Tipo de artículo: Artículo original Recibido: 07/01/2020

Aceptado: 22/04/2020

Indicadores fisiológicos cardiovasculares y su relación con la Educación Física. Análisis en estudiantes de    medicina

Cardiovascular physiological indicators and their         relationship with Physical Education. Analysis in medicine students

Eirina  Pernas  Cano1*,  Yorexis  Abrahantes  Gallego2,  Jorge  Enrique  Morales  Mendoza3, Gonzalo Ramos Alfonso4 

1 Universidad de Ciencias Médicas de Villa Clara, Cuba. Orcid 0000-0001-5011-4901

2 Dirección Municipal de Deportes. Zulueta, Cuba. Orcid 0000-0002-4901-2761

3 Universidad Central “Marta Abreu” de Las Villas. Facultad de Cultura Física, Cuba. Orcid 0000-0001-8215- 7674 

4 Universidad Central “Marta Abreu” de Las Villas. Facultad de Cultura Física, Cuba. Orcid 0000-0002-3708- 2578  * Autor para correspondencia: epernas@uclv.cu

Resumen  

Uno de los problemas que agrava a la sociedad en la actualidad son las enfermedades crónicas no trasmisibles,  dentro  de  ellas  se  encuentra  la  hipertensión  arterial,  objeto  de  análisis  en  esta investigación por el incremento paulatino en la comunidad de adolescentes y jóvenes. Se formuló como objetivo: describir el comportamiento de la condición cardiovascular de estudiantes de primero y segundo años de la carrera  de Medicina, como premisa para su incorporación a la Educación Física. El estudio se contextualizó en la Universidad de Ciencias Médicas de Villa Clara con 100 estudiantes de 1º y 2º años de dicha carrera, donde las edades oscilan entre los 18 y 20 años de edad. Para ello se utilizaron métodos como la observación, la encuesta, la entrevista, la medición. Los principales  resultados  se  enmarcaron  en  la  descripción  de  los  indicadores,  la  estratificación  de grupos, resultando que los estudiantes del sexo masculino tienden a padecer la enfermedad más que en el sexo femenino, por lo que se recomienda el trabajo profiláctico por parte de los profesores de Educación Física, propiciándole el mejoramiento de su condición física y a su vez calidad de vida y lograr en ellos una formación integral.

Palabras clave: indicadores fisiológicos, diagnóstico, educación física, estudiantes

Abstract 

One of the problems that aggravate society at present is chronic non-communicable diseases, among them is high blood pressure, the object of analysis in this research due to the gradual increase in the community of adolescents and young people. The objective formulated: to describe the behavior of the cardiovascular condition of first and second year students of the Medicine career, as a premise for their incorporation into Physical Education. The study was contextualized at the Villa Clara University of Medical Sciences with 100 students of 1st and 2nd years of this career, with ages range between 18 and 20 years of age. To do this, methods such as observation, survey, interview, and measurement  were used. The main results were framed in  the description  of  the indicators, the stratification of groups, resulting that male students tend to suffer from the disease more than female, so  prophylactic  work  is  recommended  by  teachers  of  Physical  Education,  promoting  the improvement of their physical condition and in turn quality of life and achieving comprehensive training in them.

Keywords: physiological indicators, diagnosis, Physical Education, students

Introducción

In the most recent statistical report of the World Health Organization (WHO)published in Geneva- Switzerland, a Global Action Plan 2013-2020 was prepared, in order to define a roadmap for actions led by countries in the field of prevention and control of non-communicable diseases, bad habits such as  smoking,  lack  of  exercise,  not  having  a  balanced  diet  and  excess  consumption  of  alcoholic beverages, they are the main causes of non-communicable diseases, the greatest threat to human beings, which cause two thirds of the deaths in the world. (Chang, 2015)

The Pan-American Health Organization (PAHO) and the WHO seek to prevent and improve the control of non-communicable chronical diseases. In terms of attributable deaths, the main metabolic risk factor is the increase in blood pressure (to which 19% of deaths are attributed worldwide), followed by overweight, obesity and an increase in blood glucose. Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets increase the risk of dying from one of the non- communicable diseases (NCDs).

Several Latin American countries suggest, in studies carried out, that arterial hypertension (HT) is considered one of the main cardiovascular risk factors, increasing  morbidity  and mortality from myocardial infarction and contributing to the development of cardiovascular, cerebrovascular and renal diseases. Globally, one in five adults is estimated to have high blood pressure, that is, a systolic blood pressure (SBP) ≥ 140 mmHg, and / or a diastolic blood pressure (DBP) ≥ 90 mmHg4.

In Cuba one of the diseases that constitutes a health problem is high blood pressure, therefore, its prevention is a universal and important health measure. In this sense, population promotion and education strategies have been created to decrease the mean arterial pressure, to influence its risk factors (lack of exercise, high salt intake, obesity, smoking, inadequate alcohol intake) and propose modifications. of lifestyle of the population. However, an individual strategy is necessary to achieve an adequate perception of the risk of having high blood pressure.

Cardiovascular diseases are today the leading cause of death in most Latin American countries and worldwide, as well as infectious diseases have declined. In developed countries around 50% of all deaths are caused by cardiovascular diseases, while in developing countries this proportion is close to 16%.

Cardiovascular  diseases  are  responsible  for  a  third  of  deaths  worldwide  and  they  are  eminently foreseeable, thus, to produce a significant reduction, population-level strategies are required such as lifestyle modifications, which should include: healthy diet, physical activity, decrease in smoking.

The WHO declares an integrative conception of health by stating that it is a behavior of complete physical, mental, and social well-being, and not just the absence of disease or illness. The enjoyment of the maximum degree of health that can be achieved is one of the fundamental rights of every human being without distinction of race, religion, political ideology or economic or social condition. The health of all peoples is a fundamental condition for achieving peace and security and depends on the widest cooperation of individuals and States. World Health Organization (WHO, 2015).

Studies by Bauman, Lewicka and Schöppe (2005); Warburton (2009); World Health Organization (2018);  Muñoz,  Arango  and  Segura  (2018);  Along  with  reports  from  the  Pan  American  Health Organization (PAHO, 2016) for the Americas region, they warned that the negative consequences of chronic  non-communicable  diseases  (CNCDs)   turn  upon  the  health  conditions  of  people,  their families and the community, as well as its economy  and the public and private systems of the nations, which threatens the economic growth of Latin America and the Caribbean. Therefore, the recommendations for its prevention and control are directed towards the implementation of highly cost-effective strategies such as the promotion of physical activity.

Muñoz, Arango and Segura (2018) also warn that although the problem of chronic diseases has aroused interest in researchers and clinicians worldwide for their study and management, strategies to  increase  their  performance  are  still  ineffective.  Despite  the  knowledge  about  the  benefits  of physical activity, the prevalence of this activity is very low worldwide.

Dealing  with  the  above  ideas,  the  WHO  (2018)  presents  "World  recommendations  on  physical activity for health", including some recommended levels of physical activity for health for three age groups: from 5 to 17 years old, from 18 to 64 years old, and from 65 onwards. In the case of the group of 18 to 64 years, it refers that for the adults of this group, physical activity generally consists of recreational or leisure activities, displacements, occupational activities, domestic tasks, games, sports or exercises programmed in the context of daily, work, family and community activities.

Among  the  investigations  related  to  physical  activity  and  cardio  respiratory  functions,  those  of Warburton (2009) and Bauman et al (2005) stand out, who insist on the direct relationship between physical  activity  and  cardio  respiratory  health  (reduction  of  risk  of  cerebrovascular  diseases, cerebrovascular accident and hypertension), based on the  following statements:  physical  activity improves  cardio-respiratory  functions;  physical  fitness  has  direct  dose-response  relationships between intensity, frequency, duration and volume of activity; risk reduction is achieved from 150 minutes of moderate or intense exercise per week.

In the Statistical Yearbook of Cuba (2018) it is highlighted that the modifiable factors that affect the high prevalence rates of hypertension worldwide are dissimilar. These include consumption of foods that contain too much salt or fat, insufficient intake of fruits and vegetables, overweight and obesity, the harmful use of alcohol and tobacco, physical  inactivity, psychological  stress, socioeconomic determinants and access inadequate to health care.

In investigations carried out in precedent years according to the previous publication, it is stated that the prevalence in the province of Villa Clara is that every 1,000 inhabitants, 227.9 suffer from HT, starting from the age between 19-24 years that represent the age of medical students in that province. In this context, high blood pressure is conceived as the elevation of systolic and / or diastolic blood pressure, which in all probability represents the most frequent  chronic disease of the many that plague humanity, according to Hernandez (2015). Its importance lies in the fact that the higher the figures, both for diastolic and systolic pressure, the higher the morbidity and mortality, and this is the case in all the populations studied, in all age groups and in both sexes.

HTA  is  considered  a  chronic  non-communicable  disease  characterized  not  only  by  high  blood pressure levels, but as another risk factor related to a greater number of cardiovascular phenomena, therefore,  HTA  according  to  Casanova  (2010),  must  be  considered  as  something  more  than  a problem of high blood pressure.

