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Calderon-Ramirez PM, Fernandez-Guzman D, Caira-Chuquineyra B, Mamani-García CS, Medina HM, Diaz-Arocutipa C. Exercise-based training programs for patients with chronic Chagas cardiomyopathy: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2023; 48:101256. [PMID: 37794957 PMCID: PMC10545933 DOI: 10.1016/j.ijcha.2023.101256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 10/06/2023]
Abstract
Background We assessed the effects of exercise-based training programs (EBTP) in patients with chronic Chagas cardiomyopathy (CCC) through a systematic review and meta-analysis. Methods We conducted a search in Pubmed/Medline, Embase, Scopus, Web of Science, Cochrane Library, Virtual Health Library, and SciELO until January 2023. Randomized controlled trials (RCTs) and non-randomized intervention studies (NRIS) investigating the effects of EBTP in CCC patients were included. The primary outcomes were all-cause mortality, cardiovascular mortality, and health-related quality of life (HRQoL), and the secondary outcomes were exercise capacity by peak VO2, heart failure-related hospital admissions (HFRHA), and left ventricular ejection fraction (LVEF). Results The search strategy yielded 3617 studies. After removing duplicates and screening, eight studies (3 RCTs and 5 NRIS) involving 222 patients were included. Seven studies were conducted in Brazil. The age range was from 30 to 71 years, and 47.1% were male. Data on mortality, HRQoL, LVEF, and HFRHA were scarcely reported. The meta-analysis pooling four studies showed that the peak VO2 was significantly higher (mean difference 4.45, 95% confidence interval 3.50 to 5.39 mL/kg/min, I2 = 0%) in the EBTP group compared to the control group. Conclusion The evidence available was limited and heterogeneous. While EBTP has shown to improve HRQoL and exercise capacity, there is no conclusive information about the other proposed outcomes. These positive effects present an opportunity to provide treatment to CCC patients in low- and middle-income countries. Further studies are needed to ascertain the effects of EBTP on hard outcomes in this population.Registration number: CRD42022334060.
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Affiliation(s)
| | | | | | | | - Héctor M. Medina
- Division of Cardiology, Fundacion CardioInfantil-La Cardio, Bogota, Colombia
| | - Carlos Diaz-Arocutipa
- Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Mediano MFF, Ribeiro LG, Silva RS, Xavier IGG, Vieira MC, Gonçalves TR, Paravidino VB, Borges JP, Rodrigues Junior LF, Costa HS, Reis MS, Liporagi-Lopes LC, Martinez-Amezcua P, Silva PS, Sperandio Da Silva GM, Sousa AS, Holanda MT, Veloso HH, Carneiro FM, Mazzoli-Rocha F, Costa AR, Saraiva RM, Mendes FSNS, Sangenis LHC, Hasslocher-Moreno AM. Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): A study protocol for a randomized clinical trial. Front Med (Lausanne) 2023; 9:1087188. [PMID: 36687410 PMCID: PMC9852894 DOI: 10.3389/fmed.2022.1087188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Background Chagas disease (CD) is a neglected endemic disease with worldwide impact due to migration. Approximately 50-70% of individuals in the chronic phase of CD present the indeterminate form, characterized by parasitological and/or serological evidence of Trypanosoma cruzi infection, but without clinical signs and symptoms. Subclinical abnormalities have been reported in indeterminate form of CD, including pro-inflammatory states and alterations in cardiac function, biomarkers and autonomic modulation. Moreover, individuals with CD are usually impacted on their personal and professional life, making social insertion difficult and impacting their mental health and quality of life (QoL). Physical exercise has been acknowledged as an important strategy to prevent and control numerous chronic-degenerative diseases, but unexplored in individuals with the indeterminate form of CD. The PEDI-CHAGAS study (which stands for "Home-Based Exercise Program in the Indeterminate Form of Chagas Disease" in Portuguese) aims to evaluate the effects of a home-based exercise program on physical and mental health outcomes in individuals with indeterminate form of CD. Methods and design The PEDI-CHAGAS is a two-arm (exercise and control) phase 3 superiority randomized clinical trial including patients with indeterminate form of CD. The exclusion criteria are <18 years old, evidence of non-Chagasic cardiomyopathy, musculoskeletal or cognitive limitations that preclude the realization of exercise protocol, clinical contraindication for regular exercise, and regular physical exercise (≥1 × per week). Participants will be assessed at baseline, and after three and 6 months of follow-up. The primary outcome will be QoL. Secondary outcomes will include blood pressure, physical fitness components, nutritional status, fatigability, autonomic modulation, cardiac morphology and function, low back pain, depression and anxiety, stress, sleep quality, medication use and adherence, and biochemical, inflammatory and cardiac biomarkers. Participants in the intervention group will undergo a home-based exercise program whilst those in the control group will receive only general information regarding the benefits of physical activity. Both groups will receive the same general nutritional counseling consisting of general orientations about healthy diets. Conclusion The findings from the present study may support public health intervention strategies to improve physical and mental health parameters to be implemented more effectively in this population. Clinical trial registration [https://ensaiosclinicos.gov.br/rg/RBR-10yxgcr9/], identifier [U1111-1263-0153].
