ABSTRACT OBJECTIVE To update the estimated cost of physical inactivity for the Brazilian Unified Health System (SUS). METHODS The hospitalization costs were accessed via a database of the Ministry of Health – Informatics Department of the Brazilian SUS. Physical inactivity for the year 2017 was accessed via the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel – Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey). Seven chronic non-communicable diseases (NCD) were selected via the international classification of disease (ICD-10). The population fraction attributable to physical inactivity was calculated based on relative risk reported in previous studies and the prevalence of physical inactivity. RESULTS In 2017, the seven NCD considered in the analysis were responsible for 154,017 hospital admissions in adults older than 40 years old, residing in the state capitals and the Federal District, which corresponded to 6.5% of hospitalizations and 10.6% of SUS costs at an estimated US$ 112,524,914.47. Considering the group of individuals with insufficient physical activity in their leisure time, the percentage cost attributed to physical inactivity reached 17.4% of the estimated costs with NCD. At a national level, NCD were responsible for approximately 740 thousand hospitalizations, costing US$ 482 million, from which 17.4%, US$ 83 million were attributed to physical inactivity. CONCLUSION This study provides evidence to conclude that physical inactivity exerts an economic impact on the SUS due to NCD hospitalization. Physical inactivity is a modifiable lifestyle and compelling evidence, including that of this article, supports the promotion of a more active community as one of the major targets of public health care policies.

ABSTRACT OBJECTIVE To update the estimated cost of physical inactivity for the Brazilian Unified Health System (SUS). METHODS The hospitalization costs were accessed via a database of the Ministry of Health – Informatics Department of the Brazilian SUS. Physical inactivity for the year 2017 was accessed via the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel – Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey). Seven chronic non-communicable diseases (NCD) were selected via the international classification of disease (ICD-10). The population fraction attributable to physical inactivity was calculated based on relative risk reported in previous studies and the prevalence of physical inactivity. RESULTS In 2017, the seven NCD considered in the analysis were responsible for 154,017 hospital admissions in adults older than 40 years old, residing in the state capitals and the Federal District, which corresponded to 6.5% of hospitalizations and 10.6% of SUS costs at an estimated US$ 112,524,914.47. Considering the group of individuals with insufficient physical activity in their leisure time, the percentage cost attributed to physical inactivity reached 17.4% of the estimated costs with NCD. At a national level, NCD were responsible for approximately 740 thousand hospitalizations, costing US$ 482 million, from which 17.4%, US$ 83 million were attributed to physical inactivity. CONCLUSION This study provides evidence to conclude that physical inactivity exerts an economic impact on the SUS due to NCD hospitalization. Physical inactivity is a modifiable lifestyle and compelling evidence, including that of this article, supports the promotion of a more active community as one of the major targets of public health care policies.

ABSTRACT The literature on hemodynamic responses during inspiratory muscle exercise (IME) lacks a consensus. To evaluate and compare hemodynamic responses during an IME session with and without resistive load, 15 sedentary men were subjected to two randomized IME sessions: one with 40% of maximal inspiratory pressure (IME 40%) and another without a resistive load (Sham), both of which were performed for two minutes over eight sessions with one-minute intervals. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), total peripheral resistance (TPR), stroke volume (SV), cardiac output (CO), and heart rate (HR) were measured by infrared digital photoplethysmography during five basal minutes and during the IME sessions. One-way analysis of variance and the Student’s t test for paired data were used to analyze hemodynamic response and delta values between sessions. Effect size was evaluated by Cohen’s D. A 5% significance level was adopted. SBP responses (sham: ∆−1±2 vs. 40%: ∆−4±2mmHg, p=0.27), DBP (sham: ∆2±1 vs. 40%: ∆1±2mmHg, p=0.60) and MBP (sham: ∆2±1 vs. 40%: ∆0±2mmHg, p=0.28) were similar between sessions. HR increases were higher in the 40% IME session than in the sham session (sham: ∆9±2 vs. 40%: ∆3±2bpm, p=0.001). SV only decreased during the sham session but responses were similar between sessions (sham: ∆−2±2 vs. IME 40%: ∆−6±2ml, p=0.13). Both sessions did not change SBP, DBP, MBP, CO, and TPR, but we observed a greater increase in HR in the IME 40% session. Only the Sham session decreased SV.

