Lourenço Sampaio de Mara

Hidratação e nutrição no esporte

Some disorders derived from flaws in eating as well as hydric, electrolytic and energetic substrate reposition greatly harm tolerance to exertion and respond for health risk and even death to practitioners of physical exercise. Such disorders, which are more commonly observed in long-duration activities, are strongly influenced by environmental conditions. This article, which is focused on professionals from the sports field who work with physical exercise programs to the general population, presents data based on scientific evidence, with the aim to present safe exercise practice and health maintenance. This information should be considered by all sports practitioners, either competitive or simply health clubs goers. This article approaches some of the essential aspects of sports hydration and nutrition which were didatically sorted in six sessions: body fluid compartments; thermorregulation in physical exercise; sweat composition; dehydration; hydrogluco electrolytic reposition and nutritional recommendations.

Validation of the International Index of Erectile Function (IIFE) for use in Brazil.

Background The International Index of Erectile Function has been proposed as a method for assessing sexual function assisting the diagnosis and classification of erectile dysfunction. However, IIEF was not validated for the Portuguese language. Objective Validate the International Index of Erectile Function in patients with cardiopulmonary and metabolic diseases. Methods The sample consisted of 108 participants of to Cardiopulmonary and Metabolic program Rehabilitation (CPMR) in southern Brazil. The clarity assessment of the instrument was performed using a scale ranging from zero to 10. The construct validity was carried out by confirmatory factor analysis (KMO = 0.85; Barllet p < 0.001), internal consistency by Cronbachs alpha and reproducibility and interrater reliability via the test retest method. Results The items were considered very clear with averages superior to 9. The internal consistency resulted in 0.89. The majority of items related correctly with their domains, with exception of three questions from sexual satisfaction domain, and one from erectile function. All items showed excellent stability of measure and substantial to almost perfect agreement. Conclusion The present study showed that the IIEF is valid and reliable for use in participants of a cardiopulmonary and metabolic rehabilitation program.

Alterações hidroeletrolíticas agudas ocorridas no Triatlon Ironman Brasil

The Ironman Triathlon is characterized for being an endurance activity consisting of 3.8 km of swimming, 180 km of cycling and 42.2 km of running, in which the athlete exercises an average of about 13 hours. In this context, the athlete exposed to such load of effort and environmental adversities, experiences acute organic alterations in his biological systems, including hydroelectrolytic disturbs. The objective of this study is to describe the hydric and electrolytic alterations found in Ironman triathlon athletes. From years 2002 to 2005, 109 volunteer athletes have been evaluated before and immediately after the events which took place in Florianopolis-SC Brazil, with blood analysis of sodium and potassium electrolytes, and body mass measurement. Sodium serum data from 89 athletes have been correlated with the degree of dehydration and percentage alterations of body weight. Data of 77 athletes concerning the serum potassium were separately evaluated in a descriptive way. Six athletes (6.7%) were euhydrated or superhydrated at the end of the test; 50 athletes were dehydrated from 0 to 3% (56.2%); 29 from 3 to 6 % (32.6%) and 4 athletes (4.5%) were dehydrated more than 6%. There was a tendency to hyponatremia among those who had dehydrated less or gained weight. Potassium behaved within the limits of normality in the entire sample. It was concluded that hydroelectrolytic disturbs (hyponatremia and dehydration) are recurrent in this sportive modality, being superhydration the probable etiology of hyponatremia denoted from profit or small weight loss.

Relationship of the overtraining syndrome with stress, fatigue, and serotonin

The requirements of the competitive sports have caused severe consequences in athletes involved in high level training. The changing in the aesthetic standards has leaded individuals to search for physical exercises to reduce their body mass, to increase their muscular mass as well as their aerobic fitness. It is quite common that athletes and non-athletes exceed the limits of their physical and psychological capacities causing the development of the overtraining syndrome, which is defined as the neuroendocrine disorder (hypothalamohypophysial), resulting from the imbalance between the demand of the exercise and the possibility of assimilation of the training, causing metabolic changes with consequences comprising not only the performance, but also other physiological and emotional aspects. The high level of physical, sociocultural and psychic stress are factors that contribute to such outcome, as well as to neuroendocrine changes caused by nutritional aspects that lead to serotoninergic fluctuations. Changes in the brain serotonin level can be associated to the occurrence of the physical fatigue, and this may be chronically settled, constituting one of the symptoms of the whole overtraining syndrome. Deficiencies or imbalances in neurotransmitters and neuromodulators can also be caused by severe or prolonged stress. The aim of this reviewing study was to analyze those factors that synergistically contribute to the outcome of the overtraining syndrome.The requirements of the competitive sports have caused severe consequences in athletes involved in high level training. The changing in the aesthetic standards has leaded individuals to search for physical exercises to reduce their body mass, to increase their muscular mass as well as their aerobic fitness. It is quite common that athletes and non-athletes exceed the limits of their physical and psychological capacities causing the development of the overtraining syndrome, which is defined as the neuroendocrine disorder (hypothalamohypophysial), resulting from the imbalance between the demand of the exercise and the possibility of assimilation of the training, causing metabolic changes with consequences comprising not only the performance, but also other physiological and emotional aspects. The high level of physical, sociocultural and psychic stress are factors that contribute to such outcome, as well as to neuroendocrine changes caused by nutritional aspects that lead to serotoninergic fluctuations. Changes in the brain serotonin level can be associated to the occurrence of the physical fatigue, and this may be chronically settled, constituting one of the symptoms of the whole overtraining syndrome. Deficiencies or imbalances in neurotransmitters and neuromodulators can also be caused by severe or prolonged stress. The aim of this reviewing study was to analyze those factors that synergistically contribute to the outcome of the overtraining syndrome.

Relação da síndrome do excesso de treinamento com estresse, fadiga e serotonina

The requirements of the competitive sports have caused severe consequences in athletes involved in high level training. The changing in the aesthetic standards has leaded individuals to search for physical exercises to reduce their body mass, to increase their muscular mass as well as their aerobic fitness. It is quite common that athletes and non-athletes exceed the limits of their physical and psychological capacities causing the development of the overtraining syndrome, which is defined as the neuroendocrine disorder (hypothalamohypophysial), resulting from the imbalance between the demand of the exercise and the possibility of assimilation of the training, causing metabolic changes with consequences comprising not only the performance, but also other physiological and emotional aspects. The high level of physical, sociocultural and psychic stress are factors that contribute to such outcome, as well as to neuroendocrine changes caused by nutritional aspects that lead to serotoninergic fluctuations. Changes in the brain serotonin level can be associated to the occurrence of the physical fatigue, and this may be chronically settled, constituting one of the symptoms of the whole overtraining syndrome. Deficiencies or imbalances in neurotransmitters and neuromodulators can also be caused by severe or prolonged stress. The aim of this reviewing study was to analyze those factors that synergistically contribute to the outcome of the overtraining syndrome.The requirements of the competitive sports have caused severe consequences in athletes involved in high level training. The changing in the aesthetic standards has leaded individuals to search for physical exercises to reduce their body mass, to increase their muscular mass as well as their aerobic fitness. It is quite common that athletes and non-athletes exceed the limits of their physical and psychological capacities causing the development of the overtraining syndrome, which is defined as the neuroendocrine disorder (hypothalamohypophysial), resulting from the imbalance between the demand of the exercise and the possibility of assimilation of the training, causing metabolic changes with consequences comprising not only the performance, but also other physiological and emotional aspects. The high level of physical, sociocultural and psychic stress are factors that contribute to such outcome, as well as to neuroendocrine changes caused by nutritional aspects that lead to serotoninergic fluctuations. Changes in the brain serotonin level can be associated to the occurrence of the physical fatigue, and this may be chronically settled, constituting one of the symptoms of the whole overtraining syndrome. Deficiencies or imbalances in neurotransmitters and neuromodulators can also be caused by severe or prolonged stress. The aim of this reviewing study was to analyze those factors that synergistically contribute to the outcome of the overtraining syndrome.

Avaliação do sistema locomotor de pacientes de programas de reabilitação cardiopulmonar e metabólica

BACKGROUND Participants of cardiopulmonary and metabolic rehabilitation (CPMR) programs may present with musculoskeletal changes that may affect treatment compliance and effectiveness. OBJECTIVE To develop an instrument for evaluation of the musculoskeletal system and identification of problems, especially those related to exercise, so that patients can be cleared to exercise with no restrictions, cleared with restrictions, or not cleared before approval from a specialist. METHODS Construction and validation (according to Cronbachs alpha) of a musculoskeletal system assessment inventory (MSSAI), for subsequent administration to participants in CPMR programs. RESULTS A total of 103 individuals participating in CPMR programs were evaluated by means of the MSSAI, whose internal validity and reliability proved to be satisfactory. Of these, 33 were men (32%) and 70 were women (68%), with age ranging from 36 to 84 years; 47 (45.6%) had already been diagnosed with musculoskeletal system disorders; 39 (37.9%) had already received specific treatment for the musculoskeletal system; 33 (32%) used to take medications to relieve symptoms related to the musculoskeletal system; and 10 (9.7%) had a medical restriction for performing some type of exercise. We should point out that 48 individuals (46.6%) reported pain in the musculoskeletal system; in 14 (13.6%) of them, the pain worsened by exercise, and this should have prevented them from participating in exercise programs before receiving approval from a specialist. CONCLUSION The MSSAI, whose internal validity and reliability proved satisfactory, showed that there was some restriction to exercise practice for almost half of the individuals participating in CPMR programs, and that some of them should not have been cleared without approval from a specialist.

