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Guided bone regeneration involving the use of titanium mesh and platelet-rich fibrin could be a feasible approach in cases of severely atrophic ridges. The purpose of this case report was to present an esthetic and functional rehabilitation in the anterior maxilla with the installation of dental implants in conjunction with guided bone regeneration using titanium mesh and advanced platelet-rich fibrin (A-PRF). A 60-year-old patient presented bone atrophy and partial edentulism in the anterior maxilla. After clinical and cone beam computed tomography assessment, guided bone regeneration was planned using a titanium mesh and A-PRF with xenograft bone. After 8 months of healing, the dental implants were placed with the aid of a surgical guide to obtain accurate 3-dimensional positioning. Prosthetic rehabilitation was carried out with individualized crowns. After 2 years of follow-up, radiographic analysis demonstrated a good quality and density of the bone tissue adjacent to the dental implants. No radiolucent areas were observed, and there were no clinical signs of failure. In cases of severe atrophy, using a titanium mesh and A-PRF proved to be a feasible alternative for bone reconstruction prior to dental implant placement. This approach can aid dental professionals in achieving an ideal implant positioning for rehabilitation with individualized crowns.

Purpose: Given the rising burden of heart failure (HF), stratification of patients at increased risk for adverse events is critical. We aim to compare the predictive value of various maximal and submaximal cardiopulmonary exercise test (CPET) variables for adverse events in patients with HF., Methods: 237 patients with HF (66 [58-73] years, 30% women, 70% HF with reduced ejection fraction) completed a CPET and had five years of follow-up. Baseline characteristics and clinical outcomes (all-cause mortality, major adverse cardiovascular events, and cardiovascular-related hospitalization) were extracted from electronic patient files. Receiver operating characteristics curves for maximal (e.g. peak VO2) and submaximal CPET variables (e.g. VE/VCO2 slope, cardiorespiratory optimal point (COP), VO2 at anaerobic threshold) were compared using the Akaike Information Criterion (AIC) method, whereas their calibration was assessed., Results: 103 participants (43%) reached the composite endpoint, and 55 (23%) died. Percent predicted peak VO2 was the best predictor for adverse outcomes (AIC: 302.6) followed by COP (AIC: 304.3), and relative peak VO2 (mL/(kg·min), AIC: 304.4). Relative peak VO2 (AIC: 217.1) and COP (AIC: 224.4) were also among the three best predictors for mortality, together with absolute peak VO2 (ml/min, AIC: 220.5). A good calibration between observed and predicted event rate was observed for these variables., Conclusions: Percent predicated and relative peak VO2 had the best predictive accuracy for adverse events and mortality, but the submaximal COP had a non-inferior predictive accuracy for adverse events in patients with HF. These findings highlight the potential of submaximal exercise testing in patients with HF., Competing Interests: Conflict of Interest and Funding Source: This project is supported by an Eurostars Grant (E!114585). EB has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No [101064851]. All the authors have no conflicts of interest or financial ties to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Sports Medicine.)

Introduction: We assessed the cardiorespiratory optimal point (COP)-the minimal V̇E /V̇O 2 in a given minute of an incremental cardiopulmonary exercise test-in patients with heart failure (HF) and aimed to determine 1) its association with patient and disease characteristics, 2) changes after an exercise-based cardiac rehabilitation program (CR), and 3) the association with clinical outcomes., Methods: We studied 277 HF patients (67 (58-74) yr, 30% female, 72% HF with restricted ejection fraction) between 2009 and 2018. Patients participated in a 12- to 24-wk CR program, and COP was assessed pre- and post-CR. Patient and disease characteristics and clinical outcomes (mortality and cardiovascular-related hospitalization) were extracted from patient files. The incidence of clinical outcomes was compared across COP tertiles (low, <26.0; moderate, 26.0-30.7; high, >30.7)., Results: Median COP was 28.2 (24.9-32.1) and was reached at 51% ± 15% of V̇O 2peak . Lower age, female sex, higher body mass index, the absence of a pacemaker or the absence of chronic obstructive pulmonary disease, and lower N-terminal prohormone brain natriuretic peptide concentrations were associated with a lower COP. Participation in CR reduced COP (-0.8; 95% confidence interval, -1.3 to -0.3). Low COP had a reduced risk (adjusted hazard ratio, 0.53; 95% confidence interval, 0.33-0.84) for adverse clinical outcomes as compared with high COP., Conclusions: Classic cardiovascular risk factors are associated with a higher, more unfavorable, COP. CR-based exercise training reduces COP, whereas a lower COP is associated with a better clinical prognosis. As COP can be established during a submaximal exercise test, this may offer novel risk stratification possibilities for HF care programs., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Sports Medicine.)

Purpose: The cardiorespiratory optimal point (COP) is the minimum ventilatory equivalent for oxygen. The COP can be determined during a submaximal incremental exercise test. Reflecting the optimal interaction between the respiratory and cardiovascular systems, COP may have prognostic utility. The aim of this investigation was to determine the relationship between COP and all-cause mortality in a cohort of apparently healthy adults., Methods: The sample included 3160 apparently healthy adults (46% females) with a mean age of 44.0 ± 12.5 yr who performed a cardiopulmonary exercise test. Cox proportional hazards models were performed to assess the relationship between COP and mortality risk. Prognostic peak oxygen uptake (V˙ o2peak ) and COP models were compared using the concordance index., Results: There were 558 deaths (31% females) over a follow-up period of 23.0 ± 11.9 yr. For males, all Cox proportional hazards models, including the model adjusted for traditional risk factors and V˙ o2peak , had a positive association with risk for mortality ( P &lt; .05). For females, only the unadjusted COP model was associated with risk for mortality ( P &lt; .05). The concordance index values indicated that unadjusted COP models had lower discrimination compared with unadjusted V˙ o2peak models ( P &lt; .05) and V˙ o2peak did not complement COP models ( P ≥ .13)., Conclusions: Cardiorespiratory optimal point is related to all-cause mortality in males but not females. These findings suggest that a determination of COP can have prognostic utility in apparently healthy males aged 18-85 yr, which may be relevant when a maximal exercise test is not feasible or desirable., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Patients with sickle cell disease (SCD) are at increased risk for cardiovascular complications. Exercise testing is used as a prognostic marker in a variety of cardiovascular diseases. However, there is a lack of evidence on exercise in SCD patients, particularly regarding its safety, feasibility, and possible prognostic role., Objectives: We used the maximal treadmill test to determine safety and feasibility of the exercise testing in SCD patients. Additionally, the factors associated with exercise duration, as well as the impact of exercise-induced changes on clinical outcome, were also assessed., Methods: One-hundred thirteen patients with SCD, who underwent exercise testing, were prospectively enrolled. A comprehensive cardiovascular evaluation, including echocardiography and B-type natriuretic peptide (BNP) levels, were obtained. The long-term outcome was a composite endpoint of death, severe acute painful episodes, acute chest syndrome, or hospitalization for other SCD-related complications. Cox regression analysis was performed to identify the variables associated with the outcome. A p-value<0.05 was considered to be statistically significant., Results: The mean age was 36 ± 12 years (range, 18-65 years), and 62 patients were women (52%). Ischemic electrocardiogram and abnormal blood pressure (BP) response to exercise were detected in 17% and 9%, respectively. Two patients experienced pain crises within 48 hours that required hospitalization. Factors associated with exercise duration were age, sex, tricuspid regurgitation (TR) maximal velocity, and E/e' ratio, after adjustment for markers of disease severity. During the mean follow-up of 10.1 months (ranging from 1.2 to 26), the endpoint was reached in 27 patients (23%). Independent predictors of adverse events were hemoglobin concentration, late transmitral flow velocity (A wave), and BP response to exercise., Conclusions: Exercise testing in SCD patients who were clinically stable is feasible. Exercise duration was associated with diastolic function and pulmonary artery pressure. Abnormal BP response was an independent predictor of adverse events.

Cardiorespiratory optimal point (COP) during exercise may be a potentially clinically useful cardiopulmonary exercise testing (CPET) variable, but its prognostic relevance for adverse cardiovascular disease (CVD) outcomes is unknown. We aimed to assess the association of COP during exercise with fatal mortality outcomes and the extent to which COP could improve the prediction of CVD mortality. Cardiorespiratory optimal point, the minimum value of the ventilatory equivalent for oxygen (VE/VO2) in a given minute of a CPET, was defined in 2,205 men who underwent CPET. Hazard ratios (HRs) (95% confidence intervals [CIs]) for outcomes and measures of risk discrimination for CVD mortality were calculated. During a median follow-up of 28.8 years, 402 fatal CHDs, 607 fatal CVDs, and 1,348 all-cause mortality events occurred. COP was continually associated with each outcome in a dose-response manner. On adjustment for established and emerging risk factors, the HRs (95% CIs) for fatal CHD, fatal CVD, and all-cause mortality were 3.05 (1.94-4.81), 2.82 (1.91-4.18) and 2.46 (1.85-3.27), respectively, per standard deviation increase in COP. After further adjustment for high sensitivity C-reactive protein, the HRs were 2.82 (1.78-4.46), 2.57 (1.73-3.81), and 2.27 (1.70-3.02), respectively. Addition of COP to a CVD mortality risk prediction model containing established risk factors was associated with a C-index change of 0.0139 (0.0040 to 0.0238; p = 0.006) at 25 years. COP during exercise is directly associated with fatal cardiovascular and all-cause mortality events in dose-response fashions. COP during exercise may improve the prediction of the long-term risk for CVD mortality., (© 2021 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

The aim of this study was to predict carcass traits of Santa Inês lambs finished in tropical pastures by using biometric measurements. Data originated from two experiments involving 56 lambs (32 in experiment I and 24 in experiment II). In both experiments, the sheep were finished in that were finished in pastures of Panicum maximum and Brachiaria brizantha , experiment I being conducted in the rainy season and experiment II in the dry season. The following biometric measurements were recorded before slaughter: body length (BL), withers height (WH), rump height (RH), thorax width (TW), rump width (RW), chest width (CW), heart girth (HG), thigh circumference (TC), rump circumference (RC) and leg length (LL), in addition to live weight at slaughter (SW). After slaughter, hot carcass weight (HCW), cold carcass weight (CCW) and the weights of primal cuts (shoulder, neck, loin, leg and rib) were recorded. In the equations generated to predict SW, HCW and CCW, R 2 ranged from 0.58 to 0.91 and the measurements of WH, TC, CW, HG and RW were the most relevant. In the equations developed to predict the weight of primal cuts, in turn, R 2 ranged from 0.26 to 0.99. In these models, SW, BL, CW, TC, LL and HG explained most of the variation in the weight of primal cuts. Biometric measurements can be used to accurately and precisely predict HCW, CCW and the weight of primal cuts from the carcass of Santa Inês sheep finished in tropical pastures, since the equations presented R 2 and correlation coefficient and agreement above 0.8.

Aim: To analyze possible factors associated with the quality of life (QoL) of mothers of preterm infants with very low birth weight (VLBW) during the first 3 years after delivery., Methods: The World Health Organization Quality of Life (WHOQOL)-bref scores were compared and correlated with maternal and infant-related sociodemographic and clinical variables at maternal discharge (T0) and at 6 (T1), 12 (T2), 24 (T3), and 36 (T4) months after delivery. Multiple linear regression models were fitted to investigate the effect of these variables on the mothers' QoL., Results: The WHOQOL-BREF physical domain scores were higher at T1 and T2 compared to T0 (p = 0.013). Maternal variables that contributed to maternal QoL scores (p < 0.05) were stable marital union (b = 13.60; T0), family income (b = -12.75; T3), Evangelical religion (b = 8.11; T4), and beck depression inventory (BDI) score (-1.42 ≤ b ≤ -0.36; T0, T1, T2, T3, and T4). Infants' variables that most affected maternal QoL (p < 0.05) were posthemorrhagic hydrocephalus (PHH) (-18.84 ≤ b ≤ -10.05; T1, T2, and T4), bronchopulmonary dysplasia (BPD) (b = -7.41; T2), female gender (b = 8.09; T2), and SNAPPE severity score (b = -0.23; T3)., Conclusion: Mothers of preterm infants with VLBW exhibited transient improvements in physical well-being during the first year after delivery. The presence of depressive symptoms in mothers and the diagnosis of PHH or BPD were negatively associated with QoL. Social, religious, and economic aspects were also important factors for the QoL of mothers of preterm infants with VLBW.

Introduction and Aim: The cardiorespiratory optimal point (COP) is a novel index, calculated as the minimum oxygen ventilatory equivalent (VE/VO 2 ) obtained during cardiopulmonary exercise testing (CPET). In this study we demonstrate the prognostic value of COP both independently and in combination with maximum oxygen consumption (VO 2 max) in community-dwelling adults., Methods: Maximal cycle ergometer CPET was performed in 3331 adults (66% men) aged 40-85 years, healthy (18%) or with chronic disease (81%). COP cut-off values of <22, 22-30, and >30 were selected based on the log-rank test. Risk discrimination was assessed using COP as an independent predictor and combined with VO 2 max., Results: Median follow-up was 6.4 years (7.1% mortality). Subjects with COP >30 demonstrated increased mortality compared to those with COP <22 (hazard ratio [HR] 6.86, 95% confidence interval [CI] 3.69-12.75, p<0.001). Multivariate analysis including gender, age, body mass index, and the forced expiratory volume in 1 s/vital capacity ratio showed adjusted HR for COP >30 of 3.72 (95% CI 1.98-6.98; p<0.001) and for COP 22-30 of 2.15 (95% CI 1.15-4.03, p<0.001). Combining COP and VO 2 max data further enhanced risk discrimination., Conclusions: COP >30, either independently or in combination with low VO 2 max, is a good predictor of all-cause mortality in community-dwelling adults (healthy or with chronic disease). COP is a submaximal prognostic index that is simple to obtain and adds to CPET assessment, especially for adults unable or unwilling to achieve maximal exercise., (Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

The purpose of this study was to assess the effect of patellar taping on muscle activation of the knee and hip muscles in women with Patellofemoral Pain Syndrome during five proprioceptive exercises. Forty sedentary women with syndrome were randomly allocated in two groups: Patellar Taping (based in McConnell) and Placebo (vertical taping on patella without any stretching of lateral structures of the knee). Volunteers performed five proprioceptive exercises randomly: Swing apparatus, Mini-trampoline, Bosu balance ball, Anteroposterior sway on a rectangular board and Mediolateral sway on a rectangular board. All exercises were performed in one-leg stance position with injured knee at flexion of 30° during 15s. Muscle activation was measured by surface electromyography across Vastus Medialis, Vastus Lateralis and Gluteus medius muscles. Maximal voluntary contraction was performed for both hip and knee muscles in order to normalize electromyography signal relative to maximum effort during the exercises. ANOVA results reported no significant interaction (P>0.05) and no significant differences (P>0.05) between groups and intervention effects in all exercise conditions. Significant differences (P<0.01) were only reported between muscles, where hip presented higher activity than knee muscles. Patellar taping is not better than placebo for changes in the muscular activity of both hip and knee muscles during proprioceptive exercises., Trial Registration Number: ClinicalTrials.gov NCT02322515., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective:: To assess the influence of central obesity on the magnitude of the error of estimate of maximal oxygen uptake in maximal cycling exercise testing., Method:: A total of 1,715 adults (68% men) between 18-91 years of age underwent cardiopulmonary exercise testing using a progressive protocol to volitional fatigue. Subjects were stratified by central obesity into three quartile ranges: Q1, Q2-3 and Q4. Maximal oxygen uptake [mL.(kg.min)-1] was estimated by the attained maximal workload and body weight using gender- and population-specific equations. The error of estimate [mL.(kg.min)-1] and percent error between measured and estimated maximal oxygen uptake values were compared among obesity quartile ranges., Results:: The error of estimate and percent error differed (mean ± SD) for men (Q1=1.3±3.7 and 2.0±10.4; Q2-3=0.5±3.1 and -0.5±13.0; and Q4=-0.3±2.8 and -4.5±15.8 (p<0.05)) and for women (Q1=1.6±3.3 and 3.6±10.2; Q2-3=0.4±2.7 and -0.4±11.8; and Q4=-0.9±2.3 and -10.0±22.7 (p<0.05))., Conclusion:: Central obesity directly influences the magnitude of the error of estimate of maximal oxygen uptake and should be considered when direct expired gas analysis is unavailable., Competing Interests: No potential conflict of interest was reported.

Cardiopulmonary exercise test (CPET) has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: ventilation; oxygen consumption (VO2); carbon dioxide production (VCO2); and the other variables of conventional exercise testing. In addition, in specific situations, pulse oximetry and flow-volume loops during and after exertion are measured. The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion, being considered gold standard for cardiorespiratory functional assessment.1-6 The CPET allows defining mechanisms related to low functional capacity that can cause symptoms, such as dyspnea, and correlate them with changes in the cardiovascular, pulmonary and skeletal muscle systems. Furthermore, it can be used to provide the prognostic assessment of patients with heart or lung diseases, and in the preoperative period, in addition to aiding in a more careful exercise prescription to healthy subjects, athletes and patients with heart or lung diseases. Similarly to CPET clinical use, its research also increases, with the publication of several scientific contributions from Brazilian researchers in high-impact journals. Therefore, this study aimed at providing a comprehensive review on the applicability of CPET to different clinical situations, in addition to serving as a practical guide for the interpretation of that test. Resumo O teste cardiopulmonar de exercício (TCPE) vem ganhando importância crescente como método de avaliação funcional tanto no Brasil quanto no Mundo. Nas suas aplicações mais frequentes, o teste consiste em submeter o indivíduo a um exercício de intensidade gradativamente crescente até a exaustão ou o surgimento de sintomas e/ou sinais limitantes. Neste exame se mensura a ventilação (VE), o consumo de oxigênio (VO2), a produção de gás carbônico (VCO2) e as demais variáveis de um teste de exercício convencional. Adicionalmente, podem ser verificadas, em situações específicas, a oximetria de pulso e as alças fluxo-volume antes, durante e após o esforço. A análise integrada dos dados permite a completa avaliação dos sistemas cardiovascular, respiratório, muscular e metabólico no esforço, sendo considerado padrão-ouro na avaliação funcional cardiorrespiratória.1-6 O TCPE permite definir mecanismos relacionados à baixa capacidade funcional, os quais podem ser causadores de sintomas como a dispneia, correlacionando-os com alterações dos sistemas cardiovascular, pulmonar e musculoesquelético. Também pode ser de grande aplicabilidade na avaliação prognóstica em cardiopatas, pneumopatas e em pré-operatório, além de auxiliar na prescrição mais criteriosa do exercício em sujeitos normais, em atletas, em cardiopatas e em pneumopatas. Assim como ocorre com o uso clínico, a pesquisa nesse campo também cresce e várias contribuições científicas de pesquisadores nacionais são publicadas em periódicos de alto fator de impacto. Sendo assim, o objetivo deste documento é fornecer uma revisão ampla da aplicabilidade do TCPE nas diferentes situações clínicas, bem como servir como guia prático na interpretação desse teste propedêutico., Competing Interests: Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.

