Efeito da reabilitação cardiovascular sobre o balanço redox e a função vascular em mulheres com síndrome metabólica

Abstract

The sedentary lifestyle and eating habits allow the consolidation of modern diseases that determine different implications in circulatory or tissue function, culminating with the appearance of a multifactorial disease that compromises several organs (MATHIEU et al., 2006; 2009; PAOLETTI et al., 2006; BO et al., 2007; CABRÉ et al., 2008). The metabolic syndrome is characterized by the association of various risk factors for CVDs, such as hypertension, insulin resistance, hyperinsulinemia, glucose intolerance, DM 2, central obesity and dyslipidemia. These, in turn, result primarily from genetic and / or environmental factors, that may trigger vascular dysfunction and the consequent formation of the atherosclerotic process, responsible for the high rate of morbidity and mortality in this population (Nakazono et al., 2007). Moreover, oxidative stress, defined as an imbalance between the endogenous antioxidant defenses and reactive oxygen and nitrogen species (ERON) has an important role in the genesis and development of CVDs, and may be exacerbated in patients with metabolic syndrome (WITZTUM & STEINBERG, 1991; Dhalia et al., 2000; SOLA et al., 2005). The risk factors involved in the metabolic syndrome can affect both the physical status of patients regarding their functional capacity to perform activities of daily living, as focus on psychosocial aspect of these, limiting social contact and leisure wich compromises the emotional aspect. For all that, the quality of life of patients with metabolic syndrome may be compromised, since studies have shown that comorbidities is present in isolated syndrome and in patients who are diabetic, hypertensive and especially when they are considered to obese, the factors that limit social relations become more evident. Therefore we speculated that the imposition of a moderate energy expenditure, may improve vascular function, functional capacity and the quality of life in patients with metabolic syndrome. After a cardiovascular rehabilitation program performed 3 times per week for a total of 18 interventions in 11 patients with metabolic syndrome, we have observed significant changes in hemodynamic parameters, biometric, functional and redox balance in these patients. There was a significant reduction in waist circumference (p<0.028) after treatment, which is the parameter that most stands out in the guidelines for the diagnosis of metabolic syndrome. The laboratory tests: fasting plasma glucose and postprandial, HbA1C, triglycerides, total cholesterol and its fractions (VLDL-C, LDL-C and HDL-C), creatinine and uric acid were not altered after treatment. However we would like to emphasize that the 9 values before the beginning of the treatment were already within the normal range for HbA1C, total cholesterol, VLDL-C, creatinine and uric acid. The fasting glucose, triglycerides and HDL-C were slightly altered, while the post-prandial blood glucose and LDL-C were the most changed paramaters. The activity of SOD increased significantly (p <0.05) after treatment, while catalase did not change significantly. In addition, there was a significant decrease in the concentration of malonildialdehyde [MDA] (p <0.05), a strong indicator of lipid peroxidation. Systolic blood pressure decreased from (133±10) to (112 ± 2 p<0.0008) and the diastolic blood pressure decreased from (78 ± 3) to (70 ± 2 p<0.0052). The pulse pressure decreased from (55± 5) to (42 ± 2). No change in heart hate was obseved. The mean arterial pressure, calculated by the relationship between systolic and diastolic pressure in the arteries by the formula [DBP + 0.33 × (SBP - DBP)] decreased from (96 ± 4) to (84 ± 2 p<0.0005) after treatment. The double product (SBP x HR) remained unchanged (9385,13 ± 877,01 before and 8543,39 ± 482,96 after the intervention). However, the AI was significantly smaller changes after the intervention (86 ± 4 vs 93 ± 2 before, p<0,05). There was a significant increase (p <0.05) in the distance walked in meters by the patients in the test of a six-minute walk, the speed followed this increase (p <0.05). There was also improvement in the percentage obtained in the 6MWT after rehabilitation (102.97 ± 3.16% before) and (109.21 ± 3.38% after). The results obtained with the application of SF-36, showed significant modifications in the seven parameters measured, with the exception of the mental health aspect that was different before and after rehabilitation.