Información del artículo
Objetivo
Evaluar el efecto del ejercicio aeróbico en la función dependiente del endotelio (VDE) y en el consumo de oxígeno en mujeres primigestantes.
MétodosEnsayo clínico controlado, enmascarado y aleatorizado, llevado a cabo en 67 mujeres saludables, primigestantes, entre 16 a 20 semanas de gestación. Grupo de intervención: ejercicio aeróbico entre 50% y 65% de la frecuencia cardiaca máxima, durante 45 minutos, tres veces por semana, durante dieciséis semanas. Grupo control: actividad física habitual. Mediciones: VDE: vasodilatación mediada por flujo (VMF), consumo de oxígeno VO2max: prueba de caminata de seis minutos; antropometría: peso y talla.
ResultadosEn las mediciones iniciales no se encontraron diferencias entre grupos en ninguna de las variables. Al finalizar la intervención, las participantes que realizaron ejercicio tenían mayor capacidad física, medida por la distancia recorrida en el test de caminata (p=0,043) y por el VO2max (p=0,023). Además, el grupo de ejercicio tuvo menor frecuencia cardiaca en reposo y mayor VMF que el grupo control (p<0,05). Ambos grupos aumentaron la frecuencia cardiaca en reposo, el diámetro basal y el diámetro post-hiperemia de la arteria braquial al final de la intervención (p<0,05).
ConclusiónLa práctica regular de ejercicio aeróbico y controlado, mejora la función endotelial y la capacidad física en mujeres gestantes. Por esta razón, intervenciones como esta podrían ser una alternativa temprana y efectiva para fortalecer la prevención de patologías durante el embarazo asociadas con disfunción endotelial.
Palabras clave:
función endotelial
embarazo
ejercicio aeróbico
consumo de oxígeno
Objective
Evaluate the effect of aerobic exercise on endothelium-dependent function (EDF) and oxygen consumption in primigravida.
MethodsDouble-blind, randomized controlled clinical trial carried out in primigravida between 16 to 20 weeks of gestation. The intervention group had aerobic exercise between 50% to 65% of the maximum heart rate during 45 minutes, three times a week for sixteen weeks. The control group had habitual physical activity.
Measurements realized: EDF: flow-mediated dilation (FMD), oxygen consumption VO2max: 6 minute walking test, anthropometry: weight and size.
ResultsNo differences were found between the two groups in any variables in the initial measurements. At the end of the intervention, participants who exercised had greater physical capacity, measured by the distance covered in walking test (p=0.043) and VO2max (p=0.023). In addition, the exercise group had lower resting heart rate and increased FMD than the control group (p <0.05). Both groups increased the resting heart rate, basal diameter and post-hyperemia diameter of the brachial artery at the end of the intervention (p <0.05).
ConclusionRegular practice of controlled aerobic exercise improves endothelial function and physical capacity in primigravida. For this reason, interventions like this could be an early and effective alternative to strengthen prevention of pathologies associated with endothelial dysfunction during pregnancy.
Key words:
endothelial function
pregnancy
primigravida
aerobic exercise
oxygen consumption
El Texto completo está disponible en PDF
Bibliografía
[1.]
P. López-Jaramillo, E. Terán, S. Moncada.
Calcium supplementation prevent pregnancy-induced hypertension by increasing the production of vascular nitric oxide.
Med Hypoth, 45 (1995), pp. 68-72
[2.]
P. López-Jaramillo, M. Narváez, A. Calle, J. Rivera, P. Jácome, C. Ruano, E. Nava.
Cyclic guanosine 3’, 5’ monophosphate concentrations in preeclampsia: effects of hydralazine.
Br J Obstet Gynaecol, 103 (1996), pp. 33-38
[3.]
P. López-Jaramillo, W.D. Arenas, R.G. García, M.Y. Rincón, M. López.
The role of the L-arginine-nitric oxide pathway in preeclampsia.
Therap Adv Cardiovas Dis, 2 (2008), pp. 261-275
[4.]