RESUMEN No hay consenso en la literatura sobre las respuestas hemodinámicas durante el ejercicio muscular inspiratorio (EMI). El objetivo de este estudio fue evaluar y comparar las respuestas hemodinámicas durante una sesión de EMI con y sin carga resistiva. Para ello, quince hombres sedentarios recibieron dos sesiones aleatorias de EMI: el 40% de la presión inspiratoria máxima (EMI 40%) y sin carga resistiva (sham), realizadas durante dos minutos, ocho sesiones y a intervalos de un minuto. La presión arterial sistólica (PAS), la presión arterial diastólica (PAD), la presión arterial media (PAM), la resistencia periférica total (RPT), el volumen sistólico (VS), el gasto cardíaco (GC) y la frecuencia cardíaca (FC) se midieron mediante fotopletismografía infrarroja digital durante cinco minutos al inicio y durante las sesiones de EMI. Se utilizaron ANOVA unidireccional y la prueba t de Student a datos emparejados para analizar la respuesta hemodinámica y los valores delta entre las sesiones. El tamaño del efecto se evaluó por el d de Cohen. El nivel de significancia adoptado fue de 5%. Las respuestas de PAS (sham: Δ−1±2 vs. 40%: ∆−4±2mmHg, p=0,27), PAD (sham: ∆2±1 vs. 40%: ∆1±2mmHg, p=0,60) y PAM (sham: ∆2±1 vs. 40%: ∆0±2mmHg, p=0,28) fueron similares entre las sesiones. El incremento de la FC fue mayor en la sesión de EMI 40% comparada con la sesión sham (sham: Δ9±2 vs. 40%: ∆3±2bpm, p=0,001). El VS tuvo una disminución exclusiva durante la sesión sham, pero la respuesta fue similar entre las sesiones (sham: Δ−2±2 vs. EMI 40%: ∆−6±2ml, p=0,13). Ambas sesiones no tuvieron cambios en las variables PAS, PAD, PAM, DC y RPT, pero se observó un mayor incremento de la FC en la sesión EMI 40%. Solamente en la sesión sham hubo una reducción del VS.

RESUMO A literatura carece de um consenso sobre respostas hemodinâmicas durante o exercício muscular inspiratório (EMI). Este estudo buscou avaliar e comparar as respostas hemodinâmicas durante uma sessão de EMI com e sem carga resistiva. Para tanto, 15 homens sedentários foram submetidos a duas sessões randomizadas de EMI: 40% da pressão inspiratória máxima (EMI 40%) e sem carga resistiva (sham), realizadas por dois minutos em oito sessões e com intervalos de um minuto. A pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), pressão arterial média (PAM), resistência periférica total (RPT), volume sistólico (VS), débito cardíaco (DC) e frequência cardíaca (FC) foram medidos por fotopletismografia infravermelha digital por cinco minutos basais e durante as sessões de EMI. Anova de uma via e o teste t de Student para dados pareados foram usados para analisar a resposta hemodinâmica e os valores delta entre as sessões. O tamanho do efeito foi avaliado pelo d de Cohen. Adotou-se nível de significância de 5%. As respostas de PAS (sham: ∆−1±2 vs. 40%: ∆−4±2mmHg, p=0,27), PAD (sham: ∆2±1 vs. 40%: ∆1±2mmHg, p=0,60) e PAM (sham: ∆2±1 vs. 40%: ∆0±2mmHg, p=0,28) foram semelhantes entre as sessões. Os aumentos da FC foram maiores na sessão de EMI 40% do que nas sessões sham (sham: ∆9±2 vs. 40%: ∆3±2bpm, p=0,001). O VS diminuiu exclusivamente durante a sessão sham mas a resposta foi semelhante entre as sessões (sham: ∆−2±2 vs. EMI 40%: ∆−6±2ml, p=0,13). Ambas as sessões não causaram alteração nas variáveis PAS, PAD, PAM, DC e RPT, mas notamos um aumento maior da FC na sessão EMI 40%. Apenas a sessão sham reduziu o VS.

RESUMO CONTEXTO: A cirrose hepática (CH) causa várias alterações musculoesqueléticas. OBJETIVO: Testar a hipótese de que as resistências dos músculos periféricos e inspiratórios estão reduzidas em pacientes com CH. MÉTODOS: Vinte e um pacientes com CH (grupo CH; 61±14 anos) e 18 indivíduos pareados por idade (grupo controle; 56±17 anos) aceitaram participar deste estudo observacional transversal. Para avaliar a resistência muscular periférica, todos os voluntários realizaram um exercício de preensão manual rítmica a 45% de sua contração voluntária máxima. Um metrônomo foi usado para controlar os ciclos de contração-relaxamento a 60/min. A resistência muscular inspiratória foi avaliada com o PowerBreath®. Os participantes foram submetidos a exercícios musculares inspiratórios a 60% de sua força muscular inspiratória máxima. O tempo até a falha caracterizou a resistência muscular para os exercícios de preensão manual e de músculos inspiratórios. Além disso, foi avaliada a qualidade de vida dos participantes. RESULTADOS: A resistência muscular foi menor no grupo CH quando comparada ao grupo controle tanto para os exercícios de preensão manual (67 vs 130 s, P<0,001) quanto para os músculos inspiratórios (40 vs 114 s, P<0,001). A resistência muscular periférica foi diretamente correlacionada com o escore total de qualidade de vida (r=0,439, P=0,01) e com os seguintes domínios: fadiga (r=0,030, P=0,378), atividade (r=0,378 e P=0,030), sintomas sistêmicos (r=0,316, P=0,073) e preocupação (r=0,370, P=0,034). A resistência muscular inspiratória foi inversamente correlacionada com o escore total de qualidade de vida (r=0,573, P=0,001) e com os seguintes domínios: fadiga (r=0,503, P=0,002), atividade (r=0,464, P=0,004), sintomas sistêmicos (r=0,472, P=0,004), sintomas abdominais (r=0,461, P=0,005), função emocional (r=0,387, P=0,02) e preocupação (r=0,519, P=0,001). CONCLUSÃO: As resistências musculares periférica e inspiratória foram menores nos pacientes com CH quando comparados ao grupo controle.

ABSTRACT BACKGROUND: Liver cirrhosis (LC) causes several musculoskeletal changes. OBJECTIVE: To test the hypothesis that the peripheral and inspiratory muscle endurance are reduced in patients with liver cirrhosis. METHODS: Twenty-one patients with LC (LC group; 61±14 years) and 18 age-matched subjects (control group; 56±17 years) had accepted to participate in this cross-sectional observational study. To assess peripheral muscle endurance, all volunteers performed a rhythmic handgrip exercise at 45% of their maximum voluntary contraction. A metronome was used to control the contraction-relaxation cycles at 60/min. The inspiratory muscle endurance was assessed using PowerBreath®. Participants underwent inspiratory muscle exercise at 60% of their maximal inspiratory muscle strength. The time until failure characterized the muscle endurance for both handgrip and inspiratory muscle exercises. Additionally, the quality of life of the participants was assessed. RESULTS: The muscle endurance was lower in the LC group when compared to the control group for both handgrip (67 vs 130 s, P<0.001) and inspiratory muscle exercises (40 vs 114 s, P<0.001). The peripheral muscle endurance was directly correlated with the total quality of life score (r=0.439, P=0.01) and to the following domains: fatigue (r=0.378 e P=0.030), activity (r=0.583, P=0.001), systemic symptoms (r=0.316, P=0.073) and preoccupation (r=0.370, P=0.034). The inspiratory muscle endurance was inversely correlated with the total quality of life score (r=0.573, P=0.001) and the following domains: fatigue (r=0.503, P=0.002), activity (r=0.464, P=0.004), systemic symptoms (r=0.472, P=0.004), abdominal symptoms (r=0.461, P=0.005), emotional function (r=0.387, P=0.02) and preoccupation (r=0.519, P=0.001). CONCLUSION: Both peripheral and inspiratory muscle endurance were lower in LC patients when compared to the control group.

