Effect of Aerobic Training on the Health Parameters of Postmenopausal Women With Multimorbidity

September 29, 2021 updated by: Juliene Gonçalves Costa, Federal University of Uberlandia

Effect of Aerobic Training on Hemodynamic, Metabolic and Climacteric Symptoms in Postmenopausal Women With Multimorbidity

People affected by multiple chronic diseases have a greater chance of hospitalization, longer hospital stays, worse general health, worse physical and mental function and lower functional capacity, with an average risk of 50% of functional decline with each additional condition. The frequency of multimorbidity is higher in older, inactive women, who live in urban areas in low- and middle-income countries, the most affected by multimorbidity. The practice of physical exercise is an important component in the prevention of multiple chronic diseases, in which lower levels of physical activity were associated with an increased prevalence of multimorbidity in women aged 16 to 24 years. And regardless of the presence of multimorbidity, engaging in a healthier lifestyle, including regular physical activity, was associated with up to 7.6 more years of life for women, improving the individual's general health status even when multimorbid.

The hypothesis is that multimorbid women have a worse general health status when compared to women without multimorbidity, but aerobic exercise will be able to improve health parameters in 12 weeks of training.

This is a quasi-experimental clinical trial with a 12-week aerobic training intervention in postmenopausal women with and without cardiometabolic multimorbidity. Participants were allocated into groups according to the amount of cardiometabolic diseases, with the Morbidity group (MORB) being composed of women with one or no chronic cardiometabolic disease and the Multimorbidity group (MULTI) with two or more chronic cardiometabolic diseases.

The assessments of arterial stiffness, 24-hour ambulatory pressure, blood pressure variability, heart rate variability, lipid and glucose profile, body composition and climacteric symptoms were performed before and after the training period.

The study was carried out at the Laboratory of Cardiorespiratory and Metabolic Physiology at the Faculty of Physical Education of the Federal University of Uberlândia, Uberlândia, Brazil and approved by the Ethics Committee for studies in humans (CAEE: 12453719.1.0000.5152). All participants signed a consent form. The experiments followed the principles of the Declaration of Helsinki.

The program consists of aerobic physical exercises performed three times a week on non-consecutive days for 12 weeks with an intensity of 65% to 75% of the reserve heart rate.

Study Overview

Status

Suspended

Conditions

Intervention / Treatment

Detailed Description

The sample size was classified using the G * Power 3.1 software (University of Dusseldorf, Dusseldorf, Germany), adopting an α error of 5%, 80% power analysis, 0.5 correlation between repeated measures and a correction of non-sphericity of 1, in an F-family of intra-between analysis. Changes in serum triglycerides were evaluated as the primary study endpoint. The investigators did not not found the in literature the study with design and calculation prediction according to the calculation of this study with the effect size of f = 0.24 for the sample calculation. Thus, was found a minimum required sample of 38 subjects (19 per group).

Results were found as mean ± standard error. Unpaired testing was used to compare baseline characteristics between groups. Comparison between groups and duration of arterial stiffness, lipid profile, glucose profile, climacteric symptoms, body composition and ABPM were made by Generalized Equation Estimates (GEE) of two factors (time, group and their interaction) with Bonferroni correction. The analyzes were performed by intention-to-treat (including those who did not complete the study: MORB n = 18; MULTI = 24) using the last-observation carried forward method. A p value <0.05 was used for statistical significance and all statistical analyzes were performed with Statistical Package for the Social Sciences (SPSS) software v26.0 (IBM, New York, USA).

Study Type

Interventional

Enrollment (Actual)

41

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Brazil
    • Minas Gerais
      • Uberlândia, Minas Gerais, Brazil, 38400-678
        • Federal University of Uberlandia

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

50 years to 70 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Postmenopausal women (amenorrhea of at least 12 months; Estradiol <32.2 pg / mL),
  • Aged between 50 and 70 years,
  • Able to do aerobic exercise on track, do not have physical problems or cardiovascular complications that prevent them from exercising.
  • Non-smokers ,
  • Who do not use Hormone Therapy or have not finished the treatment for more than 1 year,
  • As diagnostic criteria for cardiometabolic diseases: Obesity (BMI> 29.9 kg / m2; Use of antihypertensive drugs and/or hypertension (systolic blood pressure at rest > 139 mmHg and diastolic blood pressure > 89 mmHg; dyslipidemia (LDL ≥160mg / dL and / or triglycerides ≥150mg / dL and / or total cholesterol ≥190mg / dL and / or HDL ≤50mg / dL. In the case of diabetics (blood glucose > 126 mg / dL and / or HbA1c ≥ 6.5% and diagnosed with type 2 diabetes mellitus: for at least one year, being using a hypoglycemic and clinically stable for up to minimum 6 months, with glycemic control by medication or exogenous insulin and without chronic complications such as diabetic foot, nephropathy, retinopathy or neuropathies.

Exclusion Criteria:

  • Present some inability to carry out the prescribed training volume or intensity,
  • Not obtain medical clearance after maximum exercise test
  • Start practicing another physical exercise protocol concurrently with this project.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: OTHER
  • Allocation: NON_RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: DOUBLE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Multimorbidity Group (MULTI)
Multimorbidity group is composed of post menopausal women with two or more chronic diseases cardiometabolic (Hypertension, diabetes, dislipidemias, obesity).
Behavioral: Aerobic training
The program consists of aerobic exercise performed three times a week on non-consecutive days for 12 weeks at an intensity of 65% to 75% of the reserve heart rate. During the first 4 weeks of training, the exercise duration was 40 minutes (5' warm up + 30 minutes in the intensity zone + 5' cool down). From the fifth week onwards, there was only an increase in volume to 50 minutes in duration (5'warm-up + 40 minutes in the intensity zone + 5'warm-up). The aerobic fitness assessment was performed on a maximal effort ergospirometric treadmill under the supervision of a qualified physician, using the Bruce protocol (adapted) to assess cardiopulmonary capacity (to assess possible cardiovascular capacity that prevents the proposed training) and for individualized training prescription.
Other Names:
  • Aerobic physical exercise
EXPERIMENTAL: Morbidity Group (MORB)
Morbidity group is composed of postmenopausal women with one or no chronic cardiometabolic disease (Hypertension, diabetes, dislipidemias, obesity)
Behavioral: Aerobic training
The program consists of aerobic exercise performed three times a week on non-consecutive days for 12 weeks at an intensity of 65% to 75% of the reserve heart rate. During the first 4 weeks of training, the exercise duration was 40 minutes (5' warm up + 30 minutes in the intensity zone + 5' cool down). From the fifth week onwards, there was only an increase in volume to 50 minutes in duration (5'warm-up + 40 minutes in the intensity zone + 5'warm-up). The aerobic fitness assessment was performed on a maximal effort ergospirometric treadmill under the supervision of a qualified physician, using the Bruce protocol (adapted) to assess cardiopulmonary capacity (to assess possible cardiovascular capacity that prevents the proposed training) and for individualized training prescription.
Other Names:
  • Aerobic physical exercise

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Arterial stiffness in 12 weeks
Time Frame: Before and after 12 weeks of intervention
Arterial stiffness was assessed by measuring the Pulse Wave Velocity (PWV) through the applanation tonometry method, performed on 3 measurements and the average of the three was performed to obtain the final value. It is a non-invasive, painless method with instantaneous results and considered the gold standard for determining arterial stiffness. This method is based on the principles of ocular tonometry used to measure intraocular pressure by "flattening" the surface of the eyeball.
Before and after 12 weeks of intervention
Change in Lipid profile in 12 weeks
Time Frame: Before and after 12 weeks of intervention.
The blood samples were collected after an overnight fast, five days before, and 72 h after, the last exercise training session to eliminate the acute effects of the exercise. Plasma concentrations of total cholesterol (mg/dL), triglycerides (mg/dL), high density lipoprotein (HDL) (mg/dL) and low density lipoprotein (LDL) cholesterol (mg/dL) were determined by enzymatic colorimetric methods. All analyzes were performed using an automated system using commercial kits.
Before and after 12 weeks of intervention.
Change in 24-hour ambulatory blood pressure in 12 weeks
Time Frame: Before and after 12 weeks of intervention.
Blood pressure (Systolic, diastolic, mean) (mmHg) was assessed before and after 12 weeks of training through ambulatory monitoring (ABPM) using the Dyna Mapa+ device (São Paulo, Brazil). The monitor was programmed with measurements every 30 minutes for 24 hours, standardizing the start of monitoring in the morning between 7 am and 8 am. Along with the monitor, the participants filled out a daily record of activities (sleep, food and work) or events that could interfere with blood pressure or measurements, with sleep and wakefulness periods being individually determined according to the time reported in each diary. Measurements obtained 24 hours of monitoring and with at least 70% of measurements valid in this period were considered valid.
Before and after 12 weeks of intervention.
Change in glycated hemoglobin (HbA1c)
Time Frame: Before and after 12 weeks of intervention.
The blood samples were collected after an overnight fast, five days before, and 72 h after, the last exercise training session to eliminate the acute effects of the exercise. The concentration (%) of glycated hemoglobin (HbA1c) was determined by the turbidimetry method. All analyzes were performed using an automated system, using commercial kits.
Before and after 12 weeks of intervention.
Change in glucose
Time Frame: Before and after 12 weeks of intervention.
The blood samples were collected after an overnight fast, five days before, and 72 h after, the last exercise training session to eliminate the acute effects of the exercise. Plasma concentrations of glucose (mg/dL) were determined by enzymatic colorimetric methods. The analyze was performed using an automated system using commercial kit.
Before and after 12 weeks of intervention.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Blood Pressure Variability
Time Frame: Before and after 12 weeks of intervention
The systolic, diastolic and mean blood pressure values (mmHg) from the Ambulatory Blood Pressure Monitoring will be used in the assessment of Blood Pressure Variability (BPV) according to the protocols. Comparing the variables between groups: Standard deviation, Coefficient of variation, real average variability (ARV), morning surge, night descent, with individuals classified as: present, attenuated, absent or accentuated descent, when the pressure decreases between periods wakefulness and sleep is ≥ 10%, < 10%, ≤ 0%, and ≥ 20%, respectively; Percent pressure loads of systolic blood pressure values greater than 130 mmHg during the 24 hours, greater than 135 mmHg during the waking period and greater than 120 mmHg during the sleep period; and diastolic blood pressure greater than 80 mmHg during the 24 hours, greater than 85 mmHg during the waking period and greater than 70 mmHg during the sleep period.
Before and after 12 weeks of intervention
Heart rate variability
Time Frame: Before and after 12 weeks of intervention

