ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 Table 7.2 – Fagerström test for nicotine dependence 265 1. How long after waking up do you smoke the first cigarette? [3] Within 5 minutes [2] Within 6-30 minutes [1] Within 31-60 minutes [0] After 60 minutes 2. Is is hard for you not to smoke in forbidden places? [1] Yes [0] No 3. Which of the cigarettes that you smoke during the day give you the most satisfaction? [1] The first in the morning [0] Others 4. How many cigarettes do you smoke per day? [0] Less than 10 [1] 11-20 [2] 21-30 [3] More than 31 5. Do you smoke more often in the morning? [1] Yes [0] No 6. Do you smoke even when sick, when bedridden most of the time? [1] Yes [0] No →Total: [0-2] very low; [3-4] low; [5] moderate; [6-7] high; [8-10] very high. Table 7.3 – Stages of motivation and counseling techniques 263 • Precontemplative: not yet concerned; not ready for behavior change → briefly report risks of continuing to smoke and encourage patient to think ↓ • Contemplative: recognizes that you need and want to change, but still want to smoke (ambivalence) → ponder the pros and cons of cessation and remain available to talk ↓ • Determined: Wants to quit smoking and ready to take the necessary action → choose a date to quit smoking ↓ • Action: engage in attitudes intended to bring about change and abstain → follow-up to prevent relapse and relieve withdrawal symptoms ↓ • Maintenance: Keeps the behavior change achieved and remains abstinent → reinforce the benefits gained from quitting, identify risk situations for relapse and the skills to cope with them ↓ • Relapse: unable to maintain achieved abstinence and returns to smoker behavior → offer support, review and resume the whole process 8. Physical Activity, Physical Exercise and Sport 8.1. Introduction Physical inactivity is one of the major public health problems, and physical inactivity, which is strongly related to all-cause and CVD mortality, is highly prevalent in Brazil and worldwide. 301,302 Increased physical activity is related to health gain, better quality of life and greater life expectancy. 303-307 Therefore, both in an individual and population-based CVD prevention strategy, it is of utmost importance to prioritize a strong fight against sedentarism, and requiring the questioning of PA habits and encouragement of adopting a more active lifestyle should be routinely done at medical office visits. 308 8.2. Relevant Concepts and Expressions in Physical Activity PA is used as a broad term that includes both structured and unstructured forms of leisure, sports, transportation, and domestic and work-related activities. physical activity involves body movement, with increased energy expenditure in relation to rest, and can be classified in terms of intensity as mild, moderate or high. Physical exercise is defined as a subset of structured activities aimed at improving cardiorespiratory fitness, balance, flexibility, strength and/or power and even cognitive function, particularly important in the elderly. 309 Thus, physical activity, physical exercise and sports are related but distinct terms, and Table 8.1 defines some concepts and expressions. There is a strong association of different levels of physical fitness components with all-cause mortality and the occurrence of unfavorable CV events, with inverse association, i.e., the lower the physical fitness, the higher the mortality, 310-317 requiring preventive action, focusing on combating physical inactivity as of childhood. WHO recently presented specific recommendations for children 0 to 5 years of age related to daily physical activity/exercise and sleep times, which considerably limits or restricts sitting time in front of screens. 318 Table 8.2 presents a classification of the profile of children and adolescents according to physical exercise. 319 8.3. Main Acute and Chronic Effects of Exercise The effects of exercise can be divided into acute and chronic. 320 The acute effect is that which dissipates rapidly and may be immediate after a single session or last for up to 24 hours (subacute or late acute effect). Improvement in flow-mediated response with respect to endothelial function is an example of the acute effect of a single exercise session. The chronic effect is achieved by repeated acute/subacute effects and can be evaluated at rest, even if long after the last exercise session. Resting bradycardia observed in athletes of predominantly aerobic modalities is an example of chronic effect. Repetition of responses can produce a chronic effect, as in the case of decreased blood pressure. Some of the main effects of exercise are listed in Chart 8.1. 8.4. Epidemiological Rationale of the Benefits of Physical Exercise In addition to aerobic fitness, 312-315,321,322 other components of physical fitness are associated with prognosis, with higher mortality associated with poor fitness. proven as a predictor of mortality in middle-aged and elderly men and women. 311,323 Other studies on muscle strength and power have also shown associations with mortality. 316,317 Scientific findings support the previous recommendations of national 324,328 and international guidelines 329 that recommend the regular and combined practice of aerobic and resistance exercises. Flexibility and balance exercises should be part of an exercise program, especially aimed at the elderly. Regarding PE, the greatest benefit is when comparing sedentary individuals and those who engage in very little or no exercise, since the positive impact of abandoning a sedentary lifestyle is very significant. However, comparing the varying degrees of aerobic fitness on an increasing scale, we realize that there is a continuous decrease in the risk of cardiac death 829