Takotsubo cardiomyopathy (TTC) is a disease characterized by transient left ventricular (LV) dysfunction and typical wall motion abnormalities in apical parts, without obvious signs of coronary influence. Due to its elusive natural cause and the lack of clarified pathology, further studies are needed. Thirteen patients presented with an episode of TTC, and referred to Örebro University Hospital (USÖ), were prospectively included and investigated by comparisons made at onset (acute phase) against at follow-up three months later (recovery phase). Including echocardiographic measurements, focused on biventricular systolic long-axis function and conventional diastolic function (DF) variables. Systolic improvement was shown, while most DF data were unchanged, suggesting that TTC is mainly a systolic disease affecting both ventricles. Diagnosis should include multidisciplinary engagement, as TTC associates both with emotional stress and pathological markers of physiological stress. In this thesis, such approach was offered to the aforementioned patients; to see if a common denominator could be found, thus, contributing to better handling. Emotional state was assessed, along with an array of cardiac investigations in addition to echocardiography. Acutely, imbalance in the autonomic cardiac control was shown, as well as a trend toward posttraumatic stress, but specific findings allowing conclusions on differential diagnosis could not be demonstrated. By adding another 15 TTC patients (i.e. 28 in total), through collaboration with observers from USA, a retrospective echocardiographic analysis could be done to further study DF; concluding that TTC associates with impairment of conventional DF variables which tends to parallel the systolic recovery, in contrary to the initial result but in line with other causesof LV dysfunction. Magnetic resonance imaging (MRI) is another method of choice at TTC. The USÖ patients had cardiac MRI, thus, a retrospective analysis was done to investigate the effect on LV geometry, both echocardiographic and by MRI; suggesting that TTC is consistently associated with increased LV mass, due to a local impact that seems to follow the change in LVconcentric wall motion.

Crianças com mielomeningocele (MMC) apresentam anormalidades primárias no fechamento do tubo neural com extrusão de tecido nervoso. Alterações secundárias, como a paraplegia, podem comprometer o desempenho cardiopulmonar e a função autonômica cardiovascular, sendo ainda maior, nos indivíduos que são dependentes exclusivamente de cadeira de rodas. Embora a literatura científica tenha amplamente estudado as manifestações clínicas dos diferentes níveis da MMC, pouca atenção tem sido dada à disfunção cardiopulmonar. A análise da função autonômica cardiovascular assim como a avaliação da capacidade cardiopulmonar, pelo consumo máximo de oxigênio (VO2max), tem sido utilizada como forma de predizer fatores de risco relacionados à saúde, mas o teste cardiopulmonar que é o padrão ouro, requer especificidades que limitam sua ampla utilização. Objetivos: Analisar a capacidade cardiopulmonar de crianças e adolescentes cadeirantes com mielomeningocele e comparar com a do seu respectivo controle, e aplicação de teste indireto a fim de estimar o VO2max nas crianças e adolescentes com MMC. Métodos: Participaram desse estudo transversal 22 crianças e adolescentes, de ambos os sexos, com idade entre 8 e 15 anos, separadas em dois grupos: Grupo Mielomeningocele (GM), composto por 11 crianças e adolescentes com mielomeningocele que não deambulam (estritamente usuários de cadeira de rodas); e Grupo Controle (GC), composto por 11 crianças e adolescentes saudáveis pareados por sexo, idade, massa corporal e/ou estatura. Foram obtidos dados antropométricos; composição corporal por bioimpedância elétrica; classificação do nível de maturação pelo índice de Tanner; nível de atividade física pelo Questionário Internacional de Nível de Atividade Física; avaliação da força muscular isométrica dos abdutores de ombro, flexores e extensores de cotovelo, pelo dinamômetro Handheld e força muscular de preensão palmar pelo dinamômetro de Bulbo; avaliação da Variabilidade da Frequência Cardíaca e da Pressão Arterial (VFC e VPA) e da Sensibilidade Barorreflexa Espontânea (SBRE); teste cardiopulmonar em cicloergômetro de membro superior (teste direto = TD); e, teste indireto (TI) seguindo método proposto por Franklin et al.,(1990) para estimar VO2max. Resultados: os grupos não apresentaram diferença estatística com relação à antropometria e força muscular (p > 0,05), porém o GM apresentou incremento de aproximadamente 6kg de massa gorda (p 0,05). No teste cardiopulmonar, o GM apresentou reduzido valor de VO2pico comparado ao seu controle indicando diferença significativa entre os grupos (p 0,05). O VO2pico correlacionou-se positivamente com dados antropométricos, massa magra e força muscular. Os valores de VO2max estimado pelo TI foram menores que os valores reais obtidos no TD, sofrendo uma variação de 24 à 56%; por outro lado, os dados de FCmax e FC de repouso não apresentaram diferença entre os testes. Com relação à função autonômica cardiovascular, os parâmetros espectrais da VFC não apresentaram diferença significativa entre os grupos, mas os valores de baixa frequência na VPA e a SBRE estavam reduzidos no GM (p < 0,05). Conclusão: crianças e adolescentes com MMC apresentam menor capacidade cardiopulmonar que seus controles saudáveis, e reduzida sensibilidade barorreflexa espontânea com baixo controle simpático na VPA, indicando predisposição a eventos cardíacos tardios. E ainda, o método indireto selecionado não se mostrou ideal para estimar o VO2max nos voluntários do presente estudo, subestimando os valores reais, mas permitiu alcançar valores de FCmax prevista. Este pode ser um modelo de teste de esforço máximo, que necessita ser explorado nessa população. Uma proposta de condicionamento cardiopulmonar necessita ser desenvolvida para esta população. / Children with myelomeningocele (MMC) present primary abnormalities in neural tube with nerve tissue extrusion. Secondary alterations, such as paraplegia, can compromise the cardiopulmonary performance and cardiac autonomic function, mainly in individuals who are exclusively dependent on a wheelchair. Although the scientific literature has extensively studied the clinical manifestations of MMC and their different neural lesion levels, poor attention has been addressed to cardiopulmonary dysfunction. Evaluation of cardiac autonomic function and cardiopulmonary capacity using maximum oxygen uptake (VO2max) has been used to predict risk factors related to health, but this gold standard technique requires specificities that limit its widespread use. Objectives: To analyze the difference cardiopulmonary capacity of children and adolescents with myelomeningocele unable to walk and his or her matched control by detecting data that predispose to cardiovascular risks, and using an indirect test in order to estimate the VO2max in children with MMC. Methods: Twenty two (n = 11) children and adolescents participated of this cross-sectional study, both sexes, aged 8 15 years, separated into two groups: Group Myelomeningocele (GM), with 11 children and adolescents with myelomeningocele unable to walk (wheelchair users); and Control Group (CG), with 11 healthy children and adolescents matched for sex, age, weight and/or height. The data obtained were: Anthropometric data; body composition by bioelectrical impedance analysis; index maturation classification by Taner; level of physical activity by IPAQ; isometric muscle strength of shoulder abductors, elbow flexors and extensors using Handheld dynamometer, and grip muscle strength using bulb dynamometer; Spontaneous baroreflex sensitivity (SBS) and heart rate and blood pressure variability (HRV and BPV) evaluation; cardiopulmonary exercise testing on a cycle ergometer of upper limb (direct test = DT); and indirect test following the method proposed by Franklin et al., (1990) to estimate VO2max. Results: Anthropometry data and muscle strength did not present significant difference between analyzed groups (p > 0.05). GM presented approximately 6kg increased fat mass than CG (p 0.05). By cardiopulmonary test, GM presented reduced VO2peak compared to GC, indicating a significant difference between groups (p 0.05). The VO2peak have positive correlation with anthropometric data and fat free mass and muscle strength. The VO2max in DT varied between 2456% higher than those on the IT, but rest and maximum HR mean value comparisons showed no statistical difference between the tests. Considering cardiac autonomic function, no difference was observed to spectral parameters of HRV, but low frequency of BPV and the SBS were significantly lower in GM (p < 0.05). Conclusion: Children with MMC present reduced cardiopulmonary capacity than their healthy peers and reduced spontaneous baroreflex sensitivity and sympathetic control on BPV, indicating some predisposition to risk of cardiovascular event. And yet, VO2max values estimated by the chosen IT underestimated the DT values and were not applicable to this population; however, they may represent a potential model to test maximal exercise and obtain maximal HR values, which need to be explored further in this population.

Crianças com mielomeningocele (MMC) apresentam anormalidades primárias no fechamento do tubo neural com extrusão de tecido nervoso. Alterações secundárias, como a paraplegia, podem comprometer o desempenho cardiopulmonar e a função autonômica cardiovascular, sendo ainda maior, nos indivíduos que são dependentes exclusivamente de cadeira de rodas. Embora a literatura científica tenha amplamente estudado as manifestações clínicas dos diferentes níveis da MMC, pouca atenção tem sido dada à disfunção cardiopulmonar. A análise da função autonômica cardiovascular assim como a avaliação da capacidade cardiopulmonar, pelo consumo máximo de oxigênio (VO2max), tem sido utilizada como forma de predizer fatores de risco relacionados à saúde, mas o teste cardiopulmonar que é o padrão ouro, requer especificidades que limitam sua ampla utilização. Objetivos: Analisar a capacidade cardiopulmonar de crianças e adolescentes cadeirantes com mielomeningocele e comparar com a do seu respectivo controle, e aplicação de teste indireto a fim de estimar o VO2max nas crianças e adolescentes com MMC. Métodos: Participaram desse estudo transversal 22 crianças e adolescentes, de ambos os sexos, com idade entre 8 e 15 anos, separadas em dois grupos: Grupo Mielomeningocele (GM), composto por 11 crianças e adolescentes com mielomeningocele que não deambulam (estritamente usuários de cadeira de rodas); e Grupo Controle (GC), composto por 11 crianças e adolescentes saudáveis pareados por sexo, idade, massa corporal e/ou estatura. Foram obtidos dados antropométricos; composição corporal por bioimpedância elétrica; classificação do nível de maturação pelo índice de Tanner; nível de atividade física pelo Questionário Internacional de Nível de Atividade Física; avaliação da força muscular isométrica dos abdutores de ombro, flexores e extensores de cotovelo, pelo dinamômetro Handheld e força muscular de preensão palmar pelo dinamômetro de Bulbo; avaliação da Variabilidade da Frequência Cardíaca e da Pressão Arterial (VFC e VPA) e da Sensibilidade Barorreflexa Espontânea (SBRE); teste cardiopulmonar em cicloergômetro de membro superior (teste direto = TD); e, teste indireto (TI) seguindo método proposto por Franklin et al.,(1990) para estimar VO2max. Resultados: os grupos não apresentaram diferença estatística com relação à antropometria e força muscular (p > 0,05), porém o GM apresentou incremento de aproximadamente 6kg de massa gorda (p 0,05). No teste cardiopulmonar, o GM apresentou reduzido valor de VO2pico comparado ao seu controle indicando diferença significativa entre os grupos (p 0,05). O VO2pico correlacionou-se positivamente com dados antropométricos, massa magra e força muscular. Os valores de VO2max estimado pelo TI foram menores que os valores reais obtidos no TD, sofrendo uma variação de 24 à 56%; por outro lado, os dados de FCmax e FC de repouso não apresentaram diferença entre os testes. Com relação à função autonômica cardiovascular, os parâmetros espectrais da VFC não apresentaram diferença significativa entre os grupos, mas os valores de baixa frequência na VPA e a SBRE estavam reduzidos no GM (p < 0,05). Conclusão: crianças e adolescentes com MMC apresentam menor capacidade cardiopulmonar que seus controles saudáveis, e reduzida sensibilidade barorreflexa espontânea com baixo controle simpático na VPA, indicando predisposição a eventos cardíacos tardios. E ainda, o método indireto selecionado não se mostrou ideal para estimar o VO2max nos voluntários do presente estudo, subestimando os valores reais, mas permitiu alcançar valores de FCmax prevista. Este pode ser um modelo de teste de esforço máximo, que necessita ser explorado nessa população. Uma proposta de condicionamento cardiopulmonar necessita ser desenvolvida para esta população. / Children with myelomeningocele (MMC) present primary abnormalities in neural tube with nerve tissue extrusion. Secondary alterations, such as paraplegia, can compromise the cardiopulmonary performance and cardiac autonomic function, mainly in individuals who are exclusively dependent on a wheelchair. Although the scientific literature has extensively studied the clinical manifestations of MMC and their different neural lesion levels, poor attention has been addressed to cardiopulmonary dysfunction. Evaluation of cardiac autonomic function and cardiopulmonary capacity using maximum oxygen uptake (VO2max) has been used to predict risk factors related to health, but this gold standard technique requires specificities that limit its widespread use. Objectives: To analyze the difference cardiopulmonary capacity of children and adolescents with myelomeningocele unable to walk and his or her matched control by detecting data that predispose to cardiovascular risks, and using an indirect test in order to estimate the VO2max in children with MMC. Methods: Twenty two (n = 11) children and adolescents participated of this cross-sectional study, both sexes, aged 8 15 years, separated into two groups: Group Myelomeningocele (GM), with 11 children and adolescents with myelomeningocele unable to walk (wheelchair users); and Control Group (CG), with 11 healthy children and adolescents matched for sex, age, weight and/or height. The data obtained were: Anthropometric data; body composition by bioelectrical impedance analysis; index maturation classification by Taner; level of physical activity by IPAQ; isometric muscle strength of shoulder abductors, elbow flexors and extensors using Handheld dynamometer, and grip muscle strength using bulb dynamometer; Spontaneous baroreflex sensitivity (SBS) and heart rate and blood pressure variability (HRV and BPV) evaluation; cardiopulmonary exercise testing on a cycle ergometer of upper limb (direct test = DT); and indirect test following the method proposed by Franklin et al., (1990) to estimate VO2max. Results: Anthropometry data and muscle strength did not present significant difference between analyzed groups (p > 0.05). GM presented approximately 6kg increased fat mass than CG (p 0.05). By cardiopulmonary test, GM presented reduced VO2peak compared to GC, indicating a significant difference between groups (p 0.05). The VO2peak have positive correlation with anthropometric data and fat free mass and muscle strength. The VO2max in DT varied between 2456% higher than those on the IT, but rest and maximum HR mean value comparisons showed no statistical difference between the tests. Considering cardiac autonomic function, no difference was observed to spectral parameters of HRV, but low frequency of BPV and the SBS were significantly lower in GM (p < 0.05). Conclusion: Children with MMC present reduced cardiopulmonary capacity than their healthy peers and reduced spontaneous baroreflex sensitivity and sympathetic control on BPV, indicating some predisposition to risk of cardiovascular event. And yet, VO2max values estimated by the chosen IT underestimated the DT values and were not applicable to this population; however, they may represent a potential model to test maximal exercise and obtain maximal HR values, which need to be explored further in this population.

Abstract Physical activity reduces mortality and morbidity and improves physical and psychological health. Lately, the detrimental health associations of excess sedentary time have also been acknowledged. It is still unknown how temporal patterns of physical activity and sedentary time are associated with health, as previous studies have mainly focused on summary metrics of these behaviors; for example, the weekly duration of moderate to vigorous physical activity. This study aimed to investigate the associations between the amount and temporal patterns of physical activity and sedentary time and health at mid-life. Physical activity and sedentary time were objectively measured for two weeks using an accelerometer-based activity monitor in the Northern Finland Birth Cohort 1966 46-year follow-up (n=5,621). Participants attended clinical examinations and completed health and behaviour questionnaires. A machine learning method (X-means cluster analysis) was used to identify distinct groups of participants with different patterns of physical activity and sedentary behaviour based on the activity data. A positive, dose-response association was found with perceived health and self-reported leisure time and objectively measured moderate to vigorous physical activity. Higher prolonged sedentary time was associated with better heart rate variability but not with resting heart rate or post-exercise heart rate recovery. Four distinct physical activity clusters (inactive, evening active, moderately active and very active) were recognised. The risk of developing cardiovascular disease was significantly lower in the very active cluster compared to the inactive, and in women also in the moderately active cluster compared to the inactive and evening active clusters. On average, the cardiovascular disease risk was low, indicating good cardiovascular health in the study population. Prolonged sedentary time was associated with cardiac autonomic function, which in this study was not explained by physical activity or cardiorespiratory fitness level. Higher cardiovascular disease risk was found in the activity clusters in which the amount of physical activity was lower and in women took place later in the evening. Results of the study can be used for designing feasible interventions for risk groups with unhealthy physical activity and sedentary behaviour patterns. / Tiivistelmä Fyysinen aktiivisuus vähentää sairastavuutta, kuolleisuutta sekä parantaa fyysistä ja psyykkistä terveyttä. Viime aikoina on lisäksi tunnistettu liiallisen paikallaanolon terveyshaitat. Vielä ei tiedetä, miten fyysisen aktiivisuuden ja paikallaanolon ajallinen jakautuminen päivän aikana vaikuttaa terveyteen, koska aiemmat tutkimukset ovat keskittyneet enimmäkseen tiettyihin summamuuttujiin kuten kohtuullisesti kuormittavan liikkumisen määrään viikossa. Työn tarkoituksena oli tutkia fyysisen aktiivisuuden ja paikallaanolon määrän ja ajallisen jakautumisen terveysyhteyksiä keski-iässä. Fyysinen aktiivisuus ja paikallaanolo mitattiin kiihtyvyysanturipohjaisella aktiivisuusmittarilla kahden viikon ajan Pohjois-Suomen vuoden 1966 syntymäkohortin 46-vuotistutkimuksessa (n=5621). Tutkittavat osallistuivat kliinisiin tutkimuksiin ja täyttivät kyselyitä terveydentilastaan ja käyttäytymisestään. Koneoppimismenetelmällä (X-means cluster analysis) tutkittavat luokiteltiin aktiivisuusdatan perusteella ryhmiin, joissa fyysisen aktiivisuuden määrä ja ajallinen jakautuminen päivän aikana poikkesi mahdollisimman paljon ryhmien välillä. Positiivinen annos-vasteyhteys löydettiin koetun terveyden ja itseraportoidun vapaa-ajan liikunnan sekä mitatun kohtuullisesti kuormittavan liikkumisen väliltä. Suurempi pitkittynyt paikallaanoloaika oli yhteydessä parempaan sykevälivaihteluun mutta ei leposykkeeseen tai harjoituksen jälkeiseen sykkeen palautumiseen. Neljä aktiivisuusryhmää tunnistettiin (inaktiiviset, ilta-aktiiviset, kohtuullisen aktiiviset ja erittäin aktiiviset). Sydän- ja verisuonitautien sairastumisriski oli merkitsevästi pienempi erittäin aktiivisessa ryhmässä verrattuna inaktiiviseen ryhmään ja lisäksi naisilla kohtuullisen aktiivisessa ryhmässä verrattuna inaktiiviseen ja ilta-aktiiviseen ryhmään. Sairastumisriski oli keskimäärin matala viitaten hyvään sydänterveyteen tutkimusjoukossa. Pitkillä paikallaanolojaksoilla oli yhteys sydämen autonomiseen säätelyyn, jota tässä työssä ei selittänyt fyysinen aktiivisuus tai aerobinen kunto. Korkeampi sydän- ja verisuonitautien riski löydettiin aktiivisuusryhmistä, joissa fyysisen aktiivisuuden määrä oli vähäisempää ja naisilla painottunut myöhäisempään iltaan. Tutkimuksen tuloksia voidaan hyödyntää interventioiden suunnittelussa riskiryhmille, joiden fyysisen aktiivisuuden ja paikallaanolon piirteet ovat terveydelle haitallisia.