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Affiliation(s)
- Mauro F. F. Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
- Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, RJ, Brazil
| | - Leonardo G. Ribeiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Rudson S. Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Isis G. G. Xavier
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Marcelo C. Vieira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
- Center for Cardiology and Exercise, Aloysio de Castro State Institute of Cardiology, Rio de Janeiro, RJ, Brazil
| | - Tatiana R. Gonçalves
- Institute of Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Vitor B. Paravidino
- Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Department of Physical Education and Sports, Naval Academy – Brazilian Navy, Rio de Janeiro, RJ, Brazil
| | - Juliana P. Borges
- Institute of Physical Education and Sports, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Henrique S. Costa
- Physical Therapy Department, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, MG, Brazil
| | - Michel S. Reis
- Faculty of Physical Therapy, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Pablo Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Paula S. Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - Andrea S. Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Marcelo T. Holanda
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Henrique H. Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Fernanda M. Carneiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Flavia Mazzoli-Rocha
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Andrea R. Costa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Roberto M. Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Fernanda S. N. S. Mendes
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Luiz Henrique C. Sangenis
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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3
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Viana AMN, Vieira MC, Mazzoli-Rocha F, Silva RS, Frota AX, Costa HS, Borges JP, Sperandio da Silva GM, da Silva PS, Hasslocher-Moreno AM, Saraiva RM, de Sousa AS, Mendes FDSNS, Mediano MFF. Comparative effects of a cardiovascular rehabilitation program on functional capacity in patients with chronic chagasic cardiomyopathy with or without heart failure. Disabil Rehabil 2023; 45:51-56. [PMID: 35007459 DOI: 10.1080/09638288.2021.2024282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the effects of cardiovascular rehabilitation (CR) on functional capacity of patients with chronic chagasic cardiomyopathy (CCC) and to compare the responses between CCC patients without and with heart failure (HF). MATERIALS AND METHODS A longitudinal observational retrospective study was carried out including 36 patients with CCC without HF (stage B2 [n = 7]) and with HF (stage C [n = 29]), who participated in a CR program. Functional capacity was assessed by a maximal progressive cardiopulmonary exercise test performed on a treadmill. The longitudinal effects of the CR on functional capacity were determined by linear mixed models that included an interaction term to evaluate the differential responses between patients without and with HF. RESULTS Significant improvements in peak oxygen consumption, resting heart rate and blood pressure, and maximum pulmonary ventilation were observed for the overall study sample, with no apparent differential effects according to the presence of HF. CONCLUSIONS CR significantly improved functional capacity of patients with CCC. The responses to CR appear to be similar among patients without and with HF, reinforcing the need for its inclusion as a standard treatment strategy of CCC.Implications for rehabilitationExercise-based cardiovascular rehabilitation (CR) is a safe strategy that improves functional capacity, cardiac function, and quality of life in patients with several cardiovascular diseases, and recent studies also suggested a potential beneficial effect of CR in chronic chagasic cardiomyopathy (CCC).In this observational study, CR seems to equally improve exercise capacity, resting heart rate, resting blood pressure, and maximum pulmonary ventilation in patients with CCC without (stage B2) and with heart failure (stage C).Cardiovascular rehabilitation should be included as a standard treatment strategy for patients with CCC, regardless the severity of cardiomyopathy.
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Affiliation(s)
- Aline Maria Nunes Viana
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Health Center, Veiga de Almeida University, Rio de Janeiro, Brazil
| | - Marcelo Carvalho Vieira
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Center for Cardiology and Exercise, Aloysio de Castro State Institute of Cardiology, Rio de Janeiro, Brazil
| | - Flavia Mazzoli-Rocha
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rudson Santos Silva
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Aline Xavier Frota
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Henrique Silveira Costa
- Physical Therapy Department, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Brazil
| | - Juliana Pereira Borges
- Laboratory of Physical Activity and Health Promotion, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Paula Simplício da Silva
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Roberto Magalhães Saraiva
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Andrea Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, Brazil
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Pedra-Rezende Y, Barbosa JMC, Bombaça ACS, Dantas-Pereira L, Gibaldi D, Vilar-Pereira G, Dos Santos HAM, Ramos IP, Silva-Gomes NL, Moreira OC, Lannes-Vieira J, Menna-Barreto RFS. Physical Exercise Promotes a Reduction in Cardiac Fibrosis in the Chronic Indeterminate Form of Experimental Chagas Disease. Front Immunol 2021; 12:712034. [PMID: 34804007 PMCID: PMC8599157 DOI: 10.3389/fimmu.2021.712034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/15/2021] [Indexed: 01/14/2023] Open
Abstract
Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is a neglected tropical disease and a health problem in Latin America. Etiological treatment has limited effectiveness in chronic CD; thus, new therapeutic strategies are required. The practice of physical exercises has been widely advocated to improve the quality of life of CD patients. The most frequent clinical CD manifestation is the chronic indeterminate form (CIF), and the effect of physical exercises on disease progression remains unknown. Here, in a CIF model, we aimed to evaluate the effect of physical exercises on cardiac histological, parasitological, mitochondrial, and oxidative metabolism, electro and echocardiographic profiles, and immunological features. To establish a CIF model, BALB/c and C57BL/6 mice were infected with 100 and 500 trypomastigotes of the Y T. cruzi strain. At 120 days postinfection (dpi), all mouse groups showed normal PR and corrected QT intervals and QRS complexes. Compared to BALB/c mice, C57BL/6 mice showed a lower parasitemia peak, mortality rate, and less intense myocarditis. Thus, C57BL/6 mice infected with 500 parasites were used for subsequent analyses. At 120 dpi, a decrease in cardiac mitochondrial oxygen consumption and an increase in reactive oxygen species (ROS) were detected. When we increased the number of analyzed mice, a reduced heart rate and slightly prolonged corrected QT intervals were detected, at 120 and 150 dpi, which were then normalized at 180 dpi, thus characterizing the CIF. Y-infected mice were subjected to an exercise program on a treadmill for 4 weeks (from 150 to 180 dpi), five times per week in a 30–60-min daily training session. At 180 dpi, no alterations were detected in cardiac mitochondrial and oxidative metabolism, which were not affected by physical exercises, although ROS production increased. At 120 and 180 dpi, comparing infected and non-infected mice, no differences were observed in the levels of plasma cytokines, indicating that a crucial biomarker of the systemic inflammatory profile was absent and not affected by exercise. Compared with sedentary mice, trained Y-infected mice showed similar parasite loads and inflammatory cells but reduced cardiac fibrosis. Therefore, our data show that physical exercises promote beneficial changes that may prevent CD progression.
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Affiliation(s)
- Yasmin Pedra-Rezende
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Laboratório de Biologia das Interações, Instituto Oswaldo Cruz Oswaldo Cruz, Fundação, Rio de Janeiro, Brazil
| | - Juliana M C Barbosa
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ana Cristina S Bombaça
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luiza Dantas-Pereira
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Laboratório de Biologia das Interações, Instituto Oswaldo Cruz Oswaldo Cruz, Fundação, Rio de Janeiro, Brazil
| | - Daniel Gibaldi
- Laboratório de Biologia das Interações, Instituto Oswaldo Cruz Oswaldo Cruz, Fundação, Rio de Janeiro, Brazil
| | - Glaucia Vilar-Pereira
- Laboratório de Biologia das Interações, Instituto Oswaldo Cruz Oswaldo Cruz, Fundação, Rio de Janeiro, Brazil.,Instituto Brasileiro de Medicina de Reabilitação, Rio de Janeiro, Brazil
| | - Hílton Antônio Mata Dos Santos
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratório de Análise e Desenvolvimento de Inibidores Enzimáticos e Laboratório Multiusuário de Análises por RMN, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isalira Peroba Ramos
- Centro Nacional de Biologia Estrutural e Bioimagem, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Natália Lins Silva-Gomes
- Plataforma de PCR em Tempo Real RPT09A, Laboratório de Biologia Molecular de Doenças Endêmicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Otacilio C Moreira
- Plataforma de PCR em Tempo Real RPT09A, Laboratório de Biologia Molecular de Doenças Endêmicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Joseli Lannes-Vieira
- Laboratório de Biologia das Interações, Instituto Oswaldo Cruz Oswaldo Cruz, Fundação, Rio de Janeiro, Brazil
| | - Rubem F S Menna-Barreto
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Improta-Caria AC, Aras Júnior R. Physical Exercise Training and Chagas Disease: Potential Role of MicroRNAs. Arq Bras Cardiol 2021; 117:132-141. [PMID: 34320083 PMCID: PMC8294722 DOI: 10.36660/abc.20200330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/16/2020] [Indexed: 12/12/2022] Open
Abstract
A doença de Chagas (DC) é causada pelo Trypanosoma Cruzi. Esse parasita pode infectar vários órgãos do corpo humano, especialmente o coração, causando inflamação, fibrose, arritmias e remodelação cardíaca, e promovendo a cardiomiopatia chagásica crônica (CCC) no longo prazo. Entretanto, poucas evidências científicas elucidaram os mecanismos moleculares que regulam os processos fisiopatológicos nessa doença. Os microRNAs (miRNAs) são reguladores de expressão gênica pós-transcricional que modulam a sinalização celular, participando de mecanismos fisiopatológicos da DC, mas o entendimento dos miRNAs nessa doença é limitado. Por outro lado, há muitas evidências científicas demonstrando que o treinamento com exercício físico (TEF) modula a expressão de miRNAs, modificando a sinalização celular em indivíduos saudáveis. Alguns estudos também demonstram que o TEF traz benefícios para indivíduos com DC, porém esses não avaliaram as expressões de miRNA. Dessa forma, não há evidências demonstrando o papel do TEF na expressão dos miRNAs na DC. Portanto, essa revisão teve o objetivo de identificar os miRNAs expressos na DC que poderiam ser modificados pelo TEF.
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Affiliation(s)
- Alex Cleber Improta-Caria
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA - Brasil.,Departamento de Educação Física em Cardiologia do Estado da Bahia, Sociedade Brasileira de Cardiologia,Salvador, BA - Brasil
| | - Roque Aras Júnior
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA - Brasil
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Vieira MC, Mendes FDSNS, Mazzoli-Rocha F, Silva RS, Viana AMN, Frota AX, da Silva GMS, da Silva PS, Hasslocher-Moreno AM, Saraiva RM, de Sousa AS, Mediano MFF. Factors related to the discontinuation and mortality rates of a cardiac rehabilitation programme in patients with Chagas disease: a 6-year experience in a Brazilian tertiary centre. Trop Med Int Health 2020; 26:355-365. [PMID: 33305528 DOI: 10.1111/tmi.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the clinical and sociodemographic characteristics of participants as well as discontinuation and mortality rates in a cardiac rehabilitation programme (CRP) tailored to Chagas disease (CD). METHODS Participants underwent functional capacity, anthropometry and cardiac function evaluations before beginning a CRP. Univariate and multivariate Cox proportional hazards models were performed to investigate the associations between clinical and sociodemographic characteristics at baseline with discontinuation rates and deaths. RESULTS Forty-two patients were enrolled in the CRP (61.9% men, mean age of 58.1 ± 11.8 years). During a median follow-up period of 10.8 months, 74% discontinued and 14% died while enrolled in CRP. 34% of the patients who discontinued CRP died during follow-up. White race (HR = 0.09; 95% CI 0.01-1.00), right ventricular systolic dysfunction (HR = 10.54; 95% CI 1.24-89.50) and oxygen pulse (HR = 0.69; 95% CI 0.48-0.99) were independently associated with death while enrolled in CRP. Married status (HR = 0.44; 95% CI 0.21-0.95) was independently associated with discontinuation rates from CRP. VO2 peak (HR = 0.85; 95% CI 0.74-0.98) and CRP discontinuation due to CD-related reasons (HR = 8.33; 95% CI 1.91-36.27) were the variables independently associated with death after discontinuation of CRP. CONCLUSION In this population, sociodemographic aspects and severity of CD were important determinants of CRP discontinuation and mortality.
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Affiliation(s)
- Marcelo Carvalho Vieira
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Center for Cardiology and Exercise, Aloysio de Castro State Institute of Cardiology, Rio de Janeiro, Brazil
| | | | - Flavia Mazzoli-Rocha
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rudson Santos Silva
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Aline Maria Nunes Viana
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Aline Xavier Frota
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Paula Simplício da Silva
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Roberto Magalhães Saraiva
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Andrea Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, Brazil
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Silva WT, Ávila MR, Oliveira LFFD, Figueiredo PHS, Lima VP, Bastone ADC, Costa FSMD, Mediano MFF, Costa HS, Rocha MODC. Prevalence and determinants of depressive symptoms in patients with Chagas cardiomyopathy and predominantly preserved cardiac function. Rev Soc Bras Med Trop 2020; 53:e20200123. [PMID: 33174953 PMCID: PMC7670741 DOI: 10.1590/0037-8682-0123-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/18/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION: Chagas cardiomyopathy (ChC) is highly stigmatized, and the presence of depressive symptoms may be a common feature. However, its determinants remain unclear. Therefore, the present study aimed to verify the prevalence of depression and the clinical, echocardiographic, functional, and quality of life factors associated with depressive symptoms in patients with ChC and predominantly preserved cardiac function. METHODS: Thirty-five patients with ChC (aged 40 to 60 years, 66% men, NYHA I-III) were evaluated by echocardiography, cardiopulmonary exercise testing, 6-minute walk test (6MWT), and Mini-Mental State Examination. Physical activity level was assessed using the Human Activity Profile (HAP) and health-related quality of life was assessed using the Short-Form Health Survey (SF-36). Depressive symptoms were evaluated using the Beck Depression Inventory. A cutoff point greater than 9 was indicative of depression. RESULTS: Depression was detected in 13 patients (37%). In the univariate analysis, female sex, NYHA functional class, body mass index, HAP score, mental summary of SF-36, peak oxygen uptake, and 6MWT distance were associated with depressive symptoms. The final model showed that only the HAP score (B = -0.533; 95% confidence interval [CI]: -0.804 to -0.262) and SF-36 mental summary (B = -0.269; 95% CI: -0.386 to -0.153) remained as independent predictors of depressive symptoms in patients with ChC. CONCLUSIONS: Depression was prevalent in patients with ChC and predominantly preserved cardiac function. Physical activity and mental health were independent risk factors for depressive symptoms.
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Affiliation(s)
- Whesley Tanor Silva
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Matheus Ribeiro Ávila
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Lucas Frois Fernandes de Oliveira
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Pedro Henrique Scheidt Figueiredo
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Vanessa Pereira Lima
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Alessandra de Carvalho Bastone
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Fábio Silva Martins da Costa
- Universidade Federal de Minas Gerais, Escola de Medicina, Curso de Pós-Graduação em Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil
| | | | - Henrique Silveira Costa
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.,Universidade Federal de Minas Gerais, Escola de Medicina, Curso de Pós-Graduação em Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil
| | - Manoel Otávio da Costa Rocha
- Universidade Federal de Minas Gerais, Escola de Medicina, Curso de Pós-Graduação em Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil
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8
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de Souza Nogueira Sardinha Mendes F, Mediano MFF, de Castro E Souza FC, da Silva PS, Carneiro FM, de Holanda MT, Saraiva RM, Xavier SS, Americano do Brasil PEA, de Sousa AS. Effect of Physical Exercise Training in Patients With Chagas Heart Disease (from the PEACH STUDY). Am J Cardiol 2020; 125:1413-1420. [PMID: 32171439 DOI: 10.1016/j.amjcard.2020.01.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 12/20/2022]
Abstract
Chagas heart disease (HD) is a chronic fibrosing myocarditis with high mortality. The PEACH study aimed to evaluate if exercise training can improve the functional capacity of Chagas HD patients with left ventricular dysfunction and/or heart failure. The PEACH study was a single center, parallel-group, clinical trial that randomized 30 clinical stable Chagas HD patients with left ventricular ejection fraction <45% or heart failure symptoms to either supervised exercise training 3 times/week for 6 months or a control group. Both groups had the same monthly pharmaceutical and nutritional counseling and usual care. Primary end point was functional capacity assessed by peak exercise oxygen consumption (peak VO2) obtained by cardiopulmonary exercise test. Secondary end points included other cardiopulmonary exercise test variables, cardiac function by echocardiography, body composition, muscle respiratory strength, and metabolic biomarkers. Peak VO2 increased among patients in exercise group from 17.60 ± 4.65 mlO2 kg-1 min-1 to 19.40 ± 5.51 mlO2 kg-1 min-1 while decreased in controls from 15.40 ± 6.30 mlO2 kg-1 min-1 to 12.96 ± 4.50 mlO2 kg-1 min-1, resulting in significant difference in change in peak VO2 between groups after 6 months (β = +4.6, p = 0.004). There were significant differences between groups in changes in anaerobic threshold (β = 3.7, p = 0.05), peak oxygen pulse (β = +2.7, p = 0.032) and maximum minute ventilation (β = +13.9, p < 0.0001) after 6 months of intervention. In conclusion, exercise training improved functional capacity of chronic Chagas HD patients with left ventricular dysfunction and/or heart failure.
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Affiliation(s)
| | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz Foundation, Manguinhos, Rio de Janeiro, Brazil; National Institute of Cardiology, Laranjeiras, Rio de Janeiro, Brazil
| | | | - Paula Simplício da Silva
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz Foundation, Manguinhos, Rio de Janeiro, Brazil
| | - Fernanda Martins Carneiro
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz Foundation, Manguinhos, Rio de Janeiro, Brazil
| | - Marcelo Teixeira de Holanda
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz Foundation, Manguinhos, Rio de Janeiro, Brazil
| | - Roberto Magalhães Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz Foundation, Manguinhos, Rio de Janeiro, Brazil
| | - Sergio Salles Xavier
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz Foundation, Manguinhos, Rio de Janeiro, Brazil
| | | | - Andréa Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz Foundation, Manguinhos, Rio de Janeiro, Brazil
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Costa HS, Lima MMO, Lage SM, da Costa FSM, Figueiredo PHS, da Costa Rocha MO. Six-minute walk test and incremental shuttle walk test in the evaluation of functional capacity in Chagas heart disease. J Exerc Rehabil 2018; 14:844-850. [PMID: 30443532 PMCID: PMC6222153 DOI: 10.12965/jer.1836326.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/21/2018] [Indexed: 01/04/2023] Open
Abstract
Chagas heart disease (CHD) leads to a progressive functional impairment. Field tests, as the 6-min walk test (6MWT) and the incremental shuttle walk test (ISWT), may be inexpensive approaches in the evaluation of functional capacity of these patients. The present study was addressed to compare the 6MWT and the ISWT measures, and to determine the accuracy of these tests in the identification of functional impairment in patients with CHD. Thirty-five patients with CHD (47.1±8.2 years, NYHA I–III) were evaluated by echocardiography, cardiopulmonary exercise test (CPET), 6MWT, and ISWT. Correlations between the CPET (peak oxygen uptake [peak VO2] and the ratio between ventilation and the carbon dioxide production [VE/VCO2 slope]) and the field tests (walking distances) were also performed. The receiver operating characteristic (ROC) curve was selected to identify the best distances related to identify those patients with functional impairment. There was no difference between distances walked during the 6MWT and ISWT (P=0.694). The Bland-Altman analysis showed good agreement between the field tests. Both 6MWT and ISWT correlated with peak VO2 (r=0.577, P<0.001 and r=0.587, P<0.001, respectively) and ISWT correlated with VE/VCO2 slope (r=−0.339, P=0.003). The cutoff distances of 6MWT and ISWT to identify patients with peak VO2 less than 20 mL/kg/min were 520 m and 400 m, respectively, with no difference between the areas under ROC curves (P=0.276). Both the 6MWT and the ISWT demonstrated accuracy in identify functional impairment in patients with CHD, being useful tools for the risk stratification of these patients.
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Affiliation(s)
- Henrique Silveira Costa
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clínicas of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Márcia Maria Oliveira Lima
- School of Biological and Health Sciences, School of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Susan Martins Lage
- Rehabilitation Sciences Program, Department of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Fábio Silva Martins da Costa
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clínicas of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- School of Biological and Health Sciences, School of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Manoel Otávio da Costa Rocha
- Postgraduate Course of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical School and Hospital das Clínicas of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Costa HS, Lima MMO, Costa FSMD, Chaves AT, Nunes MCP, Figueiredo PHS, Rocha MODC. Reduced functional capacity in patients with Chagas disease: a systematic review with meta-analysis. Rev Soc Bras Med Trop 2018; 51:421-426. [DOI: 10.1590/0037-8682-0158-2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022] Open
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11
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Ribeiro ALP. Functional capacity in Chagas disease. Rev Soc Bras Med Trop 2018; 51:413-414. [DOI: 10.1590/0037-8682-0324-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/21/2022] Open
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12
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Silva RRD, Reis MS, Pereira BDB, Nascimento EMD, Pedrosa RC. Additional value of anaerobic threshold in a general mortality prediction model in a urban patient cohort with Chagas cardiomyopathy. Rev Port Cardiol 2017; 36:927-934. [PMID: 29223851 DOI: 10.1016/j.repc.2017.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/22/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Anaerobic threshold (AT) is recognized as objective and direct measurement that reflects variations in metabolism of skeletal muscles during exercise. Its prognostic value in heart diseases of non-chagasic etiology is well established. However, the assessment of risk of death in Chagas heart disease is relatively well established by Rassi score. But, the added value that AT can bring to Rassi score has not been studied yet. OBJECTIVES To assess whether AT presents additional effect to Rassi score in patients with chronic Chagas' heart disease. METHODS Prospective research of dynamic cohort by review of 150 medical records of patients. Were selected for cohort 45 medical records of patients who underwent cardiopulmonary exercise testing between 1996-1997 and followed until September 2015. Data analysis to detect association between studied variables can be seen using a logistic regression model. The suitability of the models was verified using ROC curves and the coefficient of determination R2. RESULTS 8 patients (17.78%) died by September 2015, with 7 of them (87.5%) from cardiovascular causes, of which 4 (57.14%) were considered on high risk by Rassi score. With Rassi score as independent variable, and death being the outcome, we obtained an area under the curve (AUC)=0.711, with R2=0.214. Instituting AT as independent variable, we found AUC=0.706, with R2=0.078. When we define Rassi score and AT as independent variables, it was obtained AUC=0.800 and R2=0.263. CONCLUSION when AT is included in logistic regression, it increases by 5% the explanation (R2) to the death estimation.
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Affiliation(s)
- Roberto Ribeiro da Silva
- Hospital Federal de Bonsucesso, Serviço de Fisioterapia, Rio de Janeiro, RJ, Brasil; Hospital Universitário Gaffrèe e Guinle - UNIRIO, Serviço de Fisioterapia, Rio de Janeiro, RJ, Brasil.
| | - Michel Silva Reis
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil
| | - Basílio de Bragança Pereira
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil; Universidade Federal do Rio de Janeiro, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (Coppe), Rio de Janeiro, RJ, Brasil
| | - Emilia Matos do Nascimento
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil; Universidade Federal do Rio de Janeiro, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (Coppe), Rio de Janeiro, RJ, Brasil
| | - Roberto Coury Pedrosa
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil
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Silva RRD, Reis MS, Pereira BDB, Nascimento EMD, Pedrosa RC. Additional value of anaerobic threshold in a general mortality prediction model in a urban patient cohort with Chagas cardiomyopathy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mediano MFF, Mendes FDSNS, Pinto VLM, Silva PSD, Hasslocher-Moreno AM, Sousa ASD. Reassessment of quality of life domains in patients with compensated Chagas heart failure after participating in a cardiac rehabilitation program. Rev Soc Bras Med Trop 2017; 50:404-407. [PMID: 28700063 DOI: 10.1590/0037-8682-0429-2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/25/2017] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION: We evaluated the effects of a cardiac rehabilitation program on quality of life. METHODS This secondary analysis of a single-arm study included 12 patients with Chagas heart failure. The cardiac rehabilitation program comprised exercise training and nutritional and pharmaceutical counseling. Quality of life was assessed using the SF-36 questionnaire. RESULTS: The program promoted improved physical functioning (β= +5.7; p=0.003), role-physical (β= +1.9; p=0.03), and bodily pain (β= +3.5; p=0.02) scores. Moreover, the summary physical health score (β= +1.4; p=0.001) improved. CONCLUSION: The cardiac rehabilitation program significantly improved the physical quality of life of patients with Chagas heart failure.
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Affiliation(s)
| | | | - Vivian Liane Mattos Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Paula Simplício da Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | | | - Andrea Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Novaes RD, Gonçalves RV, Penitente AR, Cupertino MC, Maldonado IR, Talvani A, Natali AJ. Parasite control and skeletal myositis in Trypanosoma cruzi-infected and exercised rats. Acta Trop 2017; 170:8-15. [PMID: 28223068 DOI: 10.1016/j.actatropica.2017.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 12/17/2022]
Abstract
Non-pharmacological strategies have been rarely described in the treatment of infectious diseases. Although exercise training has been recently incorporated in the clinical management of Chagas disease, the rationale basis that supports this indication is poorly understood. Thus, we investigated the effect of an aerobic exercise on the parasitism, inflammation and oxidative tissue damage in a murine model of Trypanosoma cruzi-induced skeletal myositis. Wistar rats were randomized into four groups: trained not infected (TNI) and infected (TI), sedentary not infected (SNI) and infected (SI). A running training program was administered 5days/week for 9 weeks. Then, infected animals were inoculated with T. cruzi and followed up for another 9 weeks. Exercise training induced beneficial adaptations by increasing time to fatigue and lactate threshold in TNI and TI animals. SI animals presented higher parasitemia, skeletal muscle parasitism, cell necrosis, leukocyte infiltration, cytokines levels, reactive oxygen species and nitric oxide production, thiobarbituric acid reactive substances, carbonyl proteins, myosin heavy chain I depletion, and increased catalase (CAT) and superoxide dismutase (SOD) activities. Beyond attenuation in all these variables, TI animals showed reduced TNF-α, CCL-2/MCP-1 and CX3CL1, and increased IL-10 muscle levels. Furthermore, these animals presented higher CAT and SOD activities and reduced lipid and protein oxidation. Taken together, our findings indicated that exercise training induced a protective phenotype in T. cruzi-infected mice, enhancing host defenses against the parasite and attenuating the pathological remodeling associated with skeletal myositis, aspects potentially associated to an improved immunological and redox balance in infected animals.
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Mediano MFF, Mendes FDSNS, Pinto VLM, Silva GMSD, Silva PSD, Carneiro FM, Sangenis LHC, Saraiva RM, Xavier SS, Brasil PEAAD, Hasslocher-Moreno AM, Sousa ASD. Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study. Rev Soc Bras Med Trop 2017; 49:319-28. [PMID: 27384829 DOI: 10.1590/0037-8682-0083-2016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/11/2016] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The benefit of a cardiac rehabilitation (CR) program for patients with Chagas heart failure (CHF) remains unclear. Therefore, we aimed to investigate the effects of CR for CHF patients. METHODS A single-arm pilot study, including 12 patients with CHF, was performed. Patients participated in an 8-month physical exercise intervention, comprising aerobic, strength, and stretching exercises (3 times per week, 60 minutes per session). Nutritional and pharmaceutical counseling were also performed. Functional capacity (cardiopulmonary exercise test), muscle respiratory strength (manovacuometry), and body composition (anthropometry and skinfolds) were evaluated at baseline, and after 4 and 8 months of intervention. Cardiac function (echocardiography), biomarkers (lipid profile, glucose, and glycated hemoglobin) and quality of life (Minnesota Living with Heart Failure Questionnaire) were assessed at baseline and at the end of the intervention. RESULTS Seven of 12 patients included in the study completed the 8-month follow-up period. Only 2 moderate adverse events occurred during the exercise training. Functional capacity improved after 4 months of CR, while left ventricular ejection fraction (LVEF) and respiratory strength improved after 8 months. Patients with right ventricular (RV) dysfunction at baseline exhibited an improvement in functional capacity after 4 months, and improvements in left ventricular (LV) diastolic pressure, respiratory strength, and quality of life at the end of follow-up. Conversely, those with normal baseline RV function demonstrated LVEF increases that were not observed in patients with RV dysfunction. CONCLUSIONS CR was feasible, safe, and has important clinical benefits for patients with CHF, specifically for cardiac function and muscle respiratory strength.
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Affiliation(s)
- Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Vivian Liane Mattos Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Paula Simplício da Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Fernanda Martins Carneiro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Luiz Henrique Conde Sangenis
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Sergio Salles Xavier
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | - Andrea Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
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Mendes FDSNS, Sousa AS, Souza FCDCC, Pinto VLM, Silva PS, Saraiva RM, Xavier SS, Veloso HH, Holanda MT, Costa AR, Carneiro FM, Silva GMS, Borges JP, Tibirica E, Pinheiro RO, Lara FA, Hasslocher-Moreno AM, Brasil PEAA, Mediano MFF. Effect of physical exercise training in patients with Chagas heart disease: study protocol for a randomized controlled trial (PEACH study). Trials 2016; 17:433. [PMID: 27590681 PMCID: PMC5010675 DOI: 10.1186/s13063-016-1553-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/13/2016] [Indexed: 12/21/2022] Open
Abstract
Background The effects of exercise training on Chagas heart disease are still unclear. This study aimed to evaluate the effect of exercise training over functional capacity, cardiac function, quality of life, and biomarkers in Chagas heart disease. Methods The PEACH study is a superiority randomized clinical trial which will include subjects who meet the following criteria: Chagas heart disease with a left ventricular ejection fraction below 45 % with or without heart failure symptoms; clinical stability in the last 3 months; adherence to clinical treatment; and age above 18 years. The exclusion criteria are: pregnancy; neuromuscular limitations; smoking; evidence of non-chagasic heart disease; systemic conditions that limit exercise practice or cardiopulmonary exercise test; unavailability to attend the center three times a week during the intervention period; and practitioners of regular exercise. The intervention group will perform an exercise training intervention three times per week during 6 months and will be compared to the control group without exercise. Both groups will undergo the same monthly pharmaceutical and nutritional counseling as well as standard medical treatment according to the Brazilian consensus on Chagas disease. The primary outcome is functional capacity based on peak exercise oxygen consumption during cardiopulmonary exercise testing. Secondary outcomes are: cardiac function; body composition; muscle respiratory strength; microvascular reactivity; cardiac rhythm abnormalities; autonomic function; biochemical; oxidative stress and inflammatory biomarkers; and quality of life. Subjects will be evaluated at baseline, and at 3 and 6 months after randomization. Thirty patients will be randomly assigned into exercise or control groups at a ratio of 1:1. Discussion Findings of the present study will be useful to determine if physical exercise programs should be included as an important additional therapy in the treatment of patients with Chagas heart disease. Trial registration ClinicalTrials.gov ID: NCT02517632 (registered on 6 August 2015). Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1553-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Andréa Silvestre Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | | | - Vivian Liane Mattos Pinto
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Paula Simplicio Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Roberto Magalhães Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Sergio Salles Xavier
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Henrique Horta Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Marcelo Teixeira Holanda
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Andréa Rodrigues Costa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Fernanda Martins Carneiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Gilberto Marcelo Sperandio Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Juliana Pereira Borges
- National Institute of Cardiology, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, 22240-006, Brazil.,Physical Education and Sports Institute, State University of Rio de Janeiro, Rua São Francisco Xavier, 524, Maracanã, Rio de Janeiro, 20550-900, Brazil.,Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro, 21040-360, Brazil
| | - Eduardo Tibirica
- National Institute of Cardiology, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, 22240-006, Brazil.,Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro, 21040-360, Brazil
| | - Roberta Olmo Pinheiro
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro, 21040-360, Brazil
| | - Flávio Alves Lara
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Pavilhão Cardoso Fontes, Sala 64, Rio de Janeiro, 21040-360, Brazil
| | - Alejandro Marcel Hasslocher-Moreno
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | | | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
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Borghi-Silva A, Trimer R, Mendes RG, Arena RA, Schwartzmann PV. Rehabilitation practice patterns for patients with heart failure: the South American perspective. Heart Fail Clin 2014; 11:73-82. [PMID: 25432475 DOI: 10.1016/j.hfc.2014.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) is an important public health issue in South America. Economic impacts are substantial. Chagas heart disease is a prevalent HF etiology; it is caused by the protozoan Trypanosoma cruzi. Cardiac rehabilitation (CR) is an integral component of HF care. The benefits of CR in HF patients need to be assessed. The effectiveness and safety of CR delivery, such as home-based interventions, should be explored. Strategies to improve adherence in CR are imperative. We describe past and current CR trends for HF patients and discuss the future of this important intervention.
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Affiliation(s)
- Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Rod Washington Luis Km 235 - SP - 310, Sao Carlos, Sao Paulo 13565-90, Brazil.
| | - Renata Trimer
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Rod Washington Luis Km 235 - SP - 310, Sao Carlos, Sao Paulo 13565-90, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Rod Washington Luis Km 235 - SP - 310, Sao Carlos, Sao Paulo 13565-90, Brazil
| | - Ross A Arena
- Integrative Physiology Laboratory, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, 1918 West Taylor Street, Chicago, IL 60612, USA
| | - Pedro V Schwartzmann
- Clinical Hospital, Rehabilitation Institute Lucy Montoro, Ribeirao Preto School of Medicine, University of Sao Paulo, Monte Alegre, Ribeirão Preto, Sao Paulo 14048-900, Brazil
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Lopes WDS, Cuman RKN, Guedes TA, Araújo SMD, Gomes ML. Exercício aeróbio reduz a hipertensão arterial de mulheres com Doença de Chagas. REV BRAS MED ESPORTE 2014. [DOI: 10.1590/1517-86922014200201657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Os portadores de doença de Chagas frequentemente apresentam a hipertensão arterial sistêmica (HAS) como a principal comorbidade. Em indivíduos hipertensos com e sem doença de Chagas, o controle de HAS geralmente é medicamentoso. Medidas alternativas de intervenção como o exercício físico aeróbio têm sido preconizadas como a maneira mais efetiva para reduzir os níveis de pressão arterial.OBJETIVO: Avaliar a influência do exercício físico sobre a pressão arterial de mulheres hipertensas com e sem doença de Chagas.MÉTODOS: Dezenove voluntárias divididas nos grupos G1 (nove com doença de Chagas) e G2 (dez sem doença de Chagas) foram submetidas a um programa de treinamento de 12 semanas, com duração de 30 a 60 minutos duas vezes por semana. A pressão arterial sistólica (PAS), diastólica (PAD) e a frequência cardíaca (FC) foram avaliadas no pré e pós-esforço no início (T0), após seis (T6) e 12 (T12) semanas.RESULTADOS: Em T6, melhora significativa foi observada na PAS pré e pós-esforço e na PAD pós-esforço, para ambos os grupos. No T12, G1 apresentou melhora significativa para todas as variáveis, exceto FC pós-esforço e G2 para PAS pré e pós-esforço e FC pós-esforço. Não houve diferença significativa entre G1 e G2 para as variáveis estudadas.CONCLUSÃO: O exercício físico aeróbio de baixa intensidade reduz significativamente a pressão arterial de mulheres com doença de Chagas, pode ser realizado com segurança, e insere os pacientes com esta enfermidade na prática rotineira de exercícios.
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