Resistance and aerobic training increases genome-wide DNA methylation in women with polycystic ovary syndrome.

Physical activity is a first-line treatment for polycystic ovary syndrome (PCOS). Resistance or aerobic exercise improves metabolic complications, reproductive outcomes, and quality of life in PCOS. DNA methylation reprogramming during exercise may be the major modifier behind these changes. We sought to evaluate genome-wide DNA methylation changes after supervised resistance and aerobic exercise in women with PCOS. Exercises were performed in 56 women with PCOS (resistance, n = 30; aerobic, n = 26), for 16 weeks (wks), three times per week, in 50-minute to one-hour sessions. Anthropometric indices and hormonal and metabolic parameters were measured before and after training. Genome-wide leukocyte DNA methylation was analysed by Infinium Human MethylationEPIC 850K BeadChip microarrays (Illumina). Both resistance and aerobic exercise improved anthropometric indices, metabolic dysfunction, and hyperandrogenism in PCOS after the training programme, but no differences were observed between the two exercises. Resistance and aerobic exercise increased genome-wide DNA methylation, although resistance changed every category in the CpG island context (islands, shores, shelve, and open sea), whereas aerobic exercise altered CpG shores and the open sea. Using a stringent FDR (>40), 6 significantly differentially methylated regions (DMRs) were observed in the resistance exercise cohort and 14 DRMs in the aerobic cohort, all of which were hypermethylated. The increase in genome-wide DNA methylation may be related to the metabolic and hormonal changes observed in PCOS after resistance and aerobic exercise. Since the mammalian genome is hypermethylated globally to prevent genomic instability and ageing, resistance and aerobic exercise may promote health and longevity through environmentally induced epigenetic changes.

Dual-energy X-ray absorptiometry and adiposity index are sensitive methods to evaluate central fat accumulation in women with polycystic ovary syndrome and normal body mass index.

Objective: This study aimed to determine the differences in body fat distribution and central obesity indicators using dual-energy X-ray absorptiometry (DXA), adiposity indices, and anthropometric indices between women with and without polycystic ovary syndrome (PCOS). Materials and methods: Clinical and laboratory examination history, including transvaginal ultrasound, fasting blood samples, anthropometric measurements, and DXA scans were conducted in 179 women with PCOS (PCOS group) and 100 without PCOS (non-PCOS group). The volunteers were grouped by body mass index (BMI): normal (18-24.9 kg/m2), overweight (25-29.9 kg/m2), or obese (>30 kg/m2). The visceral adiposity index (VAI) and lipid accumulation product (LAP) were calculated, regions of interest (ROIs) were determined, and the fat mass index (FMI) was calculated using DXA. Results: VAI, LAP, ROIs, FMI, and adiposity indices by DXA were higher in women with PCOS and normal BMI. In both PCOS and non-PCOS groups, the ROIs progressively increased from normal BMI to overweight and obese, and from overweight to obese. Obese women with PCOS showed high trunk fat mass. However, obesity was not able to modify these trunk/periphery fat ratios in PCOS from overweight to higher BMI. These variables were associated with the incidence of PCOS. Conclusion: In women with PCOS and normal BMI, both DXA and the adiposity indices, VAI and LAP, are more sensitive methods to evaluate total body fat and fat accumulation in the central abdominal region. It was also observed that as BMI increased, the differences in measurements between women with and without PCOS decreased.

Alteração do estado emocional de professores da educação básica brasileira / Change in the emotional state of teachers in the Brazilian basic education

O presente estudo avaliou a associação da saúde mental com fatores do ambiente de trabalho de professores brasileiros. Para tanto, foram aplicados um questionário semiestruturado com questões socioeconômicas e o Hospital Anxiety and Depression Scale para 499 professores, recrutados por meio do Facebook e Instagram. Desses, 391 eram do gênero feminino e 108 do masculino. Verificou-se que 32,7% apresentaram escore indicativo de improvável quadro de ansiedade; 26,8% possível e 40,5% provável. Por outro lado, 45,1% exibiram escore de improvável depressão; 31,5% possível e 23,4% provável. Foi identificado que ser do gênero feminino interferiu negativamente nos escores de ansiedade e depressão (p<0,001); assim como a inadequação e insatisfação com a renda (p<0,001); a classificação como péssimo ou regular ambiente de trabalho (p<0,001); o espaço físico inadequado (p<0,001); ter sofrido violência provocada pelos estudantes ou seus respectivos pais (p<0,001). Além disso, trabalhar por um tempo ≥40 horas (p=0,030) foi indicativo de maior ansiedade. Muitos professores brasileiros sofrem com quadros de ansiedade e depressão e fatores controláveis interferem diretamente. Sugere-se que o poder público e os proprietários de escolas privadas intervenham nesses contextos para evitar o colapso da saúde desses profissionais.

