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Influence of a Medium-Impact Exercise Program on Health-Related Quality of Life and Cardiorespiratory Fitness in Females with Subclinical Hypothyroidism: An Open-Label Pilot Study

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  • Universidad Santo Tomás, Bogotá

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Objective. To examine the influence of a medium-impact exercise program (MIEP) on health-related quality of life (HRQoL) and cardiorespiratory fitness (VO2max) in females with subclinical hypothyroidism (sHT). Materials and Methods. We selected 17 sedentary women with sHT (mean age: 43.1 (standard deviation: 9.7) years). Participants carried out an MIEP consisting of 3 weekly sessions of 60 minutes during 12 weeks. Before and after the exercise program HRQoL was assessed by the SF-12v2 questionnaire, and VO2max was evaluated by Rockport walk test. Results. After the 12-week intervention, the participants that performed an MIEP showed improvements in HRQoL in most domains, particularly the vitality domain by 7 points, the social functioning domain by 10 points, the mental health domain by 7 points, and the mental component summary by 7 points. One of the four domains within the physical component summary (general health domain) showed significant effect of the exercise intervention: 6 points. Moreover, the participants that performed exercise showed a higher VO2max (28%; P < 0.01). Conclusion. After 12 weeks of medium-impact exercise program, there were remarkable improvements in HRQoL in most domains. Moreover, this exercise program proved to have a positive influence on cardiorespiratory fitness.
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Journal of yroid Research
Volume , Article ID , pages
http://dx.doi.org/.//
Clinical Study
Influence of a Medium-Impact Exercise Program on
Health-Related Quality of Life and Cardiorespiratory
Fitness in Females with Subclinical Hypothyroidism:
An Open-Label Pilot Study
Andrea Garces-Arteaga,1Nataly Nieto-Garcia,1Freddy Suarez-Sanchez,1
Héctor Reynaldo Triana-Reina,1and Robinson Ramírez-Vélez2
1Departamento de Educaci´
on F´
ısica y Deporte, Universidad del Valle, Mel´
endez Cali, Colombia
2GrupoGICAEDS,FacultaddeCulturaF
´
ısica, Deporte y Recreaci´
on, Universidad Santo Tom´
as,
Carrera 9 N51-23, Bogot´
a, DC, Colombia
Correspondence should be addressed to Robinson Ram´
ırez-V´
elez; robin@hotmail.com
Received  March ; Revised  October ; Accepted  October 
Academic Editor: Noriyuki Koibuchi
Copyright ©  Andrea Garces-Arteaga et al. is 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.
Objective. To examine the inuence of a medium-impact exercise program (MIEP) on health-related quality of life (HRQoL)
and cardiorespiratory tness (VO2max) in females with subclinical hypothyroidism (sHT). Materials and Methods. We s e l e c ted 
sedentary women with sHT (mean age: . (standard deviation: .) years). Participants carried out an MIEP consisting of  weekly
sessions of  minutes during  weeks. Before and aer the exercise program HRQoL was assessed by the SF-v questionnaire,
and VO2max was evaluated by Rockport walk test. Results. Aer the -week intervention, the participants that performed an MIEP
showed improvements in HRQoL in most domains, particularly the vitality domain by  points, the social functioning domain by 
points, the mental health domain by  points, and the mental component summary by  points. One of the four domains within the
physical component summary (general health domain) showed signicant eect of the exercise intervention:  points. Moreover,
the participants that performed exercise showed a higher VO2max (%; 𝑃 < 0.01). Conclusion. Aer  weeks of medium-impact
exercise program, there were remarkable improvements in HRQoL in most domains. Moreover, this exercise program proved to
have a positive inuence on cardiorespiratory tness.
1. Introduction
Prevalence of subclinical hypothyroidism (sHT), dened
as elevated thyroid stimulating hormone (TSH) with free
thyroxine (fT) in the normal range, increases with age
aecting about % of individuals aged  to  years and
% of those aged  or older [,]. Patients with sHT
are associated with increased prevalence of atherosclerotic
lesions and cardiovascular events [,]. Besides, thyroid
hormone deciency may also interfere substantially with
various aspects of physical, mental, and social well being
[] and many studies showed changes in functional status
(i.e., mobility limitation, disability, and poor tness level) in
patients with sHT [,].
On the other hand, the evidence for improvement of
psychiatric symptoms with hormonal treatment (levothy-
roxine) of OH and the use of triiodothyronine (T) to
potentiate the response to treatment of depressive disorders
suggests a direct relationship between thyroid hormones and
psychiatricsymptoms[,]. Neurobiological evidence seems
to corroborate the hypothesis of an organic basis of the
eects of thyroid hormone on the brain and on psychiatric
symptoms [].
Interventions for sHT have included pharmacologic ag-
ents (i.e., hormonal treatment), psychotherapy, alternative
therapies, and physical activity which can improve cardio-
vascular health, psychiatric symptoms, and health-related
Journal of yroid Research
quality of life (HRQoL) [,]. To date, few studies on
HRQoLinsubjectswithsHTinresponsetoexerciseprogram
have been reported [,].
