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 8.4 – Classification of physical exercise Denomination Characteristic By the predominant metabolic pathway Alactic anaerobic High intensity and very short duration Lactic Anaerobic High intensity and short duration Aerobic Low or medium intensity and long duration By pace Fixed or constant No change in pace over time Variable or intermittent With change in pace over time By relative intensity * Low or light Quiet breathing, very little panting. (Borg < 4) Medium or moderade Rapid breathing, panting but controlled. Can say a sentence. (Borg 4 to 7) High or heavy Very rapid breathing, a lot of panting. Speech difficult. (Borg > 7) By muscle mechanics Static No movement occurs and mechanical work is zero Dynamic There is movement and positive or negatice work * For exercises with implements or weights that use localized muscle groups, the relative intensity can be expressed according to the maximum load possible to perform a maximum repetition (MR). For example, light intensity - up to 30% of 1 MR; medium intensity - 30 to 60 or 70% of 1 MR. Another alternative is to use Borg's psychophysiological scales. For the above classification, the scale version ranging from 0 to 10 was used. Table 8.5 – Prescribed methods for moderate intensity aerobic exercise Method Description Subjective Sensation of Exertion (Borg) Exercises with self-perceived exertion as moderate, medium or heavy, ranging 2 to 4 on the Borg scale 0-10 and 10 to 13 on the 6-20 scale Speech Test Performing intense exercises with heavy breathing but controlled so that a complete sentence can be said without pauses HR Peak Percentages Exercises at intensity between 70 and 90% of peak HR* Target HR = peak HR* x percentage Reserve HR (Karvonen) Exercises at intensity between 50 and 80% of reserve HR (peak HR* - resting HR). Target HR = resting HR + (peak HR* - resting HR) x percentage Cardiopulmonary Test Thresholds Performing exercises at iintensity between ventilatory thresholds 1 and 2 (anaerobic threshold and respiratory compensation point) * Peak HR obtained in a maximum exercise test is preferred, since there are individual variations that cause errors in the prediction of HR by age, especially in patients using medications with negative chronotropic effects. Table 8.3 – Recommended levels of physical exercise to reduce cardiovascular risk Recommendation Recommendation class Level of evidence Reference During consultations, doctors should advise their patients about PA I B 341 Weekly PA of ≥ 150 minutes of moderate intensity exercise or 75 minutes of more intense exercise reduces CV risk I A 341 Weekly PA of < 150 minutes of moderate intensity exercise or <75 minutes of more intense exercise reduces CV risk IIa B 341 CV: cardiovascular; PA: physical activity. should be given to the execution of the movements so that technique and posture are correct. There are different protocols for resistance exercise, from the number of exercises used per session from 6 to 15 (when done daily, there is a tendency to work a muscle group on alternate days), ranging from one to three sets for each exercise and also in the number of repetitions from 6 to 15. When training muscle power, the speed of execution should be as fast as possible in the concentric phase of the movement. In this case, only 6 to 8 repetitions per exercise are used, requiring only 20 to 30 second interval between each series to allow replenishment of the adenosine triphosphate (ATP) and phosphocreatine stocks needed to perform the next series. This strategy also has the advantage of greatly reducing the time dedicated to resistance exercises, which in many situations may represent the difference between adhering to the prescribed exercise program and not. Flexibility exercises can offer osteomyoarticular benefits, health-related quality of life and prevention of falling in the elderly. By contributing to easier and more efficient joint movement, they ultimately reduce the demand for oxygen in moving situations and thus benefit the CV system. In these exercises, we seek to reach the maximum range of motion, reaching the point of slight discomfort and statically held position for 10 to 30 seconds. Flexibility exercises should ideally be individualized from specific assessments, such as the. 349 In general, women tend to be more flexible than men, and there is a tendency for a progressive loss of flexibility with aging. tends to be proportionally larger in shoulder and trunk movements. Depending on the age range, clinical conditions and objectives of the exercise program for a given patient, other forms of 832