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Effects of Sauna on Cardiovascular and Lifestyle-Related Diseases

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Effects of Sauna on Cardiovascular and Lifestyle-Related Diseases ARTIGO DE REVISÃO Efeitos da sauna sobre doenças cardiovasculares e doenças relacionadas com o estilo de vida B. Talebipour1, L.O.C. Rodrigues2 e M.C.V. Moreira1 RESUMO Palavras-chave: Sauna. Função endotelial. Insuficiência cardíaca. Hipertensão arte- rial sistêmica. Termorregulação. Freqüentar a sauna é uma prática popular de jovens, adultos e Keywords: Sauna. Endothelial function. Heart failure. Systemic arterial hyper- idosos saudáveis. Os médicos do esporte são, com freqüência, tension. Thermoregulation. solicitados a opinar sobre o impacto da sauna nas doenças e na Palabras-clave: Sauna. Función endotelial. Insuficiencia cardiaca. Hipertensión saúde de modo geral. A sauna pode ser benéfica ou maléfica, de- arterial sistémica. Termorregulación. pendendo do uso que fazemos dela. Nos últimos anos, a sauna está sendo considerada benéfica para os portadores de doenças cardiovasculares como a insuficiência cardíaca e doenças relacio- dilatación periférica. La disfunción endotelial está presente en casi nadas com o estilo de vida, principalmente por melhorar a função todas las enfermedades cardiovasculares. El presente artículo tie- endotelial periférica, via aumento do débito cardíaco e vasodilata- ne la intención de hacer una revisión sobre los efectos de la sauna ção periférica. A disfunção endotelial está presente em quase to- sobre el sistema cardiovascular en individuos saludables y en de- das as doenças cardiovasculares. O presente artigo pretende fa- terminadas enfermedades cardiovasculares. zer uma revisão sobre os efeitos da sauna sobre o sistema cardiovascular em indivíduos saudáveis e em determinadas doen- INTRODUÇÃO ças cardiovasculares. O banho, em suas várias formas, é um costume muito antigo praticado pelos homens, estreitamente relacionado com o movi- ABSTRACT mento cultural e tornou-se parte integrante da história da civiliza- (1) Effects of sauna on cardiovascular and lifestyle-related disea- ção . ses A sauna e os banhos turcos são muito populares, respectiva- mente, nos países escandinavos e no Oriente Médio, e vêm sen- Sauna bathes are popular practices of healthy young, adult and do praticados há séculos, inclusive com objetivo terapêutico em older people. Frequently, the sports medicine physicians are invi- várias doenças. A procura do bem-estar e o fato de a atividade ted to evaluate the impact of the sauna on diseases and on health física estar sendo cada vez mais recomendada no intuito de dimi- in general. Sauna can be beneficial or dangerous depending on its nuir o sedentarismo e incidência de doenças trazem como conse- use. In the past few years the sauna is being considered benefi- qüência a proliferação de organizações e entidades relacionadas à cial for the cardiovascular diseases’ patients, as the heart failure prática do esporte e da sauna, como os clubes e clínicas especia- and lifestyle-related diseases, mainly by improving the peripheral lizadas (spas). O público-alvo constitui-se de jovens e idosos, sau- endothelial function, through the increase of the cardiac output dáveis ou não. and peripheral vasodilation. The endothelial dysfunction is present Com o aumento da incidência e prevalência das doenças car- in most of the cardiovascular diseases. The present article intends diovasculares, da obesidade e do sedentarismo nos países indus- to review the sauna effects on the cardiovascular system in healthy trializados, inclusive no Brasil, observa-se o aumento do número individuals and in some cardiovascular diseases. de pacientes com doenças cardiovasculares que freqüentam es- sas instituições e, especificamente, a sauna. Freqüentemente, o RESUMEN médico do esporte é consultado sobre os possíveis efeitos da sauna sobre a saúde de atletas, sedentários e portadores de di- Efectos de la sauna sobre las enfermedades cardiovasculares versas doenças. y las relacionadas al estilo de vida Efeitos fisiológicos(2-4), benefícios e riscos(5), fatos e fábulas(6) da Frecuentar la sauna es una práctica popular de jóvenes, adultos sauna foram objeto de extensa revisão. Recentemente, a sauna y ancianos saludables. Los médicos de deportes son, con frecuen- foi estudada como opção terapêutica para doenças cardiovascula- cia, solicitados a opinar sobre el impacto de la sauna en las enfer- res(7) e observou-se melhora de indicadores clínicos com a terapia medades y en la salud de modo general. La sauna puede ser be- térmica em doenças relacionadas com o estilo de vida(8). néfica o maléfica dependiendo del uso que hacemos de ella. En O foco do presente artigo trata principalmente dessa opção te- los últimos años, la sauna viene siendo considerada como benéfi- rapêutica, analisando as variáveis termorregulatórias e cardiovas- ca para los portadores de enfermedades cardiovasculares, tales culares envolvidas com a exposição à sauna. como la insuficiencia cardiaca y enfermedades relacionadas con el estilo de vida, principalmente, por mejorar la función endotelial SAUNA periférica, mediante la disminución de la falla cardiaca y la vaso A sauna é caracterizada pela alta temperatura com o ar seco. A 1. Faculdade de Medicina da Universidade Federal de Minas Gerais. sauna básica é constituída de um quarto, uma plataforma em ma- 2. Laboratório de Fisiologia do Exercício da Escola de Educação Física, deira, não pintada, e uma fonte de calor (elétrica, a lenha ou a Fisioterapia e Terapia Ocupacional. gás). O tamanho da sauna é de cerca de 3m2 para permitir o equi- Recebido em 19/7/05. Versão final recebida em 7/10/05. Aceito em 25/1/06. líbrio calórico, umidade adequada e ventilação (três a oito vezes o o Endereço para correspondência: Luiz Oswaldo Carneiro Rodrigues, Rua por hora). A temperatura recomendada é de 80 -100 C ao nível da Roberto Lúcio Aroeira, 40 – 31710-570 – Belo Horizonte, MG. Tel./fax: face e 30oC ao nível do chão(9). A umidade relativa do ar deve ser (31) 3491-9460. E-mail: [email protected] de 10% a 20% (40 a 70g de vapor de água/kg do ar)(9,10). O ritual 216 Rev Bras Med Esporte _ Vol. 12, Nº 4 – Jul/Ago, 2006 habitual consiste de várias entradas de curta duração (cinco a QUADRO 1 20min) na sauna, intercaladas com períodos de resfriamento e Efeitos fisiológicos de exposição aguda à sauna seguidas de ingestão de líqüido(6,11). Efeito Resultado Referências EFEITOS AGUDOS DA SAUNA SOBRE AS VARIÁVEIS Temperatura da pele ↑ até 40oC em poucos min 2, 9 TERMORREGULATÓRIAS E CARDIOVASCULARES Temperatura retal ↑ de 0,4oC (92oC durante 20min) 12 O banho de sauna representa uma carga calórica de 300-600W/ ↑ de 1oC (80oC durante 30min) 13 2 (10) m da área de superfície corporal . A temperatura da pele au- Temperatura oral ↑ de 1oC até 3oC 16, 19, 80, 90 menta rapidamente a ± 40o-41oC(2,9-10) e os mecanismos termorre- Sudorese ↑ da taxa de sudorese de 0,6 até 2, 10 gulatórios são acionados. A transferência do calor via evaporação 1kg/h (80oC-90oC) da sudorese é a única forma efetiva de dissipação do calor do ↓ corpo na sauna seca(10). A sudorese começa rapidamente e atinge Resistência ± 40% 14, 89 periférica total o seu nível máximo em ± 15min. A secreção total de suor pode chegar a 0,5-1kg/h e representa uma perda calórica de 200W/m2 Fluxo sanguíneo ↑ 5%-10% até 50%-70% do débito 14, 39 cutâneo cardíaco (de 0,5 até 7L/min) da área de superfície corporal(2,10). O corpo não consegue contra- balançar a carga calórica, ocasionando aumento da temperatura Fluxo sanguíneo renal ↓ ± 0,4 L/min 14, 39 ↓ interna. O aumento da temperatura retal depende da condição de órgãos internos esplâncnico ± 0,6L/min exposição ao calor e varia de 0,4oC(12) a 1oC(13). A circulação cutâ- Fluxo sanguíneo ↓ ± 0,2L/min 14, 39 nea aumenta substancialmente para prevenir o aquecimento do muscular corpo. O fluxo sanguíneo cutâneo, na condição termoneutra (± Freqüência cardíaca até 100bpm durante banho de sauna 2, 17, 18, 19, 20oC) e em repouso corresponde a ± 5-10% do débito cardíaco e moderado em indivíduo acostumado 24, 82 pode chegar a ± 50-70% do débito cardíaco (7-8L/min) na sau- até 150bpm durante banho de sauna 16, 19, 20, 21, intensa ou em indivíduo não 25, 58, 80, 90, 93 (14) na . A pressão arterial tem tendência a diminuir; entretanto, essa acostumado queda é prevenida pelo aumento do débito cardíaco por meio do Débito cardíaco ↑ de 5-6L/min até 9-10L/min 3, 14 aumento da freqüência cardíaca(3,14) e pela redução do fluxo sanguí- neo nos órgãos internos(14,15). O volume de ejeção não se modifi- Duplo produto ↑ de 1,5 a 3 vezes 14, 16 ca(3,14). O efeito do banho de sauna sobre a pressão arterial é variá- Volume de ejeção sem modificação 3, 14 vel (quadro 1). Os banhos de sauna repetidos melhoram a tolerância Pressão arterial sem modificação 12, 16, 18, 19, ao calor e reduzem a magnitude das mudanças das variáveis aci- sistólica 80, 90, 93 ma mencionadas(12). ou ↓ de 8 a 31mm/Hg 17, 20, 22, 82 Os efeitos termorregulatórios e cardiovasculares da exposição ou ↑ de 9 a 21mm/Hg 16, 19, 21, 23, ↑ ↓ à sauna são mostrados no quadro 1. ou e durante a sauna 25, 58 Pressão arterial sem modificação 16, 17, 93 diastólica ou ↓ de 6 a 39mm/Hg 12, 18, 19, 20, VASODILATAÇÃO CUTÂNEA EM RESPOSTA AO ESTRESSE 21, 22, 23, 25, TÉRMICO EM INDIVÍDUOS SAUDÁVEIS 80, 82, 90 O controle reflexo do fluxo sanguíneo na pele em humanos é ↑ = aumento; ↓ = redução. efetuado por dois ramos do sistema nervoso autônomo simpáti- Adaptado e complementado a partir de ref. 5. co: o sistema vasoconstritor ativo noradrenérgico(26) e o sistema vasodilatador ativo dependente da acetilcolina(27) mediado por óxi- A função do endotélio vascular em pacientes com IC, represen- do nítrico (NO)(28-30) e prostaglandina(30). tada principalmente pela vasodilatação endotélio-dependente, está O óxido nítrico é um mediador importante do processo de ho- alterada(44-50).
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