Influência do comportamento sedentário em marcadores de risco cardiovascular e correlação entre questionários funcionais e acelerometria na avaliação do comportamento sedentário e nível de atividade física em cardiopatas
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Data
2019-12-16
Autores
Lima, Isabelle Maina [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: As doenças cardiovasculares fazem parte do grupo composto pelas doenças crônicas não transmissíveis e, portanto, devem ser abordadas pelos programas de promoção da saúde. Uma das formas de tratamento dessas doenças são os programas de reabilitação cardiovascular, que, além da prática regular de exercício físico, priorizam a prevenção secundária. Apesar da prática regular de exercício físico ter ganhado força como primeira linha para o tratamento, o avanço da tecnologia e o estilo de vida da sociedade atual vêm promovendo o aumento do denominado comportamento sedentário (CS). A mensuração deste pode ser realizada com diferentes instrumentos que irão avaliar esses indivíduos a partir de informações obtidas por auto relato, por medidas de capacidade funcional ou ainda marcadores fisiológicos. Objetivo: Verificar a presença do CS em indivíduos participantes de um programa de reabilitação cardiovascular, além de avaliar a associação entre CS e variabilidade da frequência cardíaca, frequência cardíaca de repouso, pressão arterial e saturação periférica de oxigênio, e verificar se medidas de CS obtidas por meio de questionários estão associadas a mensurações diretas desse comportamento obtidas a partir do uso do acelerômetro. Materiais e Métodos: Foram recrutados participantes de um programa de reabilitação cardiovascular, dos quais foram analisados os prontuários para caracterização da amostra. A coleta foi realizada em duas partes. Primeiramente foram coletados dados antropométricos e em seguida realizada a coleta da VFC em repouso. Posteriormente os pacientes tiveram que utilizar no período de uma semana o acelerômetro, posicionado na cintura, do lado dominante. Após a retirada do aparelho os mesmos responderam aos seguintes questionários funcionais: IPAQ versão curta, LASA – SBQ modificado para idosos e BAECKE. Análise estatística: Estatística descritiva foi utilizada para caracterização da amostra e a normalidade dos dados foi verificada pelo teste de Shapiro-Wilk. As correlações entre as classificações ou valores obtidos no questionário ou acelerometria e os valores dos índices de VFC foram analisadas por meio da análise de Regressão Linear no modelo não ajustado e ajustado, considerando o tempo de reabilitação do paciente e o uso de betabloqueadores. A comparação entre os valores obtidos dos questionários vs. obtidos pelo acelerômetro foi realizada por meio do teste de Wilcoxon. Correlação de Spearman foi utilizada para a identificação da associação. A concordância relativa foi identificada pelo coeficiente de correlação intraclasse e a concordância absoluta pelo histograma de Bland-Altman. Resultados: Existem associações positivas entre TSBK e TSBT em número absoluto com PAD e negativas entre sedentary e TSBT (número absoluto). Considerando tempo de reabilitação e uso de betabloqueadores observa-se também associação negativa entre o LASA-SBQ e SpO2. Em relação ao sistema cardiovascular, observaram-se associações positivas entre PAD vs. TSBK e TSBT (números absolutos). Em relação à modulação autonômica, associações negativas entre sedentary e TSBT (número absoluto) com índices que representam a modulação parassimpática foram observadas mesmo após a realização dos ajustes. Quando comparado ao acelerômetro os questionários LASA – SBQ e BAECKE apresentaram uma significância negativa, assim como para o questionário IPAQ para as categorias: atividade leve, moderada, moderada + vigorosa e sedentarismo. Em relação ao questionário BAECKE vs. acelerômetro houve uma correlação significativa. Em relação ao comportamento sedentário, tanto para o questionário IPAQ quanto para o questionário LASA – SBQ vs. acelerômetro foi encontrado bom nível de concordância absoluta. Conclusão: Os resultados obtidos demonstraram associações positivas entre comportamento sedentário vs. PAD e negativas entre o primeiro e índices de VFC que expressam a modulação parassimpática. Associação negativa entre os resultados do questionário LASA-SBQ e SpO2 também foram observados. Os questionários funcionais previamente citados apresentaram ainda bom nível de concordância absoluta e correlação quando comparados ao acelerômetro.
Introduction: Cardiovascular diseases are part of the group consisting of chronic noncommunicable diseases and, therefore, should be addressed by health promotion programs. One way to treat these diseases is cardiovascular rehabilitation programs, which, in addition to regular exercise, prioritize secondary prevention. Although regular exercise has gained strength as the first line for treatment, the advancement of technology and the lifestyle of today's society has promoted the increase of so called sedentary behavior (SB). The measurement of this SB can be performed with different instruments that will evaluate these individuals from information obtained by self-report, measures of functional capacity or physiological markers. Objective: To verify the presence of SB in individuals participating in a cardiovascular rehabilitation program, as well as to evaluate the association between SB and heart rate variability, resting heart rate, blood pressure and peripheral oxygen saturation. Besides to verify if SB measurements obtained by questionnaires are associated with direct measurements of this behavior obtained from the use of the accelerometer. Methods: Participants were recruited from a cardiovascular rehabilitation program, from which the medical records for characterization of the sample were analyzed. The collection was performed in two parts. First, anthropometric data were collected and then HRV collected at rest. Afterwards, the patients had to use the accelerometer on the dominant side within one week. After removing the device, they answered the following functional questionnaires: short version IPAQ, modified LASA - SBQ for the elderly and BAECKE. Statistical analysis: Descriptive statistics was used for sample characterization and data normality was verified by the Shapiro-Wilk test. Correlations between the scores or values obtained in the questionnaire or accelerometry and the HRV index values were analyzed by linear regression analysis in the unadjusted and adjusted model, considering the patient's rehabilitation time and the use of beta-blockers. The comparison between the values by the questionnaires vs. the accelerometer was performed using the Wilcoxon test. Spearman correlation was used to identify the association. Relative agreement was identified by intraclass correlation coefficient and absolute agreement by Bland-Altman histogram. Results: There are positive associations between TSBK and TSBT in absolute numbers with DBP and negative associations between sedentary and TSBT (absolute number). Considering rehabilitation time and beta-blocker use, a negative association was also observed between the results of the LASA-SBQ questionnaire and SpO2. Regarding the cardiovascular system, positive associations between DBP and the values of TSBK and TSBT (absolute numbers) were observed. About the autonomic modulation, negative associations between sedentary and TSBT (absolute number) with indices representing parasympathetic modulation were observed even after adjustments were made. When compared to the accelerometer, the LASA - SBQ and BAECKE questionnaires presented a negative significance, as well as for the IPAQ questionnaire for the categories: light, moderate, moderate + vigorous activity and sedentary behavior. Regarding the BAECKE questionnaire vs. accelerometer there was a significant correlation. Sedentary behavior, both for the IPAQ questionnaire vs. accelerometer as for the LASA - SBQ vs. accelerometer was found a good level of absolute agreement. Conclusion: The results showed positive associations between sedentary behavior vs. DBP and negatives between the first and HRV indices that express parasympathetic modulation. Negative association between the results of the LASA-SBQ questionnaire and SpO2 were also observed. The previously mentioned functional questionnaires still presented a good level of absolute agreement and correlation when compared to the accelerometer.
Introduction: Cardiovascular diseases are part of the group consisting of chronic noncommunicable diseases and, therefore, should be addressed by health promotion programs. One way to treat these diseases is cardiovascular rehabilitation programs, which, in addition to regular exercise, prioritize secondary prevention. Although regular exercise has gained strength as the first line for treatment, the advancement of technology and the lifestyle of today's society has promoted the increase of so called sedentary behavior (SB). The measurement of this SB can be performed with different instruments that will evaluate these individuals from information obtained by self-report, measures of functional capacity or physiological markers. Objective: To verify the presence of SB in individuals participating in a cardiovascular rehabilitation program, as well as to evaluate the association between SB and heart rate variability, resting heart rate, blood pressure and peripheral oxygen saturation. Besides to verify if SB measurements obtained by questionnaires are associated with direct measurements of this behavior obtained from the use of the accelerometer. Methods: Participants were recruited from a cardiovascular rehabilitation program, from which the medical records for characterization of the sample were analyzed. The collection was performed in two parts. First, anthropometric data were collected and then HRV collected at rest. Afterwards, the patients had to use the accelerometer on the dominant side within one week. After removing the device, they answered the following functional questionnaires: short version IPAQ, modified LASA - SBQ for the elderly and BAECKE. Statistical analysis: Descriptive statistics was used for sample characterization and data normality was verified by the Shapiro-Wilk test. Correlations between the scores or values obtained in the questionnaire or accelerometry and the HRV index values were analyzed by linear regression analysis in the unadjusted and adjusted model, considering the patient's rehabilitation time and the use of beta-blockers. The comparison between the values by the questionnaires vs. the accelerometer was performed using the Wilcoxon test. Spearman correlation was used to identify the association. Relative agreement was identified by intraclass correlation coefficient and absolute agreement by Bland-Altman histogram. Results: There are positive associations between TSBK and TSBT in absolute numbers with DBP and negative associations between sedentary and TSBT (absolute number). Considering rehabilitation time and beta-blocker use, a negative association was also observed between the results of the LASA-SBQ questionnaire and SpO2. Regarding the cardiovascular system, positive associations between DBP and the values of TSBK and TSBT (absolute numbers) were observed. About the autonomic modulation, negative associations between sedentary and TSBT (absolute number) with indices representing parasympathetic modulation were observed even after adjustments were made. When compared to the accelerometer, the LASA - SBQ and BAECKE questionnaires presented a negative significance, as well as for the IPAQ questionnaire for the categories: light, moderate, moderate + vigorous activity and sedentary behavior. Regarding the BAECKE questionnaire vs. accelerometer there was a significant correlation. Sedentary behavior, both for the IPAQ questionnaire vs. accelerometer as for the LASA - SBQ vs. accelerometer was found a good level of absolute agreement. Conclusion: The results showed positive associations between sedentary behavior vs. DBP and negatives between the first and HRV indices that express parasympathetic modulation. Negative association between the results of the LASA-SBQ questionnaire and SpO2 were also observed. The previously mentioned functional questionnaires still presented a good level of absolute agreement and correlation when compared to the accelerometer.
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Palavras-chave
Comportamento sedentário, Exercício físico, Sistema cardiovascular doenças, Questionários, Acelerometria, Cardiovascular disease, Sedentary behavior, Physical exercise, Questionnaire, Accelerometry