Fisioter. Mov., Curitiba, v. , n. , p. - , out./dez. Licenciado sob uma Licença Creative Commons DO): http://dx.doi.org. . / - . . .AO
[T]
Analysis of cardiovascular risks in practitioners
of unsupervised exercises
[)]
Análise dos riscos cardiovasculares em indivíduos
praticantes de exercício físico não supervisionado
[A]
Renata Cristina Oliveira Penha[a], Danielle Silva Yamamoto[b], Isabel Aparecida Porcatti de Walsh[c],
Gualberto Ruas[d], Marilita Falangola Accioly[e]
[a] Graduate, Universidade Federal do Triângulo Mineiro, Uberaba, MG - Brasil. e-mail: renata.uftm@gmail.com [b] Graduate, Universidade Federal do Triângulo Mineiro, Uberaba, MG - Brasil. e-mail: danielle-sy@hotmail.com
[c] PhD, professor, Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba, MG - Brasil,
e-mail: ewalsh@terra.com.br
[d] PhD, professor, Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba, MG - Brasil,
e-mail: gualbertoruas@yahoo.com.br
[e] PhD, professor, Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba, MG - Brasil,
e-mail: marilita@terra.com.br
[R]
Abstract
Introduction: Physical exercise is recommended by health professionals for the prevention of
cardio-vascular events; for it is important that practitioners follow recommendations of qualified professionals.
Objectives: To analyze the cardiovascular risks and the physical exercise of regulars of a municipal public
park. Materials and methods: regulars of a municipal public park were evaluated by questionnaire
and physical examination, men and women with a mean age of . ± . years. Cardiovascular risk was classified according to the American Table and physical activity following the recommendations of the American College of Sports Medicine and the American (eart Association. Results: Regarding the
524
no professional guidelines. Conclusion: The public park goers have cardiovascular risk and do exercise
without individualized guidance.
Keywords: Risk factors. Cardiovascular diseases. Physical activity. Walking.
[B] Resumo
Introdução: A prática de exercícios físicos é preconizada pelos profissionais da saúde para a prevenção de eventos cardiovasculares; para tal é importante que os praticantes sigam recomendações de profissionais qua-lificados. Objetivos: Analisar os riscos cardiovasculares e a prática do exercício físico dos frequentadores de um parque público municipal. Materiais e métodos: Foram avaliados por meio de questionário e exame fí-sico, 110 frequentadores de um parque público municipal, sendo 60 homens e 50 mulheres com idade média de 48,8 ± 11,76 anos. O risco cardiovascular foi classificado de acordo com a Tabela Americana e a atividade física seguindo as recomendações da American College of Sports Medicine e da American Heart Association. Resultados: Quanto à classificação do risco cardiovascular, 54% da população avaliada apresentou risco po-tencial e 31%, moderado. Quanto ao exercício físico praticado 58% foram considerados inativos, 14% ativos e 28% muito ativos. 90% não receberam orientações profissionais. Conclusão: Os frequentadores do parque público apresentam risco cardiovascular e praticam exercício físico sem orientações individualizadas. [K]
Palavras-chave: Fatores de risco. Doenças cardiovasculares. Atividade física. Caminhada.
Introduction
Cardiovascular disease CVD , in particular its pre-sentation as coronary artery disease CAD remains the leading cause of death worldwide , with greater involvement in underdeveloped countries which amounted to approximately % of deaths reported in world population .
The Framingham study was among the first to demonstrate that: hypertension, obesity, high cho-lesterol levels, diabetes mellitus, physical inactivity and smoking are risk factors strongly related to the development of cardiovascular and cerebrovascu-lar diseases . This relationship was confirmed by other studies, which added: psychosocial indicator, diet, regular alcohol consumption , in addition to genetic predisposition .
The increased risk of cardiovascular morbid-ity and mortalmorbid-ity is associated with an increase in
sedentary lifestyle , since the technological and
economic incentives tend to discourage physical
activity . )n contrast, physical activity prevents
and reduces the risk of cardiovascular events on – %, it increases serum levels of high density lipoprotein (DL-C , decreases in low-density li-poprotein LDLc and triglycerides, reduces blood pressure, improves blood glucose, insulin resistance,
helps in weight loss or maintaining, improves psy-chological welfare, facilitates smoking cessation, reduces symptoms and mortality after acute
myo-cardial infarction in cardiac patients , in
addi-tion to reducing the formaaddi-tion and development of atherosclerosis and the incidence of CAD . Thus, it promotes and maintains health, reduces the risk
of chronic diseases and premature mortality .
