Respostas cardiorrespiratorias ao exercicio fisico dinamico e função autonomica em primigestas

Orientadores: Luiz Eduardo Barreto Martins, Hugo SabatinoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação FisicaResumo: Este trabalho tem por objetivos avaliar a capacidade funcional cardiorrespiratória ao exercício fisico dinâmico, e estudar a função autonômica cardiovascular em primigestas durante os períodos que compreendem o 2° e o 3° trimestres gestacionais. Para avaliação da capacidade funcional cardiorrespiratória foi realizado um protocolo contínuo de esforço em cic1oergômetro (pC - rampa de 10 watts/minuto) até a exaustão fisica, com registro contínuo da freqüência cardíaca materna (PC), pressão arterial (P A), produção de dióxido de carbono (v co 2)' consumo de oxigênio (-ir 02 ), ventilação ( v ), volume corrente (VC), fteqüência respiratória (FR), temperatura corporal e fteqüência cardíaca fetal (PCF) no repouso e no exercício. A resposta autonômica cardiovascular foi estudada por meio da avaliação do comportamento da fteqüência cardíaca (PC) e da pressão arterial (P A) materna durante as Manobras Postural Passiva (MPP) e Manobras de Valsalva nas posições supina e cócoras. Constatou-se, em repouso, maiores valores de ventilação, volume corrente e pressão arterial sistólica (p<O,O5) e, menores valores de FCF na posição supina para o grupo do 3° trimestre gestacional quando comparados ao grupo do 2° trimestre. Quanto ao comportamento das variáveis estudadas no exercício, observou-se maiores valores do v CO 2 pico e da ventilação para o grupo do 3° trimestre gestacional (p<O,O5), não foram encontradas diferenças estatísticas para as variáveis -ir 02, volume corrente, fteqüência respiratória e fteqüência cardíaca entre os grupos estudados. Os valores de pressão arterial sistólica apresentaram elevação em ambos os grupos estudados, sendo maior para o grupo do 3° trimestre (p<O,OS), entretanto a pressão arterial diastólica não se modificou. O grupo do 3° trimestre atingiu maiores valores de potência de esforço tanto no limiar de anaerobiose (LA) como no pico do esforço (p<O,OS). No início da recuperação, este grupo apresentou maior aumento da temperatura corporal. A FCF apresentou aumento, quinze minutos após o término do esforço materno no 3° trimestre gestacional. Com relação à MPP, observou-se aumento da FC materna e diminuição inicial da pressão arterial sistólica, em ambos os grupos estudados. Na manobra de Valsalva observou-se menor variação da resposta da FC materna para o grupo do 3° trimestre gestacional, sendo ainda menor na posição de cócoras. Os valores de pressão arterial sistólica se elevaram no grupo do 3° trimestre, em ambas posições, retomando aos valores de repouso durante a recuperação somente na posição de cócoras. A pressão arterial diastólica não se modificou. Com estes resultados concluiu-se que Gestantes no 3° trimestre têm maior metabolismo basal, sugerido pelos valores aumentados nas variáveis ventilatórias de repouso. Os resultados obtidos no esforço fisico sugerem que a gravidez mais avançada pode apresentar fatores condicionantes da capacidade fisica da gestanteAbstract: The aim of this study was to quantify the cardiorrespiratory functional capacity during the dynamic physical exerci se and to evaluate the cardiovascular autonomic function in primigravidas in the second and third trimester. To evaluate the cardiorrespiratory functional capacity it was conducted an exerci se test (continuous protocol) up to physical exhaustion, using a cycloergometer (ramp function - 10 watts/min). We continuously monitored the maternal heart rate (HR), the arterial blood pressure (BP), the C02 production (v co ,), 02 consumption (v 02), the ventilation (v), the tidal volume (VT), the respiratory rate (t), the body temperature and fetal heart rate (FHR), during rest and exercise condition. The autonomic cardiovascular function was achieved by studying the maternal HR. and BP responses during the Head-Up Tilt (HUT) and Valsalva Maneuver (VM). Comparing the 2M and 3m gestation trimester groups, in the last the values of ventilation, tidal volume and arterial blood pressure were higher (p<0.05) and the FHR values at supine position was lower. Considering the cardiorrespiratory variables during exercise, the peak v co, at the ventilation were higher for the 3m gestation trimester (p<0.05) and the v 02, the tidal volume (VT), the respiratory rate, and HR. was not statisticaIly significant comparing the groups (2M and 3m gestation trimester). The systolic arterial pressure increase was higher for the 3m gestation trimester (p<0.05), but the diastolic arterial pressure didn't change during the exerci se for both groups. The 3m gestation trimester group presented higher values of workload at anaerobic threshold (AT) and peak exercise conditions (p<0.05). At the beginning of the recovery phase, the body temperature was higher for this group. The FHR increased 15 minutes after the end of exerci se in this same group. During the HUT the maternal HR increased and the systolic arterial pressure decreased in the beginning of the test in both groups. In the VM the maternal HR changes was lower for the 3r4 gestation trimester group and was even smaller in the squat position. The systolic arterial pressure values increased for the 3r4 gestation trimester group, at supine and squat positions, and returned to baseline values during the recovery on1y in the squat position. The diastolic arterial pressure didn't change. These results suggest that the pregnant women during the 3r4 gestation trimester have lower basal metabolism, showed by the higher values of the ventilatory variables during rest condition, and that in the more advanced pregnancy could exist conditioning factors that determine the physical capacity of the preêlantMestradoMestre em Educação Físic

Water Aerobics In Pregnancy: Cardiovascular Response, Labor And Neonatal Outcomes

Background. To evaluate the association between water aerobics, maternal cardiovascular capacity during pregnancy, labor and neonatal outcomes. Methods. A randomized, controlled clinical trial was carried out in which 34 pregnant women were allocated to a water aerobics group and 37 to a control group. All women were submitted to submaximal ergometric tests on a treadmill at 19, 25 and 35 weeks of pregnancy and were followed up until delivery. Oxygen consumption (VO 2 max), cardiac output (CO), physical fitness, skin temperature, data on labor and delivery, and neonate outcomes were evaluated. Frequency distributions of the baseline variables of both groups were initially performed and then analysis of the outcomes was carried out. Categorical data were compared using the chi-square test, and numerical using Student's t or Mann-Whitney tests. Wilk's Lambda or Friedman's analysis of repeat measurements were applied for comparison of physical capacity, cardiovascular outcomes and maternal temperature. Results. VO 2 max and physical fitness were higher in both groups in the second trimester, returning to basal levels in the third trimester. In both groups, CO increased as pregnancy progressed and peak exercise temperature was higher than resting temperature, increasing further after five minutes of recovery and remaining at this level until 15 minutes after exercise completion. There was no difference between the two groups regarding duration (457.9 ± SD 249.6 vs 428.9 ± SD 203.2 minutes) or type of delivery. Labor analgesia was requested by significantly fewer women in the water aerobics group (27% vs 65%; RR = 0.42 95%CI 0.23-0.77). Neonatal results were similar in both groups. Conclusion. The regular practice of moderate water aerobics by sedentary and low risk pregnant women was not detrimental to the health of the mother or the child. 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Avaliação de obesidade e sobrepeso como estratégia de diagnóstico organizacional para risco ocupacional: um estudo com motoristas de ônibus

Introdução: a obesidade é reconhecida como importante problema de saúde pública em todo o mundo e está fortemente associada a distúrbios metabólicos. Objetivo: o presente estudo centrou-se na verificação da relação da obesidade e do sobrepeso como fatores de risco para doenças cardiovasculares em motoristas profissionais de ônibus de um grupo empresarial. Metodologia: trata-se de um estudo de campo descritivo, analítico, aplicado e transversal que contou com amostra de 786 motoristas profissionais de ônibus, do sexo masculino, com média etária de 41,3 ± 8,4 anos, dos quais foram coletadas medidas antropométricas (peso, estatura e perímetro de abdômen), medidas sorológicas (glicemia de jejum) e medidas fisiológicas (pressão arterial sistólica – PAS e pressão arterial diastólica – PAD). O nível de significância foi de 5% (p&lt;0,05) e intervalo de confiança igual a 1,8. Resultados: sobrepeso e obesidade foram encontrados em 72,3% dos participantes, 28,6% apresentaram risco cardiovascular relacionado ao perímetro abdominal, 6,9% relacionado à glicemia de jejum, 7,7% e 6,9% apresentaram risco cardiovascular relacionado à PAS e PAD respectivamente. Conclusão: assim, ações destinadas ao acompanhamento em saúde em ambientes corporativos constitui procedimento essencial para a promoção da saúde dos colaboradores, reduzindo o ônus familiar e organizacional advindos de distúrbios relacionados às doenças crônicas não transmissíveis (DCNT). As estratégias impetradas deverão ser precedidas de ações informativas de modo a apresentar a relevância da mudança de hábitos para a promoção da saúde

Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women

<p>Abstract</p> <p>Background</p> <p>To evaluate the effectiveness and safety of water aerobics during pregnancy.</p> <p>Methods</p> <p>A randomized controlled trial carried out in 71 low-risk sedentary pregnant women, randomly allocated to water aerobics or no physical exercise. Maternal body composition and perinatal outcomes were evaluated. For statistical analysis Chi-square, Fisher's or Student's t-tests were applied. Risk ratios and their 95% CI were estimated for main outcomes. Body composition was evaluated across time using MANOVA or Friedman multiple analysis.</p> <p>Results</p> <p>There were no significant differences between the groups regarding maternal weight gain, BMI or percentage of body fat during pregnancy. Incidence of preterm births (RR = 0.84; 95%CI:0.28–2.53), vaginal births (RR = 1.24; 95%CI:0.73–2.09), low birthweight (RR = 1.30; 95%CI:0.61–2.79) and adequate weight for gestational age (RR = 1.50; 95%CI:0.65–3.48) were also not significantly different between groups. There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session.</p> <p>Conclusion</p> <p>Water aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition, type of delivery, preterm birth rate, neonatal well-being or weight.</p

Water exercises and quality of life during pregnancy

<p>Abstract</p> <p>Background</p> <p>In Brazil, concern with the quality of life of pregnant women is one of the points emphasized in the Program for the Humanization of Prenatal Care and Childbirth launched in 2000. However, there are few references in the literature on the role of either land or water-based physical exercise on women's quality of life during pregnancy. The purpose of this study was to evaluate the effects of a physical exercise program of water aerobics on the quality of life (QOL) of sedentary pregnant women.</p> <p>Methods</p> <p>A comparative observational study involving sedentary low-risk pregnant women bearing a single fetus with gestational age less than 20 weeks at the time of admission to the study, who were receiving antenatal care at a public health service. One group of 35 women was given routine antenatal care, while another group of 31 women, in addition to receiving the same routine care as the first group, also participated in three classes of water aerobics per week. QOL was evaluated by applying the WHOQOL-BREF questionnaire in both groups at the 20^th, 28^thand 36^thweeks of pregnancy. In the same occasions, women also answered another questionnaire about their experience with pregnancy and antenatal care.</p> <p>Results</p> <p>The great majority of the participants considered that the practice of water aerobics had benefitted them in some way. QOL scores were found to be high in both groups during follow-up. There was no association between the practice of water aerobics and QOL.</p> <p>Conclusions</p> <p>Further studies involving larger sample sizes should be conducted in different sociocultural contexts and/or using other instruments to adequately evaluate the QOL of women during pregnancy.</p

Fetal cardiotocography before and after water aerobics during pregnancy

<p>Abstract</p> <p>Objective</p> <p>To evaluate the effect of moderate aerobic physical activity in water on fetal cardiotocography patterns in sedentary pregnant women.</p> <p>Method</p> <p>In a non-randomized controlled trial, 133 previously sedentary pregnant women participated in multiple regular sessions of water aerobics in a heated swimming pool. Cardiotocography was performed for 20 minutes before and just after the oriented exercise. Cardiotocography patterns were analyzed pre- and post-exercise according to gestational age groups (24-27, 28-31, 32-35 and 36-40 weeks). Student's t and Wilcoxon, and McNemar tests were used, respectively, to analyze numerical and categorical variables.</p> <p>Results</p> <p>No significant variations were found between pre- and post-exercise values of fetal heart rate (FHR), number of fetal body movements (FM) or accelerations (A), FM/A ratio or the presence of decelerations. Variability in FHR was significantly higher following exercise only in pregnancies of 24-27 weeks.</p> <p>Conclusions</p> <p>Moderate physical activity in water was not associated with any significant alterations in fetal cardiotocography patterns, which suggests no adverse effect on the fetus.</p

Can We Modify the Intrauterine Environment to Halt the Intergenerational Cycle of Obesity?

Child obesity is a global epidemic whose development is rooted in complex and multi-factorial interactions. Once established, obesity is difficult to reverse and epidemiological, animal model, and experimental studies have provided strong evidence implicating the intrauterine environment in downstream obesity. This review focuses on the interplay between maternal obesity, gestational weight gain and lifestyle behaviours, which may act independently or in combination, to perpetuate the intergenerational cycle of obesity. The gestational period, is a crucial time of growth, development and physiological change in mother and child. This provides a window of opportunity for intervention via maternal nutrition and/or physical activity that may induce beneficial physiological alternations in the fetus that are mediated through favourable adaptations to in utero environmental stimuli. Evidence in the emerging field of epigenetics suggests that chronic, sub-clinical perturbations during pregnancy may affect fetal phenotype and long-term human data from ongoing randomized controlled trials will further aid in establishing the science behind ones predisposition to positive energy balance

Associação entre pratica de hidroginastica durante a gestação, capacidade cardiovascular e experiencia de parto

Orientadores: Rosa Ines Costa Pereira, Jose Guilherme CecattiTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasDoutoradoCiencias BiomedicasDoutor em Tocoginecologi