Ruth Caldeira de Melo

Exercise training improves neurovascular control and functional capacity in heart failure patients regardless of age

Background: Exercise training is a non-pharmacological strategy for treatment of heart failure. Exercise training improves functional capacity and quality of life in patients. Moreover, exercise training reduces muscle sympathetic nerve activity (MSNA) and peripheral vasoconstriction. However, most of these studies have been conducted in middle-aged patients. Thus, the effects of exercise training in older patients are much less understood. The present study was undertaken to investigate whether exercise training improves functional capacity, muscular sympathetic activation and muscular blood flow in older heart failure patients, as it does in middle-aged heart failure patients. Design: Fifty-two consecutive outpatients with heart failure from the database of the Unit of Cardiovascular Rehabilitation and Physiology Exercise were divided by age (middle-aged, defined as 45–59 years, and older, defined as 60–75 years) and exercise status (trained and untrained). Methods: MSNA was recorded directly from the peroneal nerve using the microneurography technique. Forearm Blood Flow (FBF) was measured by venous occlusion plethysmography. Functional capacity was evaluated by cardiopulmonary exercise test. Results: Exercise training significantly and similarly increased FBF and peak VO2 in middle-aged and older heart failure patients. In addition, exercise training significantly and similarly reduced MSNA and forearm vascular resistance in these patients. No significant changes were found in untrained patients. Conclusion: Exercise training improves neurovascular control and functional capacity in heart failure patients regardless of age.

Impact of gender on benefits of exercise training on sympathetic nerve activity and muscle blood flow in heart failure

We compared the effects of exercise training on neurovascular control and functional capacity in men and women with chronic heart failure (HF).

Effects of progressive exercise during phase I cardiac rehabilitation on the heart rate variability of patients with acute myocardial infarction

Purpose. Heart rate variability (HRV) decreases after an acute myocardial infarction (AMI) due to changes in cardiac autonomic balance. The purpose of the present study, therefore, was to evaluate the effects of a progressive exercise protocol used in phase I cardiac rehabilitation on the HRV of patients with post-AMI. Material and methods. Thirty-seven patients who had been admitted to hospital with their first non-complicated AMI were studied. The treated group (TG, n = 21, age = 52 ± 12 years) performed a 5-day programme of progressive exercise during phase I cardiac rehabilitation, while the control group (CG, n = 16, age = 54 ± 11 years) performed only respiratory exercises. Instantaneous heart rate (HR) and RR interval were acquired by a HR monitor (Polar®S810i). HRV was analysed by frequency domain methods. Power spectral density was expressed as normalised units (nu) at low (LF) and high (HF) frequencies, and as LF/HF. Results. After 5 days of progressive exercise, the TG showed an increase in HFnu (35.9 ± 19.5 to 65.19 ± 25.4) and a decrease in LFnu and LF/HF (58.9 ± 21.4 to 32.5 ± 24.1; 3.12 ± 4.0 to 1.0 ± 1.5, respectively) in the resting position (p < 0.05). No changes were observed in the CG. Conclusions. A progressive physiotherapeutic exercise programme carried out during phase I cardiac rehabilitation, as supplement to clinical treatment increased vagal and decreased sympathetic cardiac modulation in patients with post-AMI.

Resposta da frequência cardíaca durante o exercício isométrico de pacientes submetidos à reabilitação cardíaca fase III

BACKGROUND the magnitude of cardiovascular responses is dependent on the static and dynamic components as well as the duration and intensity of the contraction performed. OBJECTIVE to evaluate the heart rate responses to different percentages of isometric contractions in 12 patients (63 ± 11.6 years) with coronary artery disease and/or risk factors for coronary artery disease that were participating in a phase III cardiac rehabilitation program. METHODS heart rate variation (ΔHR) was evaluated during maximum (MVC, five and ten seconds in duration) and submaximal (SMVC, 30 and 60% of MVC-5, until muscle exhaustion) voluntary contraction, using a handgrip dynamometer. Additionally, the representative index of cardiac vagal modulation (RMSSD index) was calculated at rest (pre-contraction), at the final 30 seconds of SMVC and during recovery (post-contraction). RESULTS ΔHR showed higher values in MVC-10 versus MVC-5 (17 ± 5.5 vs 12 ± 4.2 bpm, p<0.05) and the SMVC-60 vs SMVC-30 (19 ± 5.8 vs 15 ± 5.1 bpm, p<0.05). However, results for CVM-10 showed similar ΔHR compared to results for CVSM (p> 0.05). RICVM at rest decreased (p<0.05) during SMVC-30 (30% = 27.9 ± 17.1 vs 12.9 ± 8.5 ms) and SMVC-60 (60% =25.8 ± 18.2 vs 9.96 ± 4.2 ms), but returned to the baseline values when the contraction was interrupted. CONCLUSIONS in patients with coronary artery disease and/or risk factors for coronary heart disease, low intensity isometric contraction, maintained over long periods of time, presents the same effect on the responses of HR, compared to a high intensity or maximal isometric contraction of briefly duration.

Fatores ambientais e risco de quedas em idosos: revisão sistemática

Falls in the elderly is the result of a complex interplay between intrinsic and extrinsic factors. Although it is difficult to separate these factors, studies indicate that environmental hazards are involved in approximately 40% of the falls. This study aimed to conduct a systematic review about the contribution of environmental hazards for falls in community-dwelling elderly. Studies published from January 2000 to May 2014 in the electronic databases MEDLINE, LILACS and SciELO were selected. Only free full-text articles written in English, Portuguese and Spanish were considered for this research. After title, abstract and full text analysis, ten articles were included in this review. In the studies analyzed, approximately half of the falls occurred during walk and involved tripping and slipping. The environmental risk factors are present in falls (20-58%), in which irregular surfaces, wet/slippery floors, objects/loose rugs and uneven floor/steps were the most prevalent hazards among the studies. There was tendency of increase in the occurrence of outdoor falls, which are often caused by extrinsic factors. More studies are needed to characterize and develop strategies to prevent outdoor falls among community-dwelling older adults.

Eccentric Torque-Producing Capacity is Influenced by Muscle Length in Older Healthy Adults.

Abstract Melo, RC, Takahashi, ACM, Quitério, RJ, Salvini, TF, and Catai, AM. Eccentric torque-producing capacity is influenced by muscle length in older healthy adults. J Strength Cond Res 30(1): 259–266, 2016—Considering the importance of muscle strength to functional capacity in the elderly, the study investigated the effects of age on isokinetic performance and torque production as a function of muscle length. Eleven younger (24.2 ± 2.9 years) and 16 older men (62.7 ± 2.5 years) were subjected to concentric and eccentric isokinetic knee extension/flexion at 60 and 120°·s−1 through a functional range of motion. The older group presented lower peak torque (in newton-meters) than the young group for both isokinetic contraction types (age effect, p < 0.001). Peak torque deficits in the older group were near 30 and 29% for concentric and eccentric contraction, respectively. Concentric peak torque was lower at 120°·s−1 than at 60°·s−1 for both groups (angular velocity effect, p < 0.001). Eccentric knee extension torque was the only exercise tested that showed an interaction effect between age and muscle length (p < 0.001), which suggested different torque responses to the muscle length between groups. Compared with the young group, the eccentric knee extension torque was 22–56% lower in the older group, with the deficits being lower in the shortened muscle length (22–27%) and higher (33–56%) in the stretched muscle length. In older men, the production of eccentric knee strength seems to be dependent on the muscle length. At more stretched positions, older subjects lose the capacity to generate eccentric knee extension torque. More studies are needed to assess the mechanisms involved in eccentric strength preservation with aging and its relationship with muscle length.

Motivational Factors and Predictors for Attending a Continuing Education Program for Older Adults

The objectives were to describe the stated motives of participants who enrolled in a program at the Open University for the Elderly (UnATI, in Portuguese), identify correlations between the stated motives and sociodemographic data, and find a set of predictors related to the listed motives. A total of 306 middle-aged and elderly adults aged 50 or older were surveyed through a sociodemographic questionnaire and a five-item scale to check their motives to enroll in the program. The following motivational factors were identified, in order of importance: enhancing general knowledge, investing in personal development, increasing social interaction, learning more in order to help others, and employing ones free time profitably. Age and years of schooling combined were strong predictors of participants seeking new knowledge. Being single and not retired was correlated with the motive Investing in Personal Development. Having attended elementary school only and being married was closely correlated to the motive Increasing Social Interaction. Employing Ones Free Time Profitably was associated with single or widowed individuals with family income between 3.1 and 4.0 times the minimum wage. As for Learning More in Order to Help Others, no predictors were found for this motive. It was found that participants seek to satisfy a desire to learn/ know more, to be up-to-date, to exercise their rights as citizens, and to play an active role in society. Our data suggest that these are the assumptions that drive middle-aged and elderly adults to look for various types of educational programs.

Beliefs, perceptions, and concepts of old age among participants of a University of the Third Age.

The objective of the study was to identify correlations between beliefs, perceptions, and concepts about old age and personal experience of aging among older persons attending a public university for the third age. Participants were 256 older adults with a mean age of 67 ± 5.54 years, 69% female. The study protocol included sociodemographic data, the Beliefs Toward aging scale, and tailored questions to assess perceptions of old age and personal aging and concepts regarding a good old age. There was a trend toward positive and neutral beliefs; the assigned age for the beginning of old age was 68 years; participants did not identify with being old; notions of a good old age were associated with physical health, good personal relationships, expectations for the future, and satisfaction with life. The multivariate analysis indicated two significantly distinct groups in terms of age, beliefs, and concepts of good old age. On an individual level, the study participants failed to acknowledge their own aging.