The present study evaluated the association between mental health and work environment factors among Brazilian teachers. In order to achieve that, a semi-structured questionnaire with socioeconomic questions and the Hospital Anxiety and Depression Scale were applied to 499 teachers, recruited through Facebook and Instagram. Among these, 391 were female and 108 were male. It was found that 32.7% had an improbable anxiety score; 26.8% possible and 40.5% probable. On the other hand, 45.1% had an improbable depression score; 31.5% possible and 23.4% probable. It was identified that being female had a negative effect on anxiety and depression scores (p<0.001); as well as inadequacy and dissatisfaction with income (p<0.001); work environment classified as poor or regular (p<0.001); inadequate physical space (p<0.001); having suffered violence caused by students or their respective parents (p<0.001). Furthermore, working for 40 hours or else (p=0.030) was indicative of greater anxiety. Many Brazilian teachers suffer from anxiety and depression and controllable factors interfere directly. It is suggested that public authorities and private school owners intervene in these contexts to prevent the health of these professionals from collapsing.

Distinct Protocols of Physical Exercise May Improve Different Aspects of Well-being in Women With Polycystic Ovary Syndrome.

The purpose of this study to assess the effects of different protocols of physical exercise on the domains of the quality of life (QoL), sexual function, anxiety, and depression scores in women with polycystic ovary syndrome (PCOS). Data of 112 women with PCOS were extracted from 2 trials with different protocols of physical exercise: continuous aerobic training (ContinuousAT, n = 23), intermittent aerobic training (IntermittentAT, n = 22), and progressive resistance training (ResistanceT, n = 43) alongside a control group (CG, n = 24). Volunteers who completed self-report questionnaires-Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression Scale (HADS), and the MOS 36-Item Short-Form Health Survey (SF-36) for QoL-preprotocol and postprotocol of physical exercise were included. Within groups, from baseline to week 16, all ContinuousAT, IntermittentAT, and ResistanceT protocols promoted improvements in multiple FSFI domains and HADS scores. However, ResistanceT did not improve the QoL aspects. Between groups, from other physical training protocols, the IntermittentAT was most effective for QoL and FSFI domains as well as HADS scores. It is concluded that all interventions were effective and improved indicators of sexual function, anxiety, and depression. When comparing protocols, interval training with high-intensity stimuli and active recovery was more effective.

Dual-energy X-ray absorptiometry and adiposity index are sensitive methods to evaluate central fat accumulation in women with polycystic ovary syndrome and normal body mass index

ABSTRACT Objective: This study aimed to determine the differences in body fat distribution and central obesity indicators using dual-energy X-ray absorptiometry (DXA), adiposity indices, and anthropometric indices between women with and without polycystic ovary syndrome (PCOS). Materials and methods: Clinical and laboratory examination history, including transvaginal ultrasound, fasting blood samples, anthropometric measurements, and DXA scans were conducted in 179 women with PCOS (PCOS group) and 100 without PCOS (non-PCOS group). The volunteers were grouped by body mass index (BMI): normal (18-24.9 kg/m2), overweight (25-29.9 kg/m2), or obese (>30 kg/m2). The visceral adiposity index (VAI) and lipid accumulation product (LAP) were calculated, regions of interest (ROIs) were determined, and the fat mass index (FMI) was calculated using DXA. Results: VAI, LAP, ROIs, FMI, and adiposity indices by DXA were higher in women with PCOS and normal BMI. In both PCOS and non-PCOS groups, the ROIs progressively increased from normal BMI to overweight and obese, and from overweight to obese. Obese women with PCOS showed high trunk fat mass. However, obesity was not able to modify these trunk/periphery fat ratios in PCOS from overweight to higher BMI. These variables were associated with the incidence of PCOS. Conclusion: In women with PCOS and normal BMI, both DXA and the adiposity indices, VAI and LAP, are more sensitive methods to evaluate total body fat and fat accumulation in the central abdominal region. It was also observed that as BMI increased, the differences in measurements between women with and without PCOS decreased.

