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
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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"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".
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.
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.
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.
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.
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.
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.
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”.
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.
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.
Khurram Arshad
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Gomez Barriga Maria Dolores
The peer reviewers process is quick and effective, the supports from editorial office is excellent,
the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Lin Shaw Chin
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project.
I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality.
We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Maria Dolores Gomez Barriga
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions,
I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients."
I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dr Maria Dolores Gomez Barriga
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing.
¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dr Maria Regina Penchyna Nieto
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions,
The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed.
The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dr Marcelo Flavio Gomes Jardim Filho
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing!
"I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Zsuzsanna Bene
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
Dr Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin.
The peer reviewers process is quick and effective, the supports from editorial office is excellent,
the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
Lin-Show Chin
My experience publishing in Psychology and Mental Health Care was exceptional.
The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work.
The editorial team was highly supportive and responsive, making the submission process smooth and efficient.
The journal's commitment to high standards and academic rigor makes it a respected platform for quality research.
I am grateful for the opportunity to publish in such a reputable journal.
Sonila Qirko
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional.
I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
Luiz Sellmann
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Zhao Jia
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery,
"The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
Thomas Urban
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient.
The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Cristina Berriozabal
To Dear Erin Aust,
I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable.
Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free.
I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
Dr Tewodros Kassahun Tarekegn
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
Dr Shweta Tiwari
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication.
This journal certainly publishes quality research articles.
I would recommend the journal for any future publications.
Dr Farooq Wandroo
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
Dr Anyuta Ivanova
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dr David Vinyes
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
Gertraud Teuchert-Noodt
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice!
I declare that I am absolutely satisfied with your work carried out with great competence
in following the manuscript during the various stages from its receipt,
during the revision process to the final acceptance for publication.
Thank
Prof. Elvira Farina
Dr Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’
I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).”
The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent.
I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation.
Sincerely and best wishes,
Dr. Oleg Golyanovskiy.
Dr Oleg Golyanovski
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