As a result, physical exercise is widely recommended
by health professionals .
)n contrast, vigorous exercise can, acute and tran-siently increase the risk of acute myocardial infarction
AM) and sudden death in susceptible individuals. The absolute risk of physical activity related to acute cardiovascular events varies with the prevalence of diagnosis or hidden heart disease and inadequate physical exercise , because the risk of AM) in sed-entary individuals is six times higher during intense exercise than in that the rest .
Thus, especially in people who already have car-diovascular risk, physical exercise should follow rec-ommendations regarding the intensity, duration and
frequency of physical activity . Population must
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Currently it is noticed great encouragement by the media, health professionals and local govern-ment actions that provide places for practicing physical activity and guidance to maintain an active life. Thus, the population is driven, in most cases, to perform exercises before being subjected to a prior cardiovascular evaluation and specific orientation of health professionals.
Thus, these individuals who practice the exercise improperly become more prone to sudden events by increasing their cardiovascular risk . Thus, it is essential to do cardiovascular assessment of indi-viduals who attend public squares, to conduct walk-ing and joggwalk-ing, as well as physical exercise. These actions may generate subsidies to public health services in order to suggest intervention measures to correct the deficiencies found and disseminate the use of this practice optimally and safely, within promotion and health prevention actions, to ensure greater gains, minimizing and slowing the risks re-lated to it.
Thus, the objectives of this study were to identify the cardiovascular risk, namely smoking, alcoholism, high blood pressure, heredity, sedentary lifestyle, stress, obesity, diabetes mellitus, dyslipidemia and physical exercise of the regulars of a municipal pub-lic park.
Materials and methods
Type of research and ethical aspects
This quantitative, cross-sectional and descrip-tive study followed ethical procedures required
by Resolution / of the National (ealth
Council, with the approval of the Federal University of Triangulo Mineiro Research Ethics Committee,
un-der number / . All subjects read and signed
the informed consent form.
Sample
individuals, men % and women
% aged between – years old, with a mean age of . ± . years old, regulars of a munici-pal public park were evaluated. This park offers a hiking/race trail, sports fields, skate park and out-door gym.
Procedures
)nitially, individuals were contacted inside the park, at a time when they were performing the ex-ercise, and the research objectives were explained. For those who expressed interest in participating, day and time were scheduled, according to their availabil-ity, to perform the evaluations at the same park. They were told to attend fasting for hours and cardiac patients should bring ergometric test.
All evaluations were conducted by physiotherapy instructors and physiotherapy students previously trained through a structured evaluation form based on American College of Sports Medicine ACSM and
the American (eart Association A(A and
physical examination. The evaluation form contained identification, followed by a questionnaire on lifestyle habits, cardiovascular risk factors, previous and fam-ily diseases and physical activity.
)ssues related to physical activity included ques-tions about the presence of cardiovascular symptoms, purpose, type of sport, frequency, duration, orienta-tion existence and evaluaorienta-tion of exercise intensity. Regarding the frequency, duration and intensity of exercise, the subjects were classified according to parameters established by (askell et al. in inac-tive, active and very acinac-tive, according to the recom-mendations of the ACSM and A(A. This classification characterizes individuals who exercise lasting less
than minutes per week in mild to moderate
in-tensity, as inactive; those who practice exercise at
moderate intensity for to minutes per week
or vigorous intensity to minutes per week as
active; and people who exercise for more than minutes a week at moderate intensity or more than
minutes in vigorous intensity as very active. Physical examination consisted of anthropometric measurements, blood pressure and heart rate (R at rest measurement, analysis of total cholesterol TC and the glycemic index.
Anthropometric measures were taken by the stature and body mass. To measure the height, a stadiometer was used. The subject was instructed to stand upright with head, buttocks and heels and lined up against the stadiometer with the head in the horizontal plane.
For the measurement of body mass, a digital scale
Filizola® , with a kg capacity and g sensitivity
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Statistical analysis
Results are presented descriptively and percentages.
