Influência da ingestão hídrica no comportamento autonômico de coronariopatas submetidos a uma sessão de reabilitação cardiovascular: ensaio clínico crossover
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Data
2019-10-31
Autores
Silva, Anne Kastelianne França da
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Universidade Estadual Paulista (Unesp)
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INTRODUÇÃO: A reposição das perdas hídricas decorrentes da atividade física é recomendada em consensos internacionais para indivíduos sadios e atletas de alto rendimento. Entretanto, permanece pouco compreendida a sua influência quando administrada, igualmente, durante e/ou após o exercício, sobre a modulação autonômica cardíaca, frequência cardíaca de recuperação (FCR) e percepções subjetivas de esforço (PSE), desconforto (PSD) e recuperação (PSR) de indivíduos com alteração autonômica conhecida, como os coronariopatas. OBJETIVO: Investigar a influência da ingestão hídrica realizada durante e/ou após uma sessão de reabilitação cardiovascular (RC) de intensidade moderada sobre a modulação autonômica cardíaca, FCR, PSE, PSD e PSR de coronariopatas. MÉTODOS: Foram recrutados 31 adultos acima de 45 anos de idade com coronariopatia isquêmica, participantes de programas de RC, os quais foram submetidos a dois desenhos de estudos, ambos compostos por três etapas (48 horas de intervalo entre elas): I) Teste de esforço máximo; II) Protocolo controle (PC); III) Protocolo experimental (PH). Os PC e PH de ambos os estudos foram compostos por atividades realizadas em RC convencional, com ingestão de água no PH, calculada a partir da variação de massa corporal no PC. A modulação autonômica foi avaliada utilizando índices de variabilidade da frequência cardíaca calculados nos domínios do tempo, frequência e geométricos durante o repouso, exercício e recuperação. Foram avaliados ainda a FCR, PSE, PSD e PSR. RESULTADOS: Hidratação durante o exercício e recuperação promoveu diferença significante entre os protocolos (RMSSD - p valor = 0,024; SD1 – p valor = 0,022), entre repouso e momentos de recuperação (RMSSD, SDNN; LFms2; HFms2; LFnu; HFnu; SD1, SD2 e SD1/SD2; TINN; todos com p valor = 0,001) e interação entre momentos e protocolo (RMSSD e SD1 - p valor = 0,019). A ingestão de água apenas durante o exercício permitiu aceleração na reentrada vagal nos primeiros 30 segundos de recuperação no PH, enquanto que no PC ocorreu após o 1º minuto. Observamos também uma melhor recuperação da FC no 1º minuto no período de recuperação no PH assim como redução significativa da PSE, em comparação ao PC. Durante o exercício a ingestão de água não influenciou as respostas autonômicas em relação ao repouso, além do fisiológico. CONCLUSÃO: Em coronariopatas, pequenas perdas de líquidos durante o exercício e recuperação são capazes de influenciar a modulação autonômica e a ingestão de água permite uma recuperação antecipada da modulação parassimpática e da variabilidade global. Além disso, a ingestão de água apenas durante o exercício permite acelerar a reentrada vagal e influencia positivamente a FCR e a PSR, no período imediato de recuperação.
BACKGROUND: The replacement of water losses due to physical activity is recommended in international consensus for healthy individuals and high performance athletes. However, its influence when administered equally during and / or after exercise on cardiac autonomic modulation, recovery heart rate (HRR) and subjective perceptions of exertion (PSE), discomfort (PSD) and recovery (PSR) of individuals with known autonomic alterations, such as coronary artery disease, remains poorly understood AIM: To investigate the influence of fluid intake during and / or after a moderate intensity cardiovascular rehabilitation (CR) session on coronary heart disease autonomic modulation, HRR, PSE, PSD and PSR. METHODS: We recruited 31 adults over 45 years of age with ischemic coronary artery disease who participated in CR programs, who underwent two study designs, both composed of three steps (48 hours apart): I) maximum effort; II) Control Protocol (PC); III) Experimental Protocol (PH). The PC and PH of both studies were composed by activities performed in conventional CR, with water intake in the PH, calculated from the body mass variation in the PC. Autonomic modulation was evaluated using heart rate variability indices calculated in the time, frequency and geometric domains during rest, exercise and recovery. FCR, PSE, PSD and PSR were also evaluated. RESULTS: Hydration during exercise and recovery promoted significant difference between protocols (RMSSD - p value = 0.024; SD1 - p value = 0.022), between rest and recovery moments (RMSSD, SDNN; LFms2; HFms2; LFnu; HFnu; SD1 , SD2 and SD1 / SD2; TINN; all with p value = 0.001) and interaction between moments and protocol (RMSSD and SD1 - p value = 0.019). Ingestion of water only during exercise allowed acceleration in vagal reentry in the first 30 seconds of recovery in PH, while in CP occurred after the first minute. We also observed a better HR recovery at 1 minute in the PH recovery period as well as a significant reduction in PSE compared to the PC. During exercise the water intake did not influence the autonomic responses in relation to rest, besides the physiological one. CONCLUSION: In coronary artery disease patients, small fluid losses during exercise and recovery are able to influence autonomic modulation and water intake allows an early recovery of parasympathetic modulation and global variability. In addition, ingestion of water only during exercise accelerates vagal reentry and positively influences HRR and PSR in the immediate recovery period.
BACKGROUND: The replacement of water losses due to physical activity is recommended in international consensus for healthy individuals and high performance athletes. However, its influence when administered equally during and / or after exercise on cardiac autonomic modulation, recovery heart rate (HRR) and subjective perceptions of exertion (PSE), discomfort (PSD) and recovery (PSR) of individuals with known autonomic alterations, such as coronary artery disease, remains poorly understood AIM: To investigate the influence of fluid intake during and / or after a moderate intensity cardiovascular rehabilitation (CR) session on coronary heart disease autonomic modulation, HRR, PSE, PSD and PSR. METHODS: We recruited 31 adults over 45 years of age with ischemic coronary artery disease who participated in CR programs, who underwent two study designs, both composed of three steps (48 hours apart): I) maximum effort; II) Control Protocol (PC); III) Experimental Protocol (PH). The PC and PH of both studies were composed by activities performed in conventional CR, with water intake in the PH, calculated from the body mass variation in the PC. Autonomic modulation was evaluated using heart rate variability indices calculated in the time, frequency and geometric domains during rest, exercise and recovery. FCR, PSE, PSD and PSR were also evaluated. RESULTS: Hydration during exercise and recovery promoted significant difference between protocols (RMSSD - p value = 0.024; SD1 - p value = 0.022), between rest and recovery moments (RMSSD, SDNN; LFms2; HFms2; LFnu; HFnu; SD1 , SD2 and SD1 / SD2; TINN; all with p value = 0.001) and interaction between moments and protocol (RMSSD and SD1 - p value = 0.019). Ingestion of water only during exercise allowed acceleration in vagal reentry in the first 30 seconds of recovery in PH, while in CP occurred after the first minute. We also observed a better HR recovery at 1 minute in the PH recovery period as well as a significant reduction in PSE compared to the PC. During exercise the water intake did not influence the autonomic responses in relation to rest, besides the physiological one. CONCLUSION: In coronary artery disease patients, small fluid losses during exercise and recovery are able to influence autonomic modulation and water intake allows an early recovery of parasympathetic modulation and global variability. In addition, ingestion of water only during exercise accelerates vagal reentry and positively influences HRR and PSR in the immediate recovery period.
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Doença cardiovascular, Sistema nervoso autônomo, Hidratação, Recuperação, Reabilitação cardíaca, Cardiovascular disease, Autonomic nervous system, Hydration, Recovery, Cardiac rehabilitation