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Effectiveness of physical activity orientation for hypertensive patients by physical educator or doctor – randomized

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Research Article | DOI: https://doi.org/10.31579/IJCM.2022/004

Effectiveness of physical activity orientation for hypertensive patients by physical educator or doctor – randomized

  • Cristianne Confessor Castilho Lopes 1*
  • Paulo Sergio Silva 2
  • Tulio Gamio Dias 3
  • Daniela dos Santos 4
  • Eduardo Barbosa Lopes 4
  • Marivane Lemos 5
  • Marilda Morais da Costa 6
  • Lucas Castilho Lopes 7
  • Vanessa da Silva Barros 3
  • Lucas Bottesini dos Santos 4
  • sabela Lara Marcondes 4
  • Nathan da Silva 4
  • Sthefany Thais Deuner Meincke 4
  • João Vitor Bertuci 4
  • Roberto Flores Amaral 4
  • Katherinne Barth Wanis Figueiredo 8
  • Leandro Vinicius Bealuka 9
  • Fabio Kopp Vanuzzi 10
  • Fábio Herget Pitanga 4
  • Liamara Basso Dala Costa 4
  • Helbert do Nascimento Lima 1
  • Anderson Ricardo Roman Gonçalves 1

1 University of Joinville Region - Joinville – SC

2 UniSociesc - Joinville – SC

3 USP School of Arts, Sciences and Humanities – São Paulo – SP       

4 Alto Vale do Rio do Peixe University - Caçador – SC

5 Contestado University Concordia - SC – Brazil

6 Lutheran Educational Association - Faculty IELUSC - Joinville – SC

7 Federal University of Santa Catarina - Florianópolis – SC

8 Hans Dieter Schmidt Regional Hospital - Joinville – SC

9 Unisul – Tubarão – SC

10 Federal University of Rio de Janeiro - Rio de Janeiro - RJ

*Corresponding Author: Cristianne Confessor Castilho Lopes, University of Joinville Region - Joinville – SC.

Citation: Cristianne Confessor Castilho Lopes, (2022). Effectiveness of physical activity orientation for hypertensive patients by physical educator or doctor – randomized. J. International Journal of Cardiovascular Medicin. 2(1); DOI: 10.31579/IJCM.2022/004

Copyright: © 2022 Cristianne Confessor Castilho Lopes, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Received: 08 April 2022 | Accepted: 22 May 2022 | Published: 07 June 2022

Keywords: Adherenc; Physical Activit; Hypertension

Abstract

Physical activity (PA) decreases blood pressure in hypertensive patients (PT). Objective: evaluate PA oriented by physical educator (PE) against physician-oriented PA. Methods: 59 pt aged ≥ 50 y.o. were randomized and PE oriented (31, GEF) or physician oriented (GC, 28). Re-evaluated at 3 and 6 m. Results: 21 (36%) male, age 64.4±9.5 y.o, weight 79.1±18.7 kg, abdominal circumference (CAbd) 103±12 cm, total body fat (GCT) 32±6%, 6 minutes treadmill test (TE) 317±115m, systolic blood pressure (PAS) 134±15 mmHg. At 3 and 6 m there were decrease in CAbd and GCT in the total sample, increase in the TE distance in the total sample and GEF, as well a decrease in the PAS in the total sample. Despite both groups showed a numeric increase in the TE distance, the paired analysis favored GEF. The self-related PA, through IPAQ, revealed an increase in the energy expenditure and a decrease in the seated time in the total sample, as well a increase in the intensity of PA and weekly energy expenditure in the GEF. Conclusion: EF oriented PA has better performance in hypertensive patients.

Introduction

The practice of physical activity (PA) is associated with greater longevity, welfare, prevention, and disease treatment, among them systemic arterial hypertension (SAH) [1].  The realization of exercise reduces blood pressure (BP) in hypertension [2]. In Brazil, there are approximately 30 million people with SAH, most of them are unaware of the disease and most of them do not know and have not been treated for their disease [3]. Promoting PA consistently and lasting in these patients is a challenge. Several techniques and strategies have been adopted, seeking to increase membership, from motivational lectures to public academies5 and programs such as the National Program for the Promotion of Physical Activity “Agita Brasil [16] However, the involvement of professionals, such as physical educators (PE) and the effectiveness of these programs is unclear. 

 For hypertensive patients, exercise guidance is almost exclusive to the medical professional, approximately, 92% of advice related to the practice of exercises [8]. The PE is trained for guidance with less risk of injury, seeks to minimize barriers, observe the intensity, duration and frequency of exercises, avoiding possible muscle and joint injuries, being able to make a PA program more effective and facilitate adherence. There are no studies evaluating the role of PE in improving adherence to PA compared to traditional medical advice. The present study aims to compare, in a randomized way, the efficiency of PE or physician guidance in aerobic performance and in reported PA.

Methods

For this cohort, randomized and prospective study, lasting 6 months, hypertensive patients were invited hypertensive patients, without contraindication for the performance of PA, of both genders, aged 50 years or more, treated at the nephrology clinic at Univille, Joinville - SC. Randomization resulted in an oriented group - PE (GPE) and a control group (CG), guided by doctors. Exclusion criteria were: inability to carry out the proposed activities, inability to understand the free and informed consent term or the guidelines provided, physical or clinical conditions that prevent or have contraindications to performing PA, such as decompensated heart failure or unstable angina pectoris, age < 50>

For further analysis, the activity level was categorized into three intensity strata: low, moderate or high, according to the value of MET-minutes/week –[45].