Results
The sample totaled individuals, %
women and % men, mean age ± years
old. Among this population, % were cardiac
patients diagnosed with Chagas disease, heart failure, valvular disease, coronary artery disease, acute myo-cardial infarction, abnormal heart rhythm and
circula-tory; % reported having another type of disease
and % said they did not have any disease.
Most subjects had more than one cardiovascular risk factor, as shown in Figure . With respect to body
weight, % were obese and % were
overweight. Thus, . % were above the ideal
weight range.
)n relation to blood glucose levels, three %
had higher than mg/dL indices. Among them,
one had drug treatment for glycemic control and the other two had no diagnosis of diabetes mellitus. )n the evaluation of dyslipidemia, measured by analysis of
total cholesterol, % were detected with high
values greater than mg/dL and only %
of these used antilipemics medications.
Based on American Table , the sample was
rated in accordance with the risk for developing car-diovascular disease, in four groups: no risk, potential risk, moderate risk and high risk Figure .
Moreover, of the individuals evaluated,
% reported being sedentary not performing
regu-lar exercise ; % physical active, all of which
practiced walking and . % associated walking
with practices of other activities. (owever, in applying the classification used by (askell et al. , it was found
that % were inactive, whereas % did
not engage in regular physical exercise and . %
performed regular walks, but did not reach this
thresh-old to be classified as active; % were active
and % , very active. When considering only the
% cardiac patients, it was observed that % were inactive, % active and % were very active. When asked about the cardiovascular signs and
symptoms present during walking, %
report-ed dyspnea, pain and tightness in chest, tachycardia and excessive tiredness. Among them, one cardiac patient presented with pain in chest tightness and Then the body mass index BM) was calculated.
For classification of nutritional status it was consid-ered as overweight BM) between to . Kg/m²; obese: BM) greater than or equal to Kg/m², normal: BM) between . to . Kg/m² and underweight
BM) less than . Kg/m² .
Circumferences of waist and hip were measured with an inelastic tape. The waist/hip ratio W(R was determined by dividing the waist circumference measured at the umbilicus by hip circumference level of the femoral trochanters . )t was considered that rate higher than . in women and higher than . in men are correlated with greater visceral fat dis-tribution, rather than peripheral, ie, increased risk of
cardiovascular disease and metabolic syndrome .
Blood pressure was measured with an aneroid
sphygmomanometer G-Tech® , only once, after
minutes of rest, following the guidelines and classification of the V) Brazilian Guidelines on
(ypertension .
The assessment regarding the diagnosis of diabe-tes mellitus was performed through the use of hypo-glycemic drugs and the analysis of the hypo-glycemic index, using a portable blood glucose monitoring equipment
Accucheck Performa Glucometer of Roche® ,
consid-ered as normal random blood glucose greater than
mg/dL .
Serum levels of total cholesterol TC were re-corded by means of a portable biochemical analyzer
Accutrend Plus of Roche® , in which the measuring
principle is based on reflectance photometry method. )t was considered a normal standard TC smaller or
equal to mg/d .
Based on the data collected, the cardiovascular risk of each participant was classified according to the American Table in: no risk, potential risk, moderate
risk and high risk .
Based on the data from the questionnaire and physical examination, individualized orientation was given, through pamphlets containing informa-tion about the necessary care when practicing physi-cal activity. )n addition, guidance was provided on methods of measurement of heart rate in determin-ing the target traindetermin-ing zone accorddetermin-ing to Karvonen
formula .
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point in the same direction, indicating a high
in-cidence of this risk , . Mendonça et al.
when assessed cardiovascular risk in active seniors verified the presence of these factors in % of the population.
Among the risk factors observed stood out hered-ity represented by % of the subjects evaluated, hypertension by %, stress by % and obesity by %, while the last three are considered modifiable risk factors, and may be reduced through changes in lifestyle.
tachycardia. Most individuals % performed
physical exercises in order to improve health
condi-tions and % had no professional guidelines
on how to accomplish them.
Discussion
)n this study, it was noted that % of the study population was cardiac patients and % had risk of developing cardiovascular disease. Other studies
Figure 1 - Cardiovascular risk factors
Figure 2 - Cardiovascular risk rating 60.9%
Heredity Stress
Ex-smokers Dyslipidemia Hyper
tensive Obesity
Sedentar y
Smokers Alcoholics
High Blood Glucose 55.45%
30.9% 30% 29.09%
26.36%
20%
8.18%
5.45%
2.72%
14%
No risk Potential risk Moderate risk High risk
54%
31%
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according to Mozaffarian et al. , regular physical
exercise promotes smoking cessation.
Regarding blood pressure, it was found that % said they are hypertensive. (owever, people who had declared normotensive presented blood pres-sure values of hypertension. During physical exer-cise, elevation of systolic blood pressure and main-taining or reducing diastolic blood pressure occurs
. Thus, people who already begin exercise with elevated blood pressure levels should be monitoring its blood pressure through supervision and proper exercise prescription, as it is well established in the
literature , hypertension is the major cause of
vascular stroke, highlighting cerebrovascular acci-dent and acute myocardial infarction.
Regarding dyslipidemia, elevated levels of TC in six volunteers % who used antilipemics medicines was verified, and also elevated levels in another % who had no knowledge of this fact was veri-fied, revealing that although the majority of the
popu-lation % practiced exercise in pursuit for better
health, they did not know their real health condition in this sense.
Although % is exercised in pursuit for better health, % did not receive professional guidance on how to accomplish it. Furthermore, . % had cardiovascular symptoms such as tachycardia, dys-pnea disproportionate to exertion and chest pain, suggesting ischemic framework while running the
exercise, and may causing an acute cardiac event .
Finally, although % of the population does not considered itself sedentary, while applying the classi-fication of (askell et al. based on the intensity, du-ration and frequency of weekly exercise performed, it was found that % is considered inactive. Thus, it is possible that this is not reaching the cardiovas-cular benefits induced by regular physical exercise
, since they did not perform on the appropriate intensity, duration and frequencies . Thus demon-strating the need for better control over the practice of physical exercise through supervised practice or even inserting in cardiac rehabilitation programs, in cases of increased cardiovascular risk.
Conclusion
)t is concluded that public park regulars evalu-ated in this study have cardiovascular risks and that physical exercises are practiced in a nonspecific )t is possible that the percentage of %,
relat-ed to herrelat-edity risk factor found in this study is re-lated to the increased incidence and prevalence of cardiovascular disease in the population since the mid-twentieth century, and that continue to prevail especially in underdeveloped countries . (owever, there is disagreement in the literature, as Oliveira
et al. compared the cardiovascular risk of active,
insufficiently active and inactive regulars of a public park, and found only % of hereditary risk factor.
While Coltro et al. evaluated the frequency of
cardiovascular risk factors in volunteers who partici-pated in an educational intervention for community health in the city of Botucatu SP , noting % of hereditary risk factor.
Besides obesity % it was observed that %
of the volunteers were overweight and a further % with high waist/hip ratio, which indicates abdomi-nal obesity.
These results corroborate the study by Matos et al. with employees of Petrobras, most of them sed-entary individuals, and % of obese was found, as
well as the Forjaz et al. research , who evaluated
the cardiovascular risk of physically active people, finding % of the obese population.
Further, Zhang et al. reported a higher
preva-lence of abdominal obesity in the last years, in the American population, which is strongly associated with insulin resistance, dyslipidemia, systemic in-flammation, factors that play an essential role in the pathogenesis of cardiovascular disease, metabolic syndrome and certain types of cancer.
A fact that has drawn attention, in the present study was the low prevalence of smokers %
and high ex-smokers % . The World (ealth
Organization reports that one-third of the adult popu-lation, about . billion people, is a smoker. )n Brazil, the Ministry of (ealth shows that . % of Brazilians
are smokers . )n this context, Carnelosso et al.
found the prevalence of cardiovascular risk in the eastern region of Goiânia, and evaluated volunteers, and % were smokers. While Viebig et
al. described the cardiovascular health profile
of an adult population in the metropolitan region of São Paulo, where the smoking rate was %.
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manner, without previous assessments and indi-vidualized guidelines.
Thus, it is relevant to emphasize that in addition to encouraging physical exercise and providing pub-lic places to facilitate its practice, it is necessary in the field of public health, greater investment in the proper orientation to the population, carried out by qualified professionals such as physiotherapists and physical educator. This strategy involves significantly little human resources and materials, with potential to reach large segments of the population, with low cost, encouraging autonomy and safety for individ-uals who exercise, enabling the physical activity to achieve its goals and hence have the greatest positive impact on the population.
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