Supervised training in primary care units but not spontaneous physical activity lowered cardiovascular risk in Brazilian low-income patients: a controlled trial

Abstract

Background: Public health strategies to increase physical activity in low-income communities may reduce cardiovascular risk in these populations. This controlled trial compared the cardiovascular risk estimated by the Framingham Risk Score (FRS) over 12 months in formally active (FA), declared active (DA), and physically inactive (PI) patients attended by the ‘Family Health Strategy’ in low-income communities at Rio de Janeiro City, Brazil (known as ‘favelas’). Methods: Patients were matched for age and assigned into three groups: a) FA (supervised training, n=53; 60.5±7.7 yrs); b) DA (self-reported, n=43; 57.0±11.2 yrs); c) PI (n=48; 57.0±10.7 yrs). FA performed twice a week a 50-min exercise circuit including strength and aerobic exercises, complemented with 30-min brisk walking on the third day, whereas DA declared to perform spontaneous physical activity twice a week. Comparisons were adjusted by sex, chronological age, body mass index, and use of anti-hypertensive/statin medications. Results: At baseline, groups were similar in regards to body mass, body mass index, triglycerides, and LDL-C, as well to FRS and most of its components (age, blood pressure, hypertension prevalence, smoking, HDL-C, and total cholesterol; P>0.05). However, diabetes prevalence was 10-15% lower in DA vs. FA and PI (P<0.05). Intention-to-treat analysis showed significant reductions after intervention (P<0.05) in FA for total cholesterol (~10%), LDL-C (~15%), triglycerides (~10%), systolic blood pressure (~8%), and diastolic blood pressure (~9%). In DA, only LDL-C decreased (~10%, P < 0.05). Significant increases were found in PI (P<0.05) for total cholesterol (~15%), LDL-C (~12%), triglycerides (~15%), and systolic blood pressure (~5%). FRS lowered 35% in FA (intention-to-treat, P<0.05), remained stable in DA (P>0.05), and increased by 20% in PI (P<0.05). Conclusions: A supervised multi-modal exercise training developed at primary care health units reduced the cardiovascular risk in adults living in very low-income communities. The risk remained stable in patients practicing spontaneous physical activity and increased among individuals who remained physically inactive. These promising results should be considered within public health strategies to prevent cardiovascular disease in communities with limited resources. Trial registration: TCTR20181221002 (registered December 21, 2018; retrospectively registered).

Effects of Supervised Versus Unsupervised Aerobic Exercise Training on Weight Loss, Functional Capacity, Quality of Life and Depression Level in Patients With Essential Hypertension

“…36 According to the previous studies, the duration of aerobic exercise for improvement of serum lipid levels is mostly 8 weeks and over. 13,37 In the present study, we found that supervised aerobic exercise training increased HDL cholesterol by 0.6 mg/dl, and reduced LDL cholesterol and triglycerides by 1.3 mg/dl and 12.5 mg/dl, respectively after 6 weeks. However, these differences were not statistically significant.…”

“…Group 2 received a standard recommendation for patients with hypertension, having declared to perform a walking in the free time, at least twice a week over the experimental period, but without supervision. 13…”

“…11,12 Previous studies have reported that hypertension patients have low long-term compliance with exercise programs. 3,13 The poor adherence to exercise as antihypertensive therapy underscores the need for the supervised aerobic exercise training to increase the motivation to exercise that possibly would favorably impact exercise adherence among patients with hypertension. 3 Aerobic exercise training relates to cardiovascular health such as functional capacity, weight loss, quality of life (QoL) and depression level in patients with hypertension.…”

“…17,20 Many studies have shown that aerobic exercise has potentially positive effects on some psychiatric conditions, such as anxiety and depression. 18,21,22 Although it is important, the effect of supervised versus unsupervised aerobic exercise training program on weight loss, functional capacity, QoL and depression level in hypertensive subjects has been poorly investigated 13,17,18,23 and none of the studies has examined all these parameters collectively in the same patient group. 24,25 Thus, the present trial aimed to evaluate the effects of a supervised aerobic exercise training program on weight loss, functional capacity, QoL and depression level in patients with essential hypertension.…”