Efeito agudo e crônico do exercício aeróbico e resistido sobre a pressão arterial dos pacientes atendidos no Centro Hiperdia de Viçosa
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2015-04-23
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Universidade Federal de Viçosa
Resumo
A literatura estabelece que a atividade física regular traz inúmeros benefícios à saúde, haja vista a associação entre sedentarismo e maior risco de doenças, principalmente as cardiovasculares. Desse modo, o treinamento físico tem sido recomendado por diretrizes atuais como medida preventiva e como ferramenta adicional à terapia farmacológica no tratamento da hipertensão arterial sistêmica (HAS) e suas manifestações patológicas, apesar da persistência de incertezas acerca da melhor metodologia de prescrição de treinamento para controle da pressão arterial. Uma ampla parcela da população hipertensa é composta por portadores de uma doença resistente, hiporresponsiva a terapia medicamentosa e associada a uma combinação de comportamentos e fatores de risco cardiovasculares. Torna-se necessário destacar que estudos sobre a resposta desta parcela de hipertensos aos exercícios físicos ainda não é uma realidade difundida. O objetivo geral desta dissertação foi analisar o efeito agudo e crônico dos exercícios aeróbicos e resistidos sobre a pressão arterial (PA) de pacientes hipertensos atendidos no centro Hiperdia de Viçosa, MG. Os objetivos específicos foram verificar a prevalência, de acordo com o sexo, dos comportamentos de risco e das comorbidades associadas à hipertensão nos pacientes atendidos no Centro Hiperdia de Viçosa, MG; investigar e comparar o comportamento da pressão arterial antes e após uma única sessão de exercício aeróbico e resistido, avaliando o fenômeno de hipotensão pós-exercício; investigar e comparar a PA antes e após 12 semanas de um programa de exercícios físicos aeróbicos e resistidos através de monitorização ambulatorial da pressão arterial (MAPA), avaliando, portanto o efeito crônico do treinamento e por último investigar e comparar o impacto dos programas de exercícios supervisionados sobre o perfil lipídico, o perfil glicêmico e as medidas antropométricas dos pacientes hipertensos. O primeiro estudo avaliou 172 prontuários de hipertensos maiores de 18 anos acompanhado no centro Hiperdia com o objetivo de verificar a prevalência, de acordo com o sexo, dos comportamentos de risco e das comorbidades associadas à hipertensão. Observou-se uma prevalência maior de homens entre os hipertensosvi analisados e as taxas de etilismo e tabagismo foram significativamente maiores neste grupo. As mulheres apresentaram uma taxa maior de obesidade. O sedentarismo e a dislipidemia estiveram presentes em 77% e 44% dos pacientes, respectivamente, sem diferença entre os sexos. Baixa escolaridade também foi uma característica muito presente entre os estudados. Dentre as condições clínicas relacionadas à hipertensão, houve um predomínio da hipertrofia do ventrículo esquerdo, seguida pela doença renal e pela doença cerebrovascular. No segundo estudo, 12 pacientes com hipertensão arterial resistente foram divididos em dois grupos aleatoriamente: treinamento resistido e treinamento aeróbico, ambos de moderada intensidade. A pressão arterial foi registrada por MAPA, durante 24 horas, num momento basal e logo após uma sessão de exercícios. Foi verificada que, durante as 24horas que se seguiram à sessão de exercícios, tanto a pressão arterial sistólica (PAS) quanto a pressão arterial diastólica (PAD) se mantiveram mais baixas do que no momento basal, porém com maior diferença numérica após a sessão de exercícios resistidos e com significância estatística sendo alcançada somente durante o período do sono após esta modalidade. Não foi observada variação significativa do descenso noturno em nenhum dos dois grupos avaliados. O terceiro estudo avaliou onze pacientes da amostra do estudo anterior e registrou a pressão arterial por MAPA, durante 24 horas, no momento basal e após 12 semanas de treinamento aeróbico ou resistido. Foram analisados também as medidas antropométricas, de composição corporal e o perfil bioquímico. A randomização do segundo estudo foi mantida, porém com a perda de um paciente ao longo das 12 semanas de treinamento. No grupo que realizou o treinamento aeróbico, os valores médios de PAS, PAD e pressão arterial média foram significativamente mais baixos no subperíodo de vigília e no total das 24 horas, com quedas de 14mmHg, 7mmHg e 10mmHg, respectivamente. O grupo de treinamento resistido não apresentou alteração significativa da pressão arterial, apesar da melhora significativa de 22% nos níveis de HDL. Os demais parâmetros bioquímicos e antropométricos não variaram significativamente em ambos os grupos. Dessa forma, verificamos pelo primeiro estudo que os hipertensos atendidos no Centro Hiperdia de Viçosa eram, em sua maioria, classificados como hipertensos resistentes e, além desta séria condição, os mesmos ainda apresentavam uma combinação de comportamentos e fatores de risco que conferem um alto risco de complicações cardiovasculares. O segundo e terceiro estudos revelam que o treinamento aeróbico e o resistido apresentaram resultados clinicamente relevantes e significativos para a amostra de hipertensos resistentes selecionada dovii Centro Hiperdia. Tanto o controle pressórico quanto o perfil lipídico foram impactados pela prática de exercícios físicos supervisionados. O segundo artigo destacou que o exercício resistido provocou um importante benefício agudo no ritmo circadiano da PA, particularmente no período do sono e, como apresentado no terceiro artigo, a realização de um exercício aeróbico de baixa à moderada intensidade em sujeitos hipertensos resistentes, mesmo por um período curto de aderência de 12 semanas, também se mostrou estatisticamente e clinicamente significativa. A metodologia proposta de treinamento resistido ou o tempo de realização não permitiu obter os mesmos resultados do treinamento aeróbico no terceiro artigo, porém esta modalidade de treinamento resultou em aumento significativo do HDL.
The literature states that regular physical activity has numerous health benefits, given the association between physical inactivity and increased risk of diseases, especially cardiovascular. Thus, physical training has been recommended by current guidelines as a preventive measure and as an additional tool to pharmacological therapy in the treatment of hypertension (SAH) and its pathological manifestations, despite the persistence of uncertainties about the best prescribing methodology of training to control blood pressure. A large portion of the hypertensive population are carriers of a disease resistant, unresponsive to drug therapy and associated with a combination of behaviors and cardiovascular risk factors. It is necessary to note that studies on the response of this portion of hypertensive to exercise is still not a reality established in the literature. The aim of this thesis was to analyze the acute and chronic effects of aerobic and resistance exercise on blood pressure (BP) of hypertensive patients seen in the Viçosa Hiperdia Centre, MG. The specific objectives were to assess the prevalence, according to sex, of risk behavior and of comorbidities associated with hypertension in the patients treated in the Viçosa Hiperdia Centre; to investigate and compare the behavior of blood pressure before and after a single aerobic and resistance exercise session, evaluating the post-exercise hypotension phenomenon; investigate and compare the PA before and after 12 weeks of a program of aerobic and resistance exercise using ambulatory blood pressure monitoring (ABPM), evaluating, so the chronic effect of training and finally to investigate and compare the impact of exercise programs supervised on the lipid profile, glycemic profile and anthropometric measures of hypertensive patients. The first study evaluated 172 records of hypertensive patients aged over 18 years, accompanied in the center of Hiperdia Viçosa, MG, in order to determine the prevalence, according to sex, risk behavior and comorbidities associated with hypertension. There was a higher prevalence of men among hypertensive analyzed and alcohol consumption and smoking rates were significantly higher in this group. Women had a higher rate of obesity. Physical inactivity and dyslipidemia were presentix in 77% and 44% of patients, respectively, with no difference between the sexes. Low education was also a very present characteristic among the studied. Among the clinical conditions related to hypertension, there was a predominance of left ventricular hypertrophy, followed by kidney disease and cerebrovascular disease. In the second study, twelve patients with resistant hypertension were randomly into two groups: resistance training and aerobic training, both of moderate intensity. Blood pressure was recorded by ABPM for 24 hours in a baseline and after an exercise session. It was found that during the 24 hours that followed the exercise session, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) remained lower than at baseline, but with higher numerical difference after the resistance training session and statistical significance was achieved only during the nighttime period after this mode. There was no significant change in the nocturnal dipping in any of both groups. The third study evaluated eleven patients of the previous sample and registered blood pressure by ABPM for 24 hours, at baseline and after 12 weeks of aerobic or resistance training. We also evaluated the anthropometric measurements, body composition and biochemical profile. The randomization of the previous study was maintained, but with a loss of a patient over the 12 weeks of training. In the group that performed the aerobic training, the mean values of SBP, DBP and mean arterial pressure were significantly lower in the daytime subperiod and on 24 hours, with falls of 14mmHg, 7 mmHg and 10 mmHg respectively. The resistance training group showed no significant change in blood pressure, despite the significant improvement of 22% in HDL levels. The other biochemical and anthropometric parameters did not vary significantly in both groups. Thus, we find the first study that hypertensive patients in the Viçosa Hiperdia center were mostly classified as resistant hypertension and in addition to this serious condition, they still had a combination of behaviors and risk factors that confer a high risk cardiovascular complications. The second and third studies show that aerobic and resistance training showed clinically relevant and significant results for the sample of selected resistant hypertensives Hiperdia Center. Both the pressure control and the lipid profile were affected by the practice of supervised physical exercise. The second article highlights that resistance exercise caused a significant acute benefit in BP circadian rhythm, particularly during sleep and, as shown in the third article, the realization of a low to moderate intensity aerobic exercise in resistant hypertensive subjects, even by a short tack 12 weeks, was also statistically and clinically significant. The proposed methodology of resistance training or performance time could not provide the samex results of aerobic training in article three, but this training method resulted in a significant increase in HDL.
