Plínio dos Santos Ramos

Ability to sit and rise from the floor as a predictor of all-cause mortality

Background: While cardiorespiratory fitness is strongly related to survival, there are limited data regarding musculoskeletal fitness indicators. Our aim was to evaluate the association between the ability to sit and rise from the floor and all-cause mortality. Design: Retrospective cohort. Methods: 2002 adults aged 51–80 years (68% men) performed a sitting-rising test (SRT) to and from the floor, which was scored from 0 to 5, with one point being subtracted from 5 for each support used (hand/knee). Final SRT score, varying from 0 to 10, was obtained by adding sitting and rising scores and stratified in four categories for analysis: 0–3; 3.5–5.5, 6–7.5, and 8–10. Results: Median follow up was 6.3 years and there were 159 deaths (7.9%). Lower SRT scores were associated with higher mortality (p < 0.001). A continuous trend for longer survival was reflected by multivariate-adjusted (age, sex, body mass index) hazard ratios of 5.44 (95% CI 3.1–9.5), 3.44 (95% CI 2.0–5.9), and 1.84 (95% CI 1.1–3.0) (p < 0.001) from lower to higher SRT scores. Each unit increase in SRT score conferred a 21% improvement in survival. Conclusions: Musculoskeletal fitness, as assessed by SRT, was a significant predictor of mortality in 51–80-year-old subjects. Application of a simple and safe assessment tool such as SRT, which is influenced by muscular strength and flexibility, in general health examinations could add relevant information regarding functional capabilities and outcomes in non-hospitalized adults.

Body weight gain and serum leptin levels of non-overweight and overweight/obese pregnant women

Background Our objective was to evaluate changes in serum leptin levels during pregnancy in overweight/obese and non-obese women and to assess total and percent weight gain during pregnancy as possible factors that influence leptin levels. Material/Methods In a prospective study of 42 low-risk pregnant women receiving prenatal care, we assessed serum leptin levels at gestational weeks 9–12, 25–28, and 34–37. Based on their pre-pregnancy body mass indices (BMIs), the cohort was divided into: non-overweight (BMI <25 kg/m2) and overweight/obese (BMI ≥25 kg/m2) subjects. Results We found a progressive increase in maternal weight gain during pregnancy in both groups. There was also a progressive increase in leptin levels in the 2 strata; however, the increase was significantly higher in the non-overweight patient group. We found that non-overweight pregnant women had a noticeably larger total weight gain. When analyzing the percent weight gain during pregnancy compared to the pre-pregnancy weight, the non-overweight group had a significantly greater percent weight gain than the overweight/obese group. Conclusions Our results suggest that the greater increase in leptin levels in non-overweight pregnant women can be explained by the higher percent weight gain in this group compared to overweight/obese women. These findings suggest that controlling the percent weight gain may be an important preventive measure when controlling leptin levels during pregnancy and subsequent medical complications.

Blood pressure measurement during aerobic exercise: subsidies for cardiac rehabilitation

FUNDAMENTO: Documentos institucionales recomiendan que las variables hemodinamicas - frecuencia cardiaca (FC) y presion arterial sistolica (PAS) y diastolica (PAD) - se mantengan bajo control en la parte aerobica de sesiones de ejercicio bajo supervision para cardiopatas. OBJETIVO: : a) Determinar el comportamiento y la reproductibilidad de la PA a lo largo de 15 minutos de ejercicio de intensidad constante y moderada; b) Comparar la medicion de PA obtenida con aparatos digital y convencional en el ejercicio. METODOS: Se Evaluaron a 30 adultos de ambos sexos (de 65 ± 11 anos) en 15 minutos en el cicloergometro de miembros inferiores. La PA se midio a cada 2 minutos: entre el 3o y el 13o minutos, por esfigmomanometro digital Tango (Suntech, Estados Unidos de America) y, en el 14o minuto, por esfigmomanometro de columna de mercurio. Luego de 7 dias y en horario similar, 6 individuos repitieron el protocolo para evaluar la reproductibilidad. RESULTADOS: La PAD no vario a lo largo del ejercicio (p > 0,05), mientras que la PAS aumento del 3o al 7o minuto (146±4,1 versus 158±4,5 mm Hg, p 0,05) y una pequena diferencia para la PAD (72±2,4 versus 78±2,3 mm Hg; p < 0,05). CONCLUSION: Para ejercicios de intensidad moderada y constante en el cicloergometro con 15 minutos de duracion, la medicion de la PA se debera llevar a cabo a partir del 7o minuto. Las mediciones digitales con el aparato Tango y las convencionales de PA resultaron, para efectos clinicos, muy semejantes y reproductibles.BACKGROUND Institutional documents recommend that hemodynamic variables--heart rate (HR) and systolic (SAP) and diastolic arterial pressure (DAP)--be routinely controlled at the aerobic part of supervised exercise sessions for coronary disease patients. OBJECTIVE a) to determine the pattern and reproducibility of the blood pressure (BP) throughout 15 minutes of physical exercise at constant and moderate intensity; and b) to compare the BP measurement obtained with digital and conventional device during the exercise. METHODS Thirty adult individuals of both sexes (65+/-11 yrs) were assessed for 15 minutes during lower-limb cycle ergometry and the BP was measured every 2 minutes, between the 3rd and the 13th minutes, using a Tango digital sphygmomanometer (Suntech, USA) and in the 14th minute, using a mercury column sphygmomanometer. Seven days later, at similar time of the day, six individuals had the test repeated to evaluate reproducibility. RESULTS Whereas the DAP did not vary throughout the exercise (p > 0.05), SAP increased from the 3rd to 7th minute (146+/-4.1 versus 158+/-4.5 mmHg, p<0.05) and thereafter remained practically constant. The digital and conventional measurements showed a strong correlation - r = 0.83 for SAP and 0.84 for DAP - with no differences for SAP (163+/-4.5 versus 162+/-4.3 mmHg; p >0.05) and a small difference for DAP (72+/-2.4 versus 78+/-2.3 mmHg; p<0.05). CONCLUSION For exercises of moderate and constant intensity in a cycle ergometer with a 15-minute duration, BP measurements must be carried out from the 7th minute on. The digital measurements with the Tango equipment and those obtained with the conventional mercury-column sphygmomanometer were, for clinical purposes, very similar and reproducible.

Comparação entre métodos de avaliação da modulação vagal cardíaca

BACKGROUND: Several methods have been used to assess cardiac vagal modulation, but there are gaps regarding the association and accuracy of these methods. OBJECTIVE: To investigate the association between three valid, reproducible and commonly methods used to assess cardiac vagal modulation and compare their accuracies. METHODS: Thirty healthy men (23 ± 4 years) and 15 men with coronary artery disease (61 ± 10 years) were evaluated in counterbalanced design by Heart Rate Variability (HRV; variables: the time domain = pNN50, SDNN and RMSSD, the frequency domain HF = ms2 and HF n.u.), Respiratory Sinus Arrhythmia (RSA) and 4-second Exercise Test (T4s). Thirty healthy men (23 ± 4 years) and 15 men with coronary artery disease (61 ± 10 years) were evaluated in counterbalanced order by Heart Rate Variability (HRV; variables: the time domain = pNN50, SDNN and RMSSD, the frequency domain HF = ms2 and HF n.u.), Respiratory Sinus Arrhythmia (RSA) and 4-second Exercise Test (T4s). RESULTS: Healthy subjects had higher vagal modulation by the three methods (p <0.05). There was a correlation in the healthy group (p <0.05) between the results of HRV (SDNN and pNN50 and RSA, but there was no correlation between the T4s and the other two methods. In the group with coronary artery disease, there was a correlation between the results of HRV (pNN50, SDNN, RMSSD, HF ms2 and HF n.u.) and RSA. In addition, there was a correlation between the RSA and T4s. Finally, the T4s and RSA methods presented more accurate effect size and better accuracy (p <0.05), when compared to the HRV. CONCLUSION: HRV and RSA generated partially redundant results in healthy subjects and in patients with coronary artery disease, while the T4s generated results that were complementary to HRV and RSA in healthy subjects. In addition, RSA and T4s methods were more accurate when discriminating cardiac vagal modulation between healthy subjects and patients with coronary artery disease, when compared to HRV.

