Modulação autonômica, pressão arterial, aptidão funcional e qualidade de vida em mulheres com hipertensão arterial submetidas a um programa de Hatha Yoga
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Data
2015-12-16
Autores
Mizuno, Julio [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
O Sistema Nervoso Autonômico (SNA) é um dos mecanismos envolvidos no controle da pressão arterial (PA). Na Hipertensão Arterial (HA) pode ocorrer aumento da modulação simpática e redução da parassimpática. A ioga apresenta exercícios de respiração (pranayamas), relaxamento e meditação, que aplicados de forma isolada podem melhorar o equilíbrio simpatovagal, mas em relação à associação dessas técnicas somada as posturas psicofísicas (modelo denominado Hatha Yoga), não há evidências conclusivas, sobretudo na HA. O objetivo do presente estudo foi verificar os efeitos de um programa de Hatha Yoga na modulação autonômica, pressão arterial, aptidão funcional e percepção de saúde e qualidade de vida em mulheres com HA. Vinte e quatro mulheres, atendidas em unidade básica de saúde municipal, entre 50 e 75 anos, com HA, foram selecionadas para participar do estudo (grupo Ioga n=13 e Controle n=11). O grupo Ioga foi submetido a um programa de Hatha Yoga, durante quatro meses (3x90 minutos/semana), enquanto o Controle manteve a rotina habitual pelo mesmo período. Antes e após o programa, as pacientes preencheram questionários com informações pessoais e clínicas, realizaram avaliações para aferição da PA e frequência cardíaca; captação da variabilidade da frequência cardíaca (VFC) em repouso na posição supina e na ortostática; e, testes de força, flexibilidade, coordenação e agilidade/equilíbrio. Ao final do estudo foram entrevistadas sobre a percepção de saúde e qualidade de vida. Foram utilizados os testes de análise de covariância, análise de variância de dois caminhos, teste t de Student e Wilcoxon. O nível de significância adotado foi de p<0,05. Após o programa de intervenção, no grupo Ioga foi observada melhora da resposta autonômica parassimpática (AFabs) durante a posição ortostática comparada ao supino [114(370) versus 42(77), p<0,05], redução da PA sistólica (134±10 versus 122±7, p=0,001) aumento da flexibilidade (62 ± 10 versus 66,7 ± 9, p=0,019), diminuição no tempo de execução do teste de coordenação (13,2 ± 3,4 versus 11,7± 2,5); menor percepção de dor (p=0,038), maior capacidade de locomoção (p=0,046); e, relatos associados a melhoras da dimensão física e social da qualidade de vida. O programa desenvolvido neste estudo, com os exercícios de Hatha Yoga, complementou o tratamento farmacológico para HA de forma efetiva. Os movimentos de transição entre as posições em pé, sentado e deitado no solo, associados a torções, flexões e extensões, melhoraram a aptidão funcional, e podem ter influenciado a resposta do SNA parassimpático para o coração no teste de estresse postural. Os relatos sobre a percepção da qualidade de vida revelaram elementos que corroboraram os dados quantitativos da pesquisa. A prática de Hatha Yoga mostrou-se exequível ao nível da atenção básica em saúde, representando uma opção aos exercícios tradicionalmente recomendados, como a caminhada e o exercício resistido.
