Cardiovascular diseases represent the first cause of death in Brazil, resulting in high costs to the public health system in the country. It´s known that the most risk factors that take to the development of these diseases occurs due to modifiable lifestyle, such as inadequate nutrition and physical inactivity, and they´re present from childhood. Therefore, it´s important that the issues involving the practice of healthy lifestyle are addressed at school so early, in order to prevent these diseases at older ages. However, for that these health education processes are effective at school in these early stages of learning, their teachers must be properly prepared for this task. Thus, the aim of this study was to discuss the health transversal theme, using the cardiovascular health generator theme with students in the normal course, future children´s educators and of the early years. To achieve this goal, some methodological tools were used, such as the physical profile evaluation of the student and the use of images on the theme. Thus, we start from own body measurements of student to be closer to the cardiovascular health generator theme, and we use the images because it´s a fun methodology and widely used by students in the normal course. We observed, according to the criteria examined, that these students didn´t constitute as a risk profile for developing cardiovascular diseases (anthropometrics appropriate), despite the physical activity being below the levels suggested for healthy individuals. Furthermore, we met a low understanding of young people about the cardiovascular health perceptions through the images used, this fact may be associated with a important deficit in addressing these issues in the current training of these students. Thus, after the discussions in large group about the proper meaning of the cardiovascular health images, as well as the explanation of the relation between physical measurements with health profile, it was found that learning was more meaningful. Thus, at a later time, the students built a didactic material, consisting of recreational activities about the studied themes for later application to early years. As a result, we realized the wealth of didactic material created by students, it was verified by creative and playful nature found in activities. Through the application of recreational activities built by students in the normal course to the early years, it was observed the effective participation of children through questions and curiosities, engaging in recreational and practices activities, and a important learning about the issues verified through their reports. Finally, the most appropriated knowledge about the cardiovascular health generator theme, and issues related to health promotion and cardiovascular disease prevention by students in the normal course and the early years were some contributions of this study to improve the teaching and learning process in science and health education. / As doenças cardiovasculares representam a primeira causa de morte no Brasil, acarretando altos custos ao sistema de saúde pública no país. É conhecido que grande parte dos fatores de risco que levam ao desenvolvimento destas doenças ocorre devido a hábitos de vida modificáveis, como a alimentação inadequada e a inatividade física, e estão presentes desde a infância. Sendo assim, é vital que as questões que envolvam a prática de hábitos de vida saudáveis sejam abordadas no ambiente escolar de forma precoce, como forma de prevenção destas doenças em idades mais tardias. Entretanto, para que estes processos de educação em saúde sejam efetivos no contexto escolar nestas fases precoces de ensino, seus docentes devem estar devidamente preparados para esta tarefa. Assim, a proposta deste estudo foi problematizar o tema transversal saúde, utilizando o tema gerador saúde cardiovascular com estudantes do curso normal, futuras educadoras infantis e dos anos iniciais. Inicialmente foram utilizadas algumas ferramentas metodológicas, a exemplo da avaliação do perfil físico da estudante e do uso de imagens sobre o tema. Assim, partimos das próprias mensurações corporais da estudante para aproximá-la do tema gerador saúde cardiovascular, bem como utilizamos as imagens por se tratar de uma metodologia lúdica e amplamente utilizada pelas estudantes do curso normal. De acordo com os critérios analisados, observou-se que estas estudantes avaliadas não se constituíram como um perfil de risco para o desenvolvimento das doenças cardiovasculares (perfil antropométrico adequado), apesar da prática de atividade física estar abaixo dos níveis sugeridos para indivíduos saudáveis. Além disto, verificou-se um baixo nível de entendimento das jovens acerca das percepções sobre saúde cardiovascular por meio das imagens utilizadas; fato este que pode estar associado a um déficit importante na abordagem destes temas na formação atual destas estudantes. Sendo assim, após as discussões em grande grupo acerca do significado adequado das imagens em saúde cardiovascular, bem como a explicação sobre a relação das mensurações físicas com um perfil de saúde, verificou-se que a aprendizagem deste tema se deu de forma mais significativa. Posteriormente, estas estudantes construíram um material didático, constando de atividades lúdicas sobre as temáticas estudadas, para posterior aplicação aos anos iniciais. Como resultados, percebeu-se a riqueza do material didático criado pelas estudantes, verificado pelo caráter criativo e lúdico encontrado nas atividades construídas. Através da aplicação das atividades lúdicas construídas pelos estudantes do curso normal aos anos iniciais, observou-se a participação efetiva das crianças, através de questionamentos e curiosidades, envolvimento em atividades lúdicas e práticas, e uma aprendizagem relevante sobre os temas, verificado através de seus relatos. Por fim, um conhecimento mais pertinente sobre o tema gerador saúde cardiovascular, e aspectos relacionados à promoção da saúde e prevenção das doenças cardiovasculares por estudantes do curso normal e dos anos iniciais, foram algumas das contribuições deste projeto para melhorar o processo de ensino aprendizagem no ensino de ciências e saúde.

Pulse wave velocity (PWV) and augmentation index (AI) are independent predictors of cardiovascular health. However, the comparability of multiple oscillometric modalities currently available for their assessment was not studied in detail. In the present study, we aimed to evaluate the relationship between indices of arterial stiffness assessed by diastolic and suprasystolic oscillometry. In total, 56 volunteers from the general population (23 males; median age 70 years [interquartile range: 65–72 years]) were recruited into observational feasibility study to evaluate the carotid-femoral/aortic PWV (cf/aoPWV), brachial-ankle PWV (baPWV), and AI assessed by 2 devices: Vicorder (VI) applying diastolic, right-sided oscillometry for the determination of all 3 indices, and Vascular explorer (VE) implementing single-point, suprasystolic brachial oscillometry (SSBO) pulse wave analysis for the assessment of cfPWV and AI. Within- and between-device correlations of measured parameters were analyzed. Furthermore, agreement of repeated measurements, intra- and inter-observer concordances were determined and compared for both devices. In VI, both baPWVand cfPWVinter-correlatedwell and showed good level of agreement with bilateral baPWVmeasured byVE (baPWV[VI]– baPWV[VE]R: overall concordance correlation coefficient [OCCC]¼0.484, mean difference¼1.94 m/s; cfPWV[VI]–baPWV[- VE]R: OCCC¼0.493, mean difference¼1.0m/s). In contrast, SSBO derived aortic PWA (cf/aoPWA[VE]) displayed only weak correlation with cfPWV(VI) (r¼0.196; P¼0.04) and ipsilateral baPWV (cf/ aoPWV[VE]R–baPWV[VE]R: r¼0.166; P¼0.08). cf/aoPWA(VE) correlated strongly with AI(VE) (right-sided: r¼0.725, P<0.001). AI exhibited marginal between-device agreement (right-sided: OCCC¼ 0.298, mean difference: 6.12%). All considered parameters showed good-to-excellent repeatability giving OCCC > 0.9 for 2-point-PWV modes and right-sided AI(VE). Intra- and inter-observer concordances were similarly high except for AI yielding a trend toward better reproducibility in VE (interobserver–OCCC[VI] vs [VE]¼0.774 vs 0.844; intraobserver OCCC[VI] vs [VE]¼0.613 vs 0.769). Both diastolic oscillometry-derived PWV modes, and AI measured either with VI or VE, are comparable and reliable alternatives for the assessment of arterial stiffness. Aortic PWV assessed by SSBO in VE is not related to the corresponding indices determined by traditional diastolic oscillometry.

Resting heart rate (RHR) is positively related with mortality. Regular exercise causes a reduction in RHR. The aim of the systematic review was to assess whether regular exercise or sports have an impact on the RHR in healthy subjects by taking different types of sports into account. A systematic literature research was conducted in six databases for the identification of controlled trials dealing with the effects of exercise or sports on the RHR in healthy subjects was performed. The studies were summarized by meta-analyses. The literature search analyzed 191 studies presenting 215 samples fitting the eligibility criteria. 121 trials examined the effects of endurance training, 43 strength training, 15 combined endurance and strength training, 5 additional school sport programs. 21 yoga, 5 tai chi, 3 qigong, and 2 unspecified types of sports. All types of sports decreased the RHR. However, only endurance training and yoga significantly decreased the RHR in both sexes. The exercise-induced decreases of RHR were positively related with the pre-interventional RHR and negatively with the average age of the participants. From this, we can conclude that exercise—especially endurance training and yoga—decreases RHR. This effect may contribute to a reduction in all-cause mortality due to regular exercise or sports.

Dans le monde, une naissance sur 10 est prématurée, se produisant avant 37 semaines de gestation, et environ 1% sont très prématurées (<30 semaines de gestation). La prématurité est associée à des altérations de la structure et fonction cardiovasculaire qui persistent à l’âge adulte et sont liées aux maladies cardiovasculaires. Il n’y a cependant pas de recommandations cliniques pour le suivi de la santé cardiovasculaire chez les jeunes adultes nés très prématurément. Cette thèse porte sur la prévention des maladies cardiovasculaires dans cette nouvelle population à risque. Ses objectifs principaux sont de décrire les effets à long terme de la prématurité sur la santé adulte et de présenter les avenues de prévention et d’intervention permettant de mitiger ces effets. Son premier chapitre présente une revue de la littérature pertinente alors que son second détaille les méthodes employées pour obtenir les résultats présentés dans les chapitres suivants. Brièvement, la cohorte HAPI (Health of Adults born Preterm Investigation) est constituée de jeunes adultes nés entre 1986 et 1996 au Québec soit prématurément (<30 semaines de gestation) ou à terme (>37 semaines de gestation). C’est la population étudiée dans les chapitres 3 à 5. Le chapitre 3 présente une diminution de la capacité aérobie à l’effort chez les sujets nés prématurément et explore les facteurs y contribuant, incluant des paramètres hémodynamiques cardiaques. Le chapitre 4 examine la perception de la santé et l’utilisation des services de santé dans cette cohorte et comment ceux-ci sont influencés ou non par les paramètres de santé objectifs identifiés précédemment dans le cadre de l’étude HAPI. Le chapitre 5 présente un plaidoyer en faveur d’un suivi médical à long terme des individus nés très prématurément dont les arguments proviennent de témoignages des participants de l’étude HAPI. Enfin, le chapitre 6 présente les résultats de l’étude HAPI Fit qui avait pour but d’évaluer les effets chez de jeunes adultes nés très prématurément d’une intervention de 14 semaines en activité physique principalement sur la capacité aérobie maximale et secondairement sur les paramètres de santé cardiovasculaire. L’ensemble de ces résultats permet de brosser un portrait des conséquences cardiovasculaires à long terme de la prématurité et des moyens disponibles pour les mitiger. La dissémination de ces résultats à la population ciblée et à ses soignants constitue la base sur laquelle pourront se bâtir de futurs programmes de prévention dans cette population à risque. / Worldwide, one in ten births is preterm, occurring before the 37th week of gestation, and approximately 1% are very preterm (<30 weeks of gestation). Preterm birth is associated with alterations of cardiovascular structure and function that persist into adulthood and are linked to cardiovascular disease. There are, however, no clinical guidelines regarding long term cardiovascular monitoring for adults who are born very preterm. This thesis’s focus is the prevention of cardiovascular disease in this new at-risk population. Its main objectives are to describe the long-term effects of prematurity on adult health and to present prevention and intervention avenues for mitigating those effects. Its first chapter presents a review of the pertinent literature while its second describes the methods that were employed to obtain results that are presented in subsequent chapters. Briefly, the HAPI (Health of Adults born Preterm Investigation) cohort recruited young adults born between 1986 and 1996 in the province of Quebec either prematurely (<30 weeks of gestation) or at term (>37 weeks of gestation). This is the population studied in chapters 3 to 5. Chapter 3 presents a diminished maximal aerobic capacity in subjects born preterm and explores contributing factors, including cardiac hemodynamic parameters. Chapter 4 examines health perception and healthcare use in the cohort and how these are influenced or not by objective health measurements previously performed in the HAPI study. Chapter 5 advocates for long-term medical follow-up in young adults born preterm, using testimonials from participants in the HAPI cohort. Finally, chapter 6 presents results from the HAPI Fit study which aimed to evaluate the effects in young adults born very preterm of a 14-week exercise intervention on their maximal aerobic capacity and cardiovascular health parameters. Overall, these results allow us to paint a global picture of long-term cardiovascular consequences of prematurity and of possible ways to mitigate them. Dissemination of these results to the target population and their healthcare providers constitute the basis of future prevention programs in this new at-risk population.

No description available.

Cardiovascular disease begins to develop in childhood. Physical activity positively impacts cardiovascular health and lowers cardiovascular disease risk in school-aged children and adults; however, there is insufficient evidence to determine the effects of physical activity on cardiovascular health during early childhood. The specific dose of physical activity required for favourable cardiovascular health in this age group is also unknown. The purpose of this thesis was to explore the relationships between physical activity and cardiovascular health indicators during early childhood. In the first study, we found that physical activity engagement has beneficial effects on cardiovascular fitness, blood pressure, autonomic function, and arterial stiffness during early childhood. We then determined in the second study that to avoid unfavourable cardiovascular health, preschool-aged children should engage in at least 240 minutes of activity at any intensity, 80 minutes of moderate-to-vigorous physical activity, or 8700 steps per day. Finally, in the third study we evaluated a novel technique for examining arterial wall properties, carotid artery longitudinal wall motion, and determined that it was weakly associated with an established indicator of arterial stiffness (pulse wave velocity) in early childhood. These findings highlight that the benefits of physical activity on cardiovascular health begin in early childhood and the minimal amount of activity to avoid unfavourable cardiovascular health is higher than current recommendations. For the most part, physical activity benefited boys and girls similarly, although it is unclear if the physical activity targets apply equally to boys. We also determined that carotid artery longitudinal wall motion may not be an indicator of arterial stiffness in young children. Future studies should determine if the favourable effects of physical activity on cardiovascular health during early childhood carry over to later years and if achieving the physical activity targets determined in this thesis are associated with additional health benefits. / Thesis / Doctor of Philosophy (PhD) / Heart disease develops slowly over time, starting in childhood. This thesis explored if physical activity can begin to prevent heart disease even in preschoolers, and how much physical activity preschoolers need in order to keep their hearts and blood vessels healthy. We found that preschool-aged children who were more active had better heart health, including better blood vessel health and higher fitness. While all activity was good, more intense, moderate-to-vigorous physical activity (sometimes called energetic play) was more beneficial and slowed down the stiffening of their blood vessels as the children grew. We determined that preschool-aged children should engage in at least 4 hours of physical activity at any intensity or 80 minutes of moderate-to-vigorous physical activity every day to avoid poor heart health. The findings in this thesis highlight the importance of regular physical activity participation to promote heart health even in preschool-aged children.

Two issues are prevalent today in K-6 education-- the integration of the Internet into schools, and the emphasis on guiding children to make wise and healthy lifestyle choices. These are the two themes reflected in this study. The purpose of this study was to design, pilot, and evaluate the Interdisciplinary Internet Module - Healthy Hearts (IIM-HH), an on-line four-week learning module for intermediate grade children. The module was developed to educate youngsters about cardiovascular health, and to encourage them to adopt healthy lifestyles and practice making wise health decisions. The module, delivered via the Internet, allows for interactive, self-directed student learning. It also provides intermediate grade teachers with a valuable resource for teaching important healthy lifestyle concepts, as well as a valuable resource for successful implementation of the Internet into existing curriculums. The Module was piloted with two 5th grade classrooms (N=41) and their teachers (N=2). Qualitative findings from multiple data collection sources provided in-depth insights into the content and technical functionality of the module, and participants' recommendations for change. The formative evaluation revealed the changes that needed to be made before implementation with a large population could be successful. It also revealed that the IIM-HH has the potential to be an effective and motivational instructional unit for both students and teachers. / Ph. D.

Abstract Fatal coronary heart disease among African Americans is associated with a disproportionate burden of cardiovascular disease (CVD) risk factors. Research has indicated that CVD risk factor knowledge and the prevalence of ideal CVH both persist at suboptimal levels. However, few researchers have investigated the relationship between culturally-tailored community-based heart health sessions, short-term knowledge acquisition of CVD risk factors, and the awareness of the American Heart Association's (AHA's) CVH construct. The purpose of this cross-sectional, secondary analysis study was to examine the interplay between these variables in an urban African American sample. Guided by social cognitive theory, the study analyzed de-identified data (data sets of demographic characteristics and Heart Disease Facts Questionnaire) from participant responses collected at multiple community sites to assist in the planning of future health programs. Multiple community sites were randomized into an intervention (n = 50) or comparison group (n = 57). Pearson's correlation and multiple regression were used to analyze data. Knowledge was higher for intervention group participants (β =.44, p = .001) and tended to be higher for those with more education (β = .20, p = .06) and those with less income (β = -.22, p = .07). Notably, most participants (73%) reported awareness of the AHA construct, CVH. The results support culturally-tailored interventions as a useful strategy for CVD risk reduction. The implication for social change is that initiatives at the community-level may positively impact CVH in minority/ethnic communities and subsequently impact CVD disparities.

<p>The thesis presents three papers discussing some of the methodological issues regarding studies investigating complex community-based cardiovascular health interventions. All three studies involved the Cardiovascular Health Awareness Program (CHAP), a standardised blood pressure and risk factor assessment and educational sessions held in pharmacies or other locally accessible areas in small to mid-sized communities in Ontario, Canada.</p> <p>The first paper reviews the literature and proposes a guide on how to develop a theoretical framework for complex community-based interventions using CHAP as an example. The paper describes a stepwise process of developing a theoretical framework including challenges encountered and strategies employed to overcome them.</p> <p>The second paper presents how recently published randomized controlled trials evaluating complex community-based cardiovascular health interventions monitored and reported implementation fidelity based on a structured review of the published articles and a survey of their primary authors. The results showed that fidelity reporting of included studies was better than those described in previous reviews. Fidelity was verified through self-reports by implementers and supervision by researchers. Strategies described to standardize intervention delivery were through training of implementers and use of implementation guides. The authors’ survey results were consistent with the review results though there were some gaps which could be improved to strengthen fidelity reporting.</p> <p>A data analysis issue with studies investigating complex community-based interventions is that outcomes can be affected by factors from multiple levels. The third paper explores the association of individual, partnership, and community-related factors with CHAP participants’ use of health-related community resources and cardiovascular risk behaviours. This was a cross-sectional analysis of an on-going cohort study. The results showed that individual factors (age and self-efficacy) had the most consistent association with the outcomes. Community and partnership level variables showed less consistent association with the outcome. Methodological and analytical challenges were presented.</p> / Doctor of Philosophy (PhD)

The scope of the present work was to investigate whether the protective role of the traditional Mediterranean diet (TMD), and virgin olive oil (VOO) rich in phenolic compounds (PC), towards cardiovascular disease can be mediated through gene expression changes. Two trials were performed to assess the in vivo nutrigenomic effects of TMD and VOO in healthy volunteers. The results point out: a) significant gene expression changes of those genes related with cardiovascular-risk processes after VOO ingestion; b) a down-regulation in the expression of atherosclerosis-related genes after a 3-month intervention with a TMD; and c) an olive oil PC health-protective nutrigenomic effect within the frame of the TMD. Changes in gene expression were concomitant with decreases in oxidative damage and systemic inflammation markers. Data from our studies provide further evidence to recommend both the TMD and the VOO as a useful tool for the prevention of atherosclerosis. / El objetivo de este estudio es investigar si el papel protector de la dieta Mediterránea tradicional (TMD) y del aceite de oliva virgen (VOO), rico en compuestos fenólicos (PC), puede ser mediado a través de cambios en la expresión génica. Se realizaron dos ensayos clínicos para evaluar los efectos nutrigenómicos de la TMD y del VOO, in vivo, en voluntarios sanos. Los resultados mostraron a) cambios en la expresión génica de genes relacionados con el riesgo cardiovascular tras la ingestión del aceite virgen de oliva, b) una infra-expresión en la expresión de genes relacionados con el proceso aterosclerótico tras una intervención con TMD de 3 meses y c) que los compuestos fenólicos del aceite de oliva ejercen un efecto nutrigenómico protector en el marco de la TMD. Los cambios en la expresión génica fueron coherentes.