E. Terán, C. Escudero, W. Moya, M. Flórez, P. Vallance, P. López-Jaramillo.
Elevated C-reactive protein and pro-inflammatory cytokines in Andean women with preeclampsia.
Int J Gynaecol Obstet, 75 (2001), pp. 243-249
[5.]
M. Palm, O. Axelsson, L. Wernroth, S. Basu.
F(2)-isoprostanes, tocopherols and normal pregnancy.
Free Radic Res, 43 (2009), pp. 546-552
[6.]
V. Toescu, S.L. Nuttall, U. Martin, M.J. Kendall, F. Dunne.
Oxidative stress and normal pregnancy. Clin Endocrinol (Oxf), 7 (2002), pp. 609-613
[7.]
S.K. Walsh, F.A. English, E.J. Johns, L.C. Kenny.
Plasma-mediated vascular dysfunction in the reduced uterine perfusion pressure model of preeclampsia: a microvascular characterization.
Hypertension, 54 (2009), pp. 345-351
[8.]
P. López-Jaramillo, J.P. Casas, L. Bautista, N.C. Serrano, C.A. Morillo.
An integrated proposal to explain the epidemic of cardiovascular disease in a developing country From socioeconomic factors to free radicals.
Cardiology, 96 (2001), pp. 1-6
[9.]
P. López-Jaramillo.
Prevention of preeclampsia with calcium supplementation and its relation with the L-arginine: nitric oxide pathway.
Braz J Med Biol Res, 29 (1996), pp. 731-743
[10.]
A.P. Cockell, L. Poston.
Flow-mediated vasodilatation is enhanced in normal pregnancy but reduced in preeclampsia.
Hypertension, 30 (1997), pp. 247-251
[11.]
G.A. Knock, A.L. McCarthy, C. Lowy, L. Poston.
Association of gestational diabetes with abnormal maternal vascular endothelial function.
Br J Obstet Gynaecol, 104 (1997), pp. 229-234
[12.]
M.J. Maroun, S. Mehta, R. Turcotte, M.G. Cosio, S.N. Hussain.
Effects of physical conditioning on endogenous nitric oxide output during exercise.
J Appl Physiol, 79 (1995), pp. 1219-1225
[13.]
S.M. Bode-Böger, R.H. Böger, E.P. Schröder, J.C. Frölich.
Exercise increases systemic nitric oxide production in men.
J Cardiovasc Risk, 1 (1994), pp. 173-178
[14.]
D.J. Green, A. Maiorana, G. O’Driscoll, R. Taylor.
Effect of exercise training on endotheliumderived nitric oxide function in humans.
J Physiol, 561 (2004), pp. 1-25
[15.]
M.H. Laughlin, T. Simpson, W.L. Sexton, O.R. Brown, J.K. Smith, R.J. Korthuis.
Skeletal muscle oxidative capacity, antioxidant enzymes, and exercise training.
J Appl Physiol, 68 (1990), pp. 2337-2343
[16.]
J. Hollander, R. Fiebig, M. Gore, J. Bejma, T. Ookawara, H. Ohno, L.L. Ji.
Superoxide dismutase gene expression in skeletal muscle: fiber specific adaptation to endurance training.
Am J Physiol, 277 (1999), pp. R856-R862
[17.]
J. Hollander, R. Fiebig, M. Gore, J. Bejma, T. Ookawara, H. Ohno, L.L. Ji.
Superoxide dismutase gene expression is activated by a single bout of exercise in rat skeletal muscle.
Pflugers Arch, 442 (2001), pp. 426-434
[18.]
D.D. Symons, H.A. Hausenblas.
Women's exercise beliefs and behaviors during their pregnancy and postpartum.
J Midwifery Women's Health, 49 (2004), pp. 138-144
[19.]
D.B. Fell, K.S. Joseph, B.A. Armson, L. Dodds.
The impact of pregnancy on physical activity level.
Matern Child Health J, 3 (2009), pp. 597-603
[20.]
M.A. Black, N.T. Cable, D.H. Thijssen, D.J. Green.
Impact of age, sex, and exercise on brachial artery flow-mediated dilatation.
Am J Physiol Heart Circ Physiol, 297 (2009), pp. H1109-H1116
[21.]
J.M. Pivarnik, H.O. Chambliss, J.F. Clapp, S.A. Dugan, M.C. Hatch, C.A. Lovelady, et al.
Impact of physical activity during pregnancy and postpartum on chronic disease risk.
Med Sci Sports Exerc, 38 (2006), pp. 989-1006
[22.]
ACOG Committee Opinion No 267. Exercise during pregnancy and the postpartum period American College of Obstetricians and Gynecologists.
Obstetrics and Gynecology, 99 (2002), pp. 171-173
[23.]
American College of Sports Medicine (ACSM).
Guidelines for Exercise Testing and Prescription, 6th, Lippincott Williams & Wilkins, (2000), pp. 180-183
[24.]
H. Tanaka, F.A. Dinenno, K.D. Monahan, C.M. Clevenger, C.A. DeSouza, D.R. Seals.
Aging. Habitual exercise and dynamic arterial compliance.
Circulation, 102 (2000), pp. 1270-1275
[25.]
R.L. Matz, C. Schott, J.C. Stoclet, R. Andriantsitohaina.
Age-related endothelial dysfunction with respect to nitric oxide, endothelium-derived hyperpolarizing factor and cyclooxygenase products.
Physiol Res, 49 (2000), pp. 11-18
[26.]
Y. Dohi, M. Kojima, K. Sato, T.F. Luscher.
Age-related changes in vascular smooth muscle and endothelium.
Drugs Aging, 7 (1995), pp. 278-291
[27.]
J.A. Sánchez, P.E. Pena, R. Solano, et al.
Riesgo de déficit nutricional antropométrico en el primer trimestre del embarazo.
An Venez Nutr, 15 (2002), pp. 25-30
[28.]
D.S. Celermajer, K.E. Sorensen, W.M. Goock, et al.
Non invasive detection of endothelial disfunction in children and adults at risk of atherosclerosis.
Lancet, 340 (1992), pp. 1111-1115
[29.]
C.M. Correti, T.J. Anderson.
Guidelines for the ultrasound assessment of endothelial - dependent flow- mediated vasodilation of the brachial artery: A report of the International Brachial Artery Reactivity Task Force.
J Am Coll Cardiol, 39 (2002), pp. 257-265
[30.]
L. Accini, A. Sotomayor, F. Trujillo, J.G. Barrera, L. Bautista, P. López-Jaramillo.
Colombian Study to Assess the Use of Noninvasive Determination of Endothelium- Mediated Vasodilatation (CANDEV) Normal Values and Factors Associated.
Endothelium, 8 (2001), pp. 157-166
[31.]
S. Silva, C. Villamizar, N. Villamizar, F. Silva, C. Luengas, J.P. Casas, et al.
Colombian study to assess the use of noninvasive determination of endothelium-mediated vasodilation (CANDEV) II. Does location of the occlusion device affects diagnostic accuracy?.
Endothelium, 12 (2005), pp. 107-111
[32.]
J. Padilla, B.D. Johnson, S.C. Newcomer, D.P. Wilhite, T.D. Mickleborough, A.D. Fly, et al.
Normalization of flow-mediated dilation to shear stress area under the curve eliminates the impact of variable hyperemic stimulus.
Cardiovasc Ultrasound, 4 (2008), pp. 44
[33.]
T.G. Pickering.
Recommendations for the use of home (self) and ambulatory blood pressure monitoring American Society of Hypertension Ad HOC.
Am J Hypertens, 9 (1996), pp. 1-11
[34.]
H. Ben Saad, C. Prefaut, Z. Tabka, A.H. Mtir, M. Chemit, R. Hassaoune, et al.
6-minute walk distance in healthy North Africans older than 40 years: influence of parity.
Respir Med, 103 (2009), pp. 74-84
[35.]
G.A. Borg.
Psychophysical bases of perceived exertion.
Med Sci Sports Exercs, 14 (1982), pp. 377-381
[36.]
V. Krämer, M. Acevedo, L. Orellana, G. Chamorro, R. Corbalán, M.J. Bustamante, et al.
Association between cardiorespiratory fitness and cardiovascular risk factors in healthy individuals.
Rev Med Chil, 137 (2009), pp. 737-745
[37.]
S. Di Francescomarino, A. Sciartilli, V. Di Valerio, A. Di Baldassarre, S. Gallina.
The effect of physical exercise on endothelial function.
Sports Med, 39 (2009), pp. 797-812
[38.]
J.M. Fernández, F. Fuentes-Jiménez, J. López-Miranda.
Función endotelial y ejercicio físico.
Rev Andal Med Deporte, 2 (2009), pp. 1-9
[39.]
J. Sierra-Laguado, R.G. García, P. López-Jaramillo.
Flow-mediated dilatation of the brachial artery in pregnancy.
Int J Gynecol Obstet, 93 (2006), pp. 60-61
[40.]
I.D. Dorup, K. Skajaa, K. Sorensen.
Normal pregnancy is associated with enhanced endothelium-dependent flow-mediated vasodilation.
Am J Physiol, 276 (1999), pp. 821-825
[41.]
M.D. Savvidou, A.E. Donald, K.H. Nicolaides.
Assessment of endothelial function in normal twin pregnancy.
Ultrasound Obstet Gynecol, 17 (2001), pp. 220-223
[42.]
A.E. Quinton, C.M. Cook, M.J. Peek.
A longitudinal study using ultrasound to assess flow-mediated dilatation in normal human pregnancy.
Hypertens Pregnancy, 26 (2007), pp. 273-281
[43.]
O. Rognmo, T.H. Bjornstad, C. Kahrs, A.E. Tjonna, A. Bye, P.M. Haram, et al.
Endothelial function in highly endurance-trained men: effects of acute exercise.
J Strength Cond Res, 22 (2008), pp. 535-542
[44.]
D. Umpierre, R. Stein, P.J. Vieira, J.P. Ribeiro.
Blunted vascular responses but preserved endothelial vasodilation after submaximal exercise in chronic heart failure.
Eur J Cardiovasc Prev Rehabil, 16 (2009), pp. 53-59
[45.]
P. Clarkson, H.E. Montgomery, M.J. Mullen, A.E. Donald, A.J. Powe, T. Bull, et al.
Exercise training enhances endothelial function in young men.
J Am Coll Cardiol, 33 (1999), pp. 1379-1385
[46.]
M.J. Maroun, S. Mehta, R. Turcotte, M.G. Cosio, S.N. Hussain.
Effects of physical conditioning on endogenous nitric oxide output during exercise.
J Appl Physiol, 79 (1995), pp. 1219-1225
[47.]
I.E. Schjerve, G.A. Tyldum, A.E. Tjønna, T. Stolen, J.P. Loennechen, H.E. Hansen, et al.
Both aerobic endurance and strength training programmes improve cardiovascular health in obese adults.
Clin Sci (Lond), 115 (2008), pp. 283-293
[48.]
A. Sciacqua, M. Candigliota, R. Ceravolo, A. Scozzafava, F. Sinopoli, A. Corsonello, et al.
Weight loss in combination with physical activity improves endothelial dysfunction in human obesity.
Diabetes Care, 26 (2003), pp. 1673-1678
[49.]
A.E. Tjonna, S.J. Lee, O. Rognmo, T.O. Stolen, A. Bye, P.M. Haram, et al.
Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study.
Circulation, 118 (2008), pp. 346-354
[50.]
J.H. Walsh, G. Yong, C. Cheetham, G.F. Watts, G.J. O’Driscoll, et al.
Effects of exercise training on conduit and resistance vessel function in treated and untreated hypercholesterolaemic subjects.
Eur Heart J, 24 (2003), pp. 1681-1689
[51.]
T.P. Wycherley, G.D. Brinkworth, M. Noakes, J.D. Buckley, P.M. Clifton.
