Vol.3, No.6, 413-419 (2013) Open Journal of Preventiv e Me dic ine
http://dx.doi.org/10.4236/ojpm.2013.36056
Study on little active and sedentary women:
Comparison between protocols and prospects for
admission in physical activity program
A. D. P. Bankoff1*, C. A. Zamai1, J. Rocha2, P. R. Mendes Guimarães3
1Postural Assessment Laboratory, Faculdade de Educação Física (FEF), Unicamp, Campinas, Brazil;
*Corresponding A u thor: bankoff@fef.unicamp.br
2Department of Cardiology, Hospital de Clínicas (HC), Unicamp, Campinas, Brazil
3Policy Research Group, Institute of Mathematics, Statistics and Scientific Computation, Unicamp, Campinas, Brazil
Received 15 May 2013; revised 20 June 2013; accepted 1 July 2013
Copyright © 2013 A. D. P. Bankoff et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
The aim of this work was to study little active
and sedentary women through physical assess-
ments using anthropometric measurements and
exercise testing using the Naughton and Bruce
protocols. Approximately 53 women were eval-
uated: Group 1—comprised of 17 completely
sedentary women, aged 25-58 years, mean age
44.4 years, and Group 2—comprised of 36 wo-
men who answered doing physical activities
once or twice a week (low active), aged 28 - 54
years, mean age 39.5 years. The results Group 1—
high weight, body mass index showing over-
weight, heart rate above the target areas of your
training, i.e., above 85% effort. Systolic blood
pressure reached a high level in the seventh
stage with 21 minutes of effort (177.3) and dia-
stolic (92.7). Group 2—normal weight, body mass
index recorded is considered thin, heart rate
heart zones above the target of your training, i.e.,
above 85% effort also. Systolic blood pressure
reached the highest level in phase 1 recovery
(156.75). Diastolic blood pressure re corded pres-
sure levels considered normal for the type of
work done by the group. The values reported for
the double product are considered normal for
the type of effort made by both groups. Conclu-
sion: The participants from group 1 are able to
join physical activity programs from the results
presented, specifically due to weight, BMI, heart
rate and blood pressure. The participants from
group 2 require more days of practice of physi-
cal activities and longer hours to improve the
levels of heart rate and blood pressur e.
Keywords: Sedentary Lifestyle; Double Product;
Heart Rate; Blood Pressure
1. INTRODUCTION
A sedentary lifestyle is the lack or decrease of physical
activity. A sedentary person is one who spends few calo-
ries per week with occupational activities, not necessar-
ily in sports activities. This entails a great risk to health:
physical inactivity is associated with increased incidence
of various diseases and ailments such as obesity, diabetes,
increase bad cholesterol (LDL), fat deposits in arteries,
hypertension and myocardial infarction [1].
Today, the leading causes of deaths in Brazil may be
related to lack of physical activity. Only 13% of Brazil-
ians prac tice exer cises and mo re than 60% of the popula-
tion is completely sedentary. Sedentary lifestyle in-
creases in 54% the cases of myocardial infarction and in
50% the risk of death from stroke. Every year, more than
300,000 die in Brazil by lack of physical activity. The
risk of death from heart disease is reduced by 40% by
becoming a little more active [2].
[3] reports that more and more people have acquired
the habit of regular physical activity, whether spontane-
ous or controlled by physical education professionals.
Overall, this option of incorporating exercise habits to
everyday life brings important benefits to the body in
various organs and systems, favorably reflecting on the
overall health of the individual. Obviously, this conduct
in relation to physical exercise must be encouraged at
various levels and segments of society, given its scien-
tifically proven effectiveness with regard to disease pre-
vention, health promotion and improved overall levels of
quality of life.
Physical assessment must precede any type of exercise
program. It is of fundamental importance to carry physi-
Copyright © 2013 SciRes. OPEN A CCESS
A. D. P. Bankoff et al. / Open Journal of Preventive Medicine 3 (2013) 413-419
414
cal assessments before starting a physical activity pro-
gram, not only to check possible health problems of a
general nature, but also to verify the evolution of the
individual in the post-assessment [4].
Physical activity is a way to restore health from the
harmful effects of work routine. It can be observed that
the more the individual has an active life, the better their
quality of life is. Furthermore, there are differences be-
tween people who practice physical activity and those
who do not, regarding the quality of life and psychologi-
cal and cognitive aspects [4].
Exercise is a form of leisure and restores health from
the harmful effects that the stressful work produces
through routine. Thus, stress is the way the body responds
to any stimulus that alters its equilibrium state, and this
stimulus can be good or bad, real or imaginary [5].
Research conducted by the Society of Cardiology of
the State of São Paulo [6] found that half of the state
population has a sedentary life. In São José dos Campos,
the also revealed that most residents do not engage in
exercise as they should.
“[6] Sedentary lifestyle can be included as the major
risk factor for cardiovascular diseases and is a major
cause of death in the country,” he said. According to the
cardiologist, who also works with sports medicine, the
lack of routine exercise increases the chances of devel-
oping new diseases in the body. The study also showed
that women are more sedentary than men: 57% are not
physically active. Among m en, thi s num ber drops to 42%.
The elders would also be more sedentary, since 56% of
people over 35 do not exercise. From 14 to 17 years the
rate is 30%, between 18 and 24 it is 43%, and from 25 to
34 it rises to 50%. [6] emphasizes that the ideal is to do
aerobic exercises like swimming, running and walking
three times a week, and more intense exercise as weight
training twice a week.
[7] investigated the association between anthropomet-
ric indicators and metabolic variables in 69 subjects of
both genders. The results showed that heart rate corre-
lated with the intensity of effo rt, being related to fat per-
centage and BMI. Blood pressure (systolic and diastolic)
showed good correlation with BMI for the female group.
In the male group, WHR was the anthropometric indica-
tor that showed a higher association with blood pressure.
The double product had a higher correlation with BMI,
indicating that this variable reflects the work of the
myocardium.
2. MATERIAL AND METHOD
2.1. Population Studied
Fifty three women attended the Postural Assessment
Laboratory/Electromyography of the School of Physical
Education, University of Campinas, to participate in this
study. After replying to a brief questionnaire and taken
the measurements of height and weight, they were di-
vided into two groups, namely:
Group 1—comprised of 17 completely sedentary wo-
men, aged between 25 to 58 years, mean age 44.4 years;
Group 2—comprised of 36 women who answered do-
ing physical activities once or twice a week (low active),
aged 28 - 54 years, mean age 39.5 years. We reco rded in
the average hours of this group, amounting 01:30 min-
utes of physical activity per week for each woman.
All participants are from administrative sectors of
Unicamp.
2.2. Evaluations Conducted
Anthropometric measurements (weight and height)
and ergometry were done on both groups. Group 1 er-
gometry was evaluated by the Naughton Protocol and
Group 2 was evaluated by the Bruce Protocol. Noting
that the Naughton Protocol is indicated for people com-
pletely sedentary, the elderly and cardiac patients, and
the Bruce Protocol is designed for trained people, ath-
letes and low physical condition people [8].
2.2.1. Material Used
We used the Ergometry-TEB System, which is formed
by an Ergometer APEX 2200 Treadmill, two monitors,
configured for 06 protocols and others that meet the lim-
its of speed and tilt of th e system. The system is prep ared
to act in automatic, semi-automatic or emergency stop. It
is a system made up of 13 simultaneous channels and
allows the performance of exercise tests with the classic
configuration of the three leads MV5, D2M and V2M,
which is the configuration used. This System starts with
the speed of 1.5 mph containing 07 stages.
For anthropometric measurements we used a Welmy
scale, with toesa, with capacity of up to 150 Kg.
2.2.2. Dat a Collection
During the assessments, the women were wearing Bra
and Shorts to facilitate the placement of the electrodes
according to the selected derivations. The electrodes used
were from the brand 3M (Electrode for cardiac monitor-
ing) Ag/AgCl, with adhesive gel. All participants signed
the Free Informed Consent prior to the start of the
testings. The project was approved by the Ethics Com-
mittee of UNIC AM P No. 431/2007 (Figure 1).
The women were instructed to be at the site of evalua-
tions (Postural Assessment Laboratory and Electromy-
ography of the School of Physical Education, University
of Campinas) one hour before the start of evaluations.
They also received a week in advance from the labo-
ratory a folder with the following guidelines:
1) Eat up to two hours before the start of the Protocol;
2) Avoid any kind of physical activity the day before
the Protocol;
3) Bring appropriate attire for the realization of the
Copyright © 2013 SciRes. OPEN A CCESS
A. D. P. Bankoff et al. / Open Journal of Preventive Medicine 3 (2013) 413-419 415
Figure 1. Representative model of electrode placement.
Protocol (shorts, two piece swimsuit and sneakers);
4) Avoid abuses and excesses the night before;
5) Sleep from 6 to 8 hours the day before the exam;
6) Avoid usi ng sedatives; and comm unicat e any chan ge s
in their health status in the past 24 hours.
3. PRESENTATION OF RESULTS
For purposes of data, we collected data related to: age,
weight and height extracted for the BMI. Regarding the
variables, we studied resting heart rate, systolic blood
pressure, diastolic blood pressure and double product
during the stages of the protocols and in the recovery
phase. We also obtained the maximal and submaximal
heart rate.
We highlight the differences listed in the Tables re-
garding the number of stages completed by groups 1 and
2, namely: Group 1 completed the test on the 7th stage of
the Naughton protocol and group 2 completed the test in
the 4th stage of the Bruce protocol.
Before starting the presentation of results, we recall
that the group 1 held 21 minutes of effort during exercise
testing using the Naughton protocol, and group 2 held 12
minutes of effort during exercise testing using the Bruce
protocol. The specifications of each protocol find ex-
pressed in Tables 1 and 2.
The results that are presented below are Ta b l es 3 and
4. Group 1 Group 2 differs in age, height, weight and
body mass index, with women being the group 1 over-
weight in relation to body mass index-BMI (28.6). Ac-
cording to the classification of the World Health Organi-
zation is considered over weight when the body mass
index scale present in 25 and 29.99. For group 2, the
Tabl e 1. Representative model of the naughton protocol model
I (modified according to the specificities of the integrated
APEX TEB 2200 system) [9].
Phases Mph % inclination VO2 max METs mim
1 1.5 0 5.4 1.5 3
2 2.0 0 7.0 2.0 3
3 2.0 3.5 10.5 3.0 3
4 2.0 7.0 14.0 4.0 3
5 2.0 10.5 17.5 5.0 3
6 2.0 14.0 21.0 6.0 3
7 2.0 17.5 24.5 7.0 3
Table 2. Representative model of the bruce protocol [9].
Phases Mph % inclination VO2 ma x METs mim
1 1.7 10 15 4 1
2 2.5 12 25 7 3
3 3.4 14 35 10 3
4 4.2 16 45 13 3
5 5.0 18 55 16 3
6 5.5 20 65 19 3
7 6.0 22 75 22 3
Table 3. Overall average of the variables related to anthropom-
etric measurements, age, BMI and heart rate, systolic blood
pressure, diastolic blood pressure and double product of Group
1—naughton protocol.
AGE 43.4 SBPrest121.9 DBP 6 89.7
WEIGHT73.4 SBP 1 127.2 DBP 7 92.7
HEIGHT160.6 SBP 2 134.1 DBPrec 190
BMI 28.6 SBP 3 140.6 DBPrec 287.8
HRmax176.6 SBP 4 145.6 DBPrec 384.4
HRsubm149.5 SBP 5 152.8 DBPrec 481.9
HRrest72.7 SBP 6 164.7 DPrest 9260
HR 1 94.3 SBP 7 177.3 DP 1 12030
HR 2 110.1 SBPrec 1168.8 DP 2 14833
HR 3 112.5 SBPrec 2159.1 DP 3 15710
HR 4 120.5 SBPrec 3145.3 DP 4 17667
HR 5 125.3 SBPrec 4135.4 DP 5 19234
HR 6 137.7 DBPrest79.7 DP 6 22665
HR 7 152 DBP 1 82.2 DP 7 26932
HRrec 1117.9 DBP 2 84.1 DPrec 1 19980
HRrec 2111.9 DBP 3 85.6 DPrec 2 17910
HRrec 3108.4 DBP 4 86.9 DPrec 3 16113
HRrec 4106.8 DBP 5 89.4 DPrec 4 14467
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A. D. P. Bankoff et al. / Open Journal of Preventive Medicine 3 (2013) 413-419
416
Table 4. Overall average of the variables related to anthropom-
etric measurements, age, BMI and heart rate, systolic blood
pressure, diastolic blood pressure and double product of Group
2—bruce protocol.