SUMMARY OBJECTIVE: To analyze the sociodemographic and clinical factors associated with the perceived benefits and barriers to physical activity (PA) in subjects with liver cirrhosis. METHODS: This cross-sectional study assessed 102 outpatients with liver cirrhosis regarding the clinical and sociodemographic profile and the perceived benefits and barriers to PA by the Exercise Benefits and Barriers Scale and muscle strength. A Generalized Step-Forward linear regression analysis was used to identify the factors associated. RESULTS: The participants were 59±10 years and 60.8% were men. Around 29.4% had ascites decompensation. Perceived benefits and barriers were associated with the presence of ascites (95%CI −0.079 – 0.03; p=0.06 and 95%CI 0.003 – 0.217; p=0.045, respectively). In the group with ascites, both benefits and barriers were associated with muscle strength. In the group without ascites, benefits were associated with cardiovascular risks and no association was observed with barriers to physical activity. CONCLUSIONS: Perceived benefits and barriers to physical activity are associated with intrinsic factors such as the presence of ascites and cardiovascular risk in individuals with liver cirrhosis. The results of this study highlight key elements that must be considered for increasing physical activity in this population.

Resumo Introdução: A obesidade, caracterizada por acúmulo excessivo de tecido adiposo no organismo, pode alterar a mecânica ventilatória, trazendo prejuízos funcionais. Considerando a prevalência crescente da obesidade, bem como a grande morbidade associada a esta condição, torna-se relevante investigar técnicas de mensuração rápidas e fáceis da função ventilatória e a possível correlação com a capacidade funcional. Objetivo: Avaliar a função ventilatória e a capacidade funcional em adultos obesos e determinar se pico de fluxo expiratório reduzido está correlacionado com prejuízo da capacidade funcional. Métodos: 30 participantes, distribuídos em dois grupos: obeso (36 ± 13 anos) e eutrófico (31 ± 9 anos) foram avaliados por meio de medidas antropométricas, do teste de caminhada de seis minutos (TC6´) e da avaliação do pico de fluxo expiratório (PFE). Resultados: Os indivíduos obesos apresentaram reduzido PFE (382 ± 99 vs. 497 ± 104 L/min, p < 0,01) e percorreram menor distância no TC6´ (453 ± 37 vs. 617 ± 50 m, p < 0,01) com maior pressão arterial e percepção de esforço (p < 0,05) quando comparados aos eutróficos. Além disso, foi encontrada correlação positiva e significativa entre fluxo expiratório e distância percorrida (r = 0,635 e p < 0,001). Conclusão: Os indivíduos obesos tiveram menor PFE e menor distância percorrida no TC6´, constatada correlação positiva entre essas duas variáveis. Diante de tal desfecho, a inclusão dos métodos avaliativos utilizados podem contribuir para melhor análise da condição respiratória e funcional dessa população e auxiliar na prescrição de exercícios.

Abstract Introduction: Obesity, characterized by the accumulation of excess body fat, can alter respiratory mechanics and compromise functional capacity. Given its increasing prevalence and the significant morbidity associated with the condition, it is important to investigate techniques that enable rapid, easy measurement of lung function and the possible correlation between obesity and functional capacity. Objective: To assess lung function and functional capacity in obese adults and determine whether there is a correlation between reduced peak expiratory flow and impaired functional capacity. Methods: 30 participants, distributed into two groups: obese (36 ± 13 years) and normal weight (31 ± 9 years) were evaluated based on anthropometric measurements, the six-minute walk test (6MWT) and peak expiratory flow (PEF). Results: The obese individuals showed reduced PEF (382 ± 99 vs. 497 ± 104 L/min, p < 0.01), walked shorter distances in the 6MWT (453 ± 37 vs. 617 ± 50 m, p < 0.01), had higher blood pressure and perceived exertion (p < 0.05) when compared to normal weight participants. Additionally, there was a positive significant association between expiratory flow and distance walked in the 6MWT (r = 0.635 and p < 0.001). Conclusion: Obese individuals exhibited lower PEF and walked shorter distances in the 6MWT, indicating a positive correlation between these two variables. In light of this outcome, the assessment methods used could contribute to improving analysis of respiratory and functional status in this population and aid in exercise prescription.