The analysis of heart rate variability (HRV) will be analyzed in the frequency and time domain, using a specific software for such analysis. In the time domain, the following indexes will be calculated: interval between two consecutive R waves (RR), (RMSSD) square root of the mean of the sums of the squared differences of the adjacent RR intervals; (SDNN) standard deviation of all normal RR intervals in a time interval; (pNN50) Percentage of adjacent RR interval pairs that are at least 50 ms apart during recording.

For frequency domain analysis: the series of RR intervals, to calculate the power density of the spectrum, the fast Fourier transform (FFT) will be used. The high (HF) and low (LF) frequency spectrum zones will be calculated from the integral of the spectrum power density curve in their respective zones.
Before and after 12 weeks of intervention
Assessment of anthropometry
Time Frame: Before and after 12 weeks of intervention
Anthropometric assessments were carried out in a reserved environment, in which waist, hip and abdomen circumferences (cm) were assessed using a 0.5 cm wide inelastic measuring tape device.
Before and after 12 weeks of intervention
Assessment of climacteric symptoms - Cervantes Quality of Life Scale
Time Frame: Before and after 12 weeks of intervention.
Climacteric symptoms were assessed using the Cervantes Quality of Life Scale, which has 31 questions in the domains: menopause and health, psychic domain, marital relationship and sexuality, and the score goes from 0 to 155, considering that the higher the total score, the worse the quality of life.
Before and after 12 weeks of intervention.
Change in Body composition in 12 weeks
Time Frame: Before and after 12 weeks of intervention.
The assessment of body composition (kg) was performed using the Bioimpedance technique, which features a tetrapolar system with 8 electrodes and a frequency of 20-100 kilohertz.
Before and after 12 weeks of intervention.
Assessment of climacteric symptoms - Menopause Rating Scale (MRS)
Time Frame: Before and after 12 weeks of intervention.
The Menopause Rating Scale (MRS) is composed of eleven questions and the symptoms are divided into somatovegetative, psychological and urogenital. Classification according to total score: asymptomatic or sparse (0-4 points), mild (5-8 points), moderate (9-15 points) or severe (more than 16 points).
Before and after 12 weeks of intervention.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Federal University of Uberlandia

Investigators

  • Principal Investigator: Juliene Dechichi, MSc, Federal University of Uberlandia
  • Study Director: Guilherme Puga, PhD, Federal University of Uberlandia

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

February 1, 2019

Primary Completion (ACTUAL)

March 18, 2020

Study Completion (ANTICIPATED)

March 1, 2022

Study Registration Dates

First Submitted

August 25, 2021

First Submitted That Met QC Criteria

September 29, 2021

First Posted (ACTUAL)

October 13, 2021

Study Record Updates

Last Update Posted (ACTUAL)

October 13, 2021

Last Update Submitted That Met QC Criteria

September 29, 2021

Last Verified

September 1, 2021

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CAAE: 12453719.1.0000.5152

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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