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 8.2 – Childhood and adolescence profile according to physical exercise (adapted from Balassiano et al.) 319 Score Definition Childhood/Adolescence 0 Sedentary or very inactive Sometimes riding a bicycle, often dismissed from physical education at school. 1 Little active Normal frequency in school physical education and short and intermittent periods of sports or dancing. 2 Moderately active Regular participation most of the time in physical activity classes or sports activities or dance or fighting academies. 3 Very active Regular and frequent participation in various sports activities on most days of the week. 4 Very active and competitive Participation most of the time in training and/or sports competition or regular and frequent practice of predominantly aerobic exercise. Table 8.1 – Main concepts and terms in the subject: exercise, sedentarism and health Concepts and terms Significance Physical aptitude Ability to perform activities and physical exercises expected for their age group, gender and body, which promote health, survival and adequate functionality in the environment in which they live. It is divided into aerobic and non-aerobic components (muscle strength/power, flexibility, balance and body composition). Physical activity Any body movement produced by skeletal muscles that results in energy expenditure. Physical exercise Structured and repetitive physical activity, for the purpose of maintaining or optimizing physical fitness, body aesthetics and health. Sport Physical exercises with variable energy demand, involving rules and competitions and aimed at individual or collective winning. Sedentarism It is a condition in which there is no regular exercise or frequent physical activity involving energy expenditure > 2 to 3 times that at rest, at work, personal transportation or leisure. Exerciser One who works out regularly. Athlete One who simultaneously meets the following criteria: a) training in sports to improve performance, b) actively participating in sports competitions, c) being formally registered in sports organizations, and d) having sports training and competition as their focus of interest or way of life. and all-cause death. The higher aerobic fitness, the lower the risk is of total morbidity and mortality and CVD both in healthy individuals and in CVD patients. 312-315,321,322 Greater physical fitness and amount of physical activity are associated with lower risk of developing hypertension. 330 In already hypertensive individuals, PE reduces BP, and better results have been found with aerobic exercise (mean SBP reduction of 8.3 mmHg and DBP 5.2 mmHg). Smaller but significant reductions also occur with dynamic resistance training. 150 Another useful and clinically safe strategy for BP reduction is based on manual isometric training. 150,331 In patients with resistant hypertension - those with over- target BP despite the use of three or more antihypertensive medications, exercise in warm water (30 to 32°C) resulted in a more marked reduction in BP, and should be considered when available. 332-334 The effects of reducing blood pressure levels during exercise occur immediately after the end of exercise and last up to 24 to 48 hours. Thus, as with drugs, this action in the CV system needs to be repeated periodically for the benefit to be chronically maintained. Regular PE exerts a hypotensive action, which adds to the effects of pharmacotherapy 335 and may, in some cases, require reduction of medication doses. It has also been suggested that dyslipidemic individuals with higher cardiorespiratory fitness, even without statin use, have a lower CVD risk than those with poor fitness using medication. Those with higher aerobic fitness and statin use have lower all-cause mortality, which reinforces the importance of physical exercise and greater physical fitness, even in patients with optimized drug treatment. 336,337 8.5. Risks of Physical Activity, Physical Exercise and Sport Healthy individuals have an extremely low risk of events due to regular exercise. A study of more than 20,000 physicians with an average follow-up of 12 years found that the risk was approximately one out of every 1.5 million hours of exercise exposure (during and within the first 30 minutes post- exercise). 338 Thus, the recommendation to be physically active is quite safe and the fear of exercise-related problems should not be a barrier or justification for maintaining a sedentary lifestyle. This message needs to be widely disseminated to the population because the percentage of physically active individuals is very low in our country. 339 For further information regarding sport and pre-participation assessment, it is recommended to read the recent update of the Brazilian Society of Cardiology Guidelines for Cardiology of Sport and Exercise. 328 8.6. Recommendations for Exercise and Physical Activity Although a meta-analysis has shown that simply stimulating the adoption of a more active lifestyle can increase physical activity levels, 340,341 the physician’s guidance should be for physical exercise to be in an organized and structured manner. 830