The program of physical activity for hypertensive practitioners of the National Institute of Sports, Physical Education and Recreation (INDER 2015), is structured in stages: stage I (familiarization stage) and stage II (development stage), aims to promote the development of physical condition in hypertensive patients to contribute to their work, social and personal well-being. And among its contents it includes exercises: stretching and joint mobility; strengthening exercises with or without implements; aerobic exercises; adapted sports games; respiratory and muscle relaxation exercises.

These previously mentioned contents can be pedagogically treated from the Physical Education class, however, it is stated than in Medicine carrier they are not widely promoted in first and second years, it is also observed in young people with this condition are unaware of it and limit themselves to do physical-educational practices that can promote their, physical health and integral formation.

Currently, a great number of medical students are excluded from physical activity simply because of this disease. The objective of this article is to describe the behavior of the cardiovascular condition of first  and second years  students of the medicine career, as a premise for their incorporation into Physical Education.

As it is already known, the importance of physical activity for people's health is more than proven, both in specialized literature and in daily practice; hence, its benefits for ECNT carriers such as HTA must be taken into account, especially if they are of young ages such as university students, who in this  context  can  take  advantage  of  the  practice  of  physical  activity  in  order  to  reduce  the consequences of it due to inactivity processes. In this sense lies the importance of this article.

Materials and methods

In the development of the investigation, the theoretical and empirical methods were used. Among the empirical methods:

Documentary review: with the aim of verifying in the official documentation, aspects related to the state of health of the students.

The survey: hypertensive students to know needs and interests for the practice of physical activity.

The interview: to the physical education teachers, with the purpose of knowing the characteristics of the physical activity that they direct.

Measurement to students: in order to know the state of the physiological indicators related to cardio respiratory fitness.

Methodological triangulation: to verify the data obtained from different methods.

For statistical processing, the frequency distribution to obtain the mathematical values of the data obtained related to cardio respiratory fitness, and represents them in tables.

The population used was the 256 first and second year students of the medicine career. A sample of 100 students was taken from them, who reported a history of chronic non-communicable diseases, of both sexes, the average age being 19.4 years. All with a history of being exempted from Physical Education in the above centers.

The intentional selection of the sample obeys to the following criteria: Refer HTA history

Be part of the first and second years

Be willing to participate in the research

To obtain the values of the indicators, the institution's doctor was used as facilitator and specialist, the professional that works and is related every day with these students.

Cardiovascular physiological indicators to measure: HR: heart rate (beats / min)

PAD: diastolic blood pressure (mmHg)

SBP: systolic blood pressure (mmHg)

MAP: medium arterial pressure (mmHg)

These  physiological  indicators  are  obtained  in  two  moments:  under  basal  conditions  and  under sustained weight test conditions, to establish the significant differences and to get to conclusions for taking correct decisions with the high blood pressure students.

Results and Discussion

Results of the methodological triangulation

•         It is verified that the orientation to carry out therapeutic physical activity exists in the documents.

•         The limitation of participation and incorporation of students to Physical Education activities and classes was verified.

•         Conformism with the exempted condition is evidenced.

•         There is ignorance of the characteristics of the disease.

•         Low teacher responsibility is appreciated towards these students. 

•         There is low knowledge from students about the importance of Physical Education to counteract their illness.

The application of the measurement allowed the students to be grouped into three groups based on the  criteria  of  the  Cuban  National  Program  of  Arterial  Hypertension:  normal  tensive  ,  pre hypertensive and hypertensive, they were constituted as expressed in the following table.

Table 1. Distribution of the simple by sex and groups

Normotensive  Prehypertensive  Hypertensive

Female  Male  Female  Male  Female  Male

It is seen in Table # 2 that the basal values of heart rate (HR) were higher in the female sex in all groups, with statistical differences in normotensive and pre-hypertensive.

During the sustained weight test, the heart rate values reached higher values in the female sex in all groups, and were higher only for normotensive and prehypertensive women. The values obtained for the systolic blood pressure, diastolic blood pressure and medium arterial pressure at rest did not differ between the sexes. However, these indicators at the end of the exercise were slightly higher in women,  except  the  SBP,  which  was  higher  in  men,  although  without  significant  statistical differences.

It is appropriate in this section to consider the importance and need to take advantage of the benefit of physical activity on the organic functioning of the students categorized in one of the three groups of the HTA, reflected in the table.

After the  applied  tests,  it  is  determined  that  hypertensive  students  should  be  linked  to  Physical Education classes, where they work with a purpose to counteract the disease through the practice of physical exercises.

