ABSTRACT Objective: The present study aimed to evaluate glucose variability and hormonal responses during and after an aerobic exercise session performed after breakfast in type 2 diabetes patients treated with metformin. Materials and methods: In this quasi-experimental study individuals underwent clinical and laboratory evaluations and maximal exercise test. After two weeks an aerobic exercise session (30 minutes at 60%-70% of the peak heart rate) was performed. At rest, during and after the exercise session, glucose variability (mean amplitude glucose excursions, glucose coefficient of variation, and glucose standard deviation) and levels of plasma glucose, insulin, glucagon, and glucagon-like-peptide-1 were evaluated. Results: Thirteen patients were enrolled in the study. Plasma glucose increased at 15 minutes during the exercise session (244.6 ± 61.9 mg/dL), and decreased at 60 min after exercise (195.6 ± 50.0 mg/dL). Glucose variability did not show any difference before and after exercise. Insulin levels at 15 min [27.1 µU/mL (14.2-42.1)] and 30 min [26.3 µU/mL (14.6-37.4)] during the exercise were higher than those at fasting [11.2 µU/mL (6.7-14.9)] but decreased 60 minutes after exercise (90 minutes) [16.6 µU/mL (8.7-31.7)]. Glucagon levels did not show any difference. GLP-1 levels increased at 30 min [7.9 pmol/L (7.1-9.2)] during exercise and decreased 60 min after exercise (90 minutes) [7.7 pmol/L (6.8-8.5)]. Conclusion: Subjects with type 2 diabetes presented expected changes in insulin, glucagon and GLP-1 levels after breakfast and a single aerobic exercise session, not accompanied by glycemic variability changes.

Abstract Background Increasing thoracic expansion is effective at reducing blood pressure in hypertensive subjects. Yoga prescribes many respiratory techniques with a growing number of practitioners. However, very little is known whether sedentary or yoga practitioners show measurable differences in their respiratory patterns. Objective This study aims to demonstrate differences between healthy sedentary individuals and healthy yoga practitioners regarding maximal respiratory pressures and thoracic and abdominal respiratory expansibility. Methods Maximal inspiratory and expiratory pressures (MIP and MEP, respectively) were evaluated by manovacuometry, while respiratory expansion was assessed by the cirtometry of abdominal (CA), thoracic xiphoidal (CTX), and thoracic axillary (CTA) circumferences at rest (end expiratory moment) and at full inspiration in healthy sedentary individuals (SED) and yoga practitioners (YOGA). A delta derived from rest and full inspiration measures (ΔCA, ΔCTX, and ΔCTA, respectively), followed by a percentage of each item (ΔCA/CA, ΔCTX/CTX, and ΔCTA/CTA) was then calculated. Groups were compared by means of an unpaired Student’s t-test, with a significance level p < 0.05. Results All respiratory expansion measures were significantly higher in in the YOGA group. A significantly higher MEP (cmH2O) was also detected in yoga practitioners: SED 89.3 ± 19.3 and YOGA 114.7 ± 24.8 ( p = 0.007), along with decreased heart rate at rest (bpm): SED 84±6 and YOGA 74±15 ( p = 0.001). Conclusions Yoga practitioners have shown greater thoracic and abdominal expansion and increased MEP, when compared to healthy sedentary individuals, as well as significantly lower heart rates at rest and body mass index (BMI). However, whether or not these findings are related to respiratory patterns is uncertain.

Resumo Fundamento: A variabilidade da pressão arterial (PA) pode ser avaliada por meio da monitorização ambulatorial da PA em 24 horas (MAPA-24h), mas sua concordância com os resultados da medição da PA digital (MPAD) ainda não foi estabelecida. Objetivo: O objetivo deste estudo foi comparar os parâmetros da variabilidade a curto prazo (MAPA-24h) com a variabilidade da PA a muito curto prazo (MPAD) em sujeitos saudáveis (C) e diabéticos-hipertensos (DH). Métodos: Estudo transversal com 51 sujeitos DH e 12 sujeitos C que se submeteram a MAPA-24h [extraindo time rate, desvio padrão (SD) e coeficiente de variação (CV)] e registro batimento-a-batimento em repouso e após manobra de manobra de ortostatismo ativo [MPAD, extraindo parâmetros de variabilidade da PA e da frequência cardíaca (FC) no domínio da frequência, análise espectral por modelagem autoregressiva]. O coeficiente de correlação de postos de Spearman foi utilizado para correlacionar os parâmetros de variabilidade de PA e FC obtidos tanto da MPAD quanto da MAPA-24h (dividida em dia, noite e total). A significância estatística foi estabelecida em p < 0.05. Resultados: Houve uma variação circadiana dos níveis de PA nos grupos C e DH; A PA sistólica e a taxa de tempo foram maiores em indivíduos DH em todos os períodos avaliados. Em indivíduos C, foram apresentadas altas correlações positivas entre o índice de taxa de tempo (MAPA-24h) e o componente de baixa frequência (LF, do inglês low frequency) da variabilidade de curto prazo (MPAD, total, R = 0,591, p = 0,043); desvio padrão (MAPA-24h) com o componente de LF VPA (MPAD, total, R = 0,608, p = 0,036), coeficiente de variação (24h-ABPM) com VPA total (MPAD, dia, -0,585, p = 0,046) e índice alfa (MPAD, dia, -0,592, p = 0,043), taxa de tempo (MAPA-24h) e delta LF/HF (MPAD, total, R = 0,636, p = 0,026; dia R = 0,857, p < 0,001). Os registros obtidos dos pacientes DH apresentaram correlações positivas fracas. Conclusões: Os índices obtidos a partir da MAPA-24h (total, durante o dia) refletem a variabilidade da PA e da FC avaliada pela MPAD em indivíduos saudáveis, o que não se aplica a indivíduos DH.

Abstract Background: Blood pressure (BP) variability can be evaluated by 24-hour ambulatory BP monitoring (24h-ABPM), but its concordance with results from finger BP measurement (FBPM) has not been established yet. Objective: The aim of this study was to compare parameters of short-term (24h-ABPM) with very short-term BP variability (FBPM) in healthy (C) and diabetic-hypertensive (DH) subjects. Methods: Cross-sectional study with 51 DH subjects and 12 C subjects who underwent 24h-ABPM [extracting time-rate, standard deviation (SD), coefficient of variation (CV)] and short-term beat-to-beat recording at rest and after standing-up maneuvers [FBPM, extracting BP and heart rate (HR) variability parameters in the frequency domain, autoregressive spectral analysis]. Spearman correlation coefficient was used to correlate BP and HR variability parameters obtained from both FBPM and 24h-ABPM (divided into daytime, nighttime, and total). Statistical significance was set at p < 0.05. Results: There was a circadian variation of BP levels in C and DH groups; systolic BP and time-rate were higher in DH subjects in all periods evaluated. In C subjects, high positive correlations were shown between time-rate index (24h-ABPM) and LF component of short-term variability (FBPM, total, R = 0.591, p = 0.043); standard deviation (24h-ABPM) with LF component BPV (FBPM, total, R = 0.608, p = 0.036), coefficient of variation (24h-ABPM) with total BPV (FBPM, daytime, -0.585, p = 0.046) and alpha index (FBPM, daytime, -0.592, p = 0.043), time rate (24h-ABPM) and delta LF/HF (FBPM, total, R = 0.636, p = 0.026; daytime R = 0,857, p < 0.001). Records obtained from DH showed weak positive correlations. Conclusions: Indices obtained from 24h-ABPM (total, daytime) reflect BP and HR variability evaluated by FBPM in healthy individuals. This does not apply for DH subjects.

FUNDAMENTO: Em condição homeostática, o Sistema Nervoso Autônomo (SNA), pela liberação de neurotransmissores vasoconstritores, e o endotélio, pela liberação de substâncias vasodilatadoras, atuam em sintonia para manter o tônus vascular. Todavia, a associação entre esses dois sistemas em portadores da doença de Chagas na forma indeterminada (DChI) ainda não foi estudada. OBJETIVO: Verificar a associação entre parâmetros referentes à modulação autonômica e à função endotelial em portadores da DChI. MÉTODOS: Treze pacientes com DChI (59,2 ± 11,23 anos) sem fatores de risco para doença cardiovascular foram avaliados para modulação autonômica pelo método oscilométrico da pressão arterial (Finapress) e a análise dos registros mediante a técnica da Variabilidade da Frequência Cardíaca (VFC) no domínio da frequência. A função endotelial foi avaliada pelo método de dilatação mediada pelo fluxo da artéria braquial (DMF), usando imagens de ultrassom de alta resolução. RESULTADOS: Na posição em decúbito dorsal foi observada correlação entre os componentes espectrais de alta (HF) (r = 0,78 p = 0,007) e baixa (LF) frequências normalizadas (r = 0,68 p = 0,01), bem como com o balanço simpatovagal (LF/HF) (r= -0,78 p = 0,004) com a DMF. CONCLUSÃO: Nosso estudo aponta a existência de uma relação entre as alterações na modulação autonômica e na função endotelial em pacientes com Doença de Chagas na forma indeterminada.

BACKGROUND: Under homeostatic condition, the autonomic nervous system (ANS), through the release of vasoconstrictor neurotransmitters, and the endothelium, through the release of vasodilating substances, interact to maintain blood vessel tone. However, the association between those two systems in patients with Chagas disease in its indeterminate phase (IChD) has not been studied. OBJECTIVE: To assess the association between autonomic modulation parameters and endothelial function in patients with IChD. METHODS: Thirteen patients with IChD (59.2 ± 11.23 years) and no risk factors for cardiovascular disease were assessed for autonomic modulation by using the blood pressure oscillometric method (Finapress) and the heart rate variability technique (HRV) in the frequency domain. Endothelial function was assessed by use of the brachial artery flow-mediated dilation (FMD) method with high-resolution ultrasound images. RESULTS: In the dorsal decubitus position, correlation of FMD was observed with normalized high-frequency (r = 0.78; p = 0.007) and low-frequency spectral components (r = 0.68; p = 0.01), as well as with sympathovagal balance (r = -0.78; p = 0.004). CONCLUSIONS: Our study indicates the existence of a relationship between the changes in autonomic modulation and endothelial function in patients with IChD.

CONTEXTUALIZAÇÃO: A estimulação elétrica funcional (EEF) é uma forma de reabilitação que pode reverter alterações provocadas pelo envelhecimento, como diminuição da capacidade funcional e modificações na variabilidade da pressão arterial (VPA). OBJETIVOS: Avaliar os efeitos do treinamento com EEF sobre a capacidade funcional e a VPA em uma idosa centenária. MÉTODOS: Paciente do sexo feminino, 101 anos e sem patologia prévia. O treinamento com EEF foi realizado durante 12 semanas, sendo três sessões/semana e tempo máximo de aplicação de 40 min/sessão. A EEF foi aplicada com frequência de 20 Hz, largura de pulso de 0,5 ms, tempo de contração de 5 s, tempo de repouso de 10 s, intensidade máxima tolerável e aplicação de sobrecarga progressiva. A capacidade funcional foi avaliada por meio do teste de caminhada de 6 minutos (TC6) e do teste de sentar e levantar (TSL). A VPA foi mensurada pelo registro contínuo da pressão de pulso e calculada pela análise espectral. Todas as variáveis foram mensuradas pré e pós-treinamento. RESULTADOS: Após treinamento, houve um aumento de 70% na distância percorrida no TC6 e aumento de 300% no número de repetições no TSL. Observou-se redução de 8 mmHg na pressão arterial sistólica (PAS) e de 4 mmHg na pressão arterial diastólica (PAD) e na pressão arterial média (PAM), havendo ainda uma redução na variabilidade da PAS (11,8 mmHg²), da PAD (2,3 mmHg²) e da PAM (6,0 mmHg²). CONCLUSÕES: O treinamento com EEF durante três meses proporcionou aumento da capacidade funcional e melhora da VPA em uma idosa centenária.

BACKGROUND: Functional electrical stimulation (FES) is a rehabilitation method that can revert alterations provoked by aging, such as reductions in functional capacity and modifications on blood pressure variability (BPV). OBJECTIVES: To evaluate the training effects of FES on functional capacity and BPV in a centenarian woman. METHODS: A 101-year-old woman without previous disease underwent FES training for 12 weeks, with three 40 min sessions/week. FES was applied at a frequency of 20 Hz with a 0.5 ms pulse, 5 s contraction time, 10 s relaxation time, the maximum tolerable intensity and with progressive overload. Functional capacity was assessed with a six-minute walk test (6MWT) and proximal lower limb strength was assessed with a sit-and-stand test (STST). BPV was measured by continuous recording of pulse pressure and calculated by spectral analysis. All variables were measured before and after FES training. RESULTS: After training there was a 70% increase in distance walked in the 6MWT, a 300% increase in the number of STST repetitions, an 8 mmHg reduction in systolic blood pressure (SBP) and a 4 mmHg reduction in diastolic blood pressure (DBP) and mean blood pressure (MBP). Reductions in SBP (11.8 mmHg²), DBP (2.3 mmHg²) and MBP (6.0 mmHg²) variability were also observed. CONCLUSIONS: Three months of FES training improved functional capacity and BPV in a centenarian woman.