17,64%, vascular disorders. According to TCSS, 97.05% showed neuropathy, 95.59% were symmetrical. Regarding the sensitivity altered, 57.35% showed in protect; 60.29%, thermal; 26.47%, tactile; 17.64%, vibratory; 7.35%, painful; and 1.47%, kinectic-postural. In the feet, 72.05% had dry foot skin; 64.70%, fissures; 54.41%, callosity; 44.11%, mycosis; 50% reported pain; 39,7%, numbness; 41,17%, tingling; 27,94%, sensory ataxia. The reflexes were abolished or decreased in 14.71%; 38.23% are localized in Achilles tendon. There was positive correlation between the TCSS with abdominal circumference and blood glucose and glycated hemoglobin with glucose. CONCLUSION: There was great incidence of the symmetrical neuropathy; sensibility alteration with clinical manifestations, symptons, areflexia and hyporeflexia; obesity and hypertension incidences were associated. It is very necessary the physiotherapy accompaniment on the sensitivity valuation to prevent, reduce the symptons and improve the blood circulation in LL.

EFEITO AGUDO DO EXERCÍCIO AERÓBIO NA GLICEMIA EM DIABÉTICOS 2 SOB MEDICAÇÃO

Introduccion:Por su efecto hipoglucemiante, el ejercicio fisico ha sido propuesto como tratamiento no farmaco-logico de la diabetes.Objetivo:Investigar el efecto agudo del ejercicio aerobico en la glucemia capilar de diabeticos que hacian uso de insulina o antidiabeticos orales.Metodos:Hicieron parte del estudio diabeticos que hacian uso de hipoglucemiantes orales (G1, n=7), no diabeticos (G2, n = 8, grupo control) y diabeticos que utilizaban insulina (G3, n= 8) de la Asociacion de Diabeticos de Bauru (ADB). Los participantes pasaron por evaluaciones clinicas, bio-quimicas, presion arterial, antropometricas y por una sesion de ejercicio aerobico (60% a 80% FCmax). Las medidas de glucemia capilar fueron realizadas en ocho momentos (M1-M8) en la sesion. El analisis estadistica fue descriptiva (media ± desviacion estandar), con utilizacion de los testes de Kruskal Wallis y Friedman, no parametricos.Resultados:Participaron 23 diabeticos (17 mujeres y 6 hombres) con edad media de 59,35 ± 14,59 anos. Los valores de glucemia del M2 al M8 fueron comparados al M1, siendo observadas disminuciones significativas en los momentos 4, 5, 6, 7 y 8 (p ≤ 0,05). En el analisis inicial, las caracteristicas de los grupos G1 e G3 fueron de obesidad y, en G2, de sobrepeso. En el analisis de la variacion de glucemia en el ejercicio, fue observado que el G1 y G3 difirieron en los momentos 2, 3 y 5; el G2 y G3 difirieron en todos los momentos (p < 0,05). Ademas, se constato una reduccion significativa solamente en el G2 (grupo control), en los momentos 4, 5, 6 y 7 (p < 0,05).Conclusion:El ejercicio tiene accion hipoglucemiante, sin embargo, en los diabeticos con alteraciones del metabolismo de carbohidratos (G1 y G3), la reduccion glucemica es menos evidente.

The effect of sets and repetitions of the spirometer by flow in cardiorespiratory parameters

Introduction The incentive spirometer helps pulmonary ventilation and the cardiorespiratory changes of its use are controversial. Objective To evaluate the effect of sets and repetitions on cardiorespiratory parameters using a spirometer alinear flow (SAF). The sample group consisted of 50 young people, healthy and sedentary. The evaluated parameters were: systolic blood pressure (SBP), diastolic (DBP), heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2), minute volume (VE), tidal volume (VT), vital capacity (VC), maximal inspiratory pressure (Pimax), maximal expiratory pressure (Pemax), and peak expiratory flow (PEF). The moments of study were: initial evaluations (M1); 3 sets of 10 repetitions using SAF (M2); 3 sets of 15 repetitions using SAF (M3); and final evaluation (M4). Statistical analysis was made by t test, ANOVA and Tukey test (p < 0.05). Results SBP and HR decreased in M2 after the 2nd set. In the 3rd set, SBP and RR decreased. Comparing the initial and final variables in M2, SBP and RR decreased, and Pemax increased. After 1st set in M3, SBP and SaO2 decreased. The 2nd set: SBP, HR, RR, and SaO2 decreased. After the 3rd set: SBP, HR, SaO2, and RR decreased. Comparing the initial and final variables in M3, SBP, HR, RR decreased, and Pimax and Pemax increased. Comparing M4 to M1, Pimax, Pemax, and VC increased, and RR decreased. Conclusion There are changes in cardiorespiratory parameters after the use of a spirometer alinear flow, especially in the sets with more repetitions.

Influencia del Ejercicio Aeróbico en la Renina de Portadores de Hipertensión Arterial con Sobrepeso

BACKGROUND The activity of the renin-angiotensin-aldosterone system (RAAS) is directly related to overweight and sedentary lifestyles, both of which are associated with hypertension. Aerobic exercise helps control blood pressure (BP) by acting on mechanisms of blood pressure regulation, such as plasma renin activity (PRA). OBJECTIVE To assess the effect of aerobic exercise on plasma renin activity in overweight hypertensive patients. METHODS Blood pressure, serum biochemistry and anthropometric parameters of twenty subjects were measured before and after a 16-week exercise training program, three days a week, at 60-80% of maximal heart rate. Data were expressed as mean +/- standard deviation or median and interquartile range and analyzed using the students t-test, Mann-Whitney test, and ANOVA (p < 0.05). RESULTS Mean age of the study population was 57 +/- 7.0, and mean body mass index was 30 +/- 3.5 kg/m(2). The aerobic training decreased body fat (35 +/- 7.8 to 30 +/- 5.6 %), heart rate (HR) (80 +/- 10.4 to 77 +/- 8.5 bpm), and pulse pressure (PP) (50 +/- 11.8 to 46 +/- 10.0 mmHg) (p < 0.05), but not plasma renin activity, which ranged from 0.8 (0.45-2.0) to 1.45 (0.8-2.15) etag/ml/h (p = 0.055). The group that achieved a reduction in waist circumference (WC) (n = 8) experienced also a reduction in systolic BP and PP (p < 0.05). In the group without reduction in WC, none of the BP variables changed. Plasma renin activity (PRA) was not associated with any variable studied. Aerobic training was associated with a decrease in PP in the study group as a whole and with a decrease in systolic BP in the subgroup who experienced a decrease in waist circumference. CONCLUSION The aerobic exercise training failed to reduce plasma renin activity in overweight hypertensive patients.Correspondencia: Bruno Martinelli • Rua Emilio Carlos, 215 Santa Tereza 14940-000 Ibitinga, SP Brasil E-mail: bnomartinelli@yahoo.com.br Articulo recibido el 18/11/08; revisado recibido el 21/12/09; aceptado el 25/02/10. Resumen Fundamento: La actividad del sistema renina-angiotensina-aldosterona tiene relacion directa con sobrepeso y sedentarismo, y esas variables se asocian a la hipertension arterial (HA). El ejercicio aerobico propicia mejor control de la presion arterial (PA) por actuar en los mecanismos de la regulacion presorica, entre ellos, la actividad de renina plasmatica (ARP).