Study on little active and sedentary women: Comparison between protocols and prospects for admission in physical activity program

doi:10.4236/ojpm.2013.36056

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Vol.3, No.6, 413-419 (2013) Open Journal of Preventiv e Me dic ine

http://dx.doi.org/10.4236/ojpm.2013.36056

Study on little active and sedentary women:

Comparison between protocols and prospects for

admission in physical activity program

A. D. P. Bankoff1*, C. A. Zamai1, J. Rocha2, P. R. Mendes Guimarães3

1Postural Assessment Laboratory, Faculdade de Educação Física (FEF), Unicamp, Campinas, Brazil;

*Corresponding A u thor: [email protected]

2Department of Cardiology, Hospital de Clínicas (HC), Unicamp, Campinas, Brazil

3Policy Research Group, Institute of Mathematics, Statistics and Scientific Computation, Unicamp, Campinas, Brazil

Received 15 May 2013; revised 20 June 2013; accepted 1 July 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

The aim of this work was to study little active

and sedentary women through physical assess-

ments using anthropometric measurements and

exercise testing using the Naughton and Bruce

protocols. Approximately 53 women were eval-

uated: Group 1—comprised of 17 completely

sedentary women, aged 25-58 years, mean age

44.4 years, and Group 2—comprised of 36 wo-

men who answered doing physical activities

once or twice a week (low active), aged 28 - 54

years, mean age 39.5 years. The results Group 1—

high weight, body mass index showing over-

weight, heart rate above the target areas of your

training, i.e., above 85% effort. Systolic blood

pressure reached a high level in the seventh

stage with 21 minutes of effort (177.3) and dia-

stolic (92.7). Group 2—normal weight, body mass

index recorded is considered thin, heart rate

heart zones above the target of your training, i.e.,

above 85% effort also. Systolic blood pressure

reached the highest level in phase 1 recovery

(156.75). Diastolic blood pressure re corded pres-

sure levels considered normal for the type of

work done by the group. The values reported for

the double product are considered normal for

the type of effort made by both groups. Conclu-

sion: The participants from group 1 are able to

join physical activity programs from the results

presented, specifically due to weight, BMI, heart

rate and blood pressure. The participants from

group 2 require more days of practice of physi-

cal activities and longer hours to improve the

levels of heart rate and blood pressur e.

Keywords: Sedentary Lifestyle; Double Product;

Heart Rate; Blood Pressure

1. INTRODUCTION

A sedentary lifestyle is the lack or decrease of physical

activity. A sedentary person is one who spends few calo-

ries per week with occupational activities, not necessar-

ily in sports activities. This entails a great risk to health:

physical inactivity is associated with increased incidence

of various diseases and ailments such as obesity, diabetes,

increase bad cholesterol (LDL), fat deposits in arteries,

hypertension and myocardial infarction [1].

Today, the leading causes of deaths in Brazil may be

related to lack of physical activity. Only 13% of Brazil-

ians prac tice exer cises and mo re than 60% of the popula-

tion is completely sedentary. Sedentary lifestyle in-

creases in 54% the cases of myocardial infarction and in

50% the risk of death from stroke. Every year, more than

300,000 die in Brazil by lack of physical activity. The

risk of death from heart disease is reduced by 40% by

becoming a little more active [2].

[3] reports that more and more people have acquired

the habit of regular physical activity, whether spontane-

ous or controlled by physical education professionals.

Overall, this option of incorporating exercise habits to

everyday life brings important benefits to the body in

various organs and systems, favorably reflecting on the

overall health of the individual. Obviously, this conduct

in relation to physical exercise must be encouraged at

various levels and segments of society, given its scien-

tifically proven effectiveness with regard to disease pre-

vention, health promotion and improved overall levels of

quality of life.

Physical assessment must precede any type of exercise

program. It is of fundamental importance to carry physi-

A. D. P. Bankoff et al. / Open Journal of Preventive Medicine 3 (2013) 413-419

414

cal assessments before starting a physical activity pro-

gram, not only to check possible health problems of a

general nature, but also to verify the evolution of the

individual in the post-assessment [4].

Physical activity is a way to restore health from the

harmful effects of work routine. It can be observed that

the more the individual has an active life, the better their

quality of life is. Furthermore, there are differences be-

tween people who practice physical activity and those

who do not, regarding the quality of life and psychologi-

cal and cognitive aspects [4].

Exercise is a form of leisure and restores health from

the harmful effects that the stressful work produces

through routine. Thus, stress is the way the body responds

to any stimulus that alters its equilibrium state, and this

stimulus can be good or bad, real or imaginary [5].

Research conducted by the Society of Cardiology of

the State of São Paulo [6] found that half of the state

population has a sedentary life. In São José dos Campos,

the also revealed that most residents do not engage in

exercise as they should.

“[6] Sedentary lifestyle can be included as the major

risk factor for cardiovascular diseases and is a major

cause of death in the country,” he said. According to the

cardiologist, who also works with sports medicine, the

lack of routine exercise increases the chances of devel-

oping new diseases in the body. The study also showed

that women are more sedentary than men: 57% are not

physically active. Among m en, thi s num ber drops to 42%.

The elders would also be more sedentary, since 56% of

people over 35 do not exercise. From 14 to 17 years the

rate is 30%, between 18 and 24 it is 43%, and from 25 to

34 it rises to 50%. [6] emphasizes that the ideal is to do

aerobic exercises like swimming, running and walking

three times a week, and more intense exercise as weight

training twice a week.

[7] investigated the association between anthropomet-

ric indicators and metabolic variables in 69 subjects of

both genders. The results showed that heart rate corre-

lated with the intensity of effo rt, being related to fat per-

centage and BMI. Blood pressure (systolic and diastolic)

showed good correlation with BMI for the female group.

In the male group, WHR was the anthropometric indica-

tor that showed a higher association with blood pressure.

The double product had a higher correlation with BMI,

indicating that this variable reflects the work of the

myocardium.

2. MATERIAL AND METHOD

2.1. Population Studied

Fifty three women attended the Postural Assessment

Laboratory/Electromyography of the School of Physical

Education, University of Campinas, to participate in this

study. After replying to a brief questionnaire and taken

the measurements of height and weight, they were di-

vided into two groups, namely:

Group 1—comprised of 17 completely sedentary wo-

men, aged between 25 to 58 years, mean age 44.4 years;

Group 2—comprised of 36 women who answered do-

ing physical activities once or twice a week (low active),

aged 28 - 54 years, mean age 39.5 years. We reco rded in

the average hours of this group, amounting 01:30 min-

utes of physical activity per week for each woman.

All participants are from administrative sectors of

Unicamp.

2.2. Evaluations Conducted

Anthropometric measurements (weight and height)

and ergometry were done on both groups. Group 1 er-

gometry was evaluated by the Naughton Protocol and

Group 2 was evaluated by the Bruce Protocol. Noting

that the Naughton Protocol is indicated for people com-

pletely sedentary, the elderly and cardiac patients, and

the Bruce Protocol is designed for trained people, ath-

letes and low physical condition people [8].

2.2.1. Material Used

We used the Ergometry-TEB System, which is formed

by an Ergometer APEX 2200 Treadmill, two monitors,

configured for 06 protocols and others that meet the lim-

its of speed and tilt of th e system. The system is prep ared

to act in automatic, semi-automatic or emergency stop. It

is a system made up of 13 simultaneous channels and

allows the performance of exercise tests with the classic

configuration of the three leads MV5, D2M and V2M,

which is the configuration used. This System starts with

the speed of 1.5 mph containing 07 stages.

For anthropometric measurements we used a Welmy

scale, with toesa, with capacity of up to 150 Kg.

2.2.2. Dat a Collection

During the assessments, the women were wearing Bra

and Shorts to facilitate the placement of the electrodes

according to the selected derivations. The electrodes used

were from the brand 3M (Electrode for cardiac monitor-

ing) Ag/AgCl, with adhesive gel. All participants signed

the Free Informed Consent prior to the start of the

testings. The project was approved by the Ethics Com-

mittee of UNIC AM P No. 431/2007 (Figure 1).

The women were instructed to be at the site of evalua-

tions (Postural Assessment Laboratory and Electromy-

ography of the School of Physical Education, University

of Campinas) one hour before the start of evaluations.

They also received a week in advance from the labo-

ratory a folder with the following guidelines:

1) Eat up to two hours before the start of the Protocol;

2) Avoid any kind of physical activity the day before

the Protocol;

3) Bring appropriate attire for the realization of the

A. D. P. Bankoff et al. / Open Journal of Preventive Medicine 3 (2013) 413-419 415

Figure 1. Representative model of electrode placement.

Protocol (shorts, two piece swimsuit and sneakers);

4) Avoid abuses and excesses the night before;

5) Sleep from 6 to 8 hours the day before the exam;

6) Avoid usi ng sedatives; and comm unicat e any chan ge s

in their health status in the past 24 hours.

3. PRESENTATION OF RESULTS

For purposes of data, we collected data related to: age,

weight and height extracted for the BMI. Regarding the

variables, we studied resting heart rate, systolic blood

pressure, diastolic blood pressure and double product

during the stages of the protocols and in the recovery

phase. We also obtained the maximal and submaximal

heart rate.

We highlight the differences listed in the Tables re-

garding the number of stages completed by groups 1 and

2, namely: Group 1 completed the test on the 7th stage of

the Naughton protocol and group 2 completed the test in

the 4th stage of the Bruce protocol.

Before starting the presentation of results, we recall

that the group 1 held 21 minutes of effort during exercise

testing using the Naughton protocol, and group 2 held 12

minutes of effort during exercise testing using the Bruce

protocol. The specifications of each protocol find ex-

pressed in Tables 1 and 2.

The results that are presented below are Ta b l es 3 and

4. Group 1 Group 2 differs in age, height, weight and

body mass index, with women being the group 1 over-

weight in relation to body mass index-BMI (28.6). Ac-

cording to the classification of the World Health Organi-

zation is considered over weight when the body mass

index scale present in 25 and 29.99. For group 2, the

Tabl e 1. Representative model of the naughton protocol model

I (modified according to the specificities of the integrated

APEX TEB 2200 system) [9].

Phases Mph % inclination VO2 max METs mim

1 1.5 0 5.4 1.5 3

2 2.0 0 7.0 2.0 3

3 2.0 3.5 10.5 3.0 3

4 2.0 7.0 14.0 4.0 3

5 2.0 10.5 17.5 5.0 3

6 2.0 14.0 21.0 6.0 3

7 2.0 17.5 24.5 7.0 3

Table 2. Representative model of the bruce protocol [9].

Phases Mph % inclination VO2 ma x METs mim

1 1.7 10 15 4 1

2 2.5 12 25 7 3

3 3.4 14 35 10 3

4 4.2 16 45 13 3

5 5.0 18 55 16 3

6 5.5 20 65 19 3

7 6.0 22 75 22 3

Table 3. Overall average of the variables related to anthropom-

etric measurements, age, BMI and heart rate, systolic blood

pressure, diastolic blood pressure and double product of Group

1—naughton protocol.

AGE 43.4 SBPrest121.9 DBP 6 89.7

WEIGHT73.4 SBP 1 127.2 DBP 7 92.7

HEIGHT160.6 SBP 2 134.1 DBPrec 190

BMI 28.6 SBP 3 140.6 DBPrec 287.8

HRmax176.6 SBP 4 145.6 DBPrec 384.4

HRsubm149.5 SBP 5 152.8 DBPrec 481.9

HRrest72.7 SBP 6 164.7 DPrest 9260

HR 1 94.3 SBP 7 177.3 DP 1 12030

HR 2 110.1 SBPrec 1168.8 DP 2 14833

HR 3 112.5 SBPrec 2159.1 DP 3 15710

HR 4 120.5 SBPrec 3145.3 DP 4 17667

HR 5 125.3 SBPrec 4135.4 DP 5 19234

HR 6 137.7 DBPrest79.7 DP 6 22665

HR 7 152 DBP 1 82.2 DP 7 26932

HRrec 1117.9 DBP 2 84.1 DPrec 1 19980

HRrec 2111.9 DBP 3 85.6 DPrec 2 17910

HRrec 3108.4 DBP 4 86.9 DPrec 3 16113

HRrec 4106.8 DBP 5 89.4 DPrec 4 14467

A. D. P. Bankoff et al. / Open Journal of Preventive Medicine 3 (2013) 413-419

416

Table 4. Overall average of the variables related to anthropom-

etric measurements, age, BMI and heart rate, systolic blood

pressure, diastolic blood pressure and double product of Group

2—bruce protocol.

AGE 39.51 HRrec 4 102.59 DBP 4 79.35

WEIGHT 62 SBPrest 111.21 DBPrec 180.13

HEIGHT 163 SBP 1 124.86 DBPrec 277.83

BMI 23.2 SBP 2 134.05 DBPrec 375

HRmax 180.48 SBP 3 145.81 DBPrec 474.86

HRsubm 153 SBP 4 150.8 DPrest 8061

HRrest 71.69 SBPrec 1 156.75 DP 1 12075

HR 1 97.02 SBPrec 2 144.72 DP 2 14629

HR 2 109.16 SBPrec 3 132.43 DP 3 18932

HR 3 130.87 SBPrec 3 123.51 DP 4 21594

HR 4 142 DBPrest 73.51 DPrec 1 18732

HRrec 1 121.24 DBP 1 75.67 DPrec 2 15156

HRrec 2 105.91 DBP 2 77.56 DPrec 3 13186

HRrec 3 100.56 DBP 3 79.05 DPrec 4 12629

body mass index presents standard (23.2) which is con-

sidered healthy. The levels of heart rate, systolic and dia-

stolic, and double product presented during physical ex-

ertion are within acceptable standards for both popula-

tions.

Heart rate is a variable that can be used as a parameter

to quantify the level of physical exertion of a particular

exercise. An exercise is considered mild to moderate if

performed at intensity between 65% e 85%, of maximum

heart rate (HRmax). For women index is obtained by

subtracting the age of 226, and then calculating the per-

centage of the total. In our study group 1 averaged 43.4

years and a maximum heart rate of 176.6. For example:

If the percentages requested are

exactly those (65% and 85%), the result is:

226 43.4182.6.

182.6 65%119

beats per minute and 1 beats per

minute. These are the minimum and maximum number

of heartbeats per minute you should keep, i.e., the target

areas of your training. Group 2, for example:

82.6 85%155

226 39.5186.4.

If the percentages requested are exactly those (65%

and 85%), the result is: 186 beats per

minute and 186 beats per minute. In

both groups, the women were above 85% of your

maximum heart rate (g1 = 176.6, g2 = 180.4) .

.4 65%121

158.4 85%

As systolic blood pressure, group 1 showed a value

considered high 177.3 mm Hg in the seventh stage of the

Naughton protocol. Group 2 showed 150.8 mm Hg in the

fourth stage, this considered within the normal range for

exercise. In the recovery 1 group 2 had the highest blood

pressure 156.7 mmHg. In this case we call active recov-

ery because O2 levels remain consumed (ventilation is

maintained at higher levels, facilitating gas exchange)

and circulation remains very active. From the recovery 2

she established normal range. The diastolic blood pres-

sure for the group 1 showed higher values during exer-

cise (82.2 and 92.7), gro up 2 showed normal values (75.6

and 74.8).

As for systolic and diastolic exercise is reported that

systolic (maximum) during a session Exercise typically

increases and, depending on the intensity of the Exercise,

can reach values higher than 200 mm Hg. The diastolic

blood pressure (minimum), during a session of Exercise

usually does not in crease or increases only slig htly (to 15

mm Hg), and may even decrease. An increase in the va l-

ues above these levels (systolic BP > 220 mm Hg or

greater than 15 mm Hg increase in diastolic BP), are

considered abnormal (systolic hypertensive response

and/or diastolic efforts).

Another important variable is the double product

which is a measurement estimate cardiac effort and

myocardial oxygen consumption. Its value is obtained by

multiplying the heart rate (measured in beats per minute)

for systolic blood pressure (measured in mm Hg). The

reference values for the double product of an individual

vary on average between 6000 at rest until 40,000 in ex-

haustive exercises. The double product for both groups

reported normal values even in recoveries, considering

the physical performance of each group g1 totally seden-

tary and g2 little active.

Given the results, we can design and prescribe physi-

cal activity program for both groups minimizing cardio-

vascular risks .

Summary of results:

Group 1—high weight, body mass index showing

overweight, heart rate above the target areas of your

training, i.e., above 85% effort, and heart rate should be

155 beats per minute, however, showed 176.6 beats per

minute. Systolic blood pressure reached a high level in

the seventh stage with 21 minutes of effort (177.3) and

diastolic (92.7). The double product recorded values

considered normal for the type of effort made by the

group.

Group 2—normal weight, body mass index recorded is

considered thin, hear t rate heart zones above the target of

your training, i.e., above 85% effort, and heart rate

should be 158 beats per minute, and however, it showed

180.4 beats per minute. Systolic blood pressure reached

the highest level in phase 1 recovery (156.75). Diastolic

blood pressure recorded pressure levels considered nor-

mal for the type of work done by the group. The double

product also re corded normal levels.

4. DISCUSSION

The qualities of “sedentary and little active” physical

fitness seem to go together, specifically in relation to the

A. D. P. Bankoff et al. / Open Journal of Preventive Medicine 3 (2013) 413-419 417

events of the cardiac cycle (heart rate, systolic and dia-

stolic blood pressure); however, group 2 is at an advan-

tage compared to group 1 because they practice physical

activities, thus influencing the quality of life. The amount

of hours and the number of times per week that group 2

practices physical activities showed to not be sufficient

to differentiate the results from group 1, who are com-

pletely sedentary, although group 2 has completed the

exercise testing using the Bruce protocol, on the 4th

stage, considered a good result. The physical perform-

ance of the group 2 in this study is consid ered better than

when compared to group 1, also see the results when

body weight and body mass index. Group 1 by body

mass index presented is overweight, according to the

World Health Organization and urgent need to change the

lifestyle and physical exercise.

[4,9] studied the events of the cardiac cycle in men

and women through the ergometry system before and

after initiating a physical activity program for six months.

The results showed: at rest, regarding gender, heart rate

showed no significant difference between the assessment

and reassessment. Regarding SBP and DBP, there were

differences between assessment and reassessment only

for men. In the recovery period: heart rate showed no

difference for both groups (male and female). As, for

Systolic blood pressure, for both groups, there were dif-

ferences regarding the assessment of the reassessment

from the first minute up to the 6th minute. As for Dia-

stolic blood pressure, there was no difference in the first

minute.

Regarding the levels of Maximum Heart Rate, both

groups are at levels recommended for adults aged 20 to

55 years considered exhaustive, i.e., above 175 bpm [10].

As our data presented in Tabl es 3 and 4 and the follow-

ing described [10] in relation to the amounts recorded

Maximum Heart Rate activity can be considered exhaus-

tive.

Studies on the desired levels of heart rate extrapolate

several decades; for example, [11] reported that a greater

physical work capacity, kept a metabolic balance, could

be achieved with a maximum limit of 170 beats per min-

ute.

According to [10], stress heart rate must be within a

range of 135 and 174 bpm, i.e., exercise should have an

intensity that can increase HR above 135 bpm, however,

cannot exceed 17 4 bp m.

The results presented in Tables 3 and 4 show that

there was little difference between groups 1 and 2 in re-

lation to the protocols used, as well as the physical fit-

ness levels of both groups.

According to [12] double product (DP) is a measure

estimating cardiac stress and myocardial oxygen con-

sumption and its value is determined by multiplying

heart rate (measured in bpm) by systolic blood pressure

(measured in mmHg).

The double product can estimate the myocardial O2

consumption (MVO2) and is its best indirect predictor

[13-16]. The correlation between double product and

MVO2 is stronger (r = 0.92) than between MVO2 and

HR (r = 0.88), [17]. There is also a linear relation be-

tween MVO2/DP and blood flow in coronary arteries.

Typical values for Double Product range from 6000 at

rest (HR = 50 beats/min, SBP = 120 mm Hg) to 40,000

during intense exercise (HR = 200 beats/min, SBP = 200

mmHg). Changes in heart rate and blood pressure

equally contribute to a change in double product [18].

The double product is a hemodynamic parameter that

sets high correlation with MVO2, determined in stress

ergometry, although the prediction is not possible in ex-

ercises against resistance. Even so, the double product

can be used as an evaluation index of cardiac stress in

RE (resistance exercise), thus being recommended by the

American College of Sports Medicine [18].

Regarding the systolic and diastolic blood pressure

variables, the literature reports that, during exercise and

physical activities, SBP and DBP tend to increase caus-

ing a significant increase also in mean arterial pressure,

even if for a short period of time. Separately, SBP and

DBP show different behaviors during exercise. In ongo-

ing activities of progressive intensity, SBP increases in

direct proportion to the intensity of the exercise, due to

the increase in cardiac out put [19,20] .

We can see in Ta b l e s 3 and 4, from the resting phase

until the 7th stage for group 1 and up to the 4 th stage for

group 2, a gradual increase in systolic and diasto lic b lood

pressure according to the increase of stress in the test. In

the recovery phase, they decrease gradually. It is inter-

esting to follow in the Tables 3 and 4 the behavior of the

double product, taking into account that its value is de-

termined by multiplyin g heart rate (measured in bpm) b y

the systolic blood pressure (measured in mm Hg).

Diastolic pressure varies little during aerobic exercise

when compared to SBP and HR, as the systemic pressure

during cardiac diastole tends to stay in rest levels. In ac-

tivities with strong static co mponent, due to the capillary

constriction by active muscles, coup led with the in crease

in cardiac output, a significant elevation in DBP 25 can

occur [21].

The research studies and discussion about the benefits

of exercise and physical activity are old considering the

scientific publications of [22] who describes that aerobic

exercises (low intensity and long duration) are excellent

for improving physical fitness and reducing body fat,

reducing the risks of cardiovascular diseases.

It was evident that group 2 needs to practice physical

activities with greater intensity and higher weekly fre-

quency so that changes and improvements can occur in

the events of the cardiac cycles (HR, SBP and DBP). As

A. D. P. Bankoff et al. / Open Journal of Preventive Medicine 3 (2013) 413-419

418

for group 1, taking into account the results presented,

they are able to enter and start physical activities to im-

prove the levels found, specifically weight, BMI, HR,

SBP and DBP.

[23,24] postulate that every adult individual should

accumulate at least 30 minutes of physical activity at

least 5 days a week, or if possible the entire week, of

moderate intensity, which can be performed continuously

or accumulated. However, the group of women consid-

ered little active completed the stress test by the Bruce

protocol in the 4th stage with the following specifica-

tions: 4.2 mph, 16% incline, VO2Max 45, 13 METs and

already amounted 10 minutes of test performance, which

can be considered good for a exercise testing, consider-

ing the physical fitness of the “little active” women. The

women in group 1 that “self-declared” completely sed-

entary, completed the exercise testing by the Naughton

protocol on stage 7 with the following specifications: 02

Mph, 17.5% incline, VO2 Max 24.5, 7 METs and already

amounted 21 minutes of test performance and yet, for the

variables of the events of the cardiac cycle in accordance

with the statistical analysis, the results were not different

between groups 1 and 2 in most of the variables, as

shown in Table 2.

5. CONCLUSIONS

Participants in group 1 are able to particip ate in urgent

and need physical activity programs from the results

presented, specifically due to body weight, BMI, heart

rate and blood pres s ure;

Participants from group 2 require more days of prac-

tice of physical activities and longer hours to improve the

levels of heart rate and blood pressure;

The results presented in Tables 3 and 4 show that

there was little difference between groups 1 and 2 in re-

lation to the protocols used, as well as the physical fit-

ness levels of both groups;

Both groups had high levels of heart rate in the effort

applied during the exercise test protocol (Naughton and

Bruce protocol).

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