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Alves LS, Chizzola PR, Castro RE, CuriSalemi V, Melo MD, Andreta CR, Guimarães GV. Exercise Training in Heart Failure With Reduced Ejection Fraction and Permanent Atrial Fibrillation: A Randomized Clinical Trial. Heart Rhythm 2022; 19:1058-1066. [PMID: 35331961 DOI: 10.1016/j.hrthm.2022.03.1217] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Heart failure (HF) associated with atrial fibrillation (AF) increases patients' physical inactivity, worsening their clinical condition and mortality. Exercise training is safe and has clear benefits in HF. However, little is known about the effects of exercise training on heart failure patients with reduced ejection fraction and permanent atrial fibrillation (HFAF). OBJECTIVE To test the hypothesis that exercise training improves functional capacity, cardiac function, and quality of life in patients with HFAF. METHODS This randomized clinical trial was conducted at the Heart Institute. Patients with HFAF, LVEF ≤40% and resting HR ≤80 bpm were included in the study. Cardiopulmonary testing, echocardiography, autonomic, and quality of life assessment were performed before and after the 12-week protocol period. RESULTS Twenty-six patients, 58±1 years, were randomized to exercise training (HFAF-trained, n=13) or no training (HFAF-untrained, n=13). At baseline, no differences between groups were found. Exercise improved VO2 peak, slope VE/VCO2, and quality of life. HFAF-trained significantly decreased resting HR (from 73±2 to 69±2 bpm, P=.02) and recovery HR (from 148±11 to 128±9 bpm, P=.001). Concomitantly, LVEF increased (from 31±1 to 36±0.9 %, P=.01), LA decreased (from 52±1.2 to 47±1mm, P=.03), and LV-ESV and LV-EDV deceased (from 69±2 to 64±1.8 mL/m2, and 99±2.1 to 91±2, P<.05, respectively). No changes were observed in the untrained group. CONCLUSION Exercise training can improve exercise capacity, quality of life, and cardiac function in patients with heart failure with reduced ejection fraction and permanent atrial fibrillation.
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Affiliation(s)
- Leandro S Alves
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Paulo Roberto Chizzola
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Rafael Ertner Castro
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Vera CuriSalemi
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Marcelo Dt Melo
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Camila Rl Andreta
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Guimarães GV, Ribeiro F, Castro RE, Roque JM, Machado ADT, Antunes-Correa LM, Ferreira SA, Bocchi EA. Effects of the exercise training on skeletal muscle oxygen consumption in heart failure patients with reduced ejection fraction. Int J Cardiol 2021; 343:73-79. [PMID: 34506822 DOI: 10.1016/j.ijcard.2021.08.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 02/05/2023]
Abstract
AIMS Skeletal muscle dysfunction is a systemic consequence of heart failure (HF) that correlates with functional capacity. However, the impairment within the skeletal muscle is not well established. We investigated the effect of exercise training on peripheral muscular performance and oxygenation in HF patients. METHODS AND RESULTS HF patients with ejection fraction ≤40% were randomized 2:1 to exercise training or control for 12 weeks. Muscle tissue oxygen was measured noninvasively by near-infrared spectroscopy (NIRS) during rest and a symptom-limited cardiopulmonary exercise test (CPET) before and after intervention. Measurements included skeletal muscle oxygenated hemoglobin concentration, deoxygenated hemoglobin concentration, total hemoglobin concentration, VO2 peak, VE/VCO2 slope, and heart rate. Muscle sympathetic nerve activity by microneurography, and muscle blood flow by plethysmography were also assessed at rest pre and post 12 weeks. Twenty-four participants (47.5 ± 7.4 years, 58% men, 75% no ischemic) were allocated to exercise training (ET, n = 16) or control (CG, n = 8). At baseline, no differences between groups were found. Exercise improved VO2 peak, slope VE/VCO2, and heart rate. After the intervention, significant improvements at rest were seen in the ET group in muscle sympathetic nerve activity and muscle blood flow. Concomitantly, a significant decreased in Oxy-Hb (from 29.4 ± 20.4 to 15.7 ± 9.0 μmol, p = 0.01), Deoxi-Hb (from 16.3 ± 8.2 to 12.2 ± 6.0 μmol, p = 0.003) and HbT (from 45.7 ± 27.6 to 27.7 ± 13.4 μmol, p = 0.008) was detected at peak exercise after training. No changes were observed in the control group. CONCLUSION Exercise training improves skeletal muscle function and functional capacity in HF patients with reduced ejection fraction. This improvement was associated with increased oxygenation of the peripheral muscles, increased muscle blood flow, and decreased sympathetic nerve activity.
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Affiliation(s)
| | - Fernando Ribeiro
- University of Aveiro, School of Health Sciences and Institute of Biomedicine - iBiMED, Aveiro, Portugal
| | - Rafael Ertner Castro
- University of São Paulo (USP), School of Medicine, Heart Institute, São Paulo, Brazil
| | - Jean Marcelo Roque
- University of São Paulo (USP), School of Medicine, Heart Institute, São Paulo, Brazil
| | | | | | - Silvia Ayub Ferreira
- University of São Paulo (USP), School of Medicine, Heart Institute, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- University of São Paulo (USP), School of Medicine, Heart Institute, São Paulo, Brazil
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Guimarães GV, Ribeiro F, Arthuso FZ, Castro RE, Cornelissen V, Ciolac EG. Contemporary review of exercise in heart transplant recipients. Transplant Rev (Orlando) 2021; 35:100597. [PMID: 33607426 DOI: 10.1016/j.trre.2021.100597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 11/26/2022]
Abstract
Heart transplantation (HTx) is a therapeutic option for a selected group of patients with end-stage heart failure. Although secondary prevention including exercise therapy is recommended in the management of patients following HTx, little information is available on their metabolic and physiological consequences in HTx. Therefore, we aimed to conduct a contemporary review the effectiveness of exercise therapy on functional capacity, cardiovascular health and health-related quality of life for adult HTx patients. We searched the database MEDLINE for articles published between January 2015 and October 2020 and were able to include 6 studies involving 202 patients. Larger improvements in exercise capacity were seen after high-intensity interval training and in patients with evidence of cardiac reinnervation. Clinically relevant reductions were observed for daytime and 24 h ambulatory blood pressure after exercise training and following a single bout of aerobic exercise. Finally, limited data suggest that quality of life is higher in HTx patients following high-intensity training. In summary, the available evidence shows the potential for exercise as a vital treatment in patients following HTx. Yet, the scant data calls for more well-designed and adequately powered studies to support its effectiveness and to unravel optimal exercise characteristics, which would allow for more effective and person-tailored exercise prescription.
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Affiliation(s)
| | - Fernando Ribeiro
- School of Health Sciences and Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - Fernanda Zane Arthuso
- Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
| | - Rafael Ertner Castro
- Heart Institute, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | | | - Emmanuel Gomes Ciolac
- Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
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Ciolac EG, Castro RE, Greve JMD, Bacal F, Bocchi EA, Guimarães GV. Prescribing and Regulating Exercise with RPE after Heart Transplant: A Pilot Study. Med Sci Sports Exerc 2016; 47:1321-7. [PMID: 25343537 DOI: 10.1249/mss.0000000000000553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The objective of this study is to analyze the use of the 6-20 RPE scale for prescribing and self-regulating heated water-based exercise (HEx) and land-based exercise (LEx) in heart transplant recipients. METHODS Fifteen (five females) clinically stable heart transplant recipients (time since surgery = 4.0 ± 2.5 yr) age 46.7 ± 11.8 yr underwent a symptom-limited maximal graded exercise test on a treadmill to determine their HR at anaerobic threshold (HRAT), respiratory compensation point (HRRCP), and maximal effort (HRmax). After a week, patients were randomized to perform 30 min of both HEx (walking inside the pool) and LEx (treadmill walking) sessions at a pace between 11 and 13 on the 6-20 RPE scale and had their HR measured every 4 min. The interval between sessions was 48-72 h. RESULTS No significant differences between sessions were found in the average HR during HEx and LEx. Patients showed a delay in HR increase during both interventions, with the stabilization beginning after 8 min of exercise. Exercise HR was maintained between the HRAT and HRRCP (in the aerobic exercise training zone) for the most part of both HEx (72% of HR measurements) and LEx (66% of HR measurements). Only a few HR measurements stayed below HRAT (HEx = 9%, LEx = 13%) or above HRRCP (HEx = 19%, LEx = 21%) during both exercise sessions. CONCLUSION Exercise HR was maintained in the aerobic exercise training zone (between HRAT and HRRCP) for the most part of both sessions, suggesting that the 6-20 RPE scale may be an efficient tool for prescribing and self-regulating HEx and LEx in heart transplant recipients.
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Affiliation(s)
- Emmanuel Gomes Ciolac
- 1Exercise and Chronic Disease Research Laboratory, Physical Education Department, School of Sciences, São Paulo State University - UNESP, Bauru, BRAZIL; 2Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, BRAZIL; 3Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, BRAZIL
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Pascoalino LN, Ciolac EG, Tavares AC, Castro RE, Ayub-Ferreira SM, Bacal F, Issa VS, Bocchi EA, Guimarães GV. Exercise training improves ambulatory blood pressure but not arterial stiffness in heart transplant recipients. J Heart Lung Transplant 2014; 34:693-700. [PMID: 25662857 DOI: 10.1016/j.healun.2014.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 10/30/2014] [Accepted: 11/04/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hypertension is the most prevalent comorbidity after heart transplantation (HT). Exercise training (ET) is widely recommended as a key non-pharmacologic intervention for the prevention and management of hypertension, but its effects on ambulatory blood pressure (ABP) and some mechanisms involved in the pathophysiology of hypertension have not been studied in this population. The primary purpose of this study was to investigate the effects of ET on ABP and arterial stiffness of HT recipients. METHODS 40 HT patients, randomized to ET (n = 31) or a control group (n = 9) underwent a maximal graded exercise test, 24-hour ABP monitoring, and carotid-femoral pulse wave velocity (PWV) assessment before the intervention and at a 12-week follow-up assessment. The ET program was performed thrice-weekly and consisted primarily of endurance exercise (40 minutes) at ~70% of maximum oxygen uptake (Vo2MAX). RESULTS The ET group had reduced 24-hour (4.0 ± 1.4 mm Hg, p < 0.01) and daytime (4.8 ± 1.6 mm Hg, p < 0.01) systolic ABP, and 24-hour (7.0 ± 1.4 mm Hg, p < 0.001) daytime (7.5 ± 1.6 mm Hg, p < 0.001) and nighttime (5.9 ± 1.5 mm Hg, p < 0.001) diastolic ABP after the intervention. The ET group also had improved Vo2MAX (9.7% ± 2.6%, p < 0.001) after the intervention. However, PWV did not change after ET. No variable was changed in the control group after the intervention. CONCLUSIONS The 12-week ET program was effective for reducing ABP but not PWV in heart transplant recipients. This result suggests that endurance ET may be a tool to counteract hypertension in this high-risk population.
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Affiliation(s)
- Lucas Nóbilo Pascoalino
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil
| | - Emmanuel Gomes Ciolac
- Exercise and Chronic Disease Research Laboratory, Physical Education Department, School of Sciences, São Paulo State University - UNESP, Bauru, São Paulo, Brazil.
| | - Aline Cristina Tavares
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil; Syrian-Lebanese Hospital, São Paulo, São Paulo, Brazil
| | - Rafael Ertner Castro
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil
| | | | - Fernando Bacal
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil
| | - Victor Sarli Issa
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil
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Ferreira DMS, Castro RE, Machado MV, Evangelista T, Silvestre A, Costa A, Coutinho J, Carepa F, Cortez-Pinto H, Rodrigues CMP. Apoptosis and insulin resistance in liver and peripheral tissues of morbidly obese patients is associated with different stages of non-alcoholic fatty liver disease. Diabetologia 2011; 54:1788-98. [PMID: 21455726 DOI: 10.1007/s00125-011-2130-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 03/02/2011] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS Non-alcoholic fatty liver disease (NAFLD) is associated with insulin resistance and characterised by different degrees of hepatic lesion. Its pathogenesis and correlation with apoptosis and insulin resistance in insulin target tissues remains incompletely understood. We investigated how insulin signalling, caspase activation and apoptosis correlate with different NAFLD stages in liver, muscle and visceral adipose tissues. METHODS Liver, muscle and adipose tissue biopsies from 26 morbidly obese patients undergoing bariatric surgery were grouped according to the Kleiner-Brunt scoring system into simple steatosis, and less severe and more severe non-alcoholic steatohepatitis (NASH). Apoptosis was assessed by DNA fragmentation, and caspase-2 and -3 activation. Insulin signalling and c-Jun NH(2)-terminal kinase (JNK) proteins were evaluated by western blot. RESULTS Caspase-3 and -2 activation, and DNA fragmentation were markedly increased in the liver of patients with severe NASH vs in that of those with simple steatosis (p < 0.01). Muscle tissue, and to a lesser extent the liver, had decreased tyrosine phosphorylated insulin receptor and insulin receptor substrate in patients with severe NASH, compared with those with simple steatosis (p < 0.01 muscle; p < 0.05 liver). Concomitantly, Akt phosphorylation decreased in muscle, liver and visceral adipose tissues in patients with severe NASH (at least p < 0.05). Finally, JNK phosphorylation was significantly increased in muscle (p < 0.01) and liver (p < 0.05) from NASH patients, compared with tissue from those with simple steatosis. CONCLUSIONS/INTERPRETATION Our results demonstrate a link between apoptosis, insulin resistance and different NAFLD stages, where JNK and caspase-2 may play a key regulatory role.
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Affiliation(s)
- D M S Ferreira
- Research Institute for Medicines and Pharmaceutical Sciences, Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003 Lisbon, Portugal
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Viana RJS, Nunes AF, Castro RE, Ramalho RM, Meyerson J, Fossati S, Ghiso J, Rostagno A, Rodrigues CMP. Tauroursodeoxycholic acid prevents E22Q Alzheimer's Abeta toxicity in human cerebral endothelial cells. Cell Mol Life Sci 2009; 66:1094-104. [PMID: 19189048 DOI: 10.1007/s00018-009-8746-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The vasculotropic E22Q mutant of the amyloid-beta (Abeta) peptide is associated with hereditary cerebral hemorrhage with amyloidosis Dutch type. The cellular mechanism(s) of toxicity and nature of the AbetaE22Q toxic assemblies are not completely understood. Comparative assessment of structural parameters and cell death mechanisms elicited in primary human cerebral endothelial cells by AbetaE22Q and wild-type Abeta revealed that only AbetaE22Q triggered the Bax mitochondrial pathway of apoptosis. AbetaE22Q neither matched the fast oligomerization kinetics of Abeta42 nor reached its predominant beta-sheet structure, achieving a modest degree of oligomerization with a secondary structure that remained a mixture of beta and random conformations. The endogenous molecule tauroursodeoxycholic acid (TUDCA) was a strong modulator of AbetaE22Q-triggered apoptosis but did not significantly change the secondary structures and fibrillogenic propensities of Abeta peptides. These data dissociate the pro-apoptotic properties of Abeta peptides from their distinct mechanisms of aggregation/fibrillization in vitro, providing new perspectives for modulation of amyloid toxicity.
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Affiliation(s)
- R J S Viana
- iMed.UL, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
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Ferreira-Dias G, Mateus L, Costa AS, Solá S, Ramalho RM, Castro RE, Rodrigues CMP. Progesterone and Caspase-3 Activation in Equine Cyclic Corpora Lutea. Reprod Domest Anim 2007; 42:380-6. [PMID: 17635775 DOI: 10.1111/j.1439-0531.2006.00795.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Soon after ovulation, the newly formed corpus luteum (CL) starts secreting progesterone (P(4)), necessary for implantation. The CL, an ovarian transient endocrine organ, undergoes growth and regression throughout its life span. The objective of this study was to evaluate if caspase-3 mediates cell death in the equine cyclic luteal structures and relate it to luteal endocrine function. Blood and luteal tissue were collected during the breeding season after slaughter from 38 randomly assigned cycling mares. Luteal tissues were classified as corpora haemorrhagica (CH; n = 7); mid luteal phase corpora lutea (Mid-CL; n = 17); late or regressing corpora lutea (Late-CL; n = 9) and corpora albicans (CA; n = 5). Plasma P(4) concentration, determined by radioimmunoassay, showed a significant increase from CH to Mid-CL (p < 0.001), followed by a decrease to Late-CL (p < 0.001) and CA (p < 0.001). Caspase-3 processing and poly (ADP) ribose polymerase (PARP) degradation were assessed by western blotting. Active caspase-3 was twofold increased in Mid-CL, Late-CL and CA as compared with CH (p < 0.05). Immunocytochemistry also showed a significant increase in caspase-3 expression in large luteal cells in all structures when compared with CH (p < 0.05). Consistently, the endogenous caspase-3 substrate, PARP, was markedly degraded from CH to CA (p < 0.05). In fact, the ratio of full-length to degraded PARP showed a significant decrease from CH to Mid-CL, Late-CL and CA (p < 0.05). Finally, the decrease in P(4) from Mid- to Late-CL coincided with no further increases in apoptosis. In conclusion, these results suggest that the effector caspase-3 of apoptosis, might play an important role during luteal tissue involution in the mare, even though its relationship with P(4) remains to be elucidated.
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