AGE 39.51 HRrec 4 102.59 DBP 4 79.35
WEIGHT 62 SBPrest 111.21 DBPrec 180.13
HEIGHT 163 SBP 1 124.86 DBPrec 277.83
BMI 23.2 SBP 2 134.05 DBPrec 375
HRmax 180.48 SBP 3 145.81 DBPrec 474.86
HRsubm 153 SBP 4 150.8 DPrest 8061
HRrest 71.69 SBPrec 1 156.75 DP 1 12075
HR 1 97.02 SBPrec 2 144.72 DP 2 14629
HR 2 109.16 SBPrec 3 132.43 DP 3 18932
HR 3 130.87 SBPrec 3 123.51 DP 4 21594
HR 4 142 DBPrest 73.51 DPrec 1 18732
HRrec 1 121.24 DBP 1 75.67 DPrec 2 15156
HRrec 2 105.91 DBP 2 77.56 DPrec 3 13186
HRrec 3 100.56 DBP 3 79.05 DPrec 4 12629
body mass index presents standard (23.2) which is con-
sidered healthy. The levels of heart rate, systolic and dia-
stolic, and double product presented during physical ex-
ertion are within acceptable standards for both popula-
tions.
Heart rate is a variable that can be used as a parameter
to quantify the level of physical exertion of a particular
exercise. An exercise is considered mild to moderate if
performed at intensity between 65% e 85%, of maximum
heart rate (HRmax). For women index is obtained by
subtracting the age of 226, and then calculating the per-
centage of the total. In our study group 1 averaged 43.4
years and a maximum heart rate of 176.6. For example:
If the percentages requested are
exactly those (65% and 85%), the result is:
226 43.4182.6.
182.6 65%119
beats per minute and 1 beats per
minute. These are the minimum and maximum number
of heartbeats per minute you should keep, i.e., the target
areas of your training. Group 2, for example:
82.6 85%155
226 39.5186.4.
If the percentages requested are exactly those (65%
and 85%), the result is: 186 beats per
minute and 186 beats per minute. In
both groups, the women were above 85% of your
maximum heart rate (g1 = 176.6, g2 = 180.4) .
.4 65%121
158.4 85%
As systolic blood pressure, group 1 showed a value
considered high 177.3 mm Hg in the seventh stage of the
Naughton protocol. Group 2 showed 150.8 mm Hg in the
fourth stage, this considered within the normal range for
exercise. In the recovery 1 group 2 had the highest blood
pressure 156.7 mmHg. In this case we call active recov-
ery because O2 levels remain consumed (ventilation is
maintained at higher levels, facilitating gas exchange)
and circulation remains very active. From the recovery 2
she established normal range. The diastolic blood pres-
sure for the group 1 showed higher values during exer-
cise (82.2 and 92.7), gro up 2 showed normal values (75.6
and 74.8).
As for systolic and diastolic exercise is reported that
systolic (maximum) during a session Exercise typically
increases and, depending on the intensity of the Exercise,
can reach values higher than 200 mm Hg. The diastolic
blood pressure (minimum), during a session of Exercise
usually does not in crease or increases only slig htly (to 15
mm Hg), and may even decrease. An increase in the va l-
ues above these levels (systolic BP > 220 mm Hg or
greater than 15 mm Hg increase in diastolic BP), are
considered abnormal (systolic hypertensive response
and/or diastolic efforts).
Another important variable is the double product
which is a measurement estimate cardiac effort and
myocardial oxygen consumption. Its value is obtained by
multiplying the heart rate (measured in beats per minute)
for systolic blood pressure (measured in mm Hg). The
reference values for the double product of an individual
vary on average between 6000 at rest until 40,000 in ex-
haustive exercises. The double product for both groups
reported normal values even in recoveries, considering
the physical performance of each group g1 totally seden-
tary and g2 little active.
Given the results, we can design and prescribe physi-
cal activity program for both groups minimizing cardio-
vascular risks .
Summary of results:
Group 1—high weight, body mass index showing
overweight, heart rate above the target areas of your
training, i.e., above 85% effort, and heart rate should be
155 beats per minute, however, showed 176.6 beats per
minute. Systolic blood pressure reached a high level in
the seventh stage with 21 minutes of effort (177.3) and
diastolic (92.7). The double product recorded values
considered normal for the type of effort made by the
group.
Group 2—normal weight, body mass index recorded is
considered thin, hear t rate heart zones above the target of
your training, i.e., above 85% effort, and heart rate
should be 158 beats per minute, and however, it showed
180.4 beats per minute. Systolic blood pressure reached
the highest level in phase 1 recovery (156.75). Diastolic
blood pressure recorded pressure levels considered nor-
mal for the type of work done by the group. The double
product also re corded normal levels.
4. DISCUSSION
The qualities of “sedentary and little active” physical
fitness seem to go together, specifically in relation to the
Copyright © 2013 SciRes. OPEN A CCESS
A. D. P. Bankoff et al. / Open Journal of Preventive Medicine 3 (2013) 413-419 417
events of the cardiac cycle (heart rate, systolic and dia-
stolic blood pressure); however, group 2 is at an advan-
tage compared to group 1 because they practice physical
activities, thus influencing the quality of life. The amount
of hours and the number of times per week that group 2
practices physical activities showed to not be sufficient
to differentiate the results from group 1, who are com-
pletely sedentary, although group 2 has completed the
exercise testing using the Bruce protocol, on the 4th
stage, considered a good result. The physical perform-
ance of the group 2 in this study is consid ered better than
when compared to group 1, also see the results when
body weight and body mass index. Group 1 by body
mass index presented is overweight, according to the
World Health Organization and urgent need to change the
lifestyle and physical exercise.
[4,9] studied the events of the cardiac cycle in men
and women through the ergometry system before and
after initiating a physical activity program for six months.
The results showed: at rest, regarding gender, heart rate
showed no significant difference between the assessment
and reassessment. Regarding SBP and DBP, there were
differences between assessment and reassessment only
for men. In the recovery period: heart rate showed no
difference for both groups (male and female). As, for
Systolic blood pressure, for both groups, there were dif-
ferences regarding the assessment of the reassessment
from the first minute up to the 6th minute. As for Dia-
stolic blood pressure, there was no difference in the first
minute.
Regarding the levels of Maximum Heart Rate, both
groups are at levels recommended for adults aged 20 to
55 years considered exhaustive, i.e., above 175 bpm [10].
As our data presented in Tabl es 3 and 4 and the follow-
ing described [10] in relation to the amounts recorded
Maximum Heart Rate activity can be considered exhaus-
tive.
Studies on the desired levels of heart rate extrapolate
several decades; for example, [11] reported that a greater
physical work capacity, kept a metabolic balance, could
be achieved with a maximum limit of 170 beats per min-
ute.
According to [10], stress heart rate must be within a
range of 135 and 174 bpm, i.e., exercise should have an
intensity that can increase HR above 135 bpm, however,
cannot exceed 17 4 bp m.
The results presented in Tables 3 and 4 show that
there was little difference between groups 1 and 2 in re-
lation to the protocols used, as well as the physical fit-
ness levels of both groups.
According to [12] double product (DP) is a measure
estimating cardiac stress and myocardial oxygen con-
sumption and its value is determined by multiplying
heart rate (measured in bpm) by systolic blood pressure
(measured in mmHg).
The double product can estimate the myocardial O2
consumption (MVO2) and is its best indirect predictor
[13-16]. The correlation between double product and
MVO2 is stronger (r = 0.92) than between MVO2 and
HR (r = 0.88), [17]. There is also a linear relation be-
tween MVO2/DP and blood flow in coronary arteries.