Briefly, the combination of any walking activity, of moderate intensity or vigorous, with values ​​above 600 and below 3000 MET-minutes / week was classified as moderate, and values ​​above 3000 MET-minutes/week were classified as vigorous [45].Low intensity was defined when it did not reach the values ​​for the other categories. Randomization was performed using an electronic spreadsheet, with a random function. The PEG was guided by the PE (P.S.S), received explanatory material printed with photos of exercises that could be performed in the residence or in public squares with outdoor gym equipment in Joinville-SC; these are called best age gyms (BAG), still a video of the same exercises, in compact disc format.

Guidance included which exercises to perform, the correct mode of execution, intensity and frequency. Based on the research subject's address, the PE suggested which BAG would be the closest to their home, using the home distance - BAG as a walk.

The exercises followed an order from the upper limb to the lower limb, seeking to avoid fatigue. For each of the exercises, fifteen repetitions were suggested in a sequence of 3 sets and a minimum frequency of 3 times a week, with a maximum of 5 times a week. At the end of the daily activities, a light stretching was recommended. For the performance at home, functional exercises were chosen using the body's own weight or, at most, 1 kg (suggested use of bagged foods of 1 kg) to provide light resistance. The use of simple features from the structure of the house was suggested, such as steps, chair and door. The CG was guided by the physicians (A.R.R.G.; H.N.L.), based on the PA guidelines recommended by the VI Brazilian guidelines on hypertension, which basically indicate 30 minutes of moderate PA continuously or accumulated, at least five times a week11.  The main activities stimulated were walking and the use of BAG equipment, available in various parts of the city. The initial assessment was repeated at the 3rd and 6th month, except for the IPAQ, which was repeated only at the end of the study. This project was approved by the Research Ethics Committee of Univille, University of the Region of Joinville, opinion 094/2012.The total sample was evaluated in evolution, and the groups were compared to each other at baseline, 3 months and 6 months. For categorical variables, the chi-square method and the marginal homogeneity test for paired data (baseline, 3 and 6 months, in the same group) were used. Data with normal distribution were analyzed by Student's t test, while data with non-normal distribution were analyzed by Mann-Whitney test and Wilcoxon test when samples were paired (baseline, 3 and 6 months, in the same group). the comparison evolution between groups for variables weight, BMI, CAbd, TCG, distance covered in the TE, blood pressure (for analysis, only systolic blood pressure, SBP was used) and PA scores (IPAQ), were compared using the general linear model of repeated measures. All tests were performed using SPSS software version 17.0 (Chicago, Ill). For the analysis of the TCG, individuals with a BMI above 35 kg/m2 were excluded. In the tables, the results will be expressed as “p paired” when compared evolutionarily in the same group and “p paired between groups” to compare the evolution between groups. P values ​​less than 0.05 were considered significant.

Results

From a total of 69 patients invited, 63 agreed to participate and were randomized into 34 PGE and 29 CG. Not appearing for the final analysis, and 1 patient from the CG who suffered a stroke during the study and 3 patients from the PGE (1 death and 2 dropouts) were excluded from the study. In the resulting total sample, 21 were male (36%), with mean age 64.4±9.5 years, weight 79.1±18.7 kg, BMI 31.3±7.1 kg/ m2, CAbd 103±12 cm TCG 32±6%, TE 317±115m, SBP 134±15 mmHg. When separated into groups after randomization, there were no significant differences between the studied variables, as shown in table 1. Within a period of 3 months, 55 patients were re-evaluated (4 did not appear for this evaluation, 3 from the PGE and 1 from the CG). It was possible to observe a reduction in the CAbd in the PGE, a reduction in the TCG in the total sample and in both groups, with no evolutionary difference between them; increase in distance covered in TE in the total sample and both groups, with a greater difference in the PGE compared to the CG, as shown in the evolutionary graph and reduction in SBP in the total sample and in both groups, with no evolutionary difference between groups (Table 1).

Evolutionary chart Test treadmill OS and C group (baseline, 3 and 6 months)
Table 1: Epidemiological and parametric variables by period and by group.
a p evolutionary pair of 0 and 3 months < 0>

At the end of 6 months, 59 patients were re-evaluated. An evolutionary analysis of 0, 3 and 6 months showed results similar to those of 3 months, such as a reduction in CAbd of the total sample and of both groups, reduction in TCG in the total sample and in both groups, increase in the distance covered in the TE in the total sample and in both groups, and reduction in SBP in the total sample and both groups. Although both groups increased the distance walked in the ET at 3 and 6 months, this was the only evolutionary difference between them, favoring the PGE (Table 1).A significant number of patients reported performing activities of moderate or high intensity in the baseline period (78% of the sample), a value that increased even more after 6 months in the total sample (83%, p<0 xss=removed>p<0>

Table 2: Physical Activity scores grouped by domain, period and by group and categorized into IPAQ physical activity intensity
Results presented as median and interquartile range, in MET-minutes/week. # Result in n (%) a. p pair evolutionary baseline and 6 months < 0 xss=removed>05; b p pair evolutionary OG vs CG < 0>

Discussion

Promoting consistent PA in hypertensive patients is possible, as demonstrated in the present study. Even after 6 months, the evaluated parameters indicated a consistent increase in PA. When the activity orientation is carried out by PE, the effectiveness is greater. These results are relevant, as it is possible to imagine that the adoption of a similar approach in public health services could have an impact on the reduction of cardiovascular events, by promoting a reduction in blood pressure. In Brazil, it is estimated that about 52% of individuals with SAH are aware of the diagnosis of the disease. Of these, about 35% are treated and only 13.7

Conclusion

The results of this study allow us to conclude that it is possible to promote physical activity with a lasting effect in hypertensive patients. Both methods had positive results, but the results are better when the orientations are carried out in a systematic way by a physical educator, especially regarding aerobic capacity. Additional, long-term studies using cardiovascular events as endpoints are needed.

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Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad