Physical training prior to myocardial infarction potentializes stem cell therapy, SDF-1/CXCR4 axis activation and inhibits the vasoconstrictor response in hypertensive rats.

Stem cell therapy is a promising strategy for recovering of injured cardiac tissue after acute myocardial infarction. The effects promoted by preventive physical training, beneficial for regeneration, are not yet understood on stem cell homing. In the present study, we evaluated the effect of preventive physical training on cell homing activation and associated mechanisms after acute myocardial infarction and therapy with adipose-derived stem cells in spontaneously hypertensive rats (SHR). Forty female SHR were allocated in sedentary (S), sedentary SHAM (S-SHAM), sedentary AMI (S-AMI), sedentary with cell therapy (S-ICT), aerobically trained (T), trained SHAM (T-SHAM), trained AMI (T-AMI) and trained with cell therapy (S-ICT) groups. Cell therapy was performed through the infusion of 2 × 105 ADSC/0.05 mL at the moment of AMI. Molecular markers of cell homing (SDF-1/CXCR4), inflammatory response (myeloperoxidase and cardiac expression of iNOS, gp91phox and NFkB), vasoconstrictor agents (Ang II and ET-1) and an angiogenesis inducer (VEGF) were measured. Functional capacity and echocardiographic parameters were also evaluated. Preventive physical training associated with cell therapy was able to reduce left ventricle ejection fraction losses in infarcted animals. Results demonstrated activation of the SDF-1/CXCR4 axis by physical training, besides a reduction in vasoconstrictor and systemic inflammatory responses. Physical training prior to AMI was able to induce a cardioprotective effect and optimize the reparative mechanism of cell therapy in an animal model of hypertension.

Preventive Physical Training Partially Preserves Heart Function and Improves Cardiac Antioxidant Responses in Rats After Myocardial Infarction Preventive Physical Training and Myocardial Infarction in Rats.

In acute myocardial infarction (AMI), reactive oxygen species may cause irreversible damage to the heart tissue. Physical training is capable of enhancing antioxidant capacity, acting as a cardioprotective factor. We assessed the preventive effects of physical training on the antioxidant and functional responses of the heart of Wistar Kyoto rats after AMI. Wistar Kyoto rats (n = 12) were allocated to sedentary (SED) or trained (EXE-aerobic training on a treadmill) groups. Echocardiographic exams were performed 48 hr before and 48 hr after the induction of AMI. Superoxide dismutase (SOD) and catalase (CAT) activities, and total glutathione (GSH) were measured in vitro in the heart tissue. After AMI, the EXE group showed higher left ventricular shortening fraction (29%; p = .004), higher cardiac output (37%; p = .032) and reduced myocardial infarction size (16%; p = .007) than SED. The EXE group showed a higher nonenzymatic antioxidant capacity (GSH, 23%; p = .004), but the SOD and CAT activities were higher in SED (23% SOD; p = .021 and 20% CAT; p = .016). In addition, the SOD activity was positively correlated with myocardial infarction size and inversely correlated with cardiac output. Physical training partially preserved cardiac function and increased intracellular antioxidant response in cardiac tissue of animals after AMI.

Effects of aerobic, resistance, and combined training on endothelial function and arterial stiffness in older adults: study protocol for a systematic review and meta-analysis.

INTRODUCTION: Aging is an independent risk factor for cardiovascular events. It promotes vascular dysfunction which is associated with risk factors for cardiovascular diseases (CVDs). Exercise can modulate vascular function parameters, but little is known about the effects of different modalities of training (aerobic, resistance, and combined) on endothelial function and arterial stiffness in older adults. METHODS: This systematic review study will include randomized controlled trials (RCTs) selected from the electronic databases MEDLINE (PubMed), Cochrane, LILACS, EMBASE, and Web of Science. We will follow the PRISMA guidelines and PICOS framework. Studies involving both male and female older adults (≥60 years old) with or without comorbidities undergoing aerobic, resistance, and/or combined training compared to a control group (no exercise) will be eligible. We will use the Cochrane Risk of Bias 2 (RoB 2) tool to evaluate the quality of individual studies and GRADE to assess the strength of evidence. Statistical analyses will be conducted with RStudio for Windows (v1.3.959) using R package meta. DISCUSSION: A systematic review and meta-analysis involving data from studies of older adults would deepen our understanding of vascular adaptations to exercise training in this population. It could provide new insights into how health providers can improve patient management and prevention of cardiovascular events in older adults. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 42021275451.