Influence of exercise on oxidative stress in patients with heart failure

Reactive oxygen species play an important role in the pathophysiology of heart failure (HF). In contrast, regular physical exercise can promote adaptations to reactive oxygen species that are beneficial for patients with HF. We completed a systematic review of randomized controlled trials that evaluate the influence of exercise on oxidative stress in patients with HF. Articles were searched in the PubMed, Cochrane, SciELO, and LILACS databases. The search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the included studies was assessed using the Physiotherapy Evidence Database scale. We selected 12 studies with a total of 353 participants. The included patients had a left ventricle ejection fraction of < 52% and New York Heart Association functional class II or III disease. A significant increase was observed in peak oxygen consumption (between 10 and 46%) in the group that underwent training (TG). There was an improvement in the oxidative capacity of skeletal muscles in the TG, related to the positive activity of mitochondrial cytochrome c oxidase (between 27 and 41%). An increase in the expression of the enzymes glutathione peroxidase (41%), catalase (between 14 and 42%), and superoxide dismutase (74.5%), and a decrease in lipid peroxidation (between 28.8 and 58.5%) were observed in the TG. Physical training positively influenced the cardiorespiratory capacity and enhanced the benefits of oxidant and antioxidant biomarkers in patients with HF. High-intensity training promoted a 15% increase in the plasma total antioxidant capacity, whereas moderate training had no effect.

Reposição hormonal e exercício físico no tratamento da insuficiência cardíaca: revisão sistemática

BACKGROUND: Despite the full use of pharmacological and non pharmacological therapy, morbidity and mortality incidence as a result from heart failure (HF) are still significantly persistent. In the therapeutic context is relevant the inhibition of the inadequate neuro-hormonal adaptations and metabolic, as well known the anabolic deficiency that develops in HF. But just recently some studies emerged about the benefits from the testosterone replacement or supplementation therapy (TRT). OBJECTIVE: Reviewing studies that address the TRT in heart failure (HF), particularly those developed in the ideal setting for clinical treatment, including physical exercise program. METHODS: It was analyzed the Scielo and Pubmed databases, Cochrane of Systematic Review and Clinical Control Trials from Cochrane Collaboration databases. RESULTS: The few studies about TRT in patients with HF showed improvement in of the hemodynamic function, insulin resistance, functional capacity and neuro-hormonal and neuromuscular responses, highlight the controversy regarding the influence on the inflammatory profile, and found no changes in function and structure in the central cardiovascular system. However, it has not been found studies about TRT associated with exercises program. CONCLUSION: the present state of knowledge, although based on a few studies, allows to considerate TRT in the treatment of patients with HF. It is not well-defined the ideal form of TRT, regarding to treatment duration, criteria for inclusion and exclusion, etc. There is a wide gap in the literature, calling attention to the lack of studies about TRT concomitant with full medical treatment, which includes an physical exercise program.

Peso corporal y estado hídrico de triatletas en el Ironman Brasil: Un factor de corrección

Introduction: The Ironman Triathlon is a long-lasting competition where commonly electrolyte changes are observed. Dehydration and hyponatremia are prevalent and the differential diagnosis between them should take into account the body weight variation of the athlete. Nevertheless, one should also consider that variations are a summation of water and no-water sources, being necessary to apply a correction factor to evaluate the real water condition of the athlete. Objective: To evaluate the water condition of the athlete based on body weight changes with and without correction factor applied. Method: Twenty-six athletes were weighed in three different times (two days before the competition, immediately before and after performance). The water was classified by calculating the percentage of isolated body weight variation and application of correction factor of 1kg proportional to the athlete of 70kg. In addition, the main clinical signs and symptoms were recorded. Results: In the 48 hours before the start there was an average weight gain of 1.2kg. After the race, 23 (88.4%) athletes were classified as dehydrated initially but after applying the correction factor to the weight change, this number dropped to 12 (46.1%). Those classified as severe dehydration decreased by 7 (26.2%) to no athlete. Ten athletes (3.8%) presented signs and symptoms of dehydration. Conclusion: The classification of hydration status based on water loss during the race was significantly modified by the application of the correction factor, and its use is justified by evidence that weight gain within 48 hours prior to the race is possibly related to the muscle glycogen and water accumulation (no intravascular water sources).INTRODUCAO: O triatlo Ironman e uma prova de longa duracao em que comumente se observam alteracoes hidroeletroliticas. A desidratacao e hiponatremia sao prevalentes e o diagnostico diferencial entre elas deve levar em conta a variacao de peso corporal do atleta. Contudo, deve-se considerar tambem que as variacoes sao um somatorio de fontes hidricas e nao hidricas, sendo necessario aplicar um fator de correcao para avaliacao do real estado hidrico do atleta. Objetivo: Avaliar o estado hidrico do atleta baseado nas variacoes de peso corporal sem e com aplicacao de fator de correcao. METODO: Vinte e seis atletas foram pesados em tres momentos distintos (dois dias antes da prova, imediatamente antes e apos a realizacao). O estado hidrico foi classificado com base no calculo da variacao percentual de peso corporal isolado e com aplicacao do fator de correcao de 1 kg proporcional ao atleta de 70 kg. Alem disso, foram registrados os principais sinais clinicos e sintomas referidos. RESULTADOS: Nas 48 horas que antecederam a largada houve um ganho medio de peso de 1,2 kg. Apos a prova, vinte e tres (88,4%) atletas foram classificados como desidratados inicialmente, porem apos a aplicacao do fator de correcao a variacao do peso, esse numero caiu para 12 (46,1%). Dos classificados como desidratacao severa houve reducao de 7 (26,2%) para nenhum atleta. Dez atletas (3,8%) apresentaram sinais e sintomas de desidratacao. CONCLUSAO: A classificacao do estado de hidratacao baseado nas perdas hidricas durante a prova foi significativamente modificado pela aplicacao do fator de correcao, sendo sua utilizacao justificada pelas evidencias de que o ganho de peso nas 48 horas anteriores a prova esta possivelmente relacionado ao acumulo muscular de glicogenio e agua (fontes nao hidricas intravasculares).

Body weight and water condition in Ironman Brasil triathletes: a correction factor.

Introduction: The Ironman Triathlon is a long-lasting competition where commonly electrolyte changes are observed. Dehydration and hyponatremia are prevalent and the differential diagnosis between them should take into account the body weight variation of the athlete. Nevertheless, one should also consider that variations are a summation of water and no-water sources, being necessary to apply a correction factor to evaluate the real water condition of the athlete. Objective: To evaluate the water condition of the athlete based on body weight changes with and without correction factor applied. Method: Twenty-six athletes were weighed in three different times (two days before the competition, immediately before and after performance). The water was classified by calculating the percentage of isolated body weight variation and application of correction factor of 1kg proportional to the athlete of 70kg. In addition, the main clinical signs and symptoms were recorded. Results: In the 48 hours before the start there was an average weight gain of 1.2kg. After the race, 23 (88.4%) athletes were classified as dehydrated initially but after applying the correction factor to the weight change, this number dropped to 12 (46.1%). Those classified as severe dehydration decreased by 7 (26.2%) to no athlete. Ten athletes (3.8%) presented signs and symptoms of dehydration. Conclusion: The classification of hydration status based on water loss during the race was significantly modified by the application of the correction factor, and its use is justified by evidence that weight gain within 48 hours prior to the race is possibly related to the muscle glycogen and water accumulation (no intravascular water sources).INTRODUCAO: O triatlo Ironman e uma prova de longa duracao em que comumente se observam alteracoes hidroeletroliticas. A desidratacao e hiponatremia sao prevalentes e o diagnostico diferencial entre elas deve levar em conta a variacao de peso corporal do atleta. Contudo, deve-se considerar tambem que as variacoes sao um somatorio de fontes hidricas e nao hidricas, sendo necessario aplicar um fator de correcao para avaliacao do real estado hidrico do atleta. Objetivo: Avaliar o estado hidrico do atleta baseado nas variacoes de peso corporal sem e com aplicacao de fator de correcao. METODO: Vinte e seis atletas foram pesados em tres momentos distintos (dois dias antes da prova, imediatamente antes e apos a realizacao). O estado hidrico foi classificado com base no calculo da variacao percentual de peso corporal isolado e com aplicacao do fator de correcao de 1 kg proporcional ao atleta de 70 kg. Alem disso, foram registrados os principais sinais clinicos e sintomas referidos. RESULTADOS: Nas 48 horas que antecederam a largada houve um ganho medio de peso de 1,2 kg. Apos a prova, vinte e tres (88,4%) atletas foram classificados como desidratados inicialmente, porem apos a aplicacao do fator de correcao a variacao do peso, esse numero caiu para 12 (46,1%). Dos classificados como desidratacao severa houve reducao de 7 (26,2%) para nenhum atleta. Dez atletas (3,8%) apresentaram sinais e sintomas de desidratacao. CONCLUSAO: A classificacao do estado de hidratacao baseado nas perdas hidricas durante a prova foi significativamente modificado pela aplicacao do fator de correcao, sendo sua utilizacao justificada pelas evidencias de que o ganho de peso nas 48 horas anteriores a prova esta possivelmente relacionado ao acumulo muscular de glicogenio e agua (fontes nao hidricas intravasculares).