Assessment of behavior-related pain in school teachers during emergency remote teaching: cross-sectional study / Avaliação de dor relacionada ao comportamento de professores durante o ensino remoto emergencial: estudo observacional transversal

ABSTRACT BACKGROUND AND OBJECTIVES: In the teacher's professional practice, there is a high level of stress, anxiety and incidence of pain. With the advent of COVID-19 and the emergence of remote teaching, it is possible that this scenario has been aggravated. The objective of this study was to evaluate chronic pain, central sensitization and pain catastrophizing among primary education teachers during remote teaching offered due to the pandemic. METHODS: A cross-sectional analytical observational study. Participants were 200 teachers from different regions of Brazil who responded through an online form a sociodemographic questionnaire and a questionnaire about their working conditions. In addition, pain intensity was assessed using the Visual Analog Pain Scale (VAS), central sensitization state was assessed using the Central Sensitization Questionnaire (CSI), and pain catastrophizing was assessed using the Catastrophic Thinking Scale about Pain (PCS). RESULTS: Most of the teachers were female, white, from the southeast region, with lato sensu specialization, had an income of 2 to 2.5 minimum wages, working 21 to 40 hours a week. Most of the teachers reported pain intensity equal to eight and the body region most affected was the lumbar spine. It was observed that teachers with low salary, uncomfortable environment and longer days dedicated to remote teaching showed a greater tendency to central sensitization and pain catastrophizing. Most teachers reported pain intensity equal to eight and the most affected body region was the lumbar spine. Teachers with uncomfortable furniture reported increased pain, especially in the lumbar spine and neck. They also showed higher levels of central sensitization to pain, inversely proportional to their salary income and, in sum, teachers with a greater feeling of discomfort catastrophized more which reflects the physical and emotional damage that pain can cause. CONCLUSION: Remote teaching during the pandemic of COVID-19 impacted physical and emotional changes in teachers of primary education. The professionals perceived that their furniture was not the most adequate for the high amount of time they had to work on academic activities using computers (in general, over 40 hours a week), they reported increased pain, especially in the lumbar spine and neck, they presented higher levels of central pain sensitization, which was influenced by low salary income, and, in sum, teachers with higher feelings of discomfort catastrophized more, which reflects the physical and emotional damage that pain may cause. All these affections tend to reduce the teachers' quality of life and, consequently, affect the teaching and learning processes.

RESUMO JUSTIFICATIVA E OBJETIVOS: Na atuação profissional do professor, há elevado nível de estresse, ansiedade e incidência de dor. Com o advento do COVID-19 e a emergência do ensino remoto, é possível que este cenário tenha sido agravado. O objetivo deste estudo foi avaliar quadros de dor crônica, sensibilização central e catastrofização da dor em professores da rede básica durante o ensino remoto ofertado devido à pandemia. MÉTODOS: Trata-se de um estudo observacional analítico do tipo transversal. Participaram 200 professores de diferentes regiões do Brasil que responderam, através de um formulário online, perguntas sobre aspectos sociodemográficos e suas condições de trabalho, além de serem avaliadas a intensidade de dor por meio da escala analógica visual de dor, o estado de sensibilização central por meio do Questionário de Sensibilização Central (CSI) e a catastrofização da dor por meio da Escala de Pensamento Catastrófico sobre a Dor. RESULTADOS: A maioria dos professores eram do sexo feminino, brancos, da região sudeste, com especialização lato sensu, apresentavam renda de 2 a 2,5 salários-mínimos e jornada de trabalho de 21 a 40 horas semanais. A maioria dos professores relatou intensidade de dor igual a oito e a região do corpo mais afetada foi a coluna lombar. Observou-se que professores com baixo salário, ambiente desconfortável e maior jornada dedicada ao ensino remoto apresentaram maior tendência à sensibilização central e à catastrofização da dor. Professores com mobiliário desconfortável relataram aumento da dor, em especial, na coluna lombar e no pescoço. Apresentaram também maiores níveis de sensibilização central à dor, inversamente proporcional à sua renda salarial e, de maneira somatória, professores com maior sensação de desconforto catastrofizaram mais o que reflete os prejuízos físicos e emocionais que a dor pode causar. CONCLUSÃO: O ensino remoto durante a pandemia do COVID-19 impactou alterações físicas e emocionais nos professores da rede básica de ensino. Os profissionais perceberam que seu mobiliário não era o mais adequado para a alta permanência de tempo que tiveram de trabalhar em atividades acadêmicas pelo computador (em geral, acima de 40 horas semanais), relataram aumento da dor, em especial na coluna lombar e no pescoço, apresentaram maiores níveis de sensibilização central à dor, que foi influenciado por baixa renda salarial e, de maneira somatória, professores com maior sensação de desconforto catastrofizaram mais, o que reflete os prejuízos físicos e emocionais que a dor pode causar. Todos estes acometimentos tendem a reduzir a qualidade de vida do professor e, consequentemente, afetar o processo de ensino e aprendizagem.