Effect of caloric restriction with and without exercise training on oxidative stress and endothelial function in obese subjects with type 2 diabetes.
Diabetes Obes Metab, 10 (2008), pp. 1062-1073
[52.]
N.D. Cohen, D.W. Dunstan, C. Robinson, E. Vulikh, P.Z. Zimmet, J.E. Shaw.
Improved endothelial function following a 14-month resistance exercise training program in adults with type 2 diabetes.
Diabetes Res Clin Pract, 79 (2008), pp. 405-411
[53.]
U. Wisloff, A. Stoylen, J.P. Loennechen, M. Bruvold, O. Rognmo, P.M. Haram, et al.
Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study.
Circulation, 115 (2007), pp. 3086-3094
[54.]
R. Hambrecht, V. Adams, S. Erbs, A. Linke, N. Kränkel, Y. Shu, et al.
Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase.
Circulation, 107 (2003), pp. 3152-3158
[55.]
C.K. Roberts, N.D. Vaziri, R.J. Barnard.
Effect of diet and exercise intervention on blood pressure, insulin, oxidative stress, and nitric oxide availability.
Circulation, 106 (2002), pp. 2530-2532
[56.]
K.E. Pyke, M.E. Tschakovsky.
The relationship between shear stress and flow-mediated dilatation: implications for the assessment of endothelial function.
J Physiol, 568 (2005), pp. 357-369
[57.]
M. Uematsu, Y. Ohara, J.P. Navas, K. Nishida, T.J. Murphy, R.W. Alexander, et al.
Regulation of endothelial cell nitric oxide synthase mRNA expression by shear stress.
Am J Physiol, 269 (1995), pp. C1371-C1378
[58.]
E. Madarász, G. Tamás, A.G. Tabák, Z. Kerényi.
Carbohydrate metabolism and cardiovascular risk factors 4 years after a pregnancy complicated by gestational diabetes.
Diabetes Res Clin Pract, 85 (2009), pp. 197-202
[59.]
C. John, Chambers, et al.
Association of maternal endothelial dysfunction with preeclampsia.
JAMA, 285 (2001), pp. 1607-1612
[60.]
P. López-Jaramillo, R.G. García, M. López.
Preventing pregnancy induced hypertension: are there regional differences for this global problem?.
J Hypertens, 23 (2005), pp. 1121-1129
[61.]
A. Kelly, J. Kevanya, M. de Onisb, P.M. Shah.
Special article. A WHO Collaborative Study of Maternal Anthropometry and Pregnancy Outcomes.
Int J Gynaecol Obstet, 53 (1996), pp. 219-233
[62.]
J.F. Clapp.
Does exercise training during pregnancy affect gestational age?.
Clin J Sport Med, 19 (2009), pp. 241-243
[63.]
J.F. Clapp 3rd, B. Lopez, R. Harcar-Sevcik.
Neonatal behavioral profile of the offspring of women who continued to exercise regularly throughout pregnancy.
Am J Obstet Gynecol, 180 (1999), pp. 91-94
[64.]
P. Dwarkanath, S. Muthayya, M. Vaz, T. Thomas, A. Mhaskar, R. Mhaskar, et al.
The relationship between maternal physical activity during pregnancy and birth weight.
Asia Pac J Clin Nutr, 16 (2007), pp. 704-710
[65.]
T.M. Rywik, M.R. Blackman, A.R. Yataco, P.V. Vaitkevicius, R.C. Zink, E.H. Cottrell, et al.
Enhanced endothelial vasoreactivity in endurance-trained older men.
J Appl Physiol, 87 (1999), pp. 2136-2142
[66.]
M.F. Amorim, J.A. dos Santos, S.M. Hirabara, E. Nascimento, S.L. de Souza, R.M. de Castro, R. Curi, C.G. Leandro.
Can physical exercise during gestation attenuate the effects of a maternal perinatal low-protein diet on oxygen consumption in rats?.
Exp Physiol, 94 (2009), pp. 906-913
Copyright © 2010. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular