Exercícios de respiração do ioga aplicados a pacientes hipertensos sob tratamento em unidade básica de saúde
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Data
2018-06-15
Autores
Brandani, Jeniffer Zanetti
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O número de indivíduos acometidos pela hipertensão arterial é alarmante em todo o mundo, por isso, a busca por estratégias eficazes para a redução dos valores de pressão arterial e suas consequências, são objetos de inúmeros estudos. As práticas de ioga vêm sendo incentivadas por meio da Política Nacional de Práticas Integrativas e Complementares no SUS, por se mostrar eficaz na prevenção e tratamento de diversas patologias, entre elas a hipertensão arterial, apresentando efeito hipotensor significativo. Podendo ser utilizado com todas as técnicas (princípios éticos, asanas, pranayamas, relaxamento, meditação) em conjunto em uma mesma sessão ou de forma isolada, como muitos estudos investigando apenas relaxamentos e/ou pranayamas. Objetivos: a) Levantar os estudos que abordam os efeitos dos exercícios de controle respiratório (pranayamas) sobre a pressão arterial; b) Verificar o efeito de intervenção com pranayamas com ritmo lento na pressão arterial de hipertensos, sob tratamento em Unidade Básica de Saúde (UBS). Métodos: Para isso, foram conduzidos dois estudos principais. a) Uma revisão sistemática de ensaios clínicos que buscaram verificar os efeitos dos pranayamas na pressão arterial. Foram pesquisadas três bases de dados eletrônicas PubMed/Medline, Scopus e Bireme, a análise de viés foi avaliada pela escala PEDro. b) Um ensaio clínico randomizado e controlado, composto por dois grupos (ioga - GI e exercício controle ativo - GCA). O programa foi composto de 16 sessões com duração de 30 minutos e as análises foram compostas por medidas de pressão arterial ao início e fim do programa. Resultados: a) Todos os estudos em que os participantes eram hipertensos apresentaram redução na pressão arterial sistólica (PAS) tanto nos estudos que avaliaram efeito agudo quanto nos que avaliaram o efeito crônico; na pressão arterial diastólica (PAD) apenas três estudos demonstraram redução significativa (dois investigando efeito crônico); já a frequência cardíaca apresentou diminuição em sete estudos (4 investigando efeito agudo). b) Os grupos apresentaram redução significativa na PAS nos momentos, porém não foi encontrada diferença entre os grupos; os pacientes eram em sua maioria mulheres, brancos, com IMC acima do valor recomendado e classe econômica B e C; apresentavam níveis de atividade física dentro das recomendações (>150min/semana). Conclusão: a) A revisão sistemática forneceu indícios de que a utilização de pranayamas lentos e/ou com narinas alternadas possa ser uma alternativa efetiva para reduzir a pressão arterial em pacientes normotensos e hipertensos. Porém, o alto número de viés nos estudos iseridos limitam estes resultados. Portanto, são necessários novos estudos com maior rigor metodológico na área de ioga, para que os benefícios desta prática seja fortalecido e ganhe espaço como complemento ao tratamento farmacológico. b) O ensaio clínico indicou que 16 sessões de pranayamas apresentam efeito hipotensor crônico para PAS em pacientes com hipertensão arterial, mas não foram encontradas diferenças entre o GI e GCA. Porém, o baixo número de pacientes incluídos, limita as análises e as possíveis respostas da pressão arterial aos pranayamas.
Introduction: The number of individuals affected by arterial hypertension is alarming worldwide, so the search for effective strategies to reduce blood pressure values and their consequences are the subject of numerous studies. The practices of yoga have been encouraged through the National Politics of Integrative and Complementary Practices in the SUS, for being effective in the prevention and treatment of several pathologies, including arterial hypertension, with a significant hypotensive effect. It can be used with all techniques (ethical principles, asanas, pranayamas, relaxation, meditation) together in the same session or in isolation, as many studies investigating only relaxation and / or pranayamas. Objectives: a) Raise studies that address the effects of respiratory control exercises (pranayamas) on blood pressure; b) To verify the effect of intervention with pranayamas with slow rhythm in the hypertensive blood pressure, under treatment in Basic Health Unit (UBS). Methods: Two main studies were conducted. a) A systematic review of clinical trials that sought to verify the effects of pranayamas on blood pressure. We searched three electronic databases PubMed / Medline, Scopus and Bireme, the bias analysis was evaluated by the PEDro scale. b) A randomized controlled trial, composed of two groups (yoga - GI and exercise control active - GCA). The program consisted of 16 sessions lasting 30 minutes and the analyzes were composed of blood pressure measurements at the beginning and end of the program. Results: a) All studies in which the participants were hypertensive had a reduction in systolic blood pressure (SBP), both in the studies that evaluated the acute effect and in those that evaluated the chronic effect; in diastolic blood pressure (DBP) only three studies showed significant reduction (two investigating chronic effect); already the heart rate presented decrease in seven studies (4 investigating acute effect). b) Groups showed a significant reduction in SBP at moments, but no difference was found between groups; the patients were mostly white women with BMI above the recommended value and economic class B and C; presented levels of physical activity within the recommendations (> 150min / week). Conclusion: a) The systematic review has provided indications that the use of slow pranayamas and / or alternate nostrils may be an effective alternative for reducing blood pressure in normotensive and hypertensive patients. However, the high number of bias in the iserid studies limits these results. Therefore, new studies with greater methodological rigor in the area of yoga are needed, so that the benefits of this practice are strengthened and gain space as a complement to pharmacological treatment. b) The clinical trial indicated that 16 sessions of pranayamas present a chronic hypotensive effect for SBP in patients with arterial hypertension, but no differences were found between GI and GCA. However, the low number of patients included limits the analyzes and possible responses of blood pressure to pranayamas.
Introduction: The number of individuals affected by arterial hypertension is alarming worldwide, so the search for effective strategies to reduce blood pressure values and their consequences are the subject of numerous studies. The practices of yoga have been encouraged through the National Politics of Integrative and Complementary Practices in the SUS, for being effective in the prevention and treatment of several pathologies, including arterial hypertension, with a significant hypotensive effect. It can be used with all techniques (ethical principles, asanas, pranayamas, relaxation, meditation) together in the same session or in isolation, as many studies investigating only relaxation and / or pranayamas. Objectives: a) Raise studies that address the effects of respiratory control exercises (pranayamas) on blood pressure; b) To verify the effect of intervention with pranayamas with slow rhythm in the hypertensive blood pressure, under treatment in Basic Health Unit (UBS). Methods: Two main studies were conducted. a) A systematic review of clinical trials that sought to verify the effects of pranayamas on blood pressure. We searched three electronic databases PubMed / Medline, Scopus and Bireme, the bias analysis was evaluated by the PEDro scale. b) A randomized controlled trial, composed of two groups (yoga - GI and exercise control active - GCA). The program consisted of 16 sessions lasting 30 minutes and the analyzes were composed of blood pressure measurements at the beginning and end of the program. Results: a) All studies in which the participants were hypertensive had a reduction in systolic blood pressure (SBP), both in the studies that evaluated the acute effect and in those that evaluated the chronic effect; in diastolic blood pressure (DBP) only three studies showed significant reduction (two investigating chronic effect); already the heart rate presented decrease in seven studies (4 investigating acute effect). b) Groups showed a significant reduction in SBP at moments, but no difference was found between groups; the patients were mostly white women with BMI above the recommended value and economic class B and C; presented levels of physical activity within the recommendations (> 150min / week). Conclusion: a) The systematic review has provided indications that the use of slow pranayamas and / or alternate nostrils may be an effective alternative for reducing blood pressure in normotensive and hypertensive patients. However, the high number of bias in the iserid studies limits these results. Therefore, new studies with greater methodological rigor in the area of yoga are needed, so that the benefits of this practice are strengthened and gain space as a complement to pharmacological treatment. b) The clinical trial indicated that 16 sessions of pranayamas present a chronic hypotensive effect for SBP in patients with arterial hypertension, but no differences were found between GI and GCA. However, the low number of patients included limits the analyzes and possible responses of blood pressure to pranayamas.
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Palavras-chave
Prática corporal complementar, Pressão arterial, Pranayama, Complementary body practice, Blood pressure