The Autonomic Nervous System (ANS) is one of the mechanisms involved in blood pressure (BP) control. Increased sympathetic and reduced parasympathetic modulation are observed in hypertension disease. Yoga gathers breathing exercises (pranayama), relaxation and meditation when applied separated can improve sympathovagal balance. However, regarding the association of these techniques plus the psycho-physical postures (model called Hatha Yoga), there is no conclusive evidence especially in hypertension disease. The aim of this study was to investigate the effects of Hatha Yoga program in autonomic cardiac modulation, blood pressure, functional fitness and health perception and quality of life in hypertensive women. Twenty-four hypertensive women treated in a municipal basic health unit, aged between 50 and 75 years, were selected for the study (n=13, Yoga group and Control, n=11). The Yoga group was submitted to a Hatha Yoga program for four months (3x90 minutes/week), while the control remained the usual routine for the same period. Before and after the program, the patients completed the questionnaire about personal and clinical information, performed evaluations to measure the blood pressure and heart rate, heart rate variability (HRV) at rest in the supine and upright, and strength, flexibility, coordination and agility/balance. At the end of the study subjects were interviewed about the perception of health and quality of life. The analysis of covariance, two way analysis of variance, Student t test and Wilcoxon tests were used in results analysis. The significance level was set at p<0.05. After the intervention program, yoga group improved parasympathetic autonomic response (AFabs) during the standing position compared to supine [114(370) versus 42(77), p<0.05], reduced systolic blood pressure (134±10 versus 122±7, p=0.001) increased flexibility (62±10 versus 66.7±9, p=0.019), decreased coordination of test execution time (13.2±3.4 versus 11.7±2.5) and perception of pain (p=0.038), increased locomotion capacity (p=0.046); and reported improvement in physical and social dimension of quality of life. The program developed in this study, with Hatha Yoga exercises, complemented the pharmacological treatment for hypertension. The movement of transition between the positions standing, sitting and lying on the ground, combined with twists, crunches and extensions, improved functional fitness, and may have influenced the response of the parasympathetic ANS to the heart of the postural stress test. The reports on the perception of quality of life revealed elements that corroborated the quantitative survey data. The practice of Hatha Yoga proved to be feasible at the primary health care, representing an option to traditionally recommended exercises such as walking and resistance exercise.
The Autonomic Nervous System (ANS) is one of the mechanisms involved in blood pressure (BP) control. Increased sympathetic and reduced parasympathetic modulation are observed in hypertension disease. Yoga gathers breathing exercises (pranayama), relaxation and meditation when applied separated can improve sympathovagal balance. However, regarding the association of these techniques plus the psycho-physical postures (model called Hatha Yoga), there is no conclusive evidence especially in hypertension disease. The aim of this study was to investigate the effects of Hatha Yoga program in autonomic cardiac modulation, blood pressure, functional fitness and health perception and quality of life in hypertensive women. Twenty-four hypertensive women treated in a municipal basic health unit, aged between 50 and 75 years, were selected for the study (n=13, Yoga group and Control, n=11). The Yoga group was submitted to a Hatha Yoga program for four months (3x90 minutes/week), while the control remained the usual routine for the same period. Before and after the program, the patients completed the questionnaire about personal and clinical information, performed evaluations to measure the blood pressure and heart rate, heart rate variability (HRV) at rest in the supine and upright, and strength, flexibility, coordination and agility/balance. At the end of the study subjects were interviewed about the perception of health and quality of life. The analysis of covariance, two way analysis of variance, Student t test and Wilcoxon tests were used in results analysis. The significance level was set at p<0.05. After the intervention program, yoga group improved parasympathetic autonomic response (AFabs) during the standing position compared to supine [114(370) versus 42(77), p<0.05], reduced systolic blood pressure (134±10 versus 122±7, p=0.001) increased flexibility (62±10 versus 66.7±9, p=0.019), decreased coordination of test execution time (13.2±3.4 versus 11.7±2.5) and perception of pain (p=0.038), increased locomotion capacity (p=0.046); and reported improvement in physical and social dimension of quality of life. The program developed in this study, with Hatha Yoga exercises, complemented the pharmacological treatment for hypertension. The movement of transition between the positions standing, sitting and lying on the ground, combined with twists, crunches and extensions, improved functional fitness, and may have influenced the response of the parasympathetic ANS to the heart of the postural stress test. The reports on the perception of quality of life revealed elements that corroborated the quantitative survey data. The practice of Hatha Yoga proved to be feasible at the primary health care, representing an option to traditionally recommended exercises such as walking and resistance exercise.
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Palavras-chave
Ioga, Saúde Pública, Variabilidade da frequência cardíaca, Promoção da saúde, Hipertensão, Yoga, Public Health, Práticas alternativas e complementares