Cardiorespiratory optimal point: a submaximal variable of the cardiopulmonary exercise testing

Background: At the maximal Cardiopulmonary Exercise Testing (CPET), several ventilatory variables are analyzed, including the ventilatory equivalent for oxygen (VE/VO2). The minimum VE/VO2 value reflects the best integration between the respiratory and cardiovascular systems and may be called “Cardiorespiratory Optimal Point (COP)”. Objective: To determine the behavior of the COP according to gender and age in healthy adults and verify its association with other CPET variables. Methods: Of 2,237 individuals, 624 were selected (62% men and 48 ± 12 years), non-athletes, healthy, who were submitted to maximal CPET. COP or minimum VE/VO2 was obtained from the analysis of ventilation and oxygen consumption in every minute of CPET. We investigated the association between age and COP for both genders, as well as associations with: VO 2 max, VO 2 at anaerobic threshold (VO 2 AT), oxygen uptake efficiency slope (OUES) and with maximum VE. We also compared the intensity of exertion (MET) at the COP, AT and VO 2 max. Results: COP increases with age, being 23.2 ± 4.48 and 25.0 ± 5.14, respectively, in men and women = (p < 0.001). There are moderate and inverse associations with VO 2 max (r = -0.47; p < 0.001), with VO 2 AT (r = -0.42; p < 0.001) and with OUES (r = -0.34; p < 0.001). COP occurred, on average, at 44% do VO 2 max and before AT (67% of VO 2 max) (p < 0.001). Conclusion: COP, a submaximal variable, increases with age and is slightly higher in women. Being modestly associated with other ventilation measures, there seems to be an independent contribution to the interpretation of the cardiorespiratory response to CPET. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0)

Lower cardiac vagal tone in non-obese healthy men with unfavorable anthropometric characteristics

OBJECTIVES: to determine if there are differences in cardiac vagal tone values in non-obese healthy, adult men with and without unfavorable anthropometric characteristics. INTRODUCTION: It is well established that obesity reduces cardiac vagal tone. However, it remains unknown if decreases in cardiac vagal tone can be observed early in non-obese healthy, adult men presenting unfavorable anthropometric characteristics. METHODS: Among 1688 individuals assessed between 2004 and 2008, we selected 118 non-obese (BMI <30 kg/m2), healthy men (no known disease conditions or regular use of relevant medications), aged between 20 and 77 years old (42 ± 12-years-old). Their evaluation included clinical examination, anthropometric assessment (body height and weight, sum of six skinfolds, waist circumference and somatotype), a 4-second exercise test to estimate cardiac vagal tone and a maximal cardiopulmonary exercise test to exclude individuals with myocardial ischemia. The same physician performed all procedures. RESULTS: A lower cardiac vagal tone was found for the individuals in the higher quintiles – unfavorable anthropometric characteristics - of BMI (p=0.005), sum of six skinfolds (p=0.037) and waist circumference (p<0.001). In addition, the more endomorphic individuals also presented a lower cardiac vagal tone (p=0.023), while an ectomorphic build was related to higher cardiac vagal tone values as estimated by the 4-second exercise test (r=0.23; p=0.017). CONCLUSIONS: Non-obese and healthy adult men with unfavorable anthropometric characteristics tend to present lower cardiac vagal tone levels. Early identification of this trend by simple protocols that are non-invasive and risk-free, using select anthropometric characteristics, may be clinically useful in a global strategy to prevent cardiovascular disease.

Medindo a pressão arterial em exercício aeróbico: subsídios para reabilitação cardíaca

