Envelhecimento saudável e atividade física: uma revisão sistemática sobre os efeitos do exercício nas doenças cardiovasculares

Autores

  • André Luiz Estrela IPB, Laboratório de Imunologia do Envelhecimento
  • Moisés Evandro Bauer IPB, Laboratório de Imunologia do Envelhecimento, Faculdade de Biociências, PUCRS

DOI:

https://doi.org/10.15448/1980-6108.2017.1.25837

Palavras-chave:

envelhecimento, doenças cardiovasculares, exercício aeróbico, educação física e treinamento.

Resumo

DOI: 10.15448/1980-6108.2017.1.25837

Objetivos: Realizar uma revisão sistemática dos ensaios clínicos randomizados que avaliaram os benefícios do exercício físico (regular ou competitivo) para a saúde de idosos e a prevenção de doenças cardiovasculares.

Métodos: Foram investigados os registros no Pubmed, Web of Science, Library of Congress, Central de Registros Cochrane e as bases de dados com os registros dos ensaios clínicos de 2005 a 2016, juntamente com os anais das maiores conferências sobre doenças cardiovasculares no envelhecimento usando os termos definidos de acordo com a metodologia "paciente, intervenção, comparação e resultado". Os descritores utilizados foram physical effort, exercise, exercise therapy, physical activity, physical fitness, resistance training, cardiovascular disease, C-reactive protein, dyslipidemia, heart failure, cardiac insufficiency, revascularization, cardiac stent e heart transplant. Somente foram incluídos ensaios clínicos randomizados, com indivíduos acima de 60 anos de idade. Os artigos foram avaliados independentemente por dois avaliadores.

Resultados: Foram acessados um total de 3672 estudos e foram eleitos os 24 que preencheram os critérios de inclusão. A maioria desses estudos descreviam amostras reduzidas e apresentavam o exercício físico como um componente para a saúde. Apenas 16 estudos apresentavam relação da aderência à prática de exercícios físicos como prevenção cardiovascular. As medidas de resultados incluem fatores de qualidade de vida, capacidade física ou estado de condicionamento físico, força muscular, frequência cardíaca, aspectos psicológicos, marcadores inflamatórios e nutricionais e a progressão de doenças cardiovasculares. As evidências mais fortes apontam para os efeitos do exercício aeróbico na melhoria da capacidade física, força muscular e qualidade de vida de pacientes idosos com doença cardiovascular.

Conclusões: Os benefícios do treinamento físico para pacientes idosos com doença cardiovascular estão bem estabelecidos, apoiando a prescrição de exercícios físicos nos seus tratamentos regulares. Intervenções que utilizam o exercício precisam ser progressivamente incluídas nos regimes dos centros de tratamento cardiovascular, embora o melhor protocolo de exercícios para pacientes com doença cardiovascular ainda não esteja completamente estabelecido.

Downloads

Não há dados estatísticos.

Referências

Partridge L. The new biology of ageing. Philos Trans R Soc Lond B Biol Sci. 2010 Jan 12;365(1537):147-54. https://doi.org/10.1098/rstb.2009.0222

Flicker L. Cardiovascular risk factors, cerebrovascular disease burden, and healthy brain aging. Clin Geriatr Med. 2010 Feb;26(1):17-27. https://doi.org/10.1016/j.cger.2009.12.005

Huffman DM. Exercise as a calorie restriction mimetic: implications for improving healthy aging and longevity. Interdiscip Top Gerontol. 2010;37:157-74. https://doi.org/10.1159/000320000

Ji LL, Dickman JR, Kang C, Koenig R. Exercise-induced hormesis may help healthy aging. Dose Response. 2010 Jan 28;8(1):73-9. https://doi.org/10.2203/dose-response.09-048.Ji

Muscari A, Giannoni C, Pierpaoli L, Berzigotti A, Maietta P, Foschi E, Ravaioli C, Poggiopollini G, Bianchi G, Magalotti D, Tentoni C, Zoli M. Chronic endurance exercise training prevents aging-related cognitive decline in healthy older adults: a randomized controlled trial. Int J Geriatr Psychiatry. 2010 Oct;25(10):1055-64. https://doi.org/10.1002/gps.2462

Rolland Y, Abellan van Kan G, Vellas B. Healthy brain aging: role of exercise and physical activity. Clin Geriatr Med. 2010 Feb;26(1):75-87. https://doi.org/10.1016/j.cger.2009.11.002

Davis JW, Chung R, Juarez DT. Prevalence of comorbid conditions with aging among patients with diabetes and cardiovascular disease. Int J Geriatr Psychiatry. 2010 Oct;25(10):1055-64.

Partridge L. Diet and healthy aging. N Engl J Med. 2012 Dec 27;367(26):2550-1. https://doi.org/10.1056/NEJMcibr1210447

Santos-Parker JR, LaRocca TJ, Seals DR. Aerobic exercise and other healthy lifestyle factors that influence vascular aging. Adv Physiol Educ. 2014 Dec;38(4):296-307. https://doi.org/10.1152/advan.00088.2014

van Empel VP, Kaye DM, Borlaug BA. Effects of healthy aging on the cardiopulmonary hemodynamic response to exercise. Am J Cardiol. 2014 Jul 1;114(1):131-5. https://doi.org/10.1016/j.amjcard.2014.04.011

Lesniewski LA, Zigler ML, Durrant JR, Nowlan MJ, Folian BJ, Donato AJ, Seals DR. Aging compounds western diet-associated large artery endothelial dysfunction in mice: prevention by voluntary aerobic exercise. Exp Gerontol. 2013 Nov;48(11):1218-25. https://doi.org/10.1016/j.exger.2013.08.001

Willcox DC, Scapagnini G, Willcox BJ. Healthy aging diets other than the Mediterranean: a focus on the Okinawan diet. Mech Ageing Dev. 2014 Mar-Apr;136-137:148-62. https://doi.org/10.1016/j.mad.2014.01.002

Bolduc V, Thorin-Trescases N, Thorin E. Endothelium-dependent control of cerebrovascular functions through age: exercise for healthy cerebrovascular aging. American journal of physiology Am J Physiol Heart Circ Physiol. 2013 Sep 1;305(5):H620-33. https://doi.org/10.1152/ajpheart.00624.2012

Joyner MJ. Buying into healthy blood vessels: exercise and aging. J Appl Physiol (1985). 2014 Sep 1;117(5):421-2.

Wister AV. Population pressures, system-level inertia and healthy aging policy revisited. Healthc Pap. 2011;11(1):41-5; discussion 86-91. https://doi.org/10.12927/hcpap.2011.22251

Bori Z, Zhao Z, Koltai E, Fatouros IG, Jamurtas AZ, Douroudos II, Terzis G, Chatzinikolaou A, Sovatzidis A, Draganidis D, Boldogh I, Radak Z. The effects of aging, physical training, and a single bout of exercise on mitochondrial protein expression in human skeletal muscle. Exp Gerontol. 2012 Jun;47(6):417-24. https://doi.org/10.1016/j.exger.2012.03.004

North BJ, Sinclair DA. The intersection between aging and cardiovascular disease. Circ Res. 2012 Apr 13;110(8):1097-108. https://doi.org/10.1161/CIRCRESAHA.111.246876

Gast U, Belavý DL, Armbrecht G, Kusy K, Lexy H, Rawer R, Rittweger J, Winwood K, Zieliński J, Felsenberg D. Bone density and neuromuscular function in older competitive athletes depend on running distance. Osteoporos Int. 2013 Jul;24(7):2033-42. https://doi.org/10.1007/s00198-012-2234-0

Heo J, Culp B, Yamada N, Won Y. Promoting successful aging through competitive sports participation: insights from older adults. Qual Health Res. 2013 Jan;23(1):105-13. https://doi.org/10.1177/1049732312457247

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Reprint--preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther. 2009 Sep;89(9):873-80.

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009 Oct;62(10):1006-12. https://doi.org/10.1016/j.jclinepi.2009.06.005

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011 Oct 18;343:d5928. https://doi.org/10.1136/bmj.d5928

de Souto Araujo ZT, de Miranda Silva Nogueira PA, Cabral EE, de Paula Dos Santos L, da Silva IS, Ferreira GM. Effectiveness of low-intensity aquatic exercise on COPD: a randomized clinical trial. Respir Med. 2012 Nov;106(11):1535-43. https://doi.org/10.1016/j.rmed.2012.06.022

Fayh AP, Lopes AL, da Silva AM, Reischak-Oliveira A, Friedman R. Effects of 5 % weight loss through diet or diet plus exercise on cardiovascular parameters of obese: a randomized clinical trial. Eur J Nutr. 2013 Aug;52(5):1443-50. https://doi.org/10.1007/s00394-012-0450-1

Taylor JD, Fletcher JP, Mathis RA, Cade WT. Effects of moderate- versus high-intensity exercise training on physical fitness and physical function in people with type 2 diabetes: a randomized clinical trial. Phys Ther. 2014 Dec;94(12):1720-30. https://doi.org/10.2522/ptj.20140097

Lakoski SG, Savage PD, Berkman AM, Penalosa L, Crocker A, Ades PA, Kahn SR, Cushman M. The safety and efficacy of early-initiation exercise training after acute venous thromboembolism: a randomized clinical trial. J Thromb Haemost. 2015 Jul;13(7):1238-44. https://doi.org/10.1111/jth.12989

Schneider KL, Pagoto SL, Handschin B, Panza E, Bakke S, Liu Q, Blendea M, Ockene IS, Ma Y. Design and methods for a pilot randomized clinical trial involving exercise and behavioral activation to treat comorbid type 2 diabetes and major depressive disorder. Ment Health Phys Act. 2011 Jun 1;4(1):13-21. https://doi.org/10.1016/j.mhpa.2011.04.001

Winter MM, van der Bom T, de Vries LC, Balducci A, Bouma BJ, Pieper PG, van Dijk AP, van der Plas MN, Picchio FM, Mulder BJ. Exercise training improves exercise capacity in adult patients with a systemic right ventricle: a randomized clinical trial. Eur Heart J. 2012 Jun;33(11):1378-85. https://doi.org/10.1093/eurheartj/ehr396

Redfield MM, Chen HH, Borlaug BA, Semigran MJ, Lee KL, Lewis G, LeWinter MM, Rouleau JL, Bull DA, Mann DL, Deswal A, Stevenson LW, Givertz MM, Ofili EO, O'Connor CM, Felker GM, Goldsmith SR, Bart BA, McNulty SE, Ibarra JC, Lin G, Oh JK, Patel MR, Kim RJ, Tracy RP, Velazquez EJ, Anstrom KJ, Hernandez AF, Mascette AM, Braunwald E; RELAX Trial. Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial. JAMA. 2013 Mar 27;309(12):1268-77. https://doi.org/10.1001/jama.2013.2024

Santaularia N, Caminal J, Arnau A, Perramon M, Montesinos J, Trapé J, Abenoza-Guardiola M, Guiteras-Val P, Jaarsma T. Randomized clinical trial to evaluate the effect of a supervised exercise training program on readmissions in patients with myocardial ischemia: a study protocol. BMC Cardiovasc Disord. 2013 Apr 25;13:32. https://doi.org/10.1186/1471-2261-13-32

Jakubseviciene E, Vasiliauskas D, Velicka L, Kubilius R, Milinaviciene E, Vencloviene J. Effectiveness of a new exercise program after lower limb arterial blood flow surgery in patients with peripheral arterial disease: a randomized clinical trial. Int J Environ Res Public Health. 2014 Aug 7;11(8):7961-76. https://doi.org/10.3390/ijerph110807961

Bø E, Bergland A, Stranden E, Jørgensen JJ, Sandbaek G, Grøtta OJ, Hisdal J. Effects of 12 Weeks of Supervised Exercise After Endovascular Treatment: A Randomized Clinical Trial. Physiother Res Int. 2015 Sep;20(3):147-57. https://doi.org/10.1002/pri.1608

Cesa CC, Barbiero SM, Petkowicz Rde O, Martins CC, Marques Rd, Andreolla AA, Pellanda LC. Effectiveness of physical exercise to reduce cardiovascular risk factors in youths: a randomized clinical trial. J Clin Med Res. 2015 May;7(5):348-55. https://doi.org/10.14740/jocmr1700w

Chrysohoou C, Angelis A, Tsitsinakis G, Spetsioti S, Nasis I, Tsiachris D, Rapakoulias P, Pitsavos C, Koulouris NG, Vogiatzis I, Dimitris T. Cardiovascular effects of high-intensity interval aerobic training combined with strength exercise in patients with chronic heart failure. A randomized phase III clinical trial. Int J Cardiol. 2015 Jan 20;179:269-74. https://doi.org/10.1016/j.ijcard.2014.11.067

Jung CH, Park CY, Ahn KJ, Kim NH, Jang HC, Lee MK, Park JY, Chung CH, Min KW, Sung YA, Park JH, Kim SJ, Lee HJ, Park SW. A randomized, double-blind, placebo-controlled, phase II clinical trial to investigate the efficacy and safety of oral DA-1229 in patients with type 2 diabetes mellitus who have inadequate glycaemic control with diet and exercise. Diabetes Metab Res Rev. 2015 Mar;31(3):295-306. https://doi.org/10.1002/dmrr.2613

Li X, Xu S, Zhou L, Li R, Wang J. Home-Based Exercise in Older Adults Recently Discharged From the Hospital for Cardiovascular Disease in China: Randomized Clinical Trial. Nurs Res. 2015 Jul-Aug;64(4):246-55. https://doi.org/10.1097/NNR.0000000000000102

Motahari-Tabari N, Ahmad Shirvani M, Shirzad EAM, Yousefi-Abdolmaleki E, Teimourzadeh M. The effect of 8 weeks aerobic exercise on insulin resistance in type 2 diabetes: a randomized clinical trial. Glob J Health Sci. 2014 Aug 14;7(1):115-21. https://doi.org/10.5539/gjhs.v7n1p115

Mazari FA, Khan JA, Carradice D, Samuel N, Abdul Rahman MN, Gulati S, Lee HL, Mehta TA, McCollum PT, Chetter IC. Randomized clinical trial of percutaneous transluminal angioplasty, supervised exercise and combined treatment for intermittent claudication due to femoropopliteal arterial disease. Br J Surg. 2012 Jan;99(1):39-48. https://doi.org/10.1002/bjs.7710

Taylor-Piliae RE, Boros D, Coull BM. Strategies to improve recruitment and retention of older stroke survivors to a randomized clinical exercise trial. J Stroke Cerebrovasc Dis. 2014 Mar;23(3):462-8. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.03.031

Meid AD, Quinzler R, Freigofas J, Saum KU, Schöttker B, Holleczek B, Heider D, König HH, Brenner H, Haefeli WE. Medication Underuse in Aging Outpatients with Cardiovascular Disease: Prevalence, Determinants, and Outcomes in a Prospective Cohort Study. PLoS One. 2015 Aug 19;10(8):e0136339. https://doi.org/10.1371/journal.pone.0136339

Gencer B, Auer R, de Rekeneire N, Butler J, Kalogeropoulos A, Bauer DC, Kritchevsky SB, Miljkovic I, Vittinghoff E, Harris T0, Rodondi N. Association between resistin levels and cardiovascular disease events in older adults: The health, aging and body composition study. Atherosclerosis. 2016 Feb;245:181-6. https://doi.org/10.1016/j.atherosclerosis.2015.12.004

Ortega R, Garcia-Ortiz L, Torcal J, Echevarria P, Vargas-Machuca C, Gomez A, Salcedo F, Lekuona I, Montoya I, Grandes G; ESCAP Group. Supervised exercise for acute coronary patients in primary care: a randomized clinical trial. Fam Pract. 2014 Feb;31(1):20-9. https://doi.org/10.1093/fampra/cmt059

Abd El-Kader S, Gari A, Salah El-Den A. Impact of moderate versus mild aerobic exercise training on inflammatory cytokines in obese type 2 diabetic patients: a randomized clinical trial. Afr Health Sci. 2013 Dec;13(4):857-63. https://doi.org/10.4314/ahs.v13i4.1

McDermott MM, Liu K, Guralnik JM, Criqui MH, Spring B, Tian L, Domanchuk K, Ferrucci L, Lloyd-Jones D, Kibbe M, Tao H, Zhao L, Liao Y, Rejeski WJ. Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial. JAMA. 2013 Jul 3;310(1):57-65. https://doi.org/10.1001/jama.2013.7231

Tousignant M, Corriveau H, Kairy D, Berg K, Dubois MF, Gosselin S, Swartz RH, Boulanger JM, Danells C. Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial. Trials. 2014 Jan 30;15:42. https://doi.org/10.1186/1745-6215-15-42

Fakhry F, Spronk S, van der Laan L, Wever JJ, Teijink JA, Hoffmann WH, Smits TM, van Brussel JP, Stultiens GN, Derom A, den Hoed PT, Ho GH, van Dijk LC, Verhofstad N, Orsini M, van Petersen A, Woltman K, Hulst I, van Sambeek MR, Rizopoulos D, Rouwet EV, Hunink MG. Endovascular Revascularization and Supervised Exercise for Peripheral Artery Disease and Intermittent Claudication: A Randomized Clinical Trial. JAMA. 2015 Nov 10;314(18):1936-44. https://doi.org/10.1001/jama.2015.14851

Barcellos FC, Santos IS, Umpierre D, Bohlke M, Hallal PC. Effects of exercise in the whole spectrum of chronic kidney disease: a systematic review. Clin Kidney J. 2015 Dec;8(6):753-65. https://doi.org/10.1093/ckj/sfv099

Downloads

Publicado

2017-03-30

Como Citar

Estrela, A. L., & Bauer, M. E. (2017). Envelhecimento saudável e atividade física: uma revisão sistemática sobre os efeitos do exercício nas doenças cardiovasculares. Scientia Medica, 27(1), ID25837. https://doi.org/10.15448/1980-6108.2017.1.25837

Edição

Seção

Artigos de Revisão