Impacto de diferentes testes de avaliação funcional sobre o sistema cardiorrespiratório e subjetivo de mulheres obesas: implementando recursos em protótipo para avaliação funcional
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2015-01-12Autor
Luporini, Luciana Di Thommazo
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Obesity is considered a worldwide epidemic, with high prevalence in females. It
is associated to increased mortality rates due to adverse consequences, such as
cardiovascular and metabolic diseases. In addition, obese individuals show
impaired cardiorespiratory fitness and functional capacity. In this context, we
have proposed two observational and cross-sectional studies that could
contribute to the understanding the cardiovascular, metabolic, ventilatory, and
perceptual responses in this population to different exercise tests, such as the
maximum cardiopulmonary test (CPX), considered the gold standard assessment
for cardiorespiratory fitness, as well as functional field tests, which were less
expensive and more similar to daily activities, such as the six-minute walk test
(6MWT), incremental shuttle walk test (ISWT), and the six-minute step test
(6MST). Moreover, we have proposed an innovative step ergometer, which
provides a performance recorder and a software for following the user´s
progression. The first study é entitled "Are cardiovascular and metabolic
responses to field walking tests interchangeable and obesity-dependent?". Aimed
to investigate if the physiological responses to the ISWT and 6MWT were in
agreement with those obtained in CPX and determine if the submaximal tests
could be interchangeable in obese women and controls. Fifty one obese women
were evaluated (ObG) and 21 controls (CG) through clinical evaluation, CPX,
ISWT and 6MWT. There was agreement between CPX and both the 6MWT
[oxygen uptake (VO2, mL•kg-1•min-1) = 6.9 (CI: 5.7-8.1), and heart rate (bpm) =
37.0 (CI: 33.3-40.7)] and ISWT [VO2 (mL•kg-1•min-1) = 6.1 (CI: 4.9-7.3), and heart
rate (bpm) = 36.2 (CI: 32.1-40.3)]. We found similar cardiovascular and metabolic
responses to both tests in the ObG but not in the CG. Strong correlations were
demonstrated between 6MWT and ISWT variables: VO2 (r=0.70); dyspnea
(r=0.80); and, leg fatigue (r=0.70). The 6MWT and the ISWT may both hold
interchangeable clinical value when contrasted with CPX in obese women and
may be a viable alternative in the clinical setting when resources and staffing are
limited. The second study was entitled "Six-minute step test as a predictor of
cardiorespiratory fitness in obese women" and aimed to assess the 6MST
accuracy to determinate cardiorespiratory fitness (CRF) and its ability to predict
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peak oxygen uptake (VO2) and heart rate (HR) achieved during CPX in sedentary
obese women. Fifty-six sedentary obese women underwent clinical evaluation,
CPX and 6MST. There was a satisfactory concurrent validity between the CPX
and 6MST, with a mean difference of 5.1±3.6 mL•kg-1•min-1 and 23±13 bpm in
relation to peak VO2 and HR, respectively. The 6MST demonstrated moderate
accuracy in predicting CPX responses (area under the curve: 0.72, 95% CI: 0.59
- 0.83). The number of step cycles and peak HR during the 6MST explained 31%
and 39% of the total variance in peak VO2 and HR obtained during CPX,
respectively. We conclude that the 6MST is accurate to discriminate obese
women with an adequate CRF from women with a poor status and it can predict
metabolic and cardiovascular maximal exercise values, as well as it may be a
valid means of assessing CRF in sedentary obese women, particularly in clinical
settings where space and resources are limited. The third study is related to a
proposal of a innovative utility model registered in the Instituto Nacional de
Propriedade Intelectual, in Brazil, as a patent and is entitled "constructive
provision introduced in portable exercise step with performance recorder and
software." The exercise step aims to fill a gap in the current trade showing
improvements over currently available steps, regarding performance, usability,
cost, portability, maintenance, safety and ergonomics. Financial support:
Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq
141331/2011-9), Brasília, DF, Brasil; and, Fundação de Amparo à Pesquisa do
Estado de São Paulo (FAPESP 2009/01842-0).