Manual Therapy, Posturology & Rehabilitation Journal
http://www.mtprehabjournal.com/doi/10.17784/mtprehabjournal.2018.16.594
Manual Therapy, Posturology & Rehabilitation Journal
Study Protocol

Modulation of the autonomic system, pulmonary function and sleep disorders in hypertensive patients submitted to aerobic training. A study protocol

Ronivaldo Lameira Dias, Luis Vicente Franco Oliveira, Jose Robertto Zaffalon Junior, Glauber Sá Brandão, Anderson Soares Silva, Francisco Kaio Rodrigues Campos, Caio Graco Simoni da Silva, Vera Lucia dos Santos Alves, Iransé Oliveira-Silva, Paulo de Tarso Camillo de Carvalho

Downloads: 0
Views: 165

Abstract

Background: Systemic arterial hypertension (SAH) is a common cardiovascular disease that reflects an important incidence and prevalence for public health, with obstructive sleep apnea (OSA) being considered the second cause of SAH. Aerobic exercise is one of the actions to control blood pressure changes. Objectives: To verify the anthropometric profile, the physical fitness, the pulmonary function, the presence of respiratory sleep disorders and the behavior of the autonomic activity in hypertensive patients submitted to aerobic training. Methods/Design: This is a randomized, controlled, blinded trial. The design, conduct and report of this study followed the guidelines of the CONSORT (CONsolidated Standards of Reporting Trials statement). The study will be conducted between July 2015 and December 2017, and will include controlled hypertensive patients of both gender, aged between 30 and 70 years, with clinical diagnosis of primary hypertension (stage 1, systolic and diastolic blood pressures with variations from 140/79 to 90/109 mmHg), controlled by specific drugs, which do not contain beta-blockers. The patients who do not present clinical release to participate in the training program, with presence of another cardiovascular disease or disease in target organs and who present the risk factors of smoke and alcohol will be in the exclusion criteria. The sample will be of convenience, forwarded from the Health Office of the Bairro Aeroporto Velho and the Reference Unit Specialized - URE of Santarem (PA). Initially, it will be a clinical evaluation performed by a cardiologist and the subjects will undergo several routine tests such as echocardiogram, chest X-ray and laboratory tests (complete blood count, glucose, fasting glucose, total cholesterol and fractions, triglycerides, C-reactive protein, potassium, etc). After the initial medical evaluation, some questionnaires will be applied and other specific tests such as Quality of Life Questionnaire (SF-36), Physical Activity Readiness Questionnaire, Berlin Questionnaire, Epworth Sleepiness Scale, Stanford Sleepiness Scale, Cardiorespiratory Sleep Monitoring, Physical Fitness Questionnaire, heart rate variability monitoring, pulmonary function tests, and Six-minute Walk Test. All patients will perform the tests before and after the 12-week rehabilitation exercise protocol. The aerobic exercise training protocol will last 30 to 60 minutes, with intensity varying between 70% and 85% of the maximum HR reached in the functional assessment effort test and will be performed for three months, three times a week. TRIAL REGISTRATION: This protocol study has been approved by the Research Ethics Committee of the Nove de Julho University (UNINOVE), Brazil, process no 370474/2010, and will be registered on ensaiosclinicos.gov.br

Keywords

Autonomic system; pulmonary function; sleep disorders; hypertension; aerobic training, physical fitness

References

1. Pereira M, Luneta N, Azevedo A, Barrosa H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. Journal of Hypertension 2009, 27:963–975.

2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003 Dec;42(6):1206-52.

3. Zanchetti A. The new WHO Expert Committee Report on Hypertension Control. Clin Exp Hypertens. 1996 Apr-May;18(3-4):371-85.

4. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJL. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360:1347–1360.

5. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 ESH-ESC Practice Guidelines for the management of arterial hypertension: ESH-ESC Task Force on the management of arterial hypertension. J Hypertens 2007; 25:1751–1762.

6. Dimeo F, Pagonas N, Seibert F, Arndt R, Zidek W, Westhoff TH. Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension. 2012; 60:653–658.

7. Tsuda K, Yoshikawa A, Kimura K, Nishio I. Effects of mild aerobic physical exercise on membrane fluidity of erythrocytes in essential hypertension. Clin Exp Pharmacol Physiol. 2003;30:382–386.

8. Stranges S, Tigbe W, Gomez-Olive FX, Thorogood M, Kandala NB. Sleep problems: an emerging global epidemic? Findings from the INDEPTH WHO-SAGE study among more than 40,000 older adults from 8 countries across Africa and Asia. Sleep. 2012; 35(8):1173–1181.

9. Insalaco, G. Obstructive Sleep Apnea: A Big Issue. The Need for Screening Tools. J Sleep Disorders Ther 2012,1:4.

10. Bradley TD, Floras JS. Obstructive sleep apnea and its cardiovascular consequences. Lancet. 2009;373:82–93.

11. Lenfant C, Chobanian AV, Jones DW, Roccella EJ; Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): resetting the hypertension sails. Hypertension. 2003 Jun; 41(6):1178-9. Epub 2003 May 19.

12. Sjostrom C, Lindberg E, Elmasry A, Ha¨gg A, Sva¨rdsudd K, Janson C. Prevalence of sleep apnea and snoring in hypertensive men: a population based study. Thorax. 2002; 57:602– 607.

13. Drager LF, Genta PR, Pedrosa RP, Nerbass FB, Gonzaga CC, Krieger EM, Lorenzi-Filho G. Characteristics and predictors of obstructive sleep apnea in patients with systemic hypertension. Am J Cardiol. 2010; 105:1135–1139.

14. Lozano L, Tovar JL, Sampol G, Romero O, Jurado MJ, Segarra A, Espinel E, Ríos J, Untoria MD, Lloberes P. Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens. 2010; 28:2161–2168.

15. Boullosa, D.A., Barros, E.S., Del Rosso, S., Nakamura, F.Y., Leicht., A.S. (2014). 497 Reliability of heart rate measures during walking before and after running maximal efforts. Int J Sports Med. 35:12, 999-1005.

16. Task Force of the European Society of Cardiology and the North American Society of 716 Pacing and Electrophysiology: Heart rate variability. Standards of measurement, physiological interpretation, and clinical use (1996). Circulation. 93, 1043-65.

17. Migliaro ER, Contreras P, Bech S, Etxagibel A, Castro M, Ricca R, et al. Relative influence of age, resting heart rate and sedentary life style in short-term analysis of heart rate variability. Braz. J. Med. Biol. Res. 2001;34(4):493-500.

18. Ribeiro TF, Cunha A, Lourenço GCD, Maraes VRFS, Catal AM, Gallo Júnior L, et al. Estudo da variabilidade da freqüência cardíaca em dois voluntários de meia idade, um coronariopata e outro saudável – relato de caso. Rev. Soc. Cardiol. Estado de Säo Paulo. 2000;10(1,supl.A):1-10.

19. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomized trials. Int J Surg. 2012;10(1):28-55.

20. World Health Organization. Measuring Obesity: Classification and Distribution of Anthropometric Data. Copenhagen: World Health Organization; 1989.

21. Ciconelli RM, et al. Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF – 36 (Brasil SF-36). Rev Bras Reumatol – Vol. 39 – N 3 – Mai/Jun, 1999.

22. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Barreto SSM, Johns MW. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol. 2009;35(9):877–83.

23. Vaz AP, Drummond M, Mota PC, Severo M, Almeida J, Winck JC. Tradução do Questionário de Berlim para língua Portuguesa e sua aplicação na identificação da SAOS numa consulta de patologia respiratória do sono. Rev Port Pneumol. 2011;17(2):59–65.

24. Shephard, R.J. 1988. PAR-Q, Canadian Home Fitness Test and exercise screening alternatives. Sports Med. 5(3): 185–195.

25. Thomas, S., Reading, J., and Shephard, R.J. 1992. Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Can. J. Sport Sci. 17(4): 338–345.

26. Roy J. Shephard, Qualified Fitness and Exercise as Professionals and Exercise Prescription: Evolution of the PAR-Q and Canadian Aerobic Fitness Test. Journal of Physical Activity and Health, 2015, 12, 454-461.

27. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug; 35(8):1381-95.

28. Vespasiano BS,Dias R, Correa AD. A utilização do Questionário Internacional de Atividade Física (IPAQ) como ferramenta diagnóstica do nível de aptidão física: uma revisão no Brasil. SAÚDE REV., Piracicaba, v. 12, n. 32, p.49-54, set.-dez. 2012.

29. Erman MK, Stewart D, Einhorn D, Gordon N, Casal E. Validation of the ApneaLink™ for the Screening of Sleep Apnea: a Novel and Simple Single-Channel Recording Device. J Clin Sleep Med. 2007 Jun 15;3(4):387-92.

30. Pereira CAC. II Consenso Brasileiro de Espirometria. J Pneumol 2002, 28(3):S1- S82.

31. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 1994, 7(6):1197-8.

32. Fenstermaker KL, Plowman SA, Looney MA. Validation of the Rockport Fitness Walking Test in females 65 years and older. Res Q Exerc Sport. 1992;63:322–327.

33. Wallén, M.B., Hasson, D., Theorell, T., Canlon, B., Osika, W. (2012). Possibilities and limitations of the Polar RS800 in measuring heart rate variability at rest. Eur J Appl Physiol. 112:3, 1153-65.

34. Leicht, A.S., Allen, G.D., Hoey, A.J. (2003). Influence of intensive cycling training on heart rate variability during rest and exercise. Can J Appl Physiol. 28:6, 898-909.

35. AMERICAN COLLEGE SPORT MEDICINE. Guidelines for graded exercise testing and prescription. 6th ed. Philadelphia: Lippincott Williams; Wilkins; 2000.
36. Duru F, Candinas R, Dziekan G, Goebbels U, Myers J, Dubach P. Effect of exercise training on heart rate variability in patients with new-onset left ventricular dysfunction after myocardial infarction. Am Heart J 2000;140:157-61.
 

5b352be20e8825691feaa58b mtprehab Articles
Links & Downloads

Man. Ther., Posturology Rehabil. J.

Share this page
Page Sections