Resumo Fundamento: O histórico familiar para hipertensão arterial está relacionado a anormalidades vasculares e autonômicas, bem como disfunções no comportamento neuro-hemodinâmico durante o exercício físico. Objetivo: Testar a hipótese de que indivíduos normotensos com histórico familiar de hipertensão arterial apresentam resposta prejudicada da resistência vascular periférica durante o exercício físico. Métodos: Foram avaliados 37 normotensos de ambos os sexos, sedentários, eutróficos e não tabagistas, sendo 23 com histórico familiar positivo (HF+, 24 ± 3 anos) e 14 com histórico familiar negativo (HF-, 27 ± 5 anos) para hipertensão arterial. Foram identificados pressão arterial, frequência cardíaca (DIXTAL®), fluxo sanguíneo muscular do antebraço e resistência vascular periférica local (Hokanson®) por 3 minutos durante o repouso e, em seguida, 3 minutos durante exercício isométrico de preensão palmar a 30% da contração voluntária máxima (Jamar®). Resultados: Em repouso, os grupos HF+ e HF- apresentaram valores semelhantes de pressão arterial média (83 ± 7 mmHg versus 83 ± 5 mmHg, p = 0,96), frequência cardíaca (69 ± 8 bpm versus 66 ± 7 bpm, p = 0,18), fluxo sanguíneo muscular (3 ± 1 mL/min/199 mL versus 2,7 ± 1 mL/min/100 mL, p = 0,16) e resistência vascular periférica (30 ± 9 unidades versus 34 ± 9 unidades, p = 0,21), respectivamente. Durante o exercício, HF+ e HF- mostraram aumento significativo e semelhante da pressão arterial média (∆ = 15 ± 7 mmHg versus 14 ± 7 mmHg, p = 0,86), frequência cardíaca (∆ = 12 ± 8 bpm versus 13 ± 7 bpm, p = 0,86) e fluxo sanguíneo muscular (∆ = 0,8 ± 1,2 mL/min/100 mL versus 1,4 ± 1,1 mL/min/100 mL, p = 0,25), respectivamente. Entretanto, no grupo HF+ não houve redução significativa da resistência vascular periférica durante o exercício, fato que ocorreu no grupo HF- (∆ = -0,4 ± 8,6 unidades versus -7,2 ± 6,3 unidades, p = 0,03). Conclusão: Indivíduos normotensos com histórico familiar de hipertensão arterial apresentam resposta prejudicada da resistência vascular periférica durante o exercício físico.

Abstract Background: A family history of hypertension is associated with vascular and autonomic abnormalities, as well as an impaired neurohemodynamic response to exercise. Objective: To test the hypothesis that normotensive individuals with a family history of hypertension present an impaired peripheral vascular resistance response to exercise. Methods: The study included 37 normotensive volunteers of both sexes who were sedentary, eutrophic, and nonsmokers, comprising 23 with (FH+; 24 ± 3 years) and 14 without (FH-; 27 ± 5 years) a family history of hypertension. Blood pressure, heart rate (DIXTAL®), forearm blood flow (Hokanson®), and peripheral vascular resistance were simultaneously measured for 3 minutes during rest and, subsequently, for 3 minutes during an isometric exercise at 30% of maximal voluntary contraction (Jamar®). Results: At rest, the FH+ and FH- groups present similar mean blood pressure (83 ± 7 versus 83 ± 5 mmHg, p = 0.96), heart rate (69 ± 8 bpm versus 66 ± 7 bpm, p = 0.18), forearm blood flow (3 ± 1 mL/min/100 mL versus 2.7 ± 1 mL/min/100 mL, p = 0.16), and peripheral vascular resistance (30 ± 9 units versus 34±9 units, p = 0.21), respectively. Both groups showed a significant and similar increase in mean blood pressure (∆ = 15 ± 7 mmHg versus 14 ± 7 mmHg, p = 0.86), heart rate (∆ = 12 ± 8 bpm versus 13 ± 7 bpm, p = 0.86), and forearm blood flow (∆ = 0.8 ± 1.2 mL/min/100 mL versus 1.4 ± 1.1 mL/min/100 mL, p = 0.25), respectively, during exercise. However, individuals in the FH+ group showed no reduction in peripheral vascular resistance during exercise, which was observed in the FH- group (∆ = -0.4 ± 8.6 units versus -7.2 ± 6.3 units, p = 0.03). Conclusion: Normotensive individuals with a family history of hypertension present an impaired peripheral vascular resistance response to exercise.

INTRODUÇÃO: O histórico familiar positivo para a doença renal crônica (HF+) é um fator de risco para o surgimento e desenvolvimento dessa doença. Desta forma, é importante avaliar traços que possam estar correlacionados à predisposição familiar para a doença renal crônica. OBJETIVO: Avaliar a modulação autonômica, pela variabilidade da frequência cardíaca, de indivíduos com HF+. MÉTODOS: Foram avaliados nove indivíduos saudáveis com HF+ e 22 indivíduos saudáveis com histórico familiar negativo para doença renal crônica (Grupo HF-), pareados por idade (27 ± 6 vs. 26 ± 4 anos; p = 0,39, respectivamente). A frequência cardíaca foi medida continuamente pelo cardiofrequencímetro Polar S810i® durante 10 minutos de repouso na posição supina. A Variabilidade da Frequência Cardíaca (VFC) foi avaliada pelos índices do domínio do tempo, média dos intervalos RR (MNN), desvio padrão dos intervalos RR (SDNN), raiz média quadrática das diferenças de intervalos RR sucessivos (RMSSD) e percentual de intervalos RR com diferença de duração maior que 50 ms (pNN50), e pelos domínios de baixa frequência (BF), alta frequência (AF) e razão baixa/alta (BF/AF). Os exames laboratoriais foram realizados após jejum de 12 horas. Os resultados são expressos como média ± desvio padrão, adotando como significativo p < 0,05. RESULTADOS: Os grupos HF+ e HFforam semelhantes em relação à estimativa da taxa de filtração glomerular (p = 0,49) e frequência cardíaca (p = 0,68). Os grupos HF+ e HF- não apresentaram diferenças significativas em relação aos índices da variabilidade da frequência cardíaca MNN; SDNN, RMSSD, pNN50, Potência total; BF; AF u.n e razão BF/AF. CONCLUSÃO: A modulação autonômica cardíaca está preservada em indivíduos saudáveis com HF+.

INTRODUCTION: The positive family history of chronic kidney disease (FH+) is a risk factor for the appearance and development of this disease. Thus, it is important to assess traits that may be related to familial predisposition to chronic kidney disease. OBJECTIVE: To evaluate the autonomic modulation by heart rate variability in individuals with FH+. METHODS: We studied 9 health subjects with FH+ and 22 health subjects with negative family history for chronic kidney disease (FH-) matched for age (27 ± 6 vs. 26 ± 4 anos; p = 0.39, respectively). Heart rate was measured continuously by the Polar S810i® for 10 minutes of rest in the supine position. The heart rate variability was evaluated by the time domain, mean of NN intervals (MNN), standard deviation of the NN intervals (SDNN), root mean squared differences of successive NN intervals (RMSSD) and percentage of NN intervals with a difference of duration greater than 50 ms (pNN50) and the fields of low frequency (LF), high frequency (HF) and ratio low/ high (LF/HF). Laboratory biochemical tests were performed after fasting for 12 hours. Results are expressed as mean ± standard deviation, adopting as significant p < 0.05. RESULTS: The groups FH+ and FH-were similar in serum creatinine (p = 0.98), estimated glomerular filtration rate (p = 0.49) and heart rate (p = 0.68). The groups FH+ and FH- showed no significant differences in relation to indices of heart rate variability MNN; SDNN; RMSSD; pNN50; Total power; LF; HF and LF/HF ration, respectively. CONCLUSION: These findings suggest that the cardiac autonomic modulation is preserved in health subjects with HF+.