It has been proved that regular exercise positively aects
the mechanisms of action associated with the physiologic
deterioration and transition from subclinical thyroid disease
[]. Several authors recommended exercise to be performed
within an intensity range of –% of maximum oxygen
consumption by VO2max. Nevertheless, more recent studies
emphasize the necessity of exploring the eects of intensity
[,]. Clinical thyroid disease is associated with changes
in the cardiovascular system, including changes in heart
rate during exercise. Considering this, we hypothesized that
medium-impact exercise program would provide a more ade-
quateexercisestimulusforimprovinganumberofmetabolic
factors in females at risk for thyroid disease. erefore, we
hypothesized that a medium-impact exercise program can
also improve HRQoL and cardiorespiratory tness in females
with sHT.
2. Materials and Methods
2.1. Subjects. From January  to September , 
sedentary Colombian women with sHT (physical exercise
less than once a week) were referred to our hospital for
health examination (Servicio Medico Universidad del Valle).
Subjects studied were between  and  years of age, mean
age 43.1 ± 9.7 years. All patients with sHT were newly
diagnosed and were positive for both antithyroid peroxidase
(TPO-Ab) and antithyroglobulin (Tg-Ab) antibodies. e
diagnosis of sHT was established on the basis of the elevated
TSH levels and normal fT and fT values. In patients with
sHT, laboratory tests were performed – days before and
 weeks aer the initiation of the training program. Obese
subjects (body mass index (BMI) >kg.m−2), smokers, and
individuals with hypertension, clinical detectable coronary
artery disease, and other diseases were excluded from the
study. None of the patients were taking any medicine, such
as estrogen supplements, T, diuretics, antihypertensive,
or hypolipidemic drugs. e University of Valle Research
Ethics Committee approved this study. Informed consent
was gained from all participants before the data collection
began.
2.2. Medium-Impact Exercise Program. Preparatory training
phase(weeks):thepresentstudybeganwitha-week
preparatory phase of training to bring all participants up their
 kcal/kg/wk goal. To accomplish this, all participants began
their exercise program at a selected intensity set at a heart
corresponding to –% of VO2max and a frequency of 
times per week.
Implementation of medium-impact exercise program
(weeks –): exercise prescription was standardized to body
weight, and it was estimated that  minutes per week of
moderate intensity exercise was equivalent to  to  kcal/kg
of body weight per week. Exercise intensity was dened
between % and % of VO2max. An aerobic dose of
 kcal/kg per week was selected for the aerobic group. Par-
ticipants were weighed weekly to calculate their kcal/kg per
week target. American College of Sports Medicine equations
(ACSM) were used to estimate caloric expenditure rate and
time required per session []. e exercise prescription used
was established from the participants baseline exercise test
and corresponded to a speed and grade associated with an
upper intensity working level of % to % VO2max followed
by recovery level of % VO2max . Each session included a
 min aerobic circuit training guided by an audio recording
(tropical and latin music). e entire workout lasted about
 minutes that, depending on the number of exercise (
stations), were usually repeated three times. During  and 
minutes throughout the routine, participants were instructed
to check their pulse to ensure that they were working within
their target heart rate range. Each session was preceded
and followed by a gradual warm-up and cool down period,
both of  minutes duration and consisting of walking and
light, static stretching (avoiding muscle pain) of most muscle
groups (upper and lower limbs, neck, and trunk muscles).
ecool-downperiodalsoincludedrelaxationandstretching
exercises. Resistance exercises were performed through the
full range of motion normally associated with correct tech-
niqueforeachexerciseandengagedthemajormusclegroups
(abdominal, dorsal, shoulder, and upper and lower limb
muscles). ey included  exercise group circuit training (
repetitions of each) using barbells (– kg/exercise) or low-to-
medium resistance bands (therabands and balls). Each type of
exercise on the back was performed for  min.
Adherence to the exercise program was encouraged by
the exercise trainer and the physician who supervised each
of the group sessions. Trainers were physical educators with
experience in developing and monitoring exercise programs
among clinical populations. In order to maximise adherence
to the training program, exercise classes consisted of relevant
activities for the group, – participants were accompanied by
music dancing and performed in a spacious, air-conditioned
room (: am). Each participant met with the study
dietician for nutrition assessment and counselling, and an
individualized nutrition intervention plan was developed
fromthebaselinefoodintakeassessment,participantpref-
erences, and the meal plan [].
2.3. Health-Related Quality of Life Assessment. e Colom-
bian standard version of the Medical Outcome Study Short-
Form Health Survey (SF- version ) is a questionnaire
comprising  questionsgrouped into eight dierent domains
of health: physical functioning, role limitation due to physical
problems, bodily pain, general health perception, vitality,
social function, role limitation due to emotional problems,
and mental health. ese eight scales are further clustered
into the physical component summary (comprising physical
function, role-physical, bodily pain and general health) and
mental component summary (comprising vitality, social
function, role-emotional, and mental health) []. e quan-
tication of the mentioned dimensions is values varying from
 to , where  corresponds to “worse health” and  to
“better health.
Journal of yroid Research
T : Baseline characteristics in females with subclinical hypo-
thyroidism.
Variabl e Me an ( SD )
Age (years) . (.)
Weight (kg) . (.)
BMI (kg/m) . (.)
Waist circumference (cm) . (.)
Hip circumference (cm) . (.)
Systolic BP (mm Hg) . (.)
Diastolic BP (mm Hg) . (.)
Submaximal oxygen consumption by VO2max . (.)
Maximum heart rate (beats/min) . (.)
Total cholesterol (mg/dL) . (.)
Triglycerides (mg/dL) . (.)
HDL-C (mg/dL) . (.)
LDL-C (mg/dL) . (.)
Glucose (mg/dL) . (.)
TSH (mIU/L) . (.)
2.4. Cardiorespiratory Fitness Evaluation. Submaximal oxy-
gen consumption (VO2max) was assessed with the Rockport
walking test. During the test, heart rate was monitored
electronically using a Polar A- pulse meter (Polar Electro
Oy, Kempele, Finland). e cardiorespiratory tness was
calculated by VO2max via the ACSM equation []:
VO2max (mL Kg min−1)
= 132.853 − 0.0769 × weight − 0.3877
×height + 6.315 × 0 − 3.2649
×time − 1565 × heart rate.
()
Statistical Methods.Itwassoughttodetectabetween-group
dierence in the change of the SF-v score of  points
(mental component summary) as it was considered clinically
important. Assuming that the standard deviation in this score
wouldbe,similartowhatwasobservedinasimilarsample
of patients [], a total sample size of  would provide
% power to detect a dierence of  points as statistically
signicant. e normality of the distribution of scores was
conrmed with the Kolmogorov-Smirnov test. e paired 𝑡-
test was later used to estimate the dierence in each outcome.
e signicance level was set at 𝑃 < 0.05.Allanalyseswere
carried out by using the statistical package SPSS  (Chicago,
IL, USA).
3. Results
e mean and standard deviation of patients’ age was 43.10±
9.70. All subjects were nonsmokers and had a sedentary
lifestyle. % of patients were females and in the reproductive
age group. e anthropometric, cardiorespirator y tness, and
metabolic prole data are listed in Ta b l e  .
Aer the -week intervention, the participants that
performed of a medium-impact exercise program showed
35
30
25
20
15
10
5
0
Week 0 Week 12
Timeline
VO2max (mL·kg·min−1)
P < 0.001
F : Inuence of a medium-impact exercise program on car-
diorespiratory tness by submaximal VO2max.
improvements in HRQoL in most domains, particularly the
vitality domain by  points (% CI  to ), the social
functioning domain by  points (% CI  to ), the mental
health domain by  points (% CI  to ), and mental
component summary by  points (% CI  to ). One of
the four domains within the physical component summary
(general health domain) showed signicant eect of the
exercise intervention:  points (% CI  to ), Table  .
e paired 𝑡-test analysis revealed that the participants
had a greater cardiorespiratory tness at the end of the
intervention, measured by Rockport walk test (𝑃 = 0.01)and
by the submaximal VO2max (%; 𝑃 < 0.001), Figure .
Finally, the subjects participated . out of  (SD .)
sessions over the  weeks. No adverse events occurred during
oraertheexerciseinanyparticipant.
4. Discussion
e purpose of this study was to examine the inuence
of a medium-impact exercise program on HRQoL and
cardiorespiratory tness in females with sHT. To the authors’
knowledge, this is the rst systematic study evaluating the
potential eectiveness of exercise program in sHT on HRQoL
and VO2max. In our clinical experience, we consider that an
improvement of  points on the SF-v resulting from this
intervention is clinically important. However, no threshold
has been established empirically for the amount of improve-
mentintheSF-vscorethatwomentypicallyfeelmakes
aerobic training worthwhile. Our estimation of the average
eect of the training had some uncertainty, with a % CI
ranging from  to  points. erefore, even if  points is
a valid estimate for the smallest worthwhile eect, it must
be acknowledged that it is uncertain whether the statistically
signicant eect of exercise is clinically worthwhile.
e median mental component summary and general
health scores observed in the present study of women
weresimilartootherstudiesofpatientpopulationswith
conditions such as overweight [] or sedentary []. ere
areveryfewstudiesthatevaluatedHRQoLinsHT[,
], and none included cardiorespiratory tness and health
Journal of yroid Research
T : Inuence of a medium-impact exercise program on health-related quality of life (SF-v).
Timeline mean (SD) Dierence mean (SD) % CI
Week  Week 
Physical component summary ( to )  ()  ()  () to
Physical function  ()  ()  () to
Role-physical  ()  ()  () to
Bodily pain  ()  ()  ()  to 
General health  ()  ()  ()  to 
Mental component summary ( to )  ()  ()  ()  to 
Vitality  ()  ()  ()  to 
Social functioning  ()  ()  ()  to 
Role-emotional  ()  ()  () to
Mental health  ()  ()  ()  to 
SF-v: Colombian standard version of the Medical Outcome Study Short-Form Health Survey.
statusinthesamestudy.Itisbelievedthatsomepsycho-
logical aspects of thyroid hypofunction, when present in
sHT, may be inuenced by physical ndings, as suggested
by the association between physical aspects of quality of
life, in the SF- evaluation and cardiorespiratory tness,
specially VO2max , in the present study. One of the primary
consequences of thyroid dysfunction is lower tolerance to
physical exertion, because of its implications involving the
muscle and cardiovascular systems. is interferes directly
with the patient’s ability to perform daily activities, thereby
reducing his quality of life. e study performed by Kahaly
et al. [] showed that subjects with thyroid dysfunction
have reduced workload tolerance at the anaerobic threshold,
compared to euthyroid subjects. According to these authors,
in hyperthyroidism this exercise intolerance is caused by
mitochondria oxidative dysfunction and in hypothyroidism,
by inadequate cardiovascular support.
Following the -week exercise program, trends to im-
provement were seen in most domains of the HRQoL
questionnaire, with statistically signicant changes in the
mental component summary and several of its domains. e
condence intervals were not narrow enough to conrm that
the benets would be worth the eort of exercising for these
women. Nevertheless, given the other benets of exercise in
females with sHT, physicians can prescribe exercise expecting
that it will improve quality of life. e recommended levels
of physical activity were positively associated with one or
more domains of health-related quality of life [,].
In particular, physical functioning, general health, vitality,
social functioning, and mental health are critically aected
by the recommended level of physical activity []. In the
current study, the physical aspects of HRQoL, such as mental
component summary and general health, seemed to be more
closely associated with the amount of physical activity than
the physical aspects are. is nding is consistent with several
previous studies [,].
e intervention showed better cardiorespiratory tness
results similar to those previously reported in healthy women
with high levels of physical activity [,,]. Interestingly,
it was observed that the VO2max diminishes progressively
during thyroid hormone deciency. So one might speculate
that the increase of VO2max observed in the training group
could have a benecial eect in patients with thyroid disease
occuring as a result of metabolic status.
e main limitation of this study is its uncontrolled
design. is study, however, was conceived as preliminary
research aiming to evaluate the potential usefulness of exer-
cise in patients with sHT. Nevertheless, the nding that sHT
mental symptoms were those showing greater improvement
is a fact that argues against a possible placebo eect despite
the lack of a control group. Investigation of other intervention
components, such as behavior therapy, is also needed. In
addition,futurerandomizedcontrolledtrialsshouldstudy
theeectsofexerciseinpatientswithdisorderssecondaryto
thyroid function variations and their implication, as well as
therapeutic options for this highly prevalent disease.
In summary, a supervised -week program of primarily
medium-impact exercise in females with sHT improves
health-related quality of life. Moreover, this exercise program
provedtohaveapositiveinuenceonthefunctionalcapacity
of the subjects, being eective in improving cardiorespiratory
tness.
Conflict of Interests
e authors declare that there is no conict of interests re-
garding the publication of this paper.
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... Treatment for hypothyroidism includes Pharmacological agents (hormonal replacement), exercises, complementary therapies, psychiatric symptoms & psychotherapy that can improve healthrelated quality of life (HRQoL) and cardiovascular health (Garces-Arteaga et al., 2013). Thyroid function can be improved through exercises. ...
... Andrea Garces-Arteaga et al. studied the effect of medium intensity exercise training given for three months in females with subclinical hypothyroidism. They reported improved quality of life-related to health and positive in luence of the exercise program on the functional capacity and also effective in improving cardiorespiratory itness (Garces-Arteaga et al., 2013). ...
... A study by Andrea Garces-Arteaga et al. showed similar results in which they examined the effects of the 3-month program of medium intensity exercises in females with subclinical hypothyroidism. Results showed a higher VO2max (28%) and suggested that there was a positive in luence of the exercise program on the functional capacity and also effective in improving cardiorespiratory it-ness (Garces-Arteaga et al., 2013). Dall' Ago et al. (2006) evaluated the effects of 12weeks inspiratory muscle training in patients with chronic heart failure and found that inspiratory muscle strength, peak VO2 and exercise capacity were signi icantly increased. ...
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The effect of hypothyroidism on the respiratory system is proven in various studies. The study is aimed to compare Inspiratory muscle training and Aer-obic training on lung functions, exercise capacity & cardiorespiratory itness in females having hypothyroidism. This comparative study was executed on 66 subjects based on the criteria of the study, which were randomly divided into Group A & B. Subjects in Group A received Inspiratory Muscle Training. Still, subjects in Group B received Aerobic Training for four weeks. Spirom-etry assessed pulmonary functions, exercise capacity was evaluated by the 6-Minute Walk Test, and cardiorespiratory itness was assessed by Step Har-vard test. All measurements were taken at the baseline, on the last day of 2 nd week and inal day of 4 th week. Independent t-test and Analysis of Variance (ANOVA) were used to analyze the data. More signi icant improvement in terms of pulmonary functions, exercise capacity and Cardiorespiratory itness was observed, in group B who received Aerobic training in contrast to group A that received Inspiratory muscle training. Results of this study showed Aero-bic training to be more effective and bene icial in improving pulmonary functions , exercise capacity and cardiorespiratory itness than Inspiratory Muscle Training.
... Treatment for hypothyroidism includes Pharmacological agents (hormonal replacement), exercises, complementary therapies, psychiatric symptoms & psychotherapy that can improve healthrelated quality of life (HRQoL) and cardiovascular health (Garces-Arteaga et al., 2013). Thyroid function can be improved through exercises. ...
... Andrea Garces-Arteaga et al. studied the effect of medium intensity exercise training given for three months in females with subclinical hypothyroidism. They reported improved quality of life-related to health and positive in luence of the exercise program on the functional capacity and also effective in improving cardiorespiratory itness (Garces-Arteaga et al., 2013). ...
... A study by Andrea Garces-Arteaga et al. showed similar results in which they examined the effects of the 3-month program of medium intensity exercises in females with subclinical hypothyroidism. Results showed a higher VO2max (28%) and suggested that there was a positive in luence of the exercise program on the functional capacity and also effective in improving cardiorespiratory it-ness (Garces-Arteaga et al., 2013). Dall' Ago et al. (2006) evaluated the effects of 12weeks inspiratory muscle training in patients with chronic heart failure and found that inspiratory muscle strength, peak VO2 and exercise capacity were signi icantly increased. ...
Article
Full-text available
The effect of hypothyroidism on the respiratory system is proven in various studies. The study is aimed to compare Inspiratory muscle training and Aerobic training on lung functions, exercise capacity & cardiorespiratory fitness in females having hypothyroidism. This comparative study was executed on 66 subjects based on the criteria of the study, which were randomly divided into Group A & B. Subjects in Group A received Inspiratory Muscle Training. Still, subjects in Group B received Aerobic Training for four weeks. Spirometry assessed pulmonary functions, exercise capacity was evaluated by the 6-Minute Walk Test, and cardiorespiratory fitness was assessed by Step Harvard test. All measurements were taken at the baseline, on the last day of 2nd week and final day of 4th week. Independent t-test and Analysis of Variance (ANOVA) were used to analyze the data. More significant improvement in terms of pulmonary functions, exercise capacity and Cardiorespiratory fitness was observed, in group B who received Aerobic training in contrast to group A that received Inspiratory muscle training. Results of this study showed Aerobic training to be more effective and beneficial in improving pulmonary functions, exercise capacity and cardiorespiratory fitness than Inspiratory Muscle Training.
... De estos 17 artículos se excluyeron en una primera etapa 5 artículos al ser evaluados el título y resumen, mientras que en una segunda etapa se excluyeron 4 artículos al analizar el texto completo. Solo 8 artículos fueron incluidos en el presente estudio (10,11,12,13,14,15,16,17) . La figura 1 presenta el diagrama de flujo con el proceso de selección de los artículos incluidos. ...
... Garcés-Arteaga, A., et al (12) estudiaron los efectos de un programa de ejercicio de impacto medio que consistió en 12 semanas de entrenamiento aeróbico (55-80% del VO2max) y resistencia en la calidad de vida y fitness cardiorrespiratorio. Encontraron que posterior a este programa los pacientes con HSC aumentaron el consumo máximo de oxígeno en un 28%. ...
... En el estudio realizado por Gárces-Arteaga A., et al (12) , se aplicó una versión distinta de la encuesta de calidad de vida relacionada a la salud (SF-12), en la cual se observaron principalmente mejoras en el componente mental, de manera específica en las esferas de vitalidad, salud mental y social. En cuanto al componente físico, se observaron mejoras principalmente respecto al dolor. ...
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Objetivo: Revisar la bibliografía disponible sobre los efectos del entrenamiento en pacientes con hipotiroidismo subclínico. Material y Métodos: Se realizó una revisión de las bases de datos PubMed, Scopus y Springer incluyendo artículos originales publicados desde el 01 enero del 2009 hasta 11 de junio de 2019 en los que se intervino de forma aguda o prolongada con entrenamiento en pacientes con hipotiroidismo subclínico. Los conectoresutilizados fueron AND y OR junto con las palabras claves hypothyroidism, exercise, effect, thyroid hormone, training, subclinical hypothyroidism, underactive thyroid, aerobic training, anaerobic training, resistance training, strength training. Las palabras claves debían encontrarse en los títulos y resumen. Se evaluó en dos fases la elegibilidad de los artículos según: título, idioma, año de publicación y el análisis de texto completo. Resultados: 8 de las 17 publicaciones encontradas en la búsqueda cumplieron con los criterios de inclusión. En estos se reportó una mejora en la calidad de vida y capacidad física posterior a la aplicación de un programa de entrenamiento mientras que ante un ejercicio físico agudo se observó una cinética cardiorrespiratoria más lenta en pacientes con HSC. Conclusiones: El entrenamiento físico produce mejoras en la calidad de vida y capacidad aeróbica. Se requierede más investigación en el área.
... [26] There are not many studies to report the influence of SCH on cardiopulmonary fitness. [27][28][29][30] The impairment of cardiopulmonary function may be considered as the indication for initiation of L-thyroxine at the subclinical stage of hypothyroidism. [31][32][33] Hence, the present study was aimed to assess the cardiopulmonary fitness by Queens College step tests in patients of SCH to find out impairment if any. ...
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Full-text available
Background: Subclinical Hypothyroidism (SCH) represents the earliest stage of hypothyroidism. SCH is defined biochemically as a high serum thyroid-stimulating hormone (TSH) and normal serum free thyroxine (fT4) and triiodothyronine (fT3) concentrations. Cardiopulmonary fitness reflects the overall capacity of the cardiovascular and respiratory system. VO2 max, also known as maximal oxygen uptake, is the measurement of the maximum amount of oxygen a person can utilize during intense exercise. Objective: The aim of this prospective observational case-control study was to evaluate the cardiopulmonary fitness of patients diagnosed with SCH. Methods: The study comprised of 140 participants (80 patients with SCH and 60 healthy controls) in the age-group of 18-55 years. VO2 max was estimated indirectly by following the protocol of Queen's College Step Test (QCT) method to assess cardiopulmonary fitness Results: The patients of SCH and Controls were comparable for age, gender, weight, waist circumference, BMI and hemodynamic parameters. TSH was significantly elevated in SCH than controls while fT4 and fT3 were comparable. The patients of SCH showed a significant reduction VO2 max as compared to controls 46.4±8.6 and 49.8±9.8 ml/kg/min respectively (P=0.029). VO2 max was significantly reduced in female SCH than male SCH (P=0.001). Conclusion: Cardiopulmonary functions were affected in patients with SCH. A mild cardiopulmonary dysfunction was seen in patients with SCH particularly in females.
... Po 12 týždňoch cvičebného programu so strednou intenzitou došlo k výraznému zlepšeniu HRQoL. Okrem toho sa ukázalo, že tento cvičebný program má pozitívny vplyv na kardiorespiračnú zdatnosť (Garces-Arteaga et al. 2013). ...
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The aim of the study was to extend knowledge about selected lifestyle factors of patients with particular non-communicable chronic diseases (NCD). We focused on their leisure activities, including physical activity (PA), patients' interest in lifestyle changes and some of the risk factors in lifestyle that may affect patient treatment - alcohol consumption and smoking. The study involved 893 patients. Data collection was carried out using a non-standardized questionnaire, which was part of a questionnaire battery designed for the purposes of the research. The cross-sectional study conducted among patients with selected NCDs found that the preference for leisure activities between the groups of patients is very similar. Household chores dominate in all groups. Furthermore, all NCD patient groups would primarily be willing to change their diet, PA and drinking regime. More than one third of patients perform PA irregularly (at oncological patients it is more than 40%). Approximately 80% of patients do not drink alcohol at all, or only 1-2 times a month. More than 50% of patients claimed to be non-smokers, in the cancer group it was almost 80% of them. The research was supportes by the scientific Grant Agency VEGA No. 1/0825/17 „Recommendations for physical activities in prevention and control of non-communicable diseases and their implementation in the eastern part of Slovakia“ implemented at UPJŠ Košice.
... Nonetheless, the slight increase in the level of T4, which has an important role in energy metabolism, observed in both groups following exercise training [34], suggests that exercise training can improve thyroid functions. Exercise training for patients with subclinical hypothyroidism is important as it can prevent reduced physical fitness and enhance self-esteem as well as prevent negative changes in the risk factors of metabolic syndrome [23]. Exercise training has been recommended as a good intervention for the conservation of musculoskeletal health [6]. ...
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This study analyzed the differences in effects of a 12-week combination of exercise training program with resistance training and aerobic exercises on the risk factors of metabolic syndrome, carotid wall thickness, and thyroid function, between subclinical hypothyroidism patients and obese groups, in middle-aged women. Subjects consisted of either 20 middle-aged women in the subclinical hypothyroidism (SCH) group or 20 obese (body mass indices [BMI], ≥ 25 kg/m²) women without hypothyroidism in the obese (OB) group. The body composition, blood lipid factors, hormones associated with thyroid functions, blood pressure (BP), and carotid intima-media thickness were measured, while physical fitness was ascertained. In the SCH group, waist circumference (WC) and high-density lipoprotein cholesterol values were outside the normal ranges, while WC and systolic BP (SBP) were outside the normal ranges in the OB group. Following the 12-week training program, significantly positive changes occurred in body fat percentage, sit and reach test results, and SBP (p < 0.05) in the SCH group, while in the OB group, significantly positive changes in BMI, WC, sit and reach test results, SBP, and diastolic BP (DBP, p < 0.05) were observed. In addition, both groups showed significant decreases in intima-media thickness of the right carotid bifurcation (p < 0.05). However, in the two groups, the 12-week exercise training program did not have similar significant impact on the hormones related to thyroid functions and blood lipids. Therefore, further research on exercise training that can effectively induce changes in the hormones associated with thyroid functions in patients with subclinical hypothyroidism is necessary.
Article
A biochemical diagnosis of subclinical hypothyroidism is defined by an elevated serum thyroid-stimulating hormone (TSH) with a normal serum free thyroxine (FT4). This paper discusses SCH in the Australian population, the impact of SCH on health-related quality of life (HRQoL), and the evidence for thyroid hormone therapy as well as exercise therapy to improve HRQoL in SCH. The prevalence of SCH in Australia is approximately 4–5% and is higher in females and the elderly. Current evidence suggests thyroid hormone therapy is not associated with an improvement in HRQoL. However, there does appear to be a subgroup of those with SCH that experience an impairment in HRQoL who may potentially benefit from treatment. Because the majority of research to date has been done in elderly, largely asymptomatic individuals, this may not be representative of the entire SCH population. Additionally, alternative treatments such as exercise therapy have not been well explored in the literature, despite exercise therapy's effects on HRQoL in other populations. Further research is required to clearly define which individuals with SCH are likely to experience an impaired HRQoL, as well as explore the effects of thyroid hormone therapy and exercise therapy in these individuals. This article is protected by copyright. All rights reserved.
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Cieľom tejto monografickej práce bolo zistiť mieru informovanosti a plnenia odporúčaní pre oblasť vykonávania pohybových aktivít v rizikových populačných skupinách vybraných chronických ochorení na východnom Slovensku. Rovnako nás zaujímalo, akú úlohu zohráva lekár a zdravotnícky personál pri odporúčaniach pre realizáciu pohybovej aktivity pri liečbe pacienta a či pacient dodržiava tieto odporúčania. Predložená prierezová štúdia realizovaná u pacientov vybraných chronických ochorení zistila, že väčšina pacientov si uvedomuje dôležitosť pohybovej aktivity pri liečbe ich ochorenia. Rovnako sme zistili, že takmer polovica pacientov dostáva od lekára iba všeobecné informácie o realizácii pohybovej aktivity. Veľmi podrobné informácie dostáva takmer tretina pacientov. Prevažná väčšina pacientov v tejto štúdii uviedla, že má informácie o minimálnych požiadavkách na pohybovú aktivitu – frekvenciu, trvanie a intenzitu zaťaženia a poznajú vhodné telesné cvičenia pre prevenciu a liečbu ich ochorenia. Tieto výsledky podčiarkujú význam osvety a informovanosti vo vzťahu k zdravému životnému štýlu, ktorého dôležitou súčasťou je pohybová aktivita nielen pre zdravých ľudí, ale i pre ľudí v rizikových populačných skupinách vybraných ochorení, ktoré im nebránia vo vykonávaní pohybovej aktivity.
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This study examined the effect of exercise on skeletal muscle symptoms experienced by women with hypothyroidism. An online survey on exercise participation was completed by female participants undergoing treatment for hypothyroidism (n = 580). Basal muscle symptoms (MS) and exercise muscle symptoms were analyzed by the type of exercise performed, cardiovascular/aerobic (CV), resistance training (RT), or both (CVRT). Exercise participation affected MS (F = 7.186, p < .01) with respondents performing a combination of CVRT reporting the lowest basal MS compared to those performing CV (p = .044), RT (p = .031) alone, or those performing no exercise at all (p < .001). Associations between muscle pain (χ² = 7.963, p = .019) and muscle fatigue (χ² = 14.240, p < .001) during exercise and by exercise type were found. Muscle pain during exercise was also associated with an exercise type and frequency (χ² = 24.164, p < .019). Finally, there was an association between recovery from exercise and frequency of exercise bouts (χ² = 32.185, p < .001). Women with hypothyroidism commonly experience skeletal muscle symptoms at rest and during exercise. The results from this study indicate the type of exercise performed may have an impact on the occurrence of these symptoms.
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Introduction: Cardiorespiratory fitness (CRF) is an excellent health status indicator, since reduced CRF values may constitute an early marker of alterations in the cardiovascular system. Objective: To determine the relationship between body mass index (BMI) and CRF in teachers working in State schools of Barranquilla, Colombia. Materials and methods: A descriptive, cross-sectional and correlational study was conducted from October 2015 to May 2016 in 363 teachers working in State schools of Barranquilla. Participants' sociodemographic data were collected, their BMI was calculated and their CRF was measured using the Rockport walking test (also known as 1-mile walking test). Results: Participants' mean age was 48.1±9.4 years, 72.1% were women, and 65.55% had a BMI >25 kg/m². On the other hand, CRF mean was 26.4 mL/kg/min and was inversely correlated with BMI (p<0.05). Conclusion: Bearing in mind the high prevalence of overweight and obesity and the low levels of CRF found in the present study it is necessary to implement health prevention programs based on physical activity and nutritional counseling aimed at encouraging public school teachers to adopt healthy lifestyles.
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Both hypo- and hyperthyroidism are characterised by exercise intolerance. In hypothyroidism, inadequate cardiovascular support appears to be the principal factor involved. Insufficient skeletal muscle blood flow compromises exercise capacity via reduced oxygen delivery, and endurance through decreased delivery of blood-borne substrates. The latter effect results in increased dependence on intramuscular glycogen. Additionally, decreased mobilisation of free fatty acids from adipose tissue and, consequently, lower plasma free fatty acid levels compound the problem of reduced lipid delivery to active skeletal muscle in the hypothyroid state. In contrast, cardiovascular support is enhanced in hyperthyroidism, implicating other factors in exercise intolerance. Greater reliance on muscle glycogen appears to be the primary reason for decreased endurance. Biochemical changes with hyperthyroidism that would favour enhanced flux through glycolysis may account for this dependence on glycogen. Deviations from normal thyroid function, and the ensuing exercise intolerance, require appropriate medical therapy to attain euthyroid status.
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Background: Clinical thyroid disease is associated with changes in the cardiovascular system, including changes in heart rate during exercise. However, data on the relation between subclinical thyroid disease (SCTD) and heart rate during exercise are limited. Methods: We investigated 3799 apparently healthy subjects who were evaluated in the Institute for Preventive Medicine at the Sheba Medical Center. All subjects answered standard health questionnaires; were examined by a physician; completed routine blood tests including thyrotropin, free triiodothyronine, and free thyroxine levels; and underwent a treadmill exercise according to the Bruce protocol. Subjects with known thyroid disease or those who were taking thyroid-related drugs were excluded from the analysis. Heart rate profile was compared between patients with subclinical hypothyroidism (SCHypoT), patients with normal thyroid function, and patients with subclinical hyperthyroidism (SCHyperT) using propensity score matching. Results: Seventy patients had SCHyperT and 273 had SCHypoT. Compared with age- and sex-matched normal subjects, SCHyperT subjects had a higher resting heart rate (83±17 vs. 76±12 beats per minute [bpm], p=0.006), a significantly higher recovery heart rate (94±12 vs. 90±12 bpm, p=0.045), and a significantly lower heart rate reserve (80±20 vs. 87±18 bpm, p=0.006). Subjects with SCHypoT showed a trend toward a lower resting heart rate (75±13 vs. 77±15 bpm, p=0.09) and had a significantly lower recovery heart rate (88±12 vs. 90±13 bpm, p=0.035). There was no significant difference in exercise duration or blood pressure between subjects with SCTD and their matched normal controls. Conclusions: Subjects with SCTD have a significantly different heart rate profile during rest, exercise, and recovery.
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To evaluate the impact of subclinical hypothyroidism (sHT) treatment on health-related quality of life (QoL), psychiatric symptoms, clinical score, and muscle function. In this randomized double-blind study, patients were assigned either to treatment (n = 35) or placebo (n = 36). Clinical and psychiatric symptoms were assessed by the Zulewski, Hamilton and Beck scales. QoL was assessed by the SF-36 questionnaire. Assessments of quadriceps (QS) and inspiratory muscle (IS) strength were performed by a chair dynamometer and a manuvacuometer. Treatment improved IS (+11.5 ± 17.2; p = 0.041), as did QoL domains "Pain" and "Role Physical" (+19.7 ± 15.2, 0.039 and +22.1 ± 47.5, p = 0.054; respectively). Clinical and psychiatric symptoms showed similar responses to both interventions. sHT treatment improved IS and physical aspects of QoL, despite no impact in other muscle parameters. Clinical score, psychiatric symptoms, and SF-36 domains, based on mental dimensions of QoL may be more susceptible to "placebo effect" in patients with sHT.
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To compare the thyroid hormonal responses to high-intensity interval exercise (IE) and steady-state endurance exercise (SEE) in highly trained males (n=15). The IE session consisted of repeated periods of 90-seconds treadmill running at 100-110% VO(2max) and 90-seconds active recovery at 40% VO(2max) for 42-47 minutes. The SEE session was a 45-minute run at 60-65% VO(2max). Total work output was equal for each session. A 45-minute supine rest control session (CON) was also performed. Pre-session (PRE), immediate post-session (POST), and 12-hours post-session (12POST) blood samples were collected and used to determine free (f) T₄, fT₃, reverse (r) T₃, and cortisol levels. All PRE hormone levels were within clinical norms and did not differ significantly between sessions. All POST IE and SEE hormone levels were significantly elevated compared to POST CON (p<0.001). At 12POST, no significant differences between CON and SEE hormonal levels were observed; however, fT₃ was significantly reduced and rT3 was significantly elevated in 12POST IE compared to 12POST SEE and CON (p=0.022). For IE, at 12POST a negative correlation (r(s) = -0.70, p<0.004) was found between fT₃ and rT₃.Also, for IE, a positive correlation (r(s) = 0.74, p<0.002) between cortisol POST and rT₃ 12POST was noted, and a negative correlation (r(s) = -0.72, p<0.003) between cortisol POST and fT₃ 12POST. IE results in a suppressed peripheral conversion of T₄ to T₃ implying that a longer recovery period is necessary for hormonal levels to return to normal following IE compared to SEE. These findings are useful in the implementation of training regimens relative to recovery needs and prevention of over-reaching-overtraining.
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The aim of the present study was to consider the trustworthiness and preliminary normative values of the SF-12 v2 in Colombian adults. The questionnaire was applied during self-administered interview of 527 people. Central tendency, dispersion and percentile measurement were used for dominions and groups; internal consistency and inter-scale correlation was calculated. It was found that the domains exceeded the proposed reliability standard (0.7 Cronbach's Alpha). The highest average mental health scores occurred in the vitality and mental health domains. The highest physical health scores were found in the body pain, physical functioning and general health domains. Inter-scale correlation resulted in an intermediate range (r=0.22-0.84; p <0.01). It was found that this version of the SF-12 proved to be a reliable instrument. The normative values will facilitate interpreting HRQOL results assessed by SF of studies in Colombia.
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Exercise response of asymptomatic subclinical hypothyroid patients may aid in early diagnosis of cardiovascular morbidity. To study and compare the heart rate and blood pressure changes during exercise and recovery in subclinical hypothyroid patients and euthyroid controls. For the study, 30 each cases (mean age of 40 ± 7 years) of subclinical hypothyroidism and healthy controls underwent exercise as per Bruce protocol. Heart rate (HR) and blood pressure (BP) changes were compared every minute (min) till 3 min of stage II exercise, continued till maximum heart rate and thereafter on recovery, for 5 min after stoppage of exercise. Both groups had normal HR and BP at rest, heart rate and BP increased with exercise and remained high even after 5 min of recovery from exercise. The increase in systolic blood pressure (SBP) with exercise was less in patients at the stage of exercise where maximum HR was achieved and up to 1 min of recovery. SBP at 5 min of recovery was higher in patients (P = 0.018). Diastolic blood pressure (DBP) increased with exercise and changes were similar in both groups during exercise and recovery. HR was higher in patients at 1 min of exercise. Changes in HR from 1 min of recovery to 2-5 min of recovery were significant in both groups. The present pilot study highlights that many parameters of HR and SBP during exercise and recovery in asymptomatic subclinical hypothyroid patients may differ from euthyroid, controls.