Taking  into  account  the  national  programs  for  both  physical  activity  and  health  areas,  it  is encouraged  that  students  who  present  HBT  maintain  their  physical  condition  and  have  better performance in their cardiovascular system, which is why the intention is to carry out a series of exercises in Physical Education classes in which the teacher can gradually make modifications due to their  intensity  of  work,  repetition,  time.  If  any  alteration  or  exhaustion  is  observed,  other modifications  must  be  made  in  correspondence  with  the  characteristics  of  each  student,  their compensation, among other elements.

Methodological guidelines for the application of exercises in Physical Education classes:

1. The teacher must have the instrument to measure the pressure.
2. Blood pressure should be controlled at the beginning and at the end of the class.
3. The increases in the load of exercises must be individual and progressive, in correspondence with the characteristics of each student.
4. Segmental work should be avoided, promoting the overall development of the organism.

5. If during the development of the class the student feels any discomfort or headache, he must suspend the activity he is doing.

Taking into account the above, the following exercise proposal is made

Warm-up exercises: The warm-up carried out by hypertensive students should be simple, with easy- to-perform exercises, since most of them with this condition have been without exercises for a long time or have never practiced.

1. Stretching exercises:

Starting position: standing up, legs apart, side arms, trunk flexion in front, with view to the front.

Starting  position:  standing  up,  arms  next  to  the  body,  extend  one  arm  up  and  the  other  down. Alternate.

Starting position: standing up, hands clasped behind, flex the trunk in front raising arms.

2. Joint mobility exercises:

Starting position: standing up, legs apart, hands on the waist, count one flexion in front of the neck and head; two flex in the back.

Starting position: standing up, legs apart, hands on the waist, twist the neck on both sides,; alternate. Starting position: standing up, legs apart, hands on waist, perform

One: lateral flexion of the neck and head to the left.

Two: right flexion. Alternate.

3. Arms and trunk exercises:

Starting position: standing up, legs apart, side arms, circle with arms in front and circle with arms behind.

Starting position: standing up, legs apart, arms extended in front, open and close the hands, changing the position of the arms (lateral, up and down).

Starting position: standing up, legs apart, arms up, perform deep trunk flexion, trying to touch the tip of your feet, return to the starting position.

4. Leg exercises:

Starting position: standing up, legs apart, hands on the waist, elevation of the knees in front in an alternative way.

Starting position: standing up, legs apart, hands on waist, diagonal assault, alternating.

5. Half squats and abdominals:

Standing up, legs apart, hands on the waist and trunk slightly flexed in front, perform knee flexion (90 °), return to the starting position.

6. Abdomen exercises:

Starting position: supine, with support of the forearms and elevation of the legs, perform scissors movement.

Starting position: supine, legs flexed at a 45-degree angle, arms crossed on the chest and hands on the shoulders, perform contraction movement of the abdomen, with small movement of the trunk in front. 

7. Breathing exercises:

Starting position: standing up, walking on the tip of your feet taking air through the nose (strong and deep), expelling it through the mouth (soft and long).

Initial position: standing up, perform arm lift from the sides up gently, taking the air in through the nose and expelling it through the mouth while lowering the arms.

Initial  position: standing up, make a gentle walk, taking a deep breath  in through the nose and blowing it out strongly through the mouth in the form of a breath.

Carrying out these exercises both in the teaching and extra-teaching hours in a systematic way, must facilitate  in  the  students  a  better  adaptation  of their  organism  to  physical  activity,  so  that  their cardiovascular  system  can  be  more  easily  compensated  by  a  determined  effort,  improving  their health and physical well-being.    

Ball games and other activities:

Some of the sports that can be used are: Volleyball, Basketball, Soccer, Quiquimbol.

Other activities of a physical - recreational nature that can be carried out on their own in or outside the school, which greatly favor the rehabilitation process of hypertensive students are: dance therapy, the beach, camping, cycling, fishing, hunting, board games and all those activities that due to their energy requirements are within the individual possibilities of realization.

Conclusions

The elements found  in the educational practice of the investigated hypertensive students, reflect unfavorable conditions in relation to conditions for carrying out physical activity, lack of materials and means for adequate attention from physical activity, which further limits their incorporation into the Physical Education.

The cardiovascular indicators of the first and second year students of the Medicine career showed a female  predominance  in  the  pre-hypertensive  condition,  while  the  male  group  was  mostly hypertensive, according to the Cuban National Program of Arterial Hypertension.

The behavior of the cardiovascular condition of students of first and second years of the Medicine career in basal conditions, did not show differences in the group of female students; however, under test conditions of sustained weight, differences were reflected in the SBP indicator of the students.

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