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Resumen El objetivo de este estudio fue conocer el impacto de la estrategia de autorregulación de Contraste Mental e Intenciones de Implementación (MCII) como complemento de una intervención con base en el Enfoque del Proceso de Acción en Salud (HAPA) para realizar ejercicio. Fueron reclutados 76 participantes con sobrepeso (índice de masa corporal [IMC]≥25) que querían perder peso (Medad =40 años; MIMC=29). Los participantes fueron asignados al azar a dos condiciones: HAPA (n=36) y HAPA+MCII (n=40). Las variables de interés (horas de ejercicio auto reportadas, medidas corporales y salud psicológica con DASS-21 e IWQOL-Lite) se midieron al inicio, en la semana 6 y en la 12. Encontramos un aumento significativo en las horas de ejercicio y disminución significativa del IMC y IWQOL-Lite Estado Físico y Autoestima al comparar las ocasiones de medición para la muestra total. Se observaron mayores efectos del protocolo HAPA+MCII que del HAPA en las variables de estudio, con excepción de las variables Ansiedad del DASS-21 y Vida sexual del IWQOL-Lite. Sin embargo, en ningún caso las diferencias resultaron estadísticamente significativas. El estudio indica el papel fundamental que desempeñan la autoeficacia y su operacionalización en el logro de una intervención exitosa. Al combinar dos protocolos, se recomienda considerar el efecto de techo que se puede obtener con un solo protocolo.
Abstrac The objective of this study was to understand the impact of the Mental Contrasting and Implementation Intentions (MCII) self-regulation technique as a complement to an intervention based on the Health Action Process Approach (HAPA) to perform exercise. Seventy-six participants with body mass index (BMI) ≥25 who wanted to lose weight (Mage =40 years; MBMI =29) were recruited. Participants were randomized into two conditions: HAPA (n=36) and HAPA + MCII (n=40). The variables of interest (self-reported hours of exercise, body measurements and psychological health with DASS-21 and IWQOL-Lite) were measured at the beginning, in week 6 and in 12. We found a significant increase in the hours of exercise and significant decrease in BMI and IWQOL-Lite Physical Functioning and Self-esteem when comparing the occasions of measurement for the total sample. Greater effects of the HAPA + MCII protocol were observed than of the HAPA for the study variables, with the exception of the DASS-21 Anxiety and the IWQOL-Lite Sexual life. However, the differences were not statistically significant. The study indicates the important role of self-efficacy and its operationalization for a successful intervention. When combining two protocols, the ceiling effect that can be obtained with a single protocol should be considered.
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Heart rate variability (HRV) is a method used to evaluate the presence of cardiac autonomic neuropathy (CAN) because it is usually attributed to oscillations in cardiac autonomic nerve activity. Recent studies in other pathologies suggest that HRV indices are strongly related to mean heart rate, and this does not depend on autonomic activity only. This study aimed to evaluate the correlation between the mean heart rate and the HRV indices in women patients with well-controlled T2DM and a control group. HRV was evaluated in 19 T2DM women and 44 healthy women during basal supine position and two maneuvers: active standing and rhythmic breathing. Time-domain (SDNN, RMSSD, pNN20) and frequency-domain (LF, HF, LF/HF) indices were obtained. Our results show that meanNN, age, and the maneuvers are the main predictors of most HRV indices, while the diabetic condition was a predictor only for pNN20. Given the known reduced HRV in patients with T2DM, it is clinically important that much of the HRV indices are dependent on heart rate irrespective of the presence of T2DM. Moreover, the multiple regression analyses evidenced the multifactorial etiology of HRV.
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Metabolic homeostasis emerges from the interplay between several feedback systems that regulate the physiological variables related to energy expenditure and energy availability, maintaining them within a certain range. Although it is well known how each individual physiological system functions, there is little research focused on how the integration and adjustment of multiple systems results in the generation of metabolic health. The aim here was to generate an integrative model of metabolism, seen as a physiological network, and study how it changes across the human lifespan. We used data from a transverse, community-based study of an ethnically and educationally diverse sample of 2572 adults. Each participant answered an extensive questionnaire and underwent anthropometric measurements (height, weight, and waist), fasting blood tests (glucose, HbA1c, basal insulin, cholesterol HDL, LDL, triglycerides, uric acid, urea, and creatinine), along with vital signs (axillar temperature, systolic, and diastolic blood pressure). The sample was divided into 6 groups of increasing age, beginning with less than 25 years and increasing by decades up to more than 65 years. In order to model metabolic homeostasis as a network, we used these 15 physiological variables as nodes and modeled the links between them, either as a continuous association of those variables, or as a dichotomic association of their corresponding pathological states. Weight and overweight emerged as the most influential nodes in both types of networks, while high betweenness parameters, such as triglycerides, uric acid and insulin, were shown to act as gatekeepers between the affected physiological systems. As age increases, the loss of metabolic homeostasis is revealed by changes in the network's topology that reflect changes in the system-wide interactions that, in turn, expose underlying health stages. Hence, specific structural properties of the network, such as weighted transitivity, i.e., the density of triangles in the network, can provide topological indicators of health that assess the whole state of the system. Overall, our findings show the importance of visualizing health as a network of organs and/or systems, and highlight the importance of triglycerides, insulin, uric acid and glucose as key biomarkers in the prevention of the development of metabolic disorders.
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Metabolic disorders, such as obesity, elevated blood pressure, dyslipidemias, insulin resistance, hyperglycemia, and hyperuricemia have all been identified as risk factors for an epidemic of important and widespread chronic-degenerative diseases, such as type 2 diabetes and cardiovascular disease, that constitute some of the world's most important public health challenges. Their increasing prevalence can be associated with an aging population and to lifestyles within an obesogenic environment. Taking educational level as a proxy for lifestyle, and using both logistic and linear regressions, we study the relation between a wide set of metabolic biomarkers, and educational level, body mass index (BMI), age, and sex as correlates, in a population of 1,073 students, academic and non-academic staff at Mexico's largest university (UNAM). Controlling for BMI and sex, we consider educational level and age as complementary measures-degree and duration-of exposure to metabolic insults. Analyzing the role of education across a wide spectrum of educational levels (from primary school to doctoral degree), we show that higher education correlates to significantly better metabolic health when compared to lower levels, and is associated with significantly less risk for waist circumference, systolic blood pressure, glucose, glycosylated hemoglobin, triglycerides, high density lipoprotein and metabolic syndrome (all p < 0.05); but not for diastolic blood pressure, basal insulin, uric acid, low density lipoprotein, and total cholesterol. We classify each biomarker, and corresponding metabolic disorder, by its associated set of statistically significant correlates. Differences among the sets of significant correlates indicate various aetiologies and the need for targeted population-specific interventions. Thus, variables strongly linked to educational level are candidates for lifestyle change interventions. Hence, public policy efforts should be focused on those metabolic biomarkers strongly linked to education, while adopting a different approach for those biomarkers not linked as they may be poor targets for educational campaigns.
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Diabetes Mellitus Tipo 2 , Síndrome Metabólica , Idoso , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Síndrome Metabólica/epidemiologia , Obesidade , Circunferência da CinturaRESUMO
Background:Diabetes affects approximately 250 million people in the world. Cardiovascular autonomic neuropathy is a common complication of diabetes that leads to severe postural hypotension, exercise intolerance, and increased incidence of silent myocardial infarction.Objective:To determine the variability of heart rate (HR) and systolic blood pressure (SBP) in recently diagnosed diabetic patients.Methods:The study included 30 patients with a diagnosis of type 2 diabetes of less than 2 years and 30 healthy controls. We used a Finapres® device to measure during five minutes beat-to-beat HR and blood pressure in three experimental conditions: supine position, standing position, and rhythmic breathing at 0.1 Hz. The results were analyzed in the time and frequency domains.Results:In the HR analysis, statistically significant differences were found in the time domain, specifically on short-term values such as standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), and number of pairs of successive NNs that differ by more than 50 ms (pNN50). In the BP analysis, there were no significant differences, but there was a sympathetic dominance in all three conditions. The baroreflex sensitivity (BRS) decreased in patients with early diabetes compared with healthy subjects during the standing maneuver.Conclusions:There is a decrease in HR variability in patients with early type 2 diabetes. No changes were observed in the BP analysis in the supine position, but there were changes in BRS with the standing maneuver, probably due to sympathetic hyperactivity.
Fundamento:O diabetes afeta aproximadamente 250 milhões de pessoas no mundo. A neuropatia autonômica cardiovascular é uma complicação comum do diabetes que leva à hipotensão postural grave, intolerância ao exercício e aumento na incidência de infarto do miocárdio silencioso.Objetivo:Determinar a variabilidade da frequência cardíaca (FC) e da pressão arterial sistólica (PAS) em pacientes diabéticos com diagnóstico recente.Métodos:O estudo incluiu 30 pacientes com diabetes tipo 2 diagnosticado há menos de 2 anos e 30 controles saudáveis. Nós utilizamos o dispositivo Finapres® para medir durante cinco minutos a FC batimento-a-batimento e a pressão arterial (PA) em três condições experimentais: posição supina, em pé e durante respiração rítmica na frequência de 0,1 Hz. Os resultados foram analisados nos domínios do tempo e da frequência.Resultados:Em relação à FC, foram encontradas diferenças estatisticamente significativas nos valores da análise do domínio do tempo, especificamente em valores determinados a curto prazo, tais como o desvio-padrão dos intervalos NN (DPNN), a raiz quadrada da média das diferenças sucessivas (RQMDS) para a FC e o número de pares de NNs sucessivos que diferem em mais de 50 ms (pNN50). Não houve diferença significativa na análise da PA, mas houve uma dominância simpática nas três condições. A sensibilidade do barorreflexo (SBR) esteve diminuída em pacientes com diabetes de início recente, em comparação aos indivíduos saudáveis durante execução da manobra na posição ortostática.Conclusões:Há uma diminuição na variabilidade da FC em pacientes com diabetes tipo 2 de início recente. Não foram observadas alterações na análise da PA na posição supina, mas a SBR apresentou mudança com a manobra em pé provavelmente causada por hiperatividade simpática.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão Sanguínea/fisiologia , /fisiopatologia , Frequência Cardíaca/fisiologia , Sistema Nervoso Autônomo/fisiopatologia , Barorreflexo/fisiologia , Estudos de Casos e Controles , Neuropatias Diabéticas/fisiopatologia , Postura/fisiologia , Fatores de TempoRESUMO
BACKGROUND: Diabetes affects approximately 250 million people in the world. Cardiovascular autonomic neuropathy is a common complication of diabetes that leads to severe postural hypotension, exercise intolerance, and increased incidence of silent myocardial infarction. OBJECTIVE: To determine the variability of heart rate (HR) and systolic blood pressure (SBP) in recently diagnosed diabetic patients. METHODS: The study included 30 patients with a diagnosis of type 2 diabetes of less than 2 years and 30 healthy controls. We used a Finapres® device to measure during five minutes beat-to-beat HR and blood pressure in three experimental conditions: supine position, standing position, and rhythmic breathing at 0.1 Hz. The results were analyzed in the time and frequency domains. RESULTS: In the HR analysis, statistically significant differences were found in the time domain, specifically on short-term values such as standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), and number of pairs of successive NNs that differ by more than 50 ms (pNN50). In the BP analysis, there were no significant differences, but there was a sympathetic dominance in all three conditions. The baroreflex sensitivity (BRS) decreased in patients with early diabetes compared with healthy subjects during the standing maneuver. CONCLUSIONS: There is a decrease in HR variability in patients with early type 2 diabetes. No changes were observed in the BP analysis in the supine position, but there were changes in BRS with the standing maneuver, probably due to sympathetic hyperactivity.