Sensory motor training programs are used in the rehabilitation and prevention of injuries among soccer players. Inconsistencies are found in the literature regarding the duration of the protocols and the exercises and equipment used., Objective: To evaluate the benefits of a five-week sensory motor training program on the functional performance and postural control of young soccer players., Methods: The study sample comprised 22 young male soccer players who were evaluated using: the Figure-of-Eight Test (F8), Side Hop Test (SHT), Star Excursion Balance Test (SEBT), and a force platform. The players were randomly divided into a control group (N = 10), who continued their soccer practice sessions and an intervention group (N = 12), who continued their soccer practice sessions and were also enrolled in a supervised five-week sensory motor training program., Results: After the five-week training program, the intervention group obtained significant results in the F8, SHT and SEBT, as well as in the following parameters: area of pressure of sway center (COP), mean velocity and mean frequency of COP., Conclusion: The five-week sensory motor training program, carried out with easily available and low cost equipment, was effective at improving functional performance and postural control in young soccer players., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Sexual activity (SA) encompasses several behaviors such as kissing (Ki), touching (T), oral (O) stimulation, masturbation (M), and vaginal/anal intercourse (I). The acronym KiTOMI is proposed here to represent these behaviors. SA, particularly coitus, is a major aspect of health-related quality of life and is often considered the most pleasant and rewarding exercise performed during an entire lifetime. Although several studies have been conducted on sexuality, relatively limited information is available regarding SA in patients with heart disease. Moreover, the level of evidence of this limited information is nearly always B or C. This article provides a comprehensive and updated review of the relevant literature and offers evidence and expert-based practical messages regarding SA in patients with heart disease. Considering the rationale for exercise prescription, SA is typically well tolerated by most clinically stable patients with heart disease. Even in more debilitated and sicker individuals, KiT activities would most likely be feasible and desirable. The absolute risk of major adverse cardiovascular events during SA is typically very low. Even lower death rates have been reported for specific groups, such as women in general, aerobically fit men, and asymptomatic young adults with congenital heart disease. Finally, we emphasize the relevance of sexual counselling for patients and their partners, including the proper use of medications to treat erectile dysfunction. Counselled patients will be reassured and adequately informed regarding how to gradually resume habitual SA after a major cardiac event or procedure, starting with KiT and progressively advancing to KiTOM until all KiTOMI activities are allowed., (Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the influence of age on the error of estimate (EE) of maximal oxygen uptake (VO2max) using sex and population specific-equations in cycle ergometer exercise testing, since estimated VO2 max is associated with a substantial EE, often exceeding 20%, possibly due to intrinsic variability of mechanical efficiency., Methods: 1850 adults (68% men), aged 18 to 91 years, underwent maximal cycle ergometer cardiopulmonary exercise testing. Cardiorespiratory fitness (CRF) was assessed relative to sex and age [younger (18 to 35 years), middle-aged (36 to 60 years) and older (> 60 years)]. VO2max [mL·(kg·min)(-1)] was directly measured by assessment of gas exchange and estimated using sex and population specific-equations. Measured and estimated values of VO2max and related EE were compared among the three age- and sex-specific groups., Results: Directly measured VO2max of men and women were 29.5 ± 10.5 mL·(kg·min)(-1) and 24.2 ± 9.0 mL·(kg·min)(-1) (P < 0.01). EE [mL·(kg·min)(-1)] and percent errors (%E) for men and women had similar values, 0.5 ± 3.2 and 0.4 ± 2.9 mL·(kg·min)(-1), and -0.8 ± 13.1% and -1.7 ± 15.4% (P > 0.05), respectively. EE and %E for each age-group were, respectively, for men: younger = 1.9 ± 4.1 mL·(kg·min)(-1) and 3.8 ± 10.5%, middle-aged = 0.6 ± 3.1 mL·(kg·min)(-1) and 0.4 ± 10.3%, older = -0.2 ± 2.7 mL·(kg·min)(-1) and -4.2 ± 16.6% (P < 0.01); and for women: younger = 1.2 ± 3.1 mL·(kg·min)(-1) and 2.7 ± 10.0%, middle-aged = 0.7 ± 2.8 mL·(kg·min)(-1) and 0.5 ± 11.1%, older = -0.8 ± 2.3 mL·(kg·min)(-1) and -9.5 ± 22.4% (P < 0.01)., Conclusion: VO2max were underestimated in younger age-groups and were overestimated in older age groups. Age significantly influences the magnitude of the EE of VO2max in both men and women and should be considered when CRF is estimated using population specific equations, rather than directly measured.

Background: Inspiratory muscle training (IMT) has been shown to generate significant benefits in different clinical conditions; however, there is scarce information regarding acute clinical and hemodynamic effects., Aim: The aim of this study was to evaluate clinical, hemodynamic and electrocardiographic responses during a single short IMT session in patients enrolled in cardiopulmonary rehabilitation program (CRP)., Design: Cross-sectional study., Setting: Patients referred and regularly attending a non-hospital based medically-supervised exercise program., Population: One hundred and sixty patients patients who regularly performed inspiratory muscle training, Methods: A convenience sample of 21 elderly patients (16 men; 60-87 years of age) had an ECG continuously recorded and heart rate (HR) and blood pressure (BP) measured before, during and one-minute after a single IMT session - two sets of 15 cycles with one-minute interval., Results: Comparing values obtained before, during second set and one-minute after IMT, no differences were found to HR (bpm) - 68±2 vs. 70±2 vs. 66±3 (P=0.05) and in systolic and diastolic BP (mm Hg) values, respectively, - 105±3 vs. 111±4 vs. 108±3 (P=0.06) and - 68±2 vs. 72±3 vs. 68±2 (P=0.14); (before, during second set and one-minute after TMI). During IMT, seven (33%) of patients presented minor cardiac arrhythmias, most of them isolated premature ventricular contractions. Additionally, no abnormal signs or symptoms were found., Conclusion: Apart of minor and clinically irrelevant ECG abnormalities seen in 1/3 of the patients, a short IMT session did not induce significant hemodynamic responses or relevant clinical abnormalities. Based on these results, for elderly patients involved in CPR, IMT seems to be clinically safe and continuous ECG monitoring did not seem to add significant or relevant information., Clinical Rehabilitation Impact: For elderly patients participating in CPR, short IMT sessions do not induce major hemodynamic responses and seem to be clinically safe. This is potentially useful information if IMT is to be prescribed in home-based programs.

Background: Toxoplasmosis is a zoonosis caused by Toxoplasma gondii, an intracellular protozoan parasite able to infect a wide range of hosts, including humans. Congenital infection can cause severe damage to the fetus. Thus, it is important to detect antibodies against the parasite to confirm clinical manifestations. Considering that all immunoglobulin isotypes may be present in biological samples from newborns and their mothers, this study aimed to evaluate the ability to diagnose recent toxoplasmosis by using colostrum, as an alternative noninvasive way to obtain biological samples, as well as to determine correlation rates between antibodies from serum samples to detect IgG, IgM and IgA isotypes against T. gondii., Methods: A total of 289 puerperal women from Clinical Hospital of Federal University of Uberlândia (mean age: 24.8 years, range: 14 - 43 years) took part in this study. Serum and colostrum samples from these patients were analyzed using ELISA and immunoblotting assays for soluble antigens from T. gondii., Results: ELISA immunoassays with serum samples showed reactivity in 47.0, 6.9 and 2.8 % of samples to anti-T. gondii IgG, IgM and IgA, respectively, in comparison with colostrum samples, which showed reactivity in 46.0, 7.9 and 2.8 % of samples to the same isotypes. Also, significant correlation rates of anti-T. gondii antibody levels between serum and colostrum samples were observed. Interestingly, reactivity to IgM and/or IgA in colostrum and/or serum confirmed clinical manifestations of congenital toxoplasmosis in three newborns. Immunoblotting assays showed that it is possible to detect IgG, IgM and IgA antibodies against various antigens of T. gondii in serum and colostrum samples. IgG antibodies in serum and colostrum samples recognized more antigenic fractions than IgM and IgA antibodies. Serum IgG detected more antigenic fractions than IgG antibodies present in the colostrum of the same patient. In contrast, specific IgA present in colostrum recognized a higher number of antigens than IgA present in serum samples of the same patient., Conclusions: Overall, the results show that it is important to investigate the occurrence of congenital toxoplasmosis, even at puerperal period. Furthermore, this study demonstrates that T. gondii-specific IgG, IgM and IgA antibodies in serum and colostrum samples from puerperal women may be detected with a significant correlation, suggesting that colostrum may also be used as an alternative biological sample to efficiently diagnose recent human toxoplasmosis.

Urban and peri-urban agriculture (UPA) is being practiced in different settings, contributing to the improvement of health in communities and healthier environments. In order to identify the meanings and implications of the practice of UPA in Primary Healthcare Units (PHU) as an activity of health promotion (HP), and to what extent its therapeutic dimension characterizes it as an activity aligned with complementary and integrative practices (CIP), a qualitative cross-sectional study was performed in Embu das Artes, State of São Paulo. From the analysis, the following main themes arose: health concept, health outcomes, the return to traditional practices and habits and the reorientation of health services. It was possible to identify the close link between the cultivation of vegetable gardens and HP guidelines and fields of action, such as creating healthier environments, boosting community actions, developing personal skills, stimulating autonomy and empowerment and demands for the reorientation of services. The garden activities, set up in PHU areas, proved to be an implementation strategy of CIP. The conclusion reached is that vegetable gardening activities in community gardens are seen to be health promotion practices that integrate key elements of CIP.

Background: Aerobic fitness, assessed by measuring VO2max in maximum cardiopulmonary exercise testing (CPX) or by estimating VO2max through the use of equations in exercise testing, is a predictor of mortality. However, the error resulting from this estimate in a given individual can be high, affecting clinical decisions., Objective: To determine the error of estimate of VO2max in cycle ergometry in a population attending clinical exercise testing laboratories, and to propose sex-specific equations to minimize that error., Methods: This study assessed 1715 adults (18 to 91 years, 68% men) undertaking maximum CPX in a lower limbs cycle ergometer (LLCE) with ramp protocol. The percentage error (E%) between measured VO2max and that estimated from the modified ACSM equation (Lang et al. MSSE, 1992) was calculated. Then, estimation equations were developed: 1) for all the population tested (C-GENERAL); and 2) separately by sex (C-MEN and C-WOMEN)., Results: Measured VO2max was higher in men than in WOMEN: -29.4 ± 10.5 and 24.2 ± 9.2 mL.(kg.min)-1 (p < 0.01). The equations for estimating VO2max [in mL.(kg.min)-1] were: C-GENERAL = [final workload (W)/body weight (kg)] x 10.483 + 7; C-MEN = [final workload (W)/body weight (kg)] x 10.791 + 7; and C-WOMEN = [final workload (W)/body weight (kg)] x 9.820 + 7. The E% for MEN was: -3.4 ± 13.4% (modified ACSM); 1.2 ± 13.2% (C-GENERAL); and -0.9 ± 13.4% (C-MEN) (p < 0.01). For WOMEN: -14.7 ± 17.4% (modified ACSM); -6.3 ± 16.5% (C-GENERAL); and -1.7 ± 16.2% (C-WOMEN) (p < 0.01)., Conclusion: The error of estimate of VO2max by use of sex-specific equations was reduced, but not eliminated, in exercise tests on LLCE.

Introduction: studies show changes in zinc metabolism in women with breast cancer. This mineral has antioxidant action, and disorders in its biochemical parameters are related to poor prognosis of the disease and increase in the carcinogenic process., Objective: this study evaluated the activity of enzyme superoxide dismutase and biochemical parameters related to zinc, and investigated the existence of correlation between these variables and the marker of oxidative stress in these patients., Methods: this was a case-control study with 66 women aged between 20 and 50 years old, distributed into: case group (women with breast cancer, n = 34) and control group (healthy women, n = 32). Zinc intake was analyzed by three-day food diary, using Nutwin software, version 1.5. Plasma and erythrocyte zinc concentrations were determined by flame atomic absorption spectrophotometry method (λ = 213.9). Superoxide dismutase activity was assessed by Griess colorimetric method, and plasma thiobarbituric acid reactive substances (TBARS) were analyzed., Results and Discussion: mean levels of zinc intake, superoxide dismutase and TBARS were higher than recommended for the study participants with statistical difference for enzyme superoxide dismutase (p < 0.05). Mean plasma and erythrocyte concentrations of zinc were reduced in both groups (p > 0.05)., Conclusions: therefore, it can be assumed that zinc intake in women with breast cancer does not impact plasma and erythrocyte concentrations of this mineral. High superoxide dismutase activity in women with breast cancer may be due to a compensatory mechanism of regulation via oxidative stress found in this disease., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Background: Physiological reflexes modulated primarily by the vagus nerve allow the heart to decelerate and accelerate rapidly after a deep inspiration followed by rapid movement of the limbs. This is the physiological and pharmacologically validated basis for the 4-s exercise test (4sET) used to assess the vagal modulation of cardiac chronotropism., Objective: To present reference data for 4sET in healthy adults., Methods: After applying strict clinical inclusion/exclusion criteria, 1,605 healthy adults (61% men) aged between 18 and 81 years subjected to 4sET were evaluated between 1994 and 2014. Using 4sET, the cardiac vagal index (CVI) was obtained by calculating the ratio between the duration of two RR intervals in the electrocardiogram: 1) after a 4-s rapid and deep breath and immediately before pedaling and 2) at the end of a rapid and resistance-free 4-s pedaling exercise., Results: CVI varied inversely with age (r = -0.33, p < 0.01), and the intercepts and slopes of the linear regressions between CVI and age were similar for men and women (p > 0.05). Considering the heteroscedasticity and the asymmetry of the distribution of the CVI values according to age, we chose to express the reference values in percentiles for eight age groups (years): 18-30, 31-40, 41-45, 46-50, 51-55, 56-60, 61-65, and 66+, obtaining progressively lower median CVI values ranging from 1.63 to 1.24., Conclusion: The availability of CVI percentiles for different age groups should promote the clinical use of 4sET, which is a simple and safe procedure for the evaluation of vagal modulation of cardiac chronotropism.

Background: Although substantial evidence relates reduced exercise heart rate (HR) reserve and recovery to a higher risk of all-cause mortality, a combined indicator of these variables has not been explored. Our aim was to combine HR reserve and recovery into a single index and to assess its utility to predict all-cause mortality., Design: Retrospective cohort analysis., Methods: Participants were 1476 subjects (937 males) aged between 41 and 79 years who completed a maximal cycle cardiopulmonary exercise test while not using medication with negative chronotropic effects or having an implantable cardiac pacemaker. HR reserve (HR maximum - HR resting) and recovery (HR maximum - HR at 1-min post exercise) were calculated and divided into quintiles. Quintile rankings were summed yielding an exercise HR gradient (EHRG) ranging from 2 to 10, reflecting the magnitude of on- and off-HR transients to exercise. Survival analyses were undertaken using EHRG scores and HR reserve and recovery in the lowest quintiles (Q1)., Results: During a mean follow up of 7.3 years, 44 participants died (3.1%). There was an inverse trend for EHRG scores and death rate (p < 0.05) that increased from 1.2% to 13.5%, respectively, for scores 10 and 2. An EHRG score of 2 was a better predictor of all-cause mortality than either Q1 for HR reserve (<80 bpm) or HR recovery alone (<27 bpm): age-adjusted hazard ratios: 3.53 (p = 0.011), 2.52 (p < 0.05), and 2.57 (p < 0.05), respectively., Conclusions: EHRG, a novel index combining HR reserve and HR recovery, is a better indicator of mortality risk than either response alone., (© The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

The non-melanoma skin cancer is the most common cancer and accounts for more than half of the diagnoses of cancer, and basal cell carcinoma (BCC), the most frequent cutaneous neoplasm, corresponding to 70-80% of cutaneous tumors. Oxidative stress is an important trigger for skin carcinogenesis. Thus, it is important to evaluate oxidative stress, in order to discern effective therapeutic strategies able to stop it or attenuate it, thereby prevent the installation of non-melanoma skin cancer. Cross-sectional study with controls, involving 84 individuals of both sexes aged between 38-84 years, divided into two groups: control group of healthy people(n = 24) and the case group included individuals who presented non-melanoma skin and they have undergoing surgery (n = 60). The blood samples of the individuals were obtained for evaluation of biomarkers of oxidative stress (F2-isoprostane, nitrite, thiobarbituric acid reactive substances (TBARS) and total antioxidant capacity). The usual dietary intake and nutritional status of the subjects were evaluated. The significance level for this study was 5%. Patients in the case group had higher serum concentrations of biomarkers of oxidative stress, F2-isoprostane concentrations were significantly higher compared to controls. The results showed high rates of overweight and obesity in the case and control groups. The dietary concentrations of antioxidant minerals zinc, copper and selenium in the case group were significantly lower compared to controls. The correlation between markers of oxidative stress and dietary concentrations of antioxidant nutrients showed the influence of food intake of vitamins A and E in reducing oxidative stress, since these nutrients behave as important antioxidants, acting as sweepers of RL, by removing of the body the negative effects on the redox balance of the skin. We emphasize the importance of adopting healthy eating habits that optimize the consumption of antioxidant nutrients as a strategy to prevent oxidative damage to the skin., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Panic disorder (PD) patients often report respiratory symptoms and tend to perform poorly during maximal cardiopulmonary exercise testing (CPX), at least partially, due to phobic anxiety. Thus, we hypothesized that a submaximal exercise variable, minimum VE/VO2 - hereafter named cardiorespiratory optimal point (COP) -, may be useful in their clinical assessment. Data from 2,338 subjects were retrospectively analyzed and 52 (2.2%) patients diagnosed with PD (PDG) (70% women; aged 48±13 years). PD patients were compared with a healthy control group (CG) precisely matched to number of cases, age and gender profiles. PDG was further divided into two subgroups, based on having achieved a maximal or a submaximal CPX (unwilling to continue until exhaustion). We compared COP, VO2 max, maximum heart rate (HR max) between PDG and CG, and also COP between maximal and submaximal PD subgroups. COP was similar between PDG and CG (21.9±0.5 vs. 23.4±0.6; p = 0.07), as well as, for PD subgroups of maximal and submaximal CPX (22.0±0.5 vs. 21.6±1.3; p = 0.746). Additionally, PD patients completing a maximal CPX obtained VO2 max (mL x kg-1 x min-1) (32.9±1.57 vs 29.6±1.48; p = 0.145) and HR max (bpm) similar to controls (173±2.0 vs 168±2.7; p = 0.178). No adverse complications occurred during CPX. Although clinically safe, it is sometimes difficult to obtain a true maximal CPX in PD patients. Normalcy of cardiorespiratory interaction at submaximal effort as assessed by COP may contribute to reassure both patients and physicians that there is no physiological substrate for exercise-related respiratory symptoms often reported by PD patients.

Background: While cardiorespiratory fitness is strongly related to survival, there are limited data regarding musculoskeletal fitness indicators. Our aim was to evaluate the association between the ability to sit and rise from the floor and all-cause mortality., Design: Retrospective cohort., Methods: 2002 adults aged 51-80 years (68% men) performed a sitting-rising test (SRT) to and from the floor, which was scored from 0 to 5, with one point being subtracted from 5 for each support used (hand/knee). Final SRT score, varying from 0 to 10, was obtained by adding sitting and rising scores and stratified in four categories for analysis: 0-3; 3.5-5.5, 6-7.5, and 8-10., Results: Median follow up was 6.3 years and there were 159 deaths (7.9%). Lower SRT scores were associated with higher mortality (p < 0.001). A continuous trend for longer survival was reflected by multivariate-adjusted (age, sex, body mass index) hazard ratios of 5.44 (95% CI 3.1-9.5), 3.44 (95% CI 2.0-5.9), and 1.84 (95% CI 1.1-3.0) (p < 0.001) from lower to higher SRT scores. Each unit increase in SRT score conferred a 21% improvement in survival., Conclusions: Musculoskeletal fitness, as assessed by SRT, was a significant predictor of mortality in 51-80-year-old subjects. Application of a simple and safe assessment tool such as SRT, which is influenced by muscular strength and flexibility, in general health examinations could add relevant information regarding functional capabilities and outcomes in non-hospitalized adults., (© The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Background: The Duke Activity Status Index (DASI) assesses the functional capacity of patients with cardiovascular disease (CVD), but there is no Portuguese version validated for CVD., Objectives: To translate and adapt cross-culturally the DASI for the Portuguese-Brazil language, and to verify its psychometric properties in the assessment of functional capacity of patients with CVD., Methods: The DASI was translated into Portuguese, then checked by back-translation into English and evaluated by an expert committee. The pre-test version was first evaluated in 30 subjects. The psychometric properties and correlation with exercise testing was performed in a second group of 67 subjects. An exploratory factor analyses was performed in all 97 subjects to verify the construct validity of the DASI., Results: The intraclass correlation coefficient for test-retest reliability was 0.87 and for the inter-rater reliability was 0.84. Cronbach's α for internal consistency was 0.93. The concurrent validity was verified by significant positive correlations of DASI scores with the VO2max (r = 0.51, p < 0.001). The factor analysis yielded two factors, which explained 54% of the total variance, with factor 1 accounting for 40% of the variance. Application of the DASI required between one and three and a half minutes per patient., Conclusions: The Brazilian version of the DASI appears to be a valid, reliable, fast and easy to administer tool to assess functional capacity among patients with CVD.

Number of subjects currently participating in high-endurance aerobic exercise training regimens and competitions has substantially increased in recent years. While there is no doubt that regular exercise practice is fundamental for the maintenance of a good health, there have been reports of cardiac structural changes of subjects exposed to strenuous endurance physical exercise. This article reports a case of a 47-year-old male very successful sportsman-including being a six-time Ultraman winner-who has accumulated more than 50,000 h of training and competition in his 35-year career, averaging 25-30 h/week. Despite this huge amount of aerobic exercise, about 25 times larger than typically recommended dose for health purposes (i.e. 75 min of vigorous exercise per week), no major abnormalities were detected in electrocardiograms (rest and maximal exercise), transthoracic echocardiogram, and magnetic resonance imaging. In fact, after this complete evaluation, his heart was found to be quite normal.

Introduction: The accumulation of visceral fat affects the metabolism of hormones and some nutrients, but these mechanisms remain unclear., Objective: To assess the influence of cortisol on the metabolism of zinc in morbidly obese women., Method: Cross-sectional, case-control study involving 80 women aged between 20 and 59 years. The participants were divided into two groups: experimental (morbidly obese, n = 40) and control (normal weight, n = 40). Zinc concentrations were determined by atomic absorption spectroscopy and serum and urinary cortisol by chemiluminescence method., Results: Zinc intake was significantly different between groups. Mean plasma zinc was lower in obese compared to control group. Mean values for erythrocyte zinc were 44.52 ± 7.84 µg/gHb and 40.17 ± 6.71 µg/gHb for obese and control groups, respectively. Urinary excretion of this mineral was higher in obese compared to control subjects (p < 0.05). Mean values for plasma cortisol were 9.58 ± 4.86 µg/dL for obese and 9.89 ± 5.61 µg/dL for control groups. Mean values for urinary cortisol were 163.00 ± 100.35 µg/dL and 109.71 ± 34.88 µg/dL for obese and control groups, respectively (p > 0.05). The correlation analysis between cortisol and zinc was not significant (p > 0.05)., Conclusions: Obese patients have hypozincemia and high erythrocyte zinc levels. The correlation between zinc parameters and cortisol concentration showed no influence of this hormone on zinc metabolism.

Background: Cardiac Anxiety (CA) is the fear of cardiac sensations, characterized by recurrent anxiety symptoms, in patients with or without cardiovascular disease. The Cardiac Anxiety Questionnaire (CAQ) is a tool to assess CA, already adapted but not validated to Portuguese., Objective: This paper presents the three phases of the validation studies of the Brazilian CAQ., Methods: To extract the factor structure and assess the reliability of the CAQ (phase 1), 98 patients with coronary artery disease were recruited. The aim of phase 2 was to explore the convergent and divergent validity. Fifty-six patients completed the CAQ, along with the Body Sensations Questionnaire (BSQ) and the Social Phobia Inventory (SPIN). To determine the discriminative validity (phase 3), we compared the CAQ scores of two subgroups formed with patients from phase 1 (n = 98), according to the diagnoses of panic disorder and agoraphobia, obtained with the MINI - Mini International Neuropsychiatric Interview., Results: A 2-factor solution was the most interpretable (46.4% of the variance). Subscales were named "Fear and Hypervigilance" (n=9; alpha = 0.88), and "Avoidance", (n = 5; alpha = 0.82). Significant correlation was found between factor 1 and the BSQ total score (p<0.01), but not with factor 2. SPIN factors showed significant correlations with CAQ subscales (p < 0.01). In phase 3, "Cardiac with panic" patients scored significantly higher in CAQ factor 1 (t = -3.42; p < 0.01, CI = -1.02 to -0.27), and higher, but not significantly different, in factor 2 (t = -1.98; p = 0.51, CI = -0.87 to 0.00)., Conclusions: These results provide a definite Brazilian validated version of the CAQ, adequate to clinical and research settings.

Although aging is commonly linked to a reduction in joint range of motion, it is unclear if all body joints behave similarly. To address this issue, the main purpose of this study was to compare age-related loss of mobility of seven body joints. A total of 6,000 participants (3,835 men and 2,165 women) aged 5 to 92 years took part in this study. The maximal passive range of motion of 20 movements was evaluated by Flexitest, and each movement was scored from 0 to 4. Composite scores were obtained for each of seven joints and for overall flexibility (Flexindex (FLX)) by adding individual movement scores. Confirming previous findings, FLX systematically decreased with aging (p < .001), with female participants being more flexible for all ages (p < 0.001) and having a more gradual, 0.6% vs. 0.8%/year, age reduction (p < .001). Starting at 30 and 40 years, respectively, for male and female participants, the relative contribution of each composite joint score to FLX dramatically changed. Shoulder contribution to FLX male's score went from 13.9% at 28 years of age to only 5.2% at 85 years of age. In general, proportionally, shoulder and trunk became less flexible, while elbow and knee mobility was preserved to a greater extent. Our findings indicated that age-related loss of mobility is rather joint-specific, which could be related to distinct routine usage patterns of the major body joints along life.

Background: The heart rate (HR) achieved at the end of an exercise test (ET) is called maximal HR and is known to have clinical and epidemiological relevance. For its correct measurement, it is necessary that the ET be truly maximal., Objective: To evaluate the influence of a history of intense physical activity and/or participation in sports competitions during youth on the maximal HR (% of age-predicted HR) on a clinical cardiopulmonary exercise test (CPET)., Methods: A total of 600 non-athlete individuals (65.8% males) with a mean age of 46 ± 13.7 years, under primary prevention of cardiovascular diseases and who underwent maximal CPET, were retrospectively selected. Their physical activity profile during childhood/adolescence (PAPCA) was classified in scores growing from 0 to 4, with value 2 corresponding to their respective age-predicted levels., Results: None of the 20 individuals with maximal HR values equal to or greater than 200 bpm had been inactive or somewhat active during childhood/adolescence. A significant association was observed between PAPCA scores and maximal HR (% of age-predicted HR) (p = 0.02), with a 7-bpm higher value for PAPCA scores 3-4 (32.9% of the sample) in comparison to PAPCA 0-2., Conclusion: Two hypotheses exist to explain these results in individuals who had been more active during youth: a) persistence of chronic adaptations to training on the cardiac chronotropism, or b) higher ability and/or motivation to achieve a truly maximal CPET. Information on the physical activity profile during childhood / adolescence may contribute to the interpretation of maximal HR on ET.

Objective: The purpose of this study was to establish whether flexibility influences the ability to sit and rise from the floor., Design: Subjects aged 6-92 yrs (n = 3927 [2645 men]) performed the Sitting-Rising Test (SRT) and the Flexitest on the same laboratory visit. The SRT evaluates components of musculoskeletal function by assessing the subject's ability to sit and rise from the floor, which was scored from 0 to 5, with 1 point being subtracted from 5 for each support used (hand/knee). The subject's final SRT score, varying from 0 to 10, was obtained by adding the sitting and rising scores. The Flexitest evaluates the maximum passive range of motion of 20 body joint movements. For each one of the movements, there are five possible scores, 0-4, in a crescent mobility order. Adding the results of the 20 movements provides an overall flexibility score called the Flexindex (FLX)., Results: The SRT score differed when the Flexindex results were stratified into quartiles: 6-26, 27-35, 36-44, and 45-77 (P < 0.001). The SRT and Flexindex scores were moderately and positively associated (r = 0.296; P < 0.001). In addition, the subjects with an SRT score of 0 are less flexible for all 20 Flexitest movements than those scoring 10 are., Conclusions: Although seemingly simple tasks, the actions of sitting and rising from the floor are also partially dependent on flexibility in male and female subjects of a wide age range. Future studies should explore the potential benefit of regular flexibility exercises for these actions.

Regular physical exercise has been shown to favorably influence mood and anxiety; however, there are few studies regarding psychiatric aspects of physically active patients with coronary artery disease (CAD). The objective of the present study was to compare the prevalence of psychiatric disorders and cardiac anxiety in sedentary and exercising CAD patients. A total sample of 119 CAD patients (74 men) were enrolled in a case-control study. The subjects were interviewed to identify psychiatric disorders and responded to the Cardiac Anxiety Questionnaire. In the exercise group (N = 60), there was a lower prevalence (45 vs 81%; P < 0.001) of at least one psychiatric diagnosis, as well as multiple comorbidities, when compared to the sedentary group (N = 59). Considering the Cardiac Anxiety Questionnaire, sedentary patients presented higher scores compared to exercisers (mean ± SEM = 55.8 ± 1.9 vs 37.3 ± 1.6; P < 0.001). In a regression model, to be attending a medically supervised exercise program presented a relevant potential for a 35% reduction in cardiac anxiety. CAD patients regularly attending an exercise program presented less current psychiatric diagnoses and multiple mental-related comorbidities and lower scores of cardiac anxiety. These salutary mental effects add to the already known health benefits of exercise for CAD patients.

Background: At the maximal Cardiopulmonary Exercise Testing (CPET), several ventilatory variables are analyzed, including the ventilatory equivalent for oxygen (VE/VO2). The minimum VE/VO2 value reflects the best integration between the respiratory and cardiovascular systems and may be called "Cardiorespiratory Optimal Point (COP)"., Objective: To determine the behavior of the COP according to gender and age in healthy adults and verify its association with other CPET variables., Methods: Of 2,237 individuals, 624 were selected (62% men and 48 ± 12 years), non- athletes, healthy, who were submitted to maximal CPET. COP or minimum VE/VO2 was obtained from the analysis of ventilation and oxygen consumption in every minute of CPET. We investigated the association between age and COP for both genders, as well as associations with: VO(2)max, VO(2) at anaerobic threshold (VO(2)AT), oxygen uptake efficiency slope (OUES) and with maximum VE. We also compared the intensity of exertion (MET) at the COP, AT and VO(2)max., Results: COP increases with age, being 23.2 ± 4.48 and 25.0 ± 5.14, respectively, in men and women = (p < 0.001). There are moderate and inverse associations with VO(2)max (r = -0.47; p < 0.001), with VO(2)AT (r = -0.42; p < 0.001) and with OUES (r = -0.34; p < 0.001). COP occurred, on average, at 44% do VO(2)max and before AT (67% of VO(2)max) (p < 0.001)., Conclusion: COP, a submaximal variable, increases with age and is slightly higher in women. Being modestly associated with other ventilation measures, there seems to be an independent contribution to the interpretation of the cardiorespiratory response to CPET.

Background: One of the difficulties in maintaining long-term adherence to exercise is the distance from home to the place of exercise., Objective: To determine, for a private supervised exercise program (PSEP), the influence of the home-PSEP distance on adherence., Methods: We identified 976 individuals and selected 796 who met the inclusion criteria. The home-PSEP distance was obtained by the Google Maps. Adherence was determined by quartiles (months): 1-4, 5-12, 13-36 and more than 36. The clinical conditions were stratified as healthy, obese and/or hypertensive and/or dyslipidemic and/or diabetic patients without coronary disease; coronary artery disease patients and other health problems like cancer, respiratory disease and panic. The home-PSEP distance was divided into (km): up to 1, 1 to 3, 3 to 10 and more than 10. For the statistical analysis, we used the Kruskal-Wallis ANOVA and the chi-square test., Results: Of respondents, 46% lived up to 3 km, 39% lived between 3 and 10 km and about 15% lived more than 10 kilometers from the place of the PSEP. No differences were found between the medians of the months of participation in the PSEP as a function of home-PSEP distance (p = 0.11)., Conclusion: For a given PSEP in the city of Rio de Janeiro, open from Monday through Saturday with free choice of time, the home-PSEP distance did not influence the adherence of participants. This was probably due to the quality of the service and/or lack of places closer to the participants' home.