IJCS | Volume 31, Nº4, July / August 2018

394 Macedo et al. Periodized model for prescribed exercises Int J Cardiovasc Sci. 2018;31(4)393-404 Original Article quality of life, and cognitive functions, and relieved clinical symptoms (dyspnea, sleep disorders, stress and depressive symptoms). 5,6 Guidelines which involve physical exercise as a form of treatment for CAD respect a relationship of equilibrium between safety and effect of training, 7,8 and recommend that resistance training (RT) be performed in combination with aerobic exercise training (AT). 5,6 For RT, they provide recommendations concerning the maximum load limits during training, such as 50% of intensity in the one repetition maximum (1RM) test. 7-9 For AT, the ventilatory threshold measured during maximum cardiopulmonary exercise test (CPT) is often used in CAD patients. For beginners with low physical function/greater cardiac risk, the guidelines recommend 40% to 50% of maximum oxygen consumption (VO 2 peak), and for CAD patients with higher fitness level or less cardiac risk, 50% to 75% of VO 2 peak. 5,6 However, none of those documents describe the way in which the prescription of the exercises should be organized by time. The maximum load limits for training allow for the elaboration of an exercise session but not for a progressive training program. Such organization, which should involve the type of stimulus according to the training phase (continuous and/or with intervals), the form of load progression (volume and/or intensity), 10 the frequency (session/week) and the evaluation and reevaluation dates, is known as periodization. 11 Periodization has been used in sport training since the 1990s, 12 and its inclusion in rehabilitation has been recently debated. 13-15 The training can be described in more detail using periodization, emphasizing its basic principles as: specificity, overload and reversibility. Periodization is the process of manipulating training variables to prevent overtraining, maximize training adaptations, and attain overcompensation or a training effect. 9 The classical approach to periodization is linear periodized training which appears in exercise guidelines for cardiac patients. 8 This type consists of initial high- volume and low-intensity. For this reason, the clinical and physical results obtained from periodized physical training in cardiopulmonary andmetabolic rehabilitation programs could be improved, improving the quality of life of the patients involved. Therefore, the objective of this study was to create a periodization model for the prescription of exercises aimed at patients with CAD in phase II of the cardiac rehabilitation program, and compare the results with those of patients submitted to a non-periodized program. Method Subjects After approval of the project by the Ethics in Research of the Parana Pontific Catholic University (434/2010), 534 patients referred to the rehabilitation service of the Hospital Cardiológico Costantini (HCC) were evaluated. The inclusion criterion was: men undergoing a percutaneous coronary intervention (angioplasty) or post-acute myocardial infarction with a left ventricular ejection fraction ≥ 50% (evaluated by transthoracic echocardiography) and stratified as of low or moderate risk for the practice of exercise according to the American Association of Cardiopulmonary Rehabilitation and Prevention. 16 The exclusion criteriawere: musculoskeletal injuries induced by exercise, failure to complete the 36 sessions and/or cardiovascular complications that lead to stop the exercise program. Patients stratified as at low or moderated risk according to the American College of Sports Medicine (ACSM) 10 were submitted to a medical admission consultancy (MAC). After evaluation, 62 patients who met the inclusion criterion were selected. Outcomes of the measures Cardiopulmonary exercise test Cardiopulmonary exercise test was carried out by a doctor from the HCC using a gas analyzer (Cortex, model Metalyzer3B), an electric treadmill (Inbramed, model Inbrasport Super ATL) and a computer program (Ergo PC Elite). The CPT chosen was an individualized ramp protocol for each patient, measuring blood pressure every 3 minutes with an analogical sphygmomanometer (Missouri) and a stethoscope (BD). In addition, the electrocardiographic tracing was monitored using electrodes (3M) throughout the entire endurance phase and recovery period. The volumes and gases (O 2 and CO 2 ) were calibrated before the tests. The V-slope method was used to determine the first ventilatory threshold (VT1). The second ventilatory threshold (VT2) was determined by respiratory point compensation, that is, transition between aerobic and anaerobic system in CPT. At this moment, the production of CO 2 loses linearity, exponentially increases and exceeds oxygen consumption (VO 2 ). This point was considered the VT2. Maximum oxygen consumption was established from the mean measured during the last 30 seconds of exercise.