Soraia P. Jürgensen

Metabolic and clinical comparative analysis of treadmill six-minute walking test and cardiopulmonary exercise testing in obese and eutrophic women

BACKGROUNDnImpaired exercise tolerance is directly linked to decreased functional capacity as a consequence of obesity.nnnOBJECTIVESnTo analyze and compare the cardiopulmonary, metabolic, and perceptual responses during a cardiopulmonary exercise test (CPX) and a treadmill six-minute walking test (tread6MWT) in obese and eutrophic women.nnnMETHODnTwenty-nine female participants, aged 20-45 years were included. Fourteen were allocated to the obese group and 15 to the eutrophic group. Anthropometric measurements and body composition assessment were performed.nnnRESULTSnIn both tests, obese women presented with significantly higher absolute oxygen uptake, minute ventilation, and systolic and diastolic blood pressure; they also presented with lower speed, distance walked, and oxygen uptake corrected by the weight compared to eutrophics. During the maximal exercise test, perceived dyspnea was greater and the respiratory exchange ratio was lower in obese subjects compared to eutrophics. During the submaximal test, carbon dioxide production, tidal volume, and heart rate were higher in obese subjects compared to eutrophic women. When analyzing possible correlations between the CPX and the tread6MWT at peak, there was a strong correlation for the variable heart rate and a moderate correlation for the variable oxygen uptake. The heart rate obtained in the submaximal test was able to predict the one obtained in the maximal test. Bland-Altman plots demonstrated the agreement between both tests to identify metabolic and physiological parameters at peak exercise.nnnCONCLUSIONSnThe six-minute walking test induced ventilatory, metabolic, and cardiovascular responses in agreement with the maximal testing. Thus, the six-minute walking test proves to be important for functional evaluation in the physical therapy routine.

Shuttle walking test in obese women: test-retest reliability and concurrent validity with peak oxygen uptake

The aim of this study was to evaluate the test–retest reliability, concurrent validity and agreement with peak oxygen uptake (VO2) obtained during cardiopulmonary exercise testing (CPX) on a treadmill for the incremental shuttle walking test (ISWT) in obese women.

Increased sympathetic modulation and decreased response of the heart rate variability in controlled asthma.

Abstract Objective: To compare the autonomic modulation of heart rate (HR) in asthmatic and healthy volunteers to correlate it with the forced expiratory volume in the first second (FEV1). Methods: Ten healthy and 14 asthmatic volunteers were included in this cross-sectional study. The volunteers underwent a cardiopulmonary exercise test, spirometry and a register of both resting heart rate variability (HRV) in the supine and seated positions along with HRV during the respiratory sinus arrhythmia maneuver (M-RSA). Results: At rest in supine, asthmatic volunteers presented a higher HR (77.1u2009±u20099.9 vs. 68.7u2009±u20098.7u2009bpm), shorter interval between two R waves (R-Ri) (807.5u2009±u2009107.2 vs. 887.5u2009±u2009112.7u2009ms) when compared with the healthy volunteers, respectively. Moreover, in the frequency domain of HRV, there was increased low frequency (LF) index (50.4u2009±u200917.1 vs. 29.2u2009±u200911.1u2009n.u.) and decreased high frequency (HF) index (49.4u2009±u200917.1 vs. 70.7u2009±u200911.1u2009n.u.). During the M-RSA, the asthmatic presented higher HR (82.6u2009±u200910.0 vs. 72.4u2009±u20097.6u2009bpm) and lower values of R-Ri (746.4u2009±u200992.1 vs. 846.4u2009±u200981.4u2009ms) and approximate entropy (ApEn) (0.7u2009±u20090.0 vs. 0.8u2009±u20090.1). FEV1 was strongly correlated with the change of the continuous beat-to-beat variability of HR (SD2) index from the seated to the supine position (ru2009=u20090.78). Conclusion: Controlled asthma in adults appears to induce an increased sympathetic modulation and attenuated response to the postural changes and the M-RSA. Furthermore, there is a correlation between the airways’ obstruction and HRV, especially during postural changes.

Does the incremental shuttle walk test require maximal effort in young obese women

Obesity is a chronic disease with a multifaceted treatment approach that includes nutritional counseling, structured exercise training, and increased daily physical activity. Increased body mass elicits higher cardiovascular, ventilatory and metabolic demands to varying degrees during exercise. With functional capacity assessment, this variability can be evaluated so individualized guidance for exercise training and daily physical activity can be provided. The aim of the present study was to compare cardiovascular, ventilatory and metabolic responses obtained during a symptom-limited cardiopulmonary exercise test (CPX) on a treadmill to responses obtained by the incremental shuttle walk test (ISWT) in obese women and to propose a peak oxygen consumption (VO2) prediction equation through variables obtained during the ISWT. Forty obese women (BMI ≥30 kg/m2) performed one treadmill CPX and two ISWTs. Heart rate (HR), arterial blood pressure (ABP) and perceived exertion by the Borg scale were measured at rest, during each stage of the exercise protocol, and throughout the recovery period. The predicted maximal heart rate (HRmax) was calculated (210 – age in years) (16) and compared to the HR response during the CPX. Peak VO2 obtained during CPX correlated significantly (P<0.05) with ISWT peak VO2 (r=0.79) as well as ISWT distance (r=0.65). The predictive model for CPX peak VO2, using age and ISWT distance explained 67% of the variability. The current study indicates the ISWT may be used to predict aerobic capacity in obese women when CPX is not a viable option.

Effects of two nonpharmacological treatments on the sleep quality of women with nocturia: a randomized controlled clinical trial

Introduction and hypothesisThe objective was to check the effects of two nonpharmacological treatments on the sleep quality of women with nocturia.MethodsA randomized controlled clinical trial in which 40 women with nocturia were randomized into two groups; one was subjected to tibial nerve stimulation (GTNS) and the other received pelvic floor muscle training associated with behavioral therapy (GPFMT). Both groups were followed for 12xa0weeks, with one session/week; evaluated by the Pittsburgh Sleep Quality Index (PSQI), King’s Heath Questionnaire (KHQ), and Epworth Sleepiness Scale (ESS). The Wilcoxon test was used to compare intra-group data and the Mann–Whitney test for intergroup results. Effect size and confidence interval were calculated, and the level of significance was set at 5%.ResultsBoth groups showed improvements in quality of sleep, observed by the PSQI total score (GTNS from 9u2009±u20090.88 to 7u2009±u20090.94, pu2009=u20090.002; GPFMT from 8u2009±u20090.80 to 5u2009±u20090.94, pu2009<u20090.001) and the sleep/energy domain of the KHQ (GTNS from 66.66u2009±u20099.03 to 16.66u2009±u20097.20, pu2009=u20090.002; GPFMT from 66.66u2009±u20099.30 to 0.00u2009±u20097.26, pu2009=u20090.001).ConclusionsBoth nonpharmacological treatments proposed (TNS or PFMT) were equally able to improve quality of sleep of women with nocturia.

Respiração lenta e profunda aumenta a modulação vagal em gestantes

OBJETIVOS: Comparar a resposta da modulacao autonomica da frequencia cardiaca de gestantes e mulheres nao gestantes, antes e apos a manobra de acentuacao da arritmia sinusal respiratoria. METODOS: Foi realizado um estudo transversal com amostra de 24 mulheres, divididas em dois grupos: grupo gestantes (independente da idade gestacional) e grupo controle (nao gestantes). A avaliacao consistiu em registro dos intervalos RR por um cardiofrequencimetro, para analise de indices lineares e nao lineares da variabilidade da frequencia cardiaca. As avaliacoes foram feitas no repouso em decubito lateral esquerdo, antes e apos a manobra de acentuacao da arritmia sinusal respiratoria, que consiste em respiracoes lentas de cinco a seis ciclos por minuto. xa0A razao expiracao/inspiracao e a diferenca entre a inspiracao e a expiracao foram avaliadas durante a manobra. Foram comparados os resultados obtidos entre os dois grupos (gestantes e nao gestantes), assim como os obtidos em cada grupo, antes e apos a manobra. Para a analise estatistica o nivel de significância considerado foi p<0,05. RESULTADOS: Os indices lineares mostraram valores iniciais da modulacao simpatica (banda de baixa frequencia) aumentados nas gestantes quando comparadas as mulheres nao gestantes (gestantes: 68,9±28,1; controles: 49,3±11,7; p=0,002). Apos a manobra respiratoria, o indice obtido pela raiz quadrada da media do quadrado das diferencas entre os intervalos RR normais adjacentes aumentou no grupo gestantes (pre manobra: 34,5±5,7; pos manobra: 38,9±5,8; p=0,027), indicando aumento da atuacao parassimpatica para essa populacao apos a aplicacao da manobra. Alem disso, houve aumento dos valores de complexidade, sugeridos pela entropia de Shanon apos a manobra, para ambos os grupos, sendo o aumento maior nas gestantes. Em relacao aos indices avaliados durante a manobra, ambos os grupos apresentaram valores da razao expiracao/inspiracao maiores que 1, o que sugere integridade do sistema nervoso autonomo. CONCLUSOES: Houve melhora da regulacao do sistema nervoso autonomo ao final da manobra respiratoria para as gestantes, sugerindo que o padrao de respiracao lenta e profunda possa aumentar a modulacao vagal e conferir efeito cardioprotetor, alem de ocasionar relaxamento e sensacao de bem-estar.