Short-Term Aerobic Exercise Did Not Change Telomere Length While It Reduced Testosterone Levels and Obesity Indexes in PCOS: A Randomized Controlled Clinical Trial Study.

Metabolic and hormonal outcomes of polycystic ovary syndrome (PCOS) have implications on telomere biology and physical activity may prevent telomere erosion. We sought to observe the effects of continuous (CAT) and intermittent (IAT) aerobic training on telomere length, inflammatory biomarkers, and its correlation with metabolic, hormonal, and anthropometric parameters of PCOS. This randomized controlled clinical trial study included 87 PCOS randomly stratified according to body mass index (BMI) in CAT (n = 28), IAT (n = 29) and non-training control group (CG, n = 30). The exercises were carried out on a treadmill, three times per week for 16 weeks. The participants' anthropometric characteristics and biochemical and hormonal concentrations were measured before and after aerobic training or observation period, as the telomere length that was evaluated using quantitative real-time PCR. Four months of aerobic exercises (CAT or IAT) did not alter telomere length and inflammatory biomarkers in PCOS women. Obesity index as BMI and waist circumference (WC), and inflammatory biomarkers negatively affect telomeres. The hyper-andro-genism measured by testosterone levels was reduced after both exercises (CAT, p ≤ 0.001; IAT, p = 0.019). In particular, the CAT reduced WC (p = 0.045), hip circumference (p = 0.032), serum cholesterol (p ≤ 0.001), and low-density lipoprotein (p = 0.030). Whereas, the IAT decreased WC (p = 0.014), waist-to-hip ratio (p = 0.012), free androgen index (FAI) (p = 0.037). WC (p = 0.049) and body fat (p = 0.015) increased in the non-training group while total cholesterol was reduced (p = 0.010). Booth exercises reduced obesity indices and hyperandrogenism on PCOS women without changes in telomere length or inflammatory biomarkers.

Continuous versus intermittent aerobic exercise in the improvement of quality of life for women with polycystic ovary syndrome: A randomized controlled trial.

Polycystic ovary syndrome predisposes alterations which contribute to the reduction of quality of life. This randomized controlled clinical trial study was to evaluate the effect of two protocols of aerobic exercise on quality of life in women with polycystic ovary syndrome. Women were allocated to three groups: continuous aerobic training (n = 28), intermittent aerobic training (n = 29), and control group (no training; n = 30). Testosterone levels, body composition indices, and quality of life were assessed at baseline and after 16 weeks of intervention. Both protocols were effective to improve testosterone levels, anthropometric indices, and quality of life in polycystic ovary syndrome women. Thus, these protocols should be included in the clinical environment to improve clinical parameters psychological, biological and social health to this population.

Physical Performance Regarding Handgrip Strength in Women with Polycystic Ovary Syndrome.

OBJECTIVE: The present study aimed to investigate the physical performance of handgrip strength (HGS) in women with polycystic ovary syndrome (PCOS). METHODS: A case-control study that included 70 women with PCOS and 93 age-matched healthy women aged between 18 and 47 years with body mass index (BMI) between 18 Kg/m2-39.9 Kg/m2. The serum levels of total testosterone, androstenedione, insulin, estradiol, thyroid-stimulating hormone (TSH), prolactin, sex hormone-binding globulin (SHBG), and 17-hydroxyprogesterone (17-OHP) were measured. The free androgen index (FAI) and the homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. The body composition regions of interest (ROIs) were assessed by dual-energy X-ray absorptiometry (DXA), and the handgrip strength (HGS) was evaluated for both the dominant and the non-dominant hands with a manual Sammons Preston (Bolingbrook, IL, US) bulb dynamometer. RESULTS: Women with PCOS had high serum levels of total testosterone (p < 0.01), androstenedione (p = 0.03), and insulin (p < 0.01), as well as high FAI (p < 0.01) and HOMA-IR (p = 0.01) scores. Compared with the non-PCOS group, the PCOS group had greater total lean mass in the dominant hand (p < 0.03) and greater HGS in both the dominant and the non-dominant hands (p < 0.01). The HGS was correlated with lean mass (p < 0.01). CONCLUSION: Women with PCOS have greater HGS. This may be associated with age and BMI, and it may be related to lean mass. In addition, the dominance effect on muscle mass may influence the physical performance regarding HGS in women with PCOS.

OBJETIVO: O objetivo deste estudo foi avaliar a força de preensão manual (FPM) em mulheres com síndrome dos ovários policísticos (SOP). MéTODOS: Estudo de caso-controle que incluiu 70 mulheres com SOP e 93 mulheres saudáveis com idade entre 18 e 47 anos e índice de massa corporal (IMC) de 18 Kg/m2 a 39.9 Kg/m2. Foram dosados os níveis séricos de testosterona total, androstenediona, insulina, estradiol, hormônio estimulador da tireoide (HET), prolactina, globulina de ligação ao hormônio sexual (GLHS), e 17-hidroxiprogesterona (17-OHP). Foram calculados o índice de androgênio livre (IAL) e a avaliação do modelo homeostático da resistência à insulina (AMH-RI). As regiões de interesse (RIs) da composição corporal foram avaliadas por absorciometria de raios-x de dupla energia (ARDE), e a força de preensão manual (FPM) das mãos dominante e não dominante foi avaliada com um dinamômetro manual Sammons Preston (Bolingbrook, IL, EUA). RESULTADOS: Mulheres com SOP apresentaram níveis séricos elevados de testosterona total (p < 0.01), androstenediona (p = 0.03), e insulina (P < 0.01), assim como valores altos no IAL (p < 0.01) e no AMH-RI (p = 0.01). Comparado ao grupo controle, o grupo SOP apresentou maior massa magra total na mão dominante (p < 0.03) e maior FPM em ambas as mãos (p < 0.01). A FPM foi correlacionada com a massa muscular magra (p <0.01). CONCLUSãO: Mulheres com SOP têm maior FPM, que pode estar associada à idade, ao IMC, e à massa magra. Além disso, o efeito de dominância na massa muscular pode influenciar o desempenho físico na força de preensão manual em mulheres com SOP.

Physical performance regarding handgrip strength in women with polycystic ovary syndrome / Desempenho físico na força de preensão manual em mulheres com síndrome dos ovários policísticos

Abstract Objective The present study aimed to investigate the physical performance of handgrip strength (HGS) in women with polycystic ovary syndrome (PCOS). Methods A case-control study that included 70 women with PCOS and 93 agematched healthy women aged between 18 and 47 years with body mass index (BMI) between 18 Kg/m2-39.9 Kg/m2. The serum levels of total testosterone, androstenedione, insulin, estradiol, thyroid-stimulating hormone (TSH), prolactin, sex hormonebinding globulin (SHBG), and 17-hydroxyprogesterone (17-OHP) were measured. The free androgen index (FAI) and the homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. The body composition regions of interest (ROIs) were assessed by dual-energy X-ray absorptiometry (DXA), and the handgrip strength (HGS) was evaluated for both the dominant and the non-dominant hands with a manual Sammons Preston (Bolingbrook, IL, US) bulb dynamometer. Results Women with PCOS had high serum levels of total testosterone (p < 0.01), androstenedione (p = 0.03), and insulin (p < 0.01), as well as high FAI (p < 0.01) and HOMA-IR (p = 0.01) scores. Compared with the non-PCOS group, the PCOS group had greater total lean mass in the dominant hand (p < 0.03) and greater HGS in both the dominant and the non-dominant hands (p < 0.01). The HGS was correlated with lean mass (p < 0.01). Conclusion Women with PCOS have greater HGS. This may be associated with age and BMI, and it may be related to lean mass. In addition, the dominance effect on muscle mass may influence the physical performance regarding HGS in women with PCOS.

Resumo Objetivo O objetivo deste estudo foi avaliar a força de preensão manual (FPM) em mulheres com síndrome dos ovários policísticos (SOP). Métodos Estudo de caso-controle que incluiu 70 mulheres com SOP e 93 mulheres saudáveis comidade entre 18 e 47 anos e índice demassa corporal (IMC) de 18 Kg/m2 a 39.9 Kg/m2. Foram dosados os níveis séricos de testosterona total, androstenediona, insulina, estradiol, hormônio estimulador da tireoide (HET), prolactina, globulina de ligação ao hormônio sexual (GLHS), e 17-hidroxiprogesterona (17-OHP). Foram calculados o índice de androgênio livre (IAL) e a avaliação do modelo homeostático da resistência à insulina (AMH-RI). As regiões de interesse (RIs) da composição corporal foram avaliadas por absorciometria de raios-x de dupla energia (ARDE), e a força de preensão manual (FPM) das mãos dominante e não dominante foi avaliada com um dinamômetro manual Sammons Preston (Bolingbrook, IL, EUA). Resultados Mulheres com SOP apresentaram níveis séricos elevados de testosterona total (p < 0.01), androstenediona (p = 0.03), e insulina (P < 0.01), assim como valores altos no IAL (p < 0.01) e no AMH-RI (p = 0.01). Comparado ao grupo controle, o grupo SOP apresentou maior massa magra total na mão dominante (p < 0.03) e maior FPM emambas asmãos (p < 0.01). A FPM foi correlacionada coma massamuscularmagra (p <0.01). Conclusão Mulheres com SOP têm maior FPM, que pode estar associada à idade, ao IMC, e à massa magra. Além disso, o efeito de dominância na massa muscular pode influenciar o desempenho físico na força de preensão manual em mulheres com SOP.

Concordance in prediction body fat percentage of Brazilian women in reproductive age between different methods of evaluation of skinfolds thickness.

OBJECTIVE: To assess the utility of bioimpedance (BIA) and skinfolds thickness (SF) in body fat percentage measuring (%BF) compared to the reference method dual-energy x-ray absorptiometry (DXA) in Brazilian reproductive age women, as well as to estimate of inter- and intra-observer precision for SF. SUBJECTS AND METHODS: 170 women aged 18-37 years with BMI between 18 and 39.9 kg/m2 were selected for this cross-sectional study. Body density was evaluated through equations proposed by Jackson, Pollock and Ward (1980) (EqJPW) and Petroski (1995) (EqPET), and %BF was estimated by BIA, DXA and Siri's formula (1961). The SF were measured by two separate observers: A and B (to determine inter-observer variability), who measured the folds at three times with 10-minute interval between them (to determine intra-observer variability - we used only observer A). RESULTS: The %BF by DXA was higher than those measured by SF and BIA (p<0.01, for all) of 90 volunteers. The Lin coefficient of agreement was considered satisfactory for %BF values obtained by EqJPW and BIA (0.55) and moderate (0.76) for sum of SF (ΣSF) values obtained by EqJPW and EqPET. No agreement was observed for the values obtained by SF (EqJPW and EqPET), BIA and DXA. Analysis of inter- and intra-observer of 59 volunteers showed that different measures of SF thickness met acceptability standards, as well as the % BF. CONCLUSION: BIA and SF measurements may underestimate %BF compared with DXA. In addition, BIA and SF measurements are not interchangeable with DXA. However, our results suggest the equation proposed by Jackson, Pollock and Ward (three skinfolds) compared to BIA are interchangeable to quantify the %BF in Brazilian women in reproductive age. Furthermore, our results show acceptable accuracy for intra- and inter-observer skinfold measurements. Arch Endocrinol Metab. 2020;64(3):257-68.

Increased Sympathetic Cardiac Autonomic Modulation after Two Consecutive Tilt Tests in Women with Polycystic Ovary Syndrome.

OBJECTIVE: The present study aimed to analyze cardiac autonomic modulation via spectral and symbolic analysis of heart rate variability (HRV) in women with polycystic ovary syndrome (PCOS) who were subjected to two consecutive tilt tests. METHODS: A total of 64 women were selected and divided into 2 groups: control (without PCOS), and PCOS. Concentrations of follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, homocysteine, sex hormone-binding globulin, thyroid stimulating hormone, fasting insulin, testosterone, androstenedione, and 17-hydroxyprogesterone levels, triglycerides, free androgen index (FAI), and homeostasis assessment model (HOMA-IR) were assessed. Cardiac autonomic modulation was evaluated by spectral and symbolic analyses during two consecutive tilt tests (two moments) and supine moments before, between and after (three moments) the tilt tests. RESULTS: Women with PCOS had higher fasting insulin, HOMA-IR indexes, testosterone and FAI. Additionally, we observed that the PCOS group had greater sympathetic autonomic cardiac modulation in supine 2, tilt 1, and supine 3 moments compared with controls. CONCLUSION: Women with PCOS had higher autonomic sympathetic cardiac modulation even after a second tilt test. No adaptation to this provocative test was observed. Spectral analysis was more sensitive for identifying differences between groups than the symbolic analysis.