Effects of Different Types of Exercise Training on Endothelial Function in Prehypertensive and Hypertensive Individuals: A Systematic Review. / Efeitos de Diferentes Tipos de Treinamento Físico na Função Endotelial em Pré-Hipertensos e Hipertensos: Uma Revisão Sistemática.

BACKGROUND: Sustained high blood pressure can lead to vascular remodeling and endothelial cell injury, which may explain the endothelial dysfunction found in hypertensive individuals. Exercise training can improve vascular health in individuals with cardiovascular risk, but little is known about its effects in prehypertensive and hypertensive individuals. OBJECTIVE: To review the literature showing evidence of changes in endothelial function in response to different modalities of exercise training in prehypertensive and hypertensive individuals. METHODS: We conducted a systematic review of studies in the MEDLINE, Cochrane, LILACS, EMBASE, and SciELO databases following both the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the PICO framework (patient/population, intervention, comparison and outcomes). Randomized clinical trials (RCTs) published up to April 2019 were selected and assessed by four independent reviewers. The methodological quality was assessed using the PEDro (Physiotherapy Evidence Database) scale. RESULTS: Our search yielded 598 abstracts, and 10 studies were eligible for review. All of them had acceptable methodological quality by PEDro scale. Of the 10 studies, 7 involved aerobic training, 1 isometric resistance training, and 2 aerobic training and dynamic resistance training separately. Seven studies used flow-mediated dilation (FMD) to assess the vascular health, and three used plethysmography. Most training protocols involved hypertensive individuals and consisted of low and moderate-intensity exercise. CONCLUSION: Our systematic review showed that moderate continuous aerobic training is effective to improve vascular health in hypertensive individuals. In prehypertensive individuals, vigorous interval aerobic training seems to be an alternative to determine vascular health benefits. Resistance exercise training, either isometric or dynamic, can be used as a secondary alternative, but still requires further investigation.

FUNDAMENTO: A hipertensão sustentada pode levar ao remodelamento vascular e lesão das células endoteliais, o que pode explicar a disfunção endotelial encontrada em hipertensos. O treinamento físico pode melhorar a saúde vascular em indivíduos com risco cardiovascular, mas pouco se sabe sobre seus efeitos em pré-hipertensos e hipertensos. OBJETIVO: Revisar a literatura mostrando evidências de alterações da função endotelial em resposta a diferentes modalidades de treinamento físico em pré-hipertensos e hipertensos. MÉTODOS: Realizamos uma revisão sistemática de estudos nas bases de dados MEDLINE, Cochrane, LILACS, EMBASE e SciELO seguindo tanto as diretrizes PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) quanto a estratégia PICO (paciente/população, intervenção, comparação e resultados). Os ensaios clínicos randomizados (ECRs) publicados até abril de 2019 foram selecionados e avaliados por quatro revisores independentes. A qualidade metodológica foi avaliada por meio da escala PEDro (Physiotherapy Evidence Database). RESULTADOS: Nossa busca rendeu 598 resumos, e 10 estudos foram elegíveis para revisão. Todos eles apresentaram qualidade metodológica aceitável pela escala PEDro. Dos 10 estudos, 7 envolveram treinamento aeróbico, 1 treinamento resistido isométrico e 2 treinamento aeróbico e treinamento resistido dinâmico separadamente. Sete estudos usaram dilatação fluxo-mediada (DFM) para avaliar a saúde vascular, e três usaram pletismografia. A maioria dos protocolos de treinamento envolveu indivíduos hipertensos e consistiu em exercícios de baixa e moderada intensidade. CONCLUSÃO: Nossa revisão sistemática mostrou que o treinamento aeróbico contínuo moderado é eficaz para melhorar a saúde vascular em indivíduos hipertensos. Em pré-hipertensos, o treinamento aeróbico intervalado vigoroso parece ser uma alternativa para benefícios à saúde vascular. O treinamento físico resistido isométrico ou dinâmico pode ser usado como alternativa secundária, mas ainda requer mais investigação.

Individuals with controlled hypertension show endothelial integrity following a bout of moderate-intensity exercise: randomized clinical trial.

To examine the acute effects of aerobic exercise (AE), resistance exercise (RE) or combined exercise (CE) on flow-mediated dilation (FMD), progenitor cells (PCs), endothelial progenitor cells (EPCs), oxidative stress markers and endothelial-cell derived microvesicles (EMVs) in patients with hypertension. This is a randomized, parallel-group clinical trial involving an intervention of one session of three different modalities of exercise. Thirty-three males (43 ± 2y) were randomly divided into three groups: a session of AE (n = 11, 40 min, cycle ergometer, 60% HRR); a session of RE (n = 11, 40 min, 4 × 12 lower limb repetitions, 60% 1-RM); or a session of CE (n = 11, 20-min RE + 20-min AE). FMD was assessed 10 min before and 10, 40 and 70 min post-intervention. Blood samples were collected at the same time points (except 40 min). FMD were similar in all groups and from baseline (within each group) after a single exercise bout (AE, RE or CE). At 70 min, RE group showed higher levels of PCs compared to the AE (81%) and CE group (60%). PC levels were reduced from baseline in all groups (AE: 32%, p = 0.037; RE: 15%, p = 0.003; CE: 17%, p = 0.048). The levels of EPCs, EMVs and oxidative stress were unchanged. There were no acute effects of moderate-intensity exercise on FMD, EPCs, EMVs and oxidative stress, but PCs decreased regardless of the exercise modality. Individuals with controlled hypertension do not seem to have impaired vascular function in response to a single exercise bout.

Effects of exercise training on endothelial function in individuals with hypertension: a systematic review with meta-analysis.

A slight increase (1%) in endothelial function is associated with reduction of cardiovascular risks by 13% in individuals with cardiovascular disease risk, including those with hypertension. Thus, we conducted a systematic review and meta-analysis to assess the efficacy of exercise training on endothelial function in individuals with hypertension.We included randomized clinical trials (RCTs) with adult participants diagnosed with hypertension undergoing exercise training (≥4 weeks), and the primary outcome was endothelial function, measured by flow-mediated dilatation (FMD). Five studies comprising a total of 362 participants (252 exercise and 110 controls; 59.3 years old, ranged from 52.0 to 67.2 years) were included in the meta-analysis. The pooled mean estimate indicated increased FMD after exercise training of 1.45 (P = .001), and 95% confidence interval -0.11 to 3.00 compared with control comparators. The studies were characterized by significant heterogeneity (χ2 = 23.34, P < .001, I2 = 70%). The present results are consistent with the notion that aerobic exercise training elicits favorable adaptations in endothelial function in individuals with hypertension. However, more studies are needed to make more definitive conclusions.

Cell Therapy in Ischemic Heart Disease: Interventions That Modulate Cardiac Regeneration.

The incidence of severe ischemic heart disease caused by coronary obstruction has progressively increased. Alternative forms of treatment have been studied in an attempt to regenerate myocardial tissue, induce angiogenesis, and improve clinical conditions. In this context, cell therapy has emerged as a promising alternative using cells with regenerative potential, focusing on the release of paracrine and autocrine factors that contribute to cell survival, angiogenesis, and tissue remodeling. Evidence of the safety, feasibility, and potential effectiveness of cell therapy has emerged from several clinical trials using different lineages of adult stem cells. The clinical benefit, however, is not yet well established. In this review, we discuss the therapeutic potential of cell therapy in terms of regenerative and angiogenic capacity after myocardial ischemia. In addition, we addressed nonpharmacological interventions that may influence this therapeutic practice, such as diet and physical training. This review brings together current data on pharmacological and nonpharmacological approaches to improve cell homing and cardiac repair.

Efeitos de Diferentes Tipos de Treinamento Físico na Função Endotelial em Pré-Hipertensos e Hipertensos: Uma Revisão Sistemática / Effects of Different Types of Exercise Training on Endothelial Function in Prehypertensive and Hypertensive Individuals: A Systematic Review

Resumo Fundamento: A hipertensão sustentada pode levar ao remodelamento vascular e lesão das células endoteliais, o que pode explicar a disfunção endotelial encontrada em hipertensos. O treinamento físico pode melhorar a saúde vascular em indivíduos com risco cardiovascular, mas pouco se sabe sobre seus efeitos em pré-hipertensos e hipertensos. Objetivo: Revisar a literatura mostrando evidências de alterações da função endotelial em resposta a diferentes modalidades de treinamento físico em pré-hipertensos e hipertensos. Métodos: Realizamos uma revisão sistemática de estudos nas bases de dados MEDLINE, Cochrane, LILACS, EMBASE e SciELO seguindo tanto as diretrizes PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) quanto a estratégia PICO (paciente/população, intervenção, comparação e resultados). Os ensaios clínicos randomizados (ECRs) publicados até abril de 2019 foram selecionados e avaliados por quatro revisores independentes. A qualidade metodológica foi avaliada por meio da escala PEDro (Physiotherapy Evidence Database). Resultados: Nossa busca rendeu 598 resumos, e 10 estudos foram elegíveis para revisão. Todos eles apresentaram qualidade metodológica aceitável pela escala PEDro. Dos 10 estudos, 7 envolveram treinamento aeróbico, 1 treinamento resistido isométrico e 2 treinamento aeróbico e treinamento resistido dinâmico separadamente. Sete estudos usaram dilatação fluxo-mediada (DFM) para avaliar a saúde vascular, e três usaram pletismografia. A maioria dos protocolos de treinamento envolveu indivíduos hipertensos e consistiu em exercícios de baixa e moderada intensidade. Conclusão: Nossa revisão sistemática mostrou que o treinamento aeróbico contínuo moderado é eficaz para melhorar a saúde vascular em indivíduos hipertensos. Em pré-hipertensos, o treinamento aeróbico intervalado vigoroso parece ser uma alternativa para benefícios à saúde vascular. O treinamento físico resistido isométrico ou dinâmico pode ser usado como alternativa secundária, mas ainda requer mais investigação.

Abstract Background: Sustained high blood pressure can lead to vascular remodeling and endothelial cell injury, which may explain the endothelial dysfunction found in hypertensive individuals. Exercise training can improve vascular health in individuals with cardiovascular risk, but little is known about its effects in prehypertensive and hypertensive individuals. Objective: To review the literature showing evidence of changes in endothelial function in response to different modalities of exercise training in prehypertensive and hypertensive individuals. Methods: We conducted a systematic review of studies in the MEDLINE, Cochrane, LILACS, EMBASE, and SciELO databases following both the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the PICO framework (patient/population, intervention, comparison and outcomes). Randomized clinical trials (RCTs) published up to April 2019 were selected and assessed by four independent reviewers. The methodological quality was assessed using the PEDro (Physiotherapy Evidence Database) scale. Results: Our search yielded 598 abstracts, and 10 studies were eligible for review. All of them had acceptable methodological quality by PEDro scale. Of the 10 studies, 7 involved aerobic training, 1 isometric resistance training, and 2 aerobic training and dynamic resistance training separately. Seven studies used flow-mediated dilation (FMD) to assess the vascular health, and three used plethysmography. Most training protocols involved hypertensive individuals and consisted of low and moderate-intensity exercise. Conclusion: Our systematic review showed that moderate continuous aerobic training is effective to improve vascular health in hypertensive individuals. In prehypertensive individuals, vigorous interval aerobic training seems to be an alternative to determine vascular health benefits. Resistance exercise training, either isometric or dynamic, can be used as a secondary alternative, but still requires further investigation.

Ballet dancers cardiorespiratory, oxidative and muscle damage responses to classes and rehearsals.

This study aimed to describe and compare ballet dancers' cardiorespiratory responses, muscle damage and oxidative stress levels during a ballet class (practice of isolated ballet exercises performed with barre/hand-rail support and across-the-floor movements to improve technical skills) and rehearsal (practice of ballet choreography involving technical-artistic skills to improve dancers' performance for shows). The 12 advanced female ballet dancers undertook three exercise sessions: maximum effort test, class and rehearsal. Heart rate (HR) and oxygen consumption (VO2) were continuously measured. Lactate was determined before 15 min and after class and rehearsal. Blood was sampled pre, post and 48 h after class and rehearsal for creatine kinase (CK), lipid peroxides (LPO) and glutathione analysis (GSSG/GSH). Class was of lower intensity than rehearsal as shown by VO2, HR and lactate values: VO2 (mL.kg(-1).min(-1)): 14.5±2.1 vs. 19.1±1.7 (p < 0.001); HR (bpm.min(-1)): 145.7±17.9 vs. 174.5±13.8 (p < 0.001); lactate (mmol.L(-1)): 4.2±1.1 vs. 5.5±2.7 (p = 0.049). CK (IU) increased following class and rehearsal, remaining high 48 h after: class (pre = 109.3±48.5; post = 144±60; 48 h = 117.2±64.6); rehearsal (pre = 78.6±52.1; post = 122±70.7; 48 h = 104.9±89.5). LPO (µM) increased from pre-class (1.27±0.19) to post-class (1.41±0.19) and went down after 48 h (1.20±0.22). No LPO time-course changes followed the rehearsal. GSSG/GSH decreased 48 h after class and rehearsal. Greater increases in LPO post-class suggest it promotes CK release by an oxidative membrane-damage mechanism. Physiological increases of LPO and CK in class indicate it prepares the dancers for exercise-induced oxidative stress and muscle damage during rehearsals. Ballet dancers' muscle damage and oxidative stress responses seem not to be dependent on exercise intensity based on VO2 responses.

Cardiac parameters and endothelial function in a strength athlete: a case report

We aimed to discuss a case of strength training athlete who competes in international competitions regarding cardiac (dimension and function), vascular (endothelium and vascular resistance), hemodynamic (blood pressure), given limited evidence supporting these cardiovascular adaptations as well as concerning endothelial function in long-term high-intensity strength training. Methods: We assessed heart structure and function (echocardiography); systolic (SBP) and diastolic blood pressure (DBP); endothelium-dependent vasodilation (flow-mediated dilation, FMD); maximum force tested in the squat, bench press, and deadlift; and maximum oxygen consumption (spirometry). Results: powerlifter's cardiac dimensions (interventricular septum 13 mm; posterior wall thickness 12 mm; LV diastolic diameter 57 mm; left ventricle mass 383 g; LV mass adjusted by body surface area 151.4 g/m2) are above the proposed cutoff values beyond which pathology may be considered. Moreover, cardiovascular function systolic (ejection fraction by Simpson's rule, 71%) is preserved and FMD measure is fairly close and above normal; however, a mild increase in systolic and diastolic blood pressure was observed (130/89 mmHg, respectively). Conclusion: Cardiac remodeling cannot be viewed as either pathological or harmful to the cardiovascular system. Furthermore, we showed an improvement in endothelial function.(AU)