FUNDAMENTO: Documentos institucionales recomiendan que las variables hemodinamicas - frecuencia cardiaca (FC) y presion arterial sistolica (PAS) y diastolica (PAD) - se mantengan bajo control en la parte aerobica de sesiones de ejercicio bajo supervision para cardiopatas. OBJETIVO: : a) Determinar el comportamiento y la reproductibilidad de la PA a lo largo de 15 minutos de ejercicio de intensidad constante y moderada; b) Comparar la medicion de PA obtenida con aparatos digital y convencional en el ejercicio. METODOS: Se Evaluaron a 30 adultos de ambos sexos (de 65 ± 11 anos) en 15 minutos en el cicloergometro de miembros inferiores. La PA se midio a cada 2 minutos: entre el 3o y el 13o minutos, por esfigmomanometro digital Tango (Suntech, Estados Unidos de America) y, en el 14o minuto, por esfigmomanometro de columna de mercurio. Luego de 7 dias y en horario similar, 6 individuos repitieron el protocolo para evaluar la reproductibilidad. RESULTADOS: La PAD no vario a lo largo del ejercicio (p > 0,05), mientras que la PAS aumento del 3o al 7o minuto (146±4,1 versus 158±4,5 mm Hg, p 0,05) y una pequena diferencia para la PAD (72±2,4 versus 78±2,3 mm Hg; p < 0,05). CONCLUSION: Para ejercicios de intensidad moderada y constante en el cicloergometro con 15 minutos de duracion, la medicion de la PA se debera llevar a cabo a partir del 7o minuto. Las mediciones digitales con el aparato Tango y las convencionales de PA resultaron, para efectos clinicos, muy semejantes y reproductibles.BACKGROUND Institutional documents recommend that hemodynamic variables--heart rate (HR) and systolic (SAP) and diastolic arterial pressure (DAP)--be routinely controlled at the aerobic part of supervised exercise sessions for coronary disease patients. OBJECTIVE a) to determine the pattern and reproducibility of the blood pressure (BP) throughout 15 minutes of physical exercise at constant and moderate intensity; and b) to compare the BP measurement obtained with digital and conventional device during the exercise. METHODS Thirty adult individuals of both sexes (65+/-11 yrs) were assessed for 15 minutes during lower-limb cycle ergometry and the BP was measured every 2 minutes, between the 3rd and the 13th minutes, using a Tango digital sphygmomanometer (Suntech, USA) and in the 14th minute, using a mercury column sphygmomanometer. Seven days later, at similar time of the day, six individuals had the test repeated to evaluate reproducibility. RESULTS Whereas the DAP did not vary throughout the exercise (p > 0.05), SAP increased from the 3rd to 7th minute (146+/-4.1 versus 158+/-4.5 mmHg, p<0.05) and thereafter remained practically constant. The digital and conventional measurements showed a strong correlation - r = 0.83 for SAP and 0.84 for DAP - with no differences for SAP (163+/-4.5 versus 162+/-4.3 mmHg; p >0.05) and a small difference for DAP (72+/-2.4 versus 78+/-2.3 mmHg; p<0.05). CONCLUSION For exercises of moderate and constant intensity in a cycle ergometer with a 15-minute duration, BP measurements must be carried out from the 7th minute on. The digital measurements with the Tango equipment and those obtained with the conventional mercury-column sphygmomanometer were, for clinical purposes, very similar and reproducible.

Heart rate variability across the menstrual cycle in young women taking oral contraceptives

Previous studies have shown that resting heart rate variability (HRV) is modified by different phases of the menstrual cycle in nonusers of oral contraceptive pills (OCP); however, the effect of OCP on autonomic control of the heart remains unclear. The purpose of this study was to investigate HRV during the low hormone (LH-not taking OCP) and during the high hormone (HH-active OCP use) phases of the menstrual cycle in young women. Seventeen healthy women (19-31 years) taking OCP for at least 6 consecutive months were enrolled in this study. Plasma estradiol and progesterone were verified at each visit. HRV was assessed by using one-lead electrocardiography in time and frequency domains, in which participants rested in the supine position for a 20-min period with a breathing rate of 15 cycles/min. In addition, resting heart rate, and systolic and diastolic blood pressure were obtained. Both plasma estradiol (LH: 19.8 ± 4.2 pg/mL vs. HH: 12.4 ± 1.5 pg/mL; p > .05) and progesterone (LH: 0.247 ± 0.58 ng/mL vs. HH: 0.371 ± 0.08 ng/mL; p > .05) (mean ± SE) levels were similar in both phases. No significant difference was obtained for any component of HRV, heart rate, or blood pressure between the LH and HH phases (p > .05). These results provide preliminary evidence that use of OCP does not affect HRV during the menstrual cycle in healthy women.

Normotensive individuals with exaggerated exercise blood pressure response have increased cardiac vagal tone.

BACKGROUND Exaggerated systolic blood pressure (SBP) levels during a maximal cardiopulmonary exercise test (CPET) are classically considered as inappropriate and associated with a higher risk for the development of cardiovascular diseases. It is known that the autonomic nervous system modulates the BP during exercise. However, the behavior of the cardiac vagal tone (CVT) has not been fully established in healthy individuals with an exaggerated BP response to CPET. OBJECTIVE To analyze the behavior of the CVT in healthy adult males presenting an exaggerated BP response to CPET. METHODS Of the 2,505 cases evaluated between 2002-2009, 154 cases were thoroughly identified, consisting of healthy male normotensive subjects aged 20-50 years. The evaluation included clinical assessment, anthropometric measurements, 4-second exercise test (cardiac vagal tone) and cardiopulmonary exercise test (CPET) performed in a cycle-ergometer, with BP measurements being taken every minute through auscultation. Based on the maximum SBP value obtained at the CPET, the sample was divided in tertiles, comparing CVT, maximum workload and VO2 max. RESULTS The CVT results differed between individuals in the lower tertile and upper tertile for the SBP response to the CPET, respectively: 1.57 +/- 0.03 and 1.65 +/- 0.04 (mean +/- standard error of mean) (p = 0.014). The two tertiles also differed regarding the VO2 max (40.7 +/- 1.3 vs 46.4 +/- 1.3 ml/kg(-1) x min(-1); p = 0.013) and the maximum workload (206 +/- 6.3 vs 275 +/- 8.7 watts; p < 0.001). CONCLUSION An increased BP response during the CPET in healthy adult males is accompanied by indicators of good clinical prognosis, including higher levels of aerobic fitness and cardiac vagal tone.BACKGROUND: Exaggerated systolic blood pressure (SBP) levels during a maximal cardiopulmonary exercise test (CPET) are classically considered as inappropriate and associated with a higher risk for the development of cardiovascular diseases. It is known that the autonomic nervous system modulates the BP during exercise. However, the behavior of the cardiac vagal tone (CVT) has not been fully established in healthy individuals with an exaggerated BP response to CPET. OBJECTIVE: To analyze the behavior of the CVT in healthy adult males presenting an exaggerated BP response to CPET. METHODS: Of the 2,505 cases evaluated between 2002-2009, 154 cases were thoroughly identified, consisting of healthy male normotensive subjects aged 20-50 years. The evaluation included clinical assessment, anthropometric measurements, 4-second exercise test (cardiac vagal tone) and cardiopulmonary exercise test (CPET) performed in a cycle-ergometer, with BP measurements being taken every minute through auscultation. Based on the maximum SBP value obtained at the CPET, the sample was divided in tertiles, comparing CVT, maximum workload and VO2 max. RESULTS: The CVT results differed between individuals in the lower tertile and upper tertile for the SBP response to the CPET, respectively: 1.57 ± 0.03 and 1.65 ± 0.04 (mean ± standard error of mean) (p = 0.014). The two tertiles also differed regarding the VO2 max (40.7 ± 1.3 vs 46.4 ± 1.3 ml/kg-1.min-1; p = 0.013) and the maximum workload (206 ± 6.3 vs 275 ± 8.7 watts; p < 0.001). CONCLUSIOn: An increased BP response during the CPET in healthy adult males is accompanied by indicators of good clinical prognosis, including higher levels of aerobic fitness and cardiac vagal tone.

GABAergic contribution to the muscle mechanoreflex-mediated heart rate responses at the onset of exercise in humans

Previous studies have indicated that central GABAergic mechanisms are involved in the heart rate (HR) responses at the onset of exercise. On the basis of previous research that showed similar increases in HR during passive and active cycling, we reasoned that the GABAergic mechanisms involved in the HR responses at the exercise onset are primarily mediated by muscle mechanoreceptor afferents. Therefore, in this study, we sought to determine whether central GABA mechanisms are involved in the muscle mechanoreflex-mediated HR responses at the onset of exercise in humans. Twenty-eight healthy subjects (14 men and 14 women) aged between 18 and 35 yr randomly performed three bouts of 5-s passive and active cycling under placebo and after oral administration of diazepam (10 mg), a benzodiazepine that produces an enhancement in GABAA activity. Beat-to-beat HR (electrocardiography) and arterial blood pressure (finger photopletysmography) were continuously measured. Electromyography of the vastus lateralis was obtained to confirm no electrical activity during passive trials. HR increased from rest under placebo and further increased after administration of diazepam in both passive (change: 12 ± 1 vs. 17 ± 1 beats/min, P < 0.01) and active (change: 14 ± 1 vs. 18 ± 1 beats/min, P < 0.01) cycling. Arterial blood pressure increased from rest similarly during all conditions ( P > 0.05). Importantly, no sex-related differences were found in any variables during experiments. These findings demonstrate, for the first time, that the GABAergic mechanisms significantly contribute to the muscle mechanoreflex-mediated HR responses at the onset of exercise in humans. NEW & NOTEWORTHY We found that passive and voluntary cycling evokes similar increases in heart rate and that these responses were enhanced after diazepam administration, a benzodiazepine that enhances GABAA activity. These findings suggest that the GABAergic system may contribute to the muscle mechanoreflex-mediated vagal withdrawal at the onset of exercise in humans.