OBJETIVO: O presente estudo teve como objetivo analisar a modulação autonômica cardíaca por análise espectral e simbólica da variabilidade da frequência cardíaca (VFC) em mulheres com síndrome dos ovários policísticos (SOP) que foram submetidas a dois testes consecutivos de inclinação. MéTODOS: Um total de 64 mulheres foram selecionadas e divididas em 2 grupos: controle (sem SOP) e SOP. Concentrações de hormônio folículo-estimulante, hormônio luteinizante, prolactina, estradiol, homocisteína, globulina de ligação a hormônios sexuais, hormônio estimulante da tireóide, insulina em jejum, testosterona e androstenediona e níveis de 17-hidroxiprogesterona, triglicerídeos, índice de andrógeno livre (FAI) e homeostase modelo de avaliação (HOMA-IR) foram avaliados. A modulação autonômica cardíaca foi avaliada por análises espectrais e simbólicas durante dois testes de inclinação consecutivos (dois momentos) e momentos supinos antes, entre e após (três momentos) os testes de inclinação. RESULTADOS: Mulheres com SOP apresentaram insulina em jejuM, índices HOMA-IR, testosterona e FAI mais altos. Além disso, observamos que o grupo PCOS apresentou maior modulação cardíaca autonômica simpática nos momentos supino 2, inclinado 1 e supino 3 em comparação aos controles. CONCLUSãO: Mulheres com SOP apresentaram modulação cardíaca simpática autonômica mais alta mesmo após um segundo teste de inclinação. Nenhuma adaptação a esse teste provocativo foi observada. A análise espectral foi mais sensível para identificar diferenças entre os grupos do que a análise simbólica.

Polycystic ovary syndrome associated with increased adiposity interferes with serum levels of TNF-alpha and IL-6 differently from leptin and adiponectin.

Objective The aim of this study was to investigate polycystic ovary syndrome (PCOS) and to explore the relationship between body fat percentage and metabolic markers. Subjects and methods Sedentary women were assigned to PCOS (N = 60) and CONTROL (N = 60) groups. Each group was subdivided into three subgroups according to body fat percentage (22-27%, 27-32% and 32-37%). The protocol consisted of assessments of glucose, insulin, androgens, follicle stimulating hormone (FSH), luteinizing hormone (LH), 17-hydroxyprogesterone (17-OHP), leptin, adiponectin, tumor necrosis factor (TNF-α) and interleukin-6 (IL-6). Results The PCOS subgroups showed higher concentrations of androgens, LH and 17-OHP. Leptin showed direct relationship with increased body fat percentage, whereas adiponectin showed the inverse effect. However, both were unaffected by PCOS. TNF-α and IL-6 were higher in PCOS women and showed a direct relationship with increased body fat percentage. Glucose showed direct relationship with body fat percentage, whereas insulin presented higher values in PCOS women and direct relationship with increased body fat percentage. Conclusions Our findings indicate that PCOS and body fat percentage directly influence concentrations of insulin, TNF-α and IL-6, whereas leptin and adiponectin are influenced only by the increase in body fat percentage in these women. Arch Endocrinol Metab. 2020;64(1):4-10.

Polycystic ovary syndrome associated with increased adiposity interferes with serum levels of TNF-alpha and IL-6 differently from leptin and adiponectin

ABSTRACT Objective The aim of this study was to investigate polycystic ovary syndrome (PCOS) and to explore the relationship between body fat percentage and metabolic markers. Subjects and methods Sedentary women were assigned to PCOS (N = 60) and CONTROL (N = 60) groups. Each group was subdivided into three subgroups according to body fat percentage (22-27%, 27-32% and 32-37%). The protocol consisted of assessments of glucose, insulin, androgens, follicle stimulating hormone (FSH), luteinizing hormone (LH), 17-hydroxyprogesterone (17-OHP), leptin, adiponectin, tumor necrosis factor (TNF-α) and interleukin-6 (IL-6). Results The PCOS subgroups showed higher concentrations of androgens, LH and 17-OHP. Leptin showed direct relationship with increased body fat percentage, whereas adiponectin showed the inverse effect. However, both were unaffected by PCOS. TNF-α and IL-6 were higher in PCOS women and showed a direct relationship with increased body fat percentage. Glucose showed direct relationship with body fat percentage, whereas insulin presented higher values in PCOS women and direct relationship with increased body fat percentage. Conclusions Our findings indicate that PCOS and body fat percentage directly influence concentrations of insulin, TNF-α and IL-6, whereas leptin and adiponectin are influenced only by the increase in body fat percentage in these women. Arch Endocrinol Metab. 2020;64(1):4-10

The effects of aerobic physical exercises on body image among women with polycystic ovary syndrome.

BACKGROUND: Both physical and mental health care for women with polycystic ovary syndrome (PCOS) require a multidisciplinary approach. We evaluated the effects of continuous (CAT) and intermittent (IAT) aerobic training in different protocols that measure body image, anxiety, depression and sexual dysfunction in women with PCOS. METHODS: In this controlled clinical trial, women with PCOS were randomly allocated for 16 weeks to 1 out of 3 groups: CAT (n = 28), IAT (n = 29), or control group (CG, n = 30). For data collection, we used the Body Shape Questionnaire (BSQ), Figure Rating Scale (FRS), Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Measurement Scales (HADS). RESULTS: No effects of CAT, IAT or CG groups were identified in the perceptual dimension of body image. The dis(satisfaction) grade improved after exercise in the CAT group (p ≤ 0.01) compared to the CG, as well as improved within CAT and IAT groups. Total FSFI, and HADS-A and HADS-D scores improved after exercise in the both groups. At baseline and after the study period, there were positive correlations between scores for dis(satisfaction), HADS-A and HADS-D scores. HADS-A and HADS-D scores had a negative correlation with FSFI total in the IAT (p = =0.02) group compared to the CG, as well as within CAT and IAT groups. LIMITATIONS: The participants were not matched for body mass index (normal, overweight and obese) which may interfere on body image dimensions. CONCLUSION: Aerobic exercise improves sexual function and indices related to anxiety and depression. Likewise, it interferes in cognitive-affective dimension of the body image.

Association of measures of central fat accumulation indices with body fat distribution and metabolic, hormonal, and inflammatory parameters in women with polycystic ovary syndrome.

OBJECTIVE: To investigate the associations among visceral adiposity index (VAI), lipid accumulation product (LAP), body fat percentage (%), and android/gynoid ratio (A/G ratio) in women with polycystic ovary syndrome (PCOS) and verify if the parameters representative of visceral obesity correlate with and exhibit the same frequency as body composition variables; anthropometric indices; and metabolic, hormonal, and inflammatory parameters. SUBJECTS AND METHODS: This was a cross-sectional study that included 94 women with PCOS. Hormonal, metabolic, and inflammatory parameters were analyzed in all women. Free androgen index (FAI) and homeostasis model assessment (HOMA-IR), as well as LAP, VAI, and anthropometric indices, were calculated. The regions of interest (ROIs) in body composition and body composition indices were evaluated using a dual X-ray absorptiometry (DXA). Overall, 32 variables were selected as markers of body fat distribution. RESULTS: Among the 32 markers evaluated, 29 correlated with LAP, whereas 25 correlated with VAI, 19 with body fat (%), and 30 with A/G ratio. Additionally, some markers correlated with the four adiposity indices evaluated: ROIs, except for total mass and leg fat (%); body composition (body mass index, waist circumference, and hip circumference) indices; fasting insulin; and C-reactive protein. CONCLUSION: LAP and VAI may be sensitive measures for screening and preventing metabolic syndrome and insulin resistance in PCOS, with LAP being more sensitive than VAI, and the A/G ratio may be more sensitive than body fat percentage.

Association of measures of central fat accumulation indices with body fat distribution and metabolic, hormonal, and inflammatory parameters in women with polycystic ovary syndrome

ABSTRACT Objective To investigate the associations among visceral adiposity index (VAI), lipid accumulation product (LAP), body fat percentage (%), and android/gynoid ratio (A/G ratio) in women with polycystic ovary syndrome (PCOS) and verify if the parameters representative of visceral obesity correlate with and exhibit the same frequency as body composition variables; anthropometric indices; and metabolic, hormonal, and inflammatory parameters. Subjects and methods This was a cross-sectