Impacto da reposição hídrica e da capacidade funcional na dinâmica não linear da frequência cardíaca em exercício e recuperação em coronariopatas
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Data
2020-02-21
Autores
Laurino, Maria Júlia Lopez [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A presença de doenças cardiovasculares e uma reduzida aptidão cardiorrespiratória são fatores que atrasam a recuperação autonômica pós-exercício. Essa condição contribui para um pior prognóstico clínico e favorece a ocorrência de eventos agudos, como isquemias e arritmias após o exercício. Nesse sentido, técnicas capazes de acelerar a recuperação pós-exercício de indivíduos que apresentam essas características devem ser estudadas. Objetivos: Investigar a influência da hidratação na dinâmica não linear da frequência cardíaca (FC) durante os períodos de exercício e recuperação de indivíduos coronariopatas, e ainda, investigar essas respostas considerando diferentes níveis de aptidão cardiorrespiratória. Metodologia: 31 homens coronariopatas foram submetidos aos seguintes procedimentos: I. Teste de esforço máximo, que determinou a carga do exercício realizado nas etapas seguintes (60-80% da FC atingida no limiar anaeróbio) e a divisão da população nos grupos pior (n = 15) e melhor (n = 16) capacidade funcional de acordo com a mediana dos valores de VO2pico; II. Protocolo controle (PC) e III. Protocolo hidratação (PH) análogos a uma sessão de reabilitação cardiovascular, compostos pelos períodos de repouso, aquecimento, exercício aeróbio e recuperação. No PC foi identificada a quantidade de líquido perdida por cada voluntário durante o experimento e no PH essa quantidade foi reposta com 8 porções iguais de água mineral durante os períodos de exercício e recuperação, em intervalos regulares de 10 minutos. Para análise do comportamento não linear da FC nos períodos de exercício e recuperação foram calculados os índices do plot de recorrência (REC, DET, SampEn e ApEn), da análise de flutuações depurada de tendência (DFA-total, Alfa-1, Alfa-2) e da análise simbólica (0V, 1V, 2LV, 2ULV). Para a avaliação da influência da hidratação nos grupos com diferentes capacidades aeróbias foram considerados os índices do plot de recorrência e do plot de Poincaré (SD1, SD2 e relação SD1/SD2). Resultados: Para a população de coronariopatas, em exercício, as respostas observadas foram fisiológicas e não se alteraram com a hidratação, porém para a análise da recuperação houve interação entre os protocolos para os índices REC (p = 0,015) e Alfa-1 (p = 0,039) e foram encontradas diferenças entre os momentos para todos os índices (p<0,01). No PH a recuperação de todos os índices ocorreu entre o 5º e 20º min de recuperação, enquanto no PC apenas os índices DFA-total, 1V e 2LV se recuperaram dentro do período de 60 minutos. Não foram encontradas diferenças significantes entre os protocolos para os índices analisados (p>0,05). Considerando os diferentes níveis de aptidão cardiorrespiratória, durante o exercício a perda de líquidos modificou a dinâmica não linear do grupo com menor aptidão. No período pós-exercício não foram encontradas diferenças entre os protocolos e interação momento vs protocolo (p>0,05), contudo diferenças foram observadas entre os momentos (p<0,05). O grupo com menor capacidade funcional apresentou melhor recuperação no PH para os índices REC, DET, SampEn, SD1 e relação SD1/SD2 e o grupo com maior condicionamento apresentou melhor recuperação no PH para os índices SampEn e SD1. Conclusão: O protocolo de hidratação utilizado não influenciou o período de exercício, porém acelerou a recuperação da dinâmica não linear da FC de coronariopatas. Considerando os diferentes níveis de aptidão cardiorrespiratória, o protocolo de hidratação minimizou a alteração não linear durante o exercício dos indivíduos com menor capacidade funcional e ainda teve maiores efeitos nesses indivíduos durante a recuperação.
The presence of cardiovascular diseases and a reduced cardiorespiratory fitness are factors that delay post-exercise autonomic recovery. This condition contributes to a worse clinical prognosis and favors the appearance of ischemia and arrythmia after exercise. Thus, strategies capable of accelerate the post-exercise recovery of individuals with these characteristics should be investigated. Aim: To investigate the hydration influence on the non-linear dynamic of heart rate (HR) during exercise and recovery of coronary artery disease subjects and to investigate this response considering different levels of cardiorespiratory fitness. Methods: 31 coronary artery disease males were submitted to the following experimental procedure: I. Maximum stress test, that determined the exercise load used in the next stages (60-80% of HR achieved at anaerobic threshold) and based on the VO2peak median, the sample was divided into group worse (n = 15) and better (n = 16) cardiorespiratory fitness; II. Control protocol (CP) and III. Hydration protocol (HP) were analogous to a cardiac rehabilitation session, and composed by initial rest, warming-up, aerobic exercise and recovery. At the end of CP, the amount of fluid lost by each volunteer during the experiment was determined and at HP this amount was replaced with 8 equal portions of mineral water during the exercise and recovery periods in regular intervals of 10 minutes. To the analysis of non-linear dynamic of HR during the exercise and recovery periods were calculated the indexes of recurrence plot (REC, DET, SampEn and ApEn), of detrended fluctuation analysis (DFAtotal, Alpha-1 and Alpha-2), and of symbolic analysis (0V, 1V, 2LV and 2ULV). To the evaluation of the hydration influence considering different cardiorespiratory fitness were considered the indexes of recurrence plot and Poincaré plot (SD1, SD2 and SD1/SD2 ratio). Results: During exercise the responses observed were physiological and do not altered with the hydration, however to the recovery analysis, there was interaction between the protocols for the indexes: REC (p = 0,015) and Alpha-1 (p = 0,039), also differences between the moments were found for all indexes (p<0,01). During HP the recovery of all indexes occurred between the 5th and 20th minutes of recovery, while during CP only the indexes DFA-total, 1V and 2LV recovered within the 60 minutes period. There were no differences between the protocols for all indexes analyzed (p>0,05). Considering the different levels of cardiorespiratory fitness, during exercise, the fluid loss modified the non-linear dynamic of HR only of the less conditionate subjects. During the post-exercise recovery there were no differences between the protocols and no interaction between moments and protocol (p>0,05), however differences between the moments were observed (p<0,05). The group with low cardiorespiratory fitness presented better recovery during the HP for the indexes REC, DET, SampEn, SD1 and SD1/SD2 ratio and the group with higher aerobic fitness presented a better recovery only for the indexes SampEn and SD1. Conclusion: The hydration protocol performed do not influenced the exercise period, however, was able to accelerate the recovery of non-linear dynamic of HR of coronary artery disease subjects. Considering the different levels of cardiorespiratory fitness, the hydration protocol minimized the non-linear perturbations during exercise of the less conditionate subjects and had a higher influence at the recovery of these individuals.
The presence of cardiovascular diseases and a reduced cardiorespiratory fitness are factors that delay post-exercise autonomic recovery. This condition contributes to a worse clinical prognosis and favors the appearance of ischemia and arrythmia after exercise. Thus, strategies capable of accelerate the post-exercise recovery of individuals with these characteristics should be investigated. Aim: To investigate the hydration influence on the non-linear dynamic of heart rate (HR) during exercise and recovery of coronary artery disease subjects and to investigate this response considering different levels of cardiorespiratory fitness. Methods: 31 coronary artery disease males were submitted to the following experimental procedure: I. Maximum stress test, that determined the exercise load used in the next stages (60-80% of HR achieved at anaerobic threshold) and based on the VO2peak median, the sample was divided into group worse (n = 15) and better (n = 16) cardiorespiratory fitness; II. Control protocol (CP) and III. Hydration protocol (HP) were analogous to a cardiac rehabilitation session, and composed by initial rest, warming-up, aerobic exercise and recovery. At the end of CP, the amount of fluid lost by each volunteer during the experiment was determined and at HP this amount was replaced with 8 equal portions of mineral water during the exercise and recovery periods in regular intervals of 10 minutes. To the analysis of non-linear dynamic of HR during the exercise and recovery periods were calculated the indexes of recurrence plot (REC, DET, SampEn and ApEn), of detrended fluctuation analysis (DFAtotal, Alpha-1 and Alpha-2), and of symbolic analysis (0V, 1V, 2LV and 2ULV). To the evaluation of the hydration influence considering different cardiorespiratory fitness were considered the indexes of recurrence plot and Poincaré plot (SD1, SD2 and SD1/SD2 ratio). Results: During exercise the responses observed were physiological and do not altered with the hydration, however to the recovery analysis, there was interaction between the protocols for the indexes: REC (p = 0,015) and Alpha-1 (p = 0,039), also differences between the moments were found for all indexes (p<0,01). During HP the recovery of all indexes occurred between the 5th and 20th minutes of recovery, while during CP only the indexes DFA-total, 1V and 2LV recovered within the 60 minutes period. There were no differences between the protocols for all indexes analyzed (p>0,05). Considering the different levels of cardiorespiratory fitness, during exercise, the fluid loss modified the non-linear dynamic of HR only of the less conditionate subjects. During the post-exercise recovery there were no differences between the protocols and no interaction between moments and protocol (p>0,05), however differences between the moments were observed (p<0,05). The group with low cardiorespiratory fitness presented better recovery during the HP for the indexes REC, DET, SampEn, SD1 and SD1/SD2 ratio and the group with higher aerobic fitness presented a better recovery only for the indexes SampEn and SD1. Conclusion: The hydration protocol performed do not influenced the exercise period, however, was able to accelerate the recovery of non-linear dynamic of HR of coronary artery disease subjects. Considering the different levels of cardiorespiratory fitness, the hydration protocol minimized the non-linear perturbations during exercise of the less conditionate subjects and had a higher influence at the recovery of these individuals.
Descrição
Palavras-chave
Sistema nervoso autônomo, Dinâmica não linear, Recuperação, Aptidão cardiorrespiratória, Exercício, Doenças cardiovasculares, DFA, Autonomic Nervous systemn, Non-linear dynamic, Recovery, Cardiorespiratory fitness, Exercise, Cardiovascular diseases