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ORIGINAL ARTICLE Table of Contents  
Ahead of print publication
A cross-sectional study to assess the correlation of cardiovascular endurance levels across the gender among sedentary adults of 18–25 years


1 Department of Physiology, Basaveshwara Medical College, Chitradurga, India
2 Department of Physiology, Mandya Institute of Medical Sciences, Mandya, India
3 Department of Physiology, Sri Siddhartha Institute of Medical Sciences, T-Begur, Nelamngala, Bengaluru Rural, Karnataka, India
4 Department of Community Medicine, PES Institute of Medical Sciences, Kuppam, Chittoor District, Andhra Pradesh, India

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Date of Submission25-Mar-2022
Date of Decision25-Jul-2022
Date of Acceptance29-Jul-2022
Date of Web Publication01-Sep-2022
 

  Abstract 


Background: Cardiorespiratory proficiency is an important estimate of healthiness. Participation in endurance activities by both genders has increased in recent times but a shift in lifestyle due to industrialization and mechanization has increased the rate of noncommunicable diseases. Objectives: The objective of this study was to assess the correlation of cardiovascular endurance levels across the gender among sedentary adults. Materials and Methods: A cross-sectional study was initiated among 400 subjects, of which 188 were male and 212 were female participants. Both the study groups were assessed for cardiovascular endurance using anthropometry, pulse rate, respiratory rate, blood pressure, and oxygen saturation at rest, followed by immediate, 1, 2, 3, and 5 min after exercise. They were asked to perform the Harvard step test and fitness index, and all these variables were compared across the gender. Results: There was a significant change in anthropometric indices across the gender. The cardiovascular endurance variables including pulse rate and respiratory rate did not show any significant change except immediately after exercise. The oxygen saturation was significantly affected all the time across the gender. All the participants could perform the Harvard step test and fitness index without any significant change except the duration of the fitness. Conclusion: Physical activity has significant health benefits in all physiological systems. Cardiorespiratory and cardiovascular suitability can be increased in sedentary individuals through trained endurance exercises leading to healthier individuals in the future and improve general health and social well-being, reducing the burden of disease, and improving their quality life years.

Keywords: Cardiovascular endurance, fitness index and anthropometry, Harvard step test, lifestyle, sedentary


How to cite this URL:
Begum A, Lakshmi T, Ali SS, Praveen Kumar B A. A cross-sectional study to assess the correlation of cardiovascular endurance levels across the gender among sedentary adults of 18–25 years. Apollo Med [Epub ahead of print] [cited 2022 Sep 27]. Available from: https://apollomedicine.org/preprintarticle.asp?id=355259





  Introduction Top


The transitional phase in epidemiological trends over the past two decades has been dramatic in India; in a shorter duration, the principle epidemiological factors have transitioned from morbidity pertaining to infectious diseases, undernutrition, maternal, and childhood illness to chronic diseases.[1] Nearly, 67% of the load for chronic disease mortality in India is currently contributed by cardiovascular morbidity-related conditions, even though with the presence of wide heterogeneity in the prevalence of risk factors across different regions.[2],[3]

Lifestyle changes due to industrialization and mechanization increase the time off which increases the rate of chronic diseases mainly in developing countries. Most chronic diseases can be avoided by delamination of the risk factors and modifying them.[4] One of the important prevalent factors causing chronic noncommunicable diseases which worsen with aging is physical inactivity.[5] Maintenance of disciplined physical activity (PA) in one's lifestyle will bring about various physiological adaptations that facilitate improved exercise tolerance and physical well-being.[6]

“Fitness pertaining to cardiorespiratory system is an important tool of human health that represents cumulative PA and underlying genetic composition in total.” Even then, there are supposed to be known differences across the genders in fitness levels. While some of these differences in fitness are physiologic, there have been some, including, social and behavioral differences between genders.[7] In practice, cardiovascular endurance indicates the ability of sustenance of long-duration exercises. Cardiovascular endurance is affected by several factors including maximal aerobic capacity. “Aerobic capacity is defined as the highest rate of oxygen consumption achieved during maximal exercise” and is extensively considered the important objective measure of endurance capacity.[6]

In the recent two decades, there has been active involvement of athletes in endurance events including marathons. Female marathon participants, in particular, have well represented and is been seen to be the same in comparison to male marathoners. Aerobic exercise on risk for cardiovascular disease role is well established and found to be beneficial for the cardiovascular system.[8],[9],[10]

Objectives

  1. The objective of this study was to compare the distribution of cardiac endurance levels across the gender
  2. To assess the impact of cardiac endurance with the outcome in levels of their performance.


We hypothesized that, while men would have higher levels of fitness than women, these levels would be associated with different absolute risks across the genders.


  Materials and Methods Top


The study was initiated under the Department of Physiology at Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India.

Type of the study

This was a cross-sectional study, sample collected between September 8, 2021, and December 31, 2021.

Sample size

The sample size was four hundred (total); of which males: 188 and females: 212.

Institutional ethical committee clearance

Obtained-“BMC and H/IEC/2021–22/21” issued on dated September 7, 2021.

Written informed consent from the study participants was obtained.

All the study participants were measured for anthropometric variables including weight and height. The participant's anthropometric indices will be measured by trained examiners at baseline while participants are minimally clothed and without footwear. Weight will be measured using a balanced scale and recorded to the nearest 0.1 kg. Height will be determined using a wall-fixed tape measure while participants were in a normal standing position and recorded to the nearest 0.5 cm. Their respective “body mass index (BMI) was calculated using weight (kgs) divided by height (sqm)” before asked to perform the tests. Their heart rate and blood pressure were measured in a seated position at rest before sending them for exercise testing under a trained clinical person. This was followed by continuous heart rate monitoring and recording of blood pressure for every 3 min during the test. By using oximeter, “pulse rate, respiratory rate, and systolic and diastolic blood pressure along with oxygen saturations were measured and recorded in the 1st, 3rd, and 5th min after the test and before the test in both the genders.” All the participants underwent through the Harward step test.

In the Harward step test, baseline recording of heart rate is performed twice after the subject has been sitting quietly for at least 5 min. The ticking rate (2/s) of metronome is checked with a watch. The subject steps up the bench taking 1 s and then steps down taking another second. This continues for 5 min., thus in all stepping up 150 times and stepping down 150 times. After the exercise, the total number of heartbeats is counted between 1 and 1.5 min, 2 and 2.5 min, and 3 and 3.5 min during the recovery period.

Fitness Index = 3000/{2 X sum of the recovery pulse (1–1.5 + 2–2.5 + 3–3.5 min)}

The cardiovascular endurance was assessed across genders using fitness index [Figure 1] and duration taken. The gender among these participants was compared across each variable.
Figure 1: Fitness index score*

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Inclusion and exclusion criteria

Inclusion criteria: Subjects between 15 and 25 years of age, who were not participating in regular physical training, No history of any type of illness hypertension, diabetes, or any chronic illness.

Exclusion criteria

Subjects below 15 years of age & those above 25 years of age, subjects with regular physical activity such as jogging and running, subjects with history of cardiac diseases, hypertension, smoking, and alcoholism, subjects on any kind of medication, subjects with pregnancy and subjects with disabilities.

Sedentary adults

Here, sedentary adults mean those who are not actively participating in any kind of physical exertion such as early morning walking, running, jogging, or any kind of outdoor games.

Statistics

Subjects with a history of smoking, alcohol, systemic diseases, or any other comorbid conditions are not included in the study. The data were evaluated with the IBM SPSS Statistics 16.0 (Chicago, IL, USA) to compare the outcomes across the two groups. Variables of mean, standard deviation, and 95% confidence interval were considered during the assessment of all variables across the genders, and the significance level was considered when P < 0.05. The groups were compared using two independent sample t-tests”.


  Results Top


It was observed that there was a significant increase in cardiovascular endurance pertaining to the anthropometric indices in males compared to females with regard to age (P = 0.0399), height (P = 0.0002), and duration of exercise (P = 0.0472) along with highly significant change in weight (P = 0.0000). The BMI across the gender showed a borderline significant effect [Table 1].
Table 1: Cardiovascular endurance across anthropometry versus gender

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There was no significant change in pulse rate across the gender at rest as well after 1st, 2nd, 3rd, and 5th min of exercise. Except, immediate after exercise (P = 0.03), minute oxygen saturation comparisons in both tests, because of increased oxygen requirement in the tissues and muscles during exercise, the rest of the findings of respiratory rate did not show any significant effect over cardiovascular endurance [Table 2] and [Table 3].
Table 2: Cardiovascular endurance across pulse rate at rest, immediately after exercise, 1, 2, 3, and 5 min

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Table 3: Cardiovascular endurance across respiratory rate at rest, immediately after exercise, 1, 2, 3, and 5 min

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All the participants in both groups could perform the Harvard step test, and there was no significant change during their performance at rest and immediately after exercise. [Table 4] The recording of systemic blood pressure showed a significant change only during the readings obtained after 2 min for systolic blood pressure and after 5 min for diastolic blood pressure [Table 5]. The oxygen saturation was significantly affected immediately after exercise (P = 0.015), followed by the values recorded after 1st, 2nd, and 3rd min [Table 6]. The fitness index did not show any significant change (P = 0.12) except a change in the time duration (P = 0.04) across the gender [Table 7].
Table 4: Cardiovascular endurance across Harvard step test at rest, immediately after exercise, 1, 2, 3, and 5 min

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Table 5: Cardiovascular endurance across blood pressure at 1, 2, 3, and 5 min

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Table 6: Cardiovascular endurance across oxygen saturation at rest, immediately after exercise, 1, 2, 3, and 5 min

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Table 7: Cardiovascular endurance across fitness index and duration (s)

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  Discussion Top


”Cardiorespiratory fitness (CRF) is usually expressed as maximal oxygen uptake or metabolic equivalent, which can be estimated through a variety of maximum or submaximal tests performed in the laboratory.”[11] The aim of this study was to compare the cardiac endurance levels across the genders and will it affect the outcome in levels of their performance. Each participant's anthropometric variables were measured, and BMI was calculated before the tests. Resting heart rate and blood pressure were measured before exercise. In addition to this, continuous heart rate monitoring and blood pressure were measured every 3 min during the test.

In this study, it was observed that there was a significant increase in cardiovascular endurance pertaining to the anthropometric indices in males compared to females with regard to age, height, and duration along with highly significant change in weight. This change may be because of changes in lifestyle as supported by self-report PA data from the World Health Organization global health status 2010 report which stated that 55.7% of female and 46.4% of male adolescents were inactive.[12] Age, gender, and genetic predispositions influence the physiological response and therefore affect the performance during aerobic exertion.[13]

The BMI across the gender showed a borderline significant effect. All the participants in both the groups in this study could perform the Harvard step test, and there was no significant change during their performance at rest and immediately after exercise. [Table 4] The recording of systemic blood pressure showed a significant change only during the readings obtained after 2 min for systolic blood pressure and after 5 min for diastolic blood pressure. Independent of other risk factors, such as high BMI and increased CRF, has been associated with decreased overall mortality and morbidity.[14]

The oxygen saturation was significantly affected immediately after exercise, followed by the values recorded after 1st, 2nd, and 3rd min. In a study, similar findings with males having a higher estimated VO2 max, and thereby, significantly more males were classified as active compared to females.[15] In this study, the fitness index did not show any significant change except a change in the time duration across the gender. [Table 7] Our study findings were correlated with another stating that higher moderate to vigorous PA, lower BMI, and sex (being male) were all significantly associated with higher VO2 max, however, sedentary time was not associated with fitness, and BMI was inversely associated with estimated VO2 max along with significant differences in BMI between males and females.[15]

The value of high levels of PA, exercise training (ET), and overall CRF in the prevention and treatment of cardiovascular diseases (CVD) substantial evidence has been established. These data strongly support the routine prescription of ET to all patients and referrals for patients with CVD.[13]

In this study, we found that disregarding with training status “women had lower blood pressure compared to men and with a significant change in VO2 max.” Thus, gender differences in the cardiovascular system are seen in both the relaxational activities and marathoner population which emphasizes the importance of concentrating the gender differences for the effects of endurance exercise over cardiovascular system. Regular endurance exercise may have important clinical implications for women, thereby, understanding the cardiovascular response with respect to changes in gender will have its own importance as the greater risk of heart failure in men as compared to women is linked with their cardiovascular risk with age. To mitigate CVD risk in women, endurance exercise may offer an important therapeutic strategy.

Limitations of the study

Currently, diseases due to changes in lifestyle are on the rise in developing countries. By excluding subjects above 25 years of age in the study, we would have missed the population who have been exposed to lifestyle diseases risk factors which together reflect the true population.

Recommendations

  1. Studies should include study participants of 25–35 years and compare how they fare against persons who have not been exposed significantly to lifestyle risk factors
  2. A follow-up of these individuals over the next 5–10 years to see the outcome in sedentary versus active individuals would benefit the outcome for society.



  Conclusion Top


Recommendations of regular endurance exercises that can increase cardiorespiratory and cardiovascular fitness levels need to be advocated which can be seen developing good habits through the performance of regular exercise programs for sedentary adults which will encourage them to sustain it for lifelong change. Thus, we believe that sedentary individuals can increase their cardiorespiratory and cardiovascular suitability levels and prevent morbidity leading to a healthier lifestyle in the future with improvement in overall well-being, thereby, bringing a reduction in the burden of disease and improve their quality of life years across the genders.

Acknowledgement

Nil.

Conflicts of interest

There are no conflicts of interest.

Institutional Ethical Committee approval

BMC and H/IEC/2021–22/21.

Author's contribution

Dr. Aftab begum: The author has contributed in the development Concept, design of study, definition of intellectual content, literature search, data acquisition, data analysis, manuscript editing and manuscript review. Dr. Lakshmi T: The author has contributed in the design of study, literature search, data acquisition, manuscript editing and manuscript review. Dr. Syed Sadat Ali: The author has contributed in the development Concept, design of study, definition of intellectual content, literature search, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing and manuscript review. Dr. Praveen Kumar BA: The author has contributed in literature search, data acquisition, data analysis, statistical analysis, manuscript editing and manuscript review.

Financial support and sponsorship

Nil.



 
  References Top

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Institute of Health Metrics and Evaluation. GBD Profile: India. Available from: http://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_india.pdf. [Last accessed on 2022 Mar 30].  Back to cited text no. 1
    
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Bara CL, Alves DL, Ruy-Barbosa MA, Palumbo DP, Sotomaior BB, Silva LD, et al. Changes in the cardiorespiratory fitness of men and women in various age groups. J Exerc Psychol 2019;22:1-10.  Back to cited text no. 11
    
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Alwan A. Global Status Report on Noncommunicable Diseases. Geneva: WHO; 2010.  Back to cited text no. 12
    
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Lavie CJ, Arena R, Swift DL, Johannsen NM, Sui X, Lee DC, et al. Exercise and the cardiovascular system: Clinical science and cardiovascular outcomes. Circ Res 2015;117:207-19.  Back to cited text no. 13
    
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Correspondence Address:
Syed Sadat Ali,
HN 78, 7TH Cross, Cambridge Layout, Ulsoor, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/am.am_52_22



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