The literature states that regular physical activity has numerous health benefits, given the association between physical inactivity and increased risk of diseases, especially cardiovascular. Thus, physical training has been recommended by current guidelines as a preventive measure and as an additional tool to pharmacological therapy in the treatment of hypertension (SAH) and its pathological manifestations, despite the persistence of uncertainties about the best prescribing methodology of training to control blood pressure. A large portion of the hypertensive population are carriers of a disease resistant, unresponsive to drug therapy and associated with a combination of behaviors and cardiovascular risk factors. It is necessary to note that studies on the response of this portion of hypertensive to exercise is still not a reality established in the literature. The aim of this thesis was to analyze the acute and chronic effects of aerobic and resistance exercise on blood pressure (BP) of hypertensive patients seen in the Viçosa Hiperdia Centre, MG. The specific objectives were to assess the prevalence, according to sex, of risk behavior and of comorbidities associated with hypertension in the patients treated in the Viçosa Hiperdia Centre; to investigate and compare the behavior of blood pressure before and after a single aerobic and resistance exercise session, evaluating the post-exercise hypotension phenomenon; investigate and compare the PA before and after 12 weeks of a program of aerobic and resistance exercise using ambulatory blood pressure monitoring (ABPM), evaluating, so the chronic effect of training and finally to investigate and compare the impact of exercise programs supervised on the lipid profile, glycemic profile and anthropometric measures of hypertensive patients. The first study evaluated 172 records of hypertensive patients aged over 18 years, accompanied in the center of Hiperdia Viçosa, MG, in order to determine the prevalence, according to sex, risk behavior and comorbidities associated with hypertension. There was a higher prevalence of men among hypertensive analyzed and alcohol consumption and smoking rates were significantly higher in this group. Women had a higher rate of obesity. Physical inactivity and dyslipidemia were presentix in 77% and 44% of patients, respectively, with no difference between the sexes. Low education was also a very present characteristic among the studied. Among the clinical conditions related to hypertension, there was a predominance of left ventricular hypertrophy, followed by kidney disease and cerebrovascular disease. In the second study, twelve patients with resistant hypertension were randomly into two groups: resistance training and aerobic training, both of moderate intensity. Blood pressure was recorded by ABPM for 24 hours in a baseline and after an exercise session. It was found that during the 24 hours that followed the exercise session, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) remained lower than at baseline, but with higher numerical difference after the resistance training session and statistical significance was achieved only during the nighttime period after this mode. There was no significant change in the nocturnal dipping in any of both groups. The third study evaluated eleven patients of the previous sample and registered blood pressure by ABPM for 24 hours, at baseline and after 12 weeks of aerobic or resistance training. We also evaluated the anthropometric measurements, body composition and biochemical profile. The randomization of the previous study was maintained, but with a loss of a patient over the 12 weeks of training. In the group that performed the aerobic training, the mean values of SBP, DBP and mean arterial pressure were significantly lower in the daytime subperiod and on 24 hours, with falls of 14mmHg, 7 mmHg and 10 mmHg respectively. The resistance training group showed no significant change in blood pressure, despite the significant improvement of 22% in HDL levels. The other biochemical and anthropometric parameters did not vary significantly in both groups. Thus, we find the first study that hypertensive patients in the Viçosa Hiperdia center were mostly classified as resistant hypertension and in addition to this serious condition, they still had a combination of behaviors and risk factors that confer a high risk cardiovascular complications. The second and third studies show that aerobic and resistance training showed clinically relevant and significant results for the sample of selected resistant hypertensives Hiperdia Center. Both the pressure control and the lipid profile were affected by the practice of supervised physical exercise. The second article highlights that resistance exercise caused a significant acute benefit in BP circadian rhythm, particularly during sleep and, as shown in the third article, the realization of a low to moderate intensity aerobic exercise in resistant hypertensive subjects, even by a short tack 12 weeks, was also statistically and clinically significant. The proposed methodology of resistance training or performance time could not provide the samex results of aerobic training in article three, but this training method resulted in a significant increase in HDL.
Descrição
Palavras-chave
Hipertensão, Pressão arterial, Exercícios aeróbicos, Exercícios físicos
Citação
CARVALHO, Cristiane Junqueira de. Efeito Agudo e Crônico do Exercício Aeróbico e Resistido sobre a Pressão Arterial dos Pacientes Atendidos no Centro Hiperdia de Viçosa. 2015. 89 f. Dissertação (Mestrado em Educação Física) - Universidade Federal de Viçosa, Viçosa. 2015.