Typical values for Double Product range from 6000 at
rest (HR = 50 beats/min, SBP = 120 mm Hg) to 40,000
during intense exercise (HR = 200 beats/min, SBP = 200
mmHg). Changes in heart rate and blood pressure
equally contribute to a change in double product [18].
The double product is a hemodynamic parameter that
sets high correlation with MVO2, determined in stress
ergometry, although the prediction is not possible in ex-
ercises against resistance. Even so, the double product
can be used as an evaluation index of cardiac stress in
RE (resistance exercise), thus being recommended by the
American College of Sports Medicine [18].
Regarding the systolic and diastolic blood pressure
variables, the literature reports that, during exercise and
physical activities, SBP and DBP tend to increase caus-
ing a significant increase also in mean arterial pressure,
even if for a short period of time. Separately, SBP and
DBP show different behaviors during exercise. In ongo-
ing activities of progressive intensity, SBP increases in
direct proportion to the intensity of the exercise, due to
the increase in cardiac out put [19,20] .
We can see in Ta b l e s 3 and 4, from the resting phase
until the 7th stage for group 1 and up to the 4 th stage for
group 2, a gradual increase in systolic and diasto lic b lood
pressure according to the increase of stress in the test. In
the recovery phase, they decrease gradually. It is inter-
esting to follow in the Tables 3 and 4 the behavior of the
double product, taking into account that its value is de-
termined by multiplyin g heart rate (measured in bpm) b y
the systolic blood pressure (measured in mm Hg).
Diastolic pressure varies little during aerobic exercise
when compared to SBP and HR, as the systemic pressure
during cardiac diastole tends to stay in rest levels. In ac-
tivities with strong static co mponent, due to the capillary
constriction by active muscles, coup led with the in crease
in cardiac output, a significant elevation in DBP 25 can
occur [21].
The research studies and discussion about the benefits
of exercise and physical activity are old considering the
scientific publications of [22] who describes that aerobic
exercises (low intensity and long duration) are excellent
for improving physical fitness and reducing body fat,
reducing the risks of cardiovascular diseases.
It was evident that group 2 needs to practice physical
activities with greater intensity and higher weekly fre-
quency so that changes and improvements can occur in
the events of the cardiac cycles (HR, SBP and DBP). As
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A. D. P. Bankoff et al. / Open Journal of Preventive Medicine 3 (2013) 413-419
418
for group 1, taking into account the results presented,
they are able to enter and start physical activities to im-
prove the levels found, specifically weight, BMI, HR,
SBP and DBP.
[23,24] postulate that every adult individual should
accumulate at least 30 minutes of physical activity at
least 5 days a week, or if possible the entire week, of
moderate intensity, which can be performed continuously
or accumulated. However, the group of women consid-
ered little active completed the stress test by the Bruce
protocol in the 4th stage with the following specifica-
tions: 4.2 mph, 16% incline, VO2Max 45, 13 METs and
already amounted 10 minutes of test performance, which
can be considered good for a exercise testing, consider-
ing the physical fitness of the “little active” women. The
women in group 1 that “self-declared” completely sed-
entary, completed the exercise testing by the Naughton
protocol on stage 7 with the following specifications: 02
Mph, 17.5% incline, VO2 Max 24.5, 7 METs and already
amounted 21 minutes of test performance and yet, for the
variables of the events of the cardiac cycle in accordance
with the statistical analysis, the results were not different
between groups 1 and 2 in most of the variables, as
shown in Table 2.
5. CONCLUSIONS
Participants in group 1 are able to particip ate in urgent
and need physical activity programs from the results
presented, specifically due to body weight, BMI, heart
rate and blood pres s ure;
Participants from group 2 require more days of prac-
tice of physical activities and longer hours to improve the
levels of heart rate and blood pressure;
The results presented in Tables 3 and 4 show that
there was little difference between groups 1 and 2 in re-
lation to the protocols used, as well as the physical fit-
ness levels of both groups;
Both groups had high levels of heart rate in the effort
applied during the exercise test protocol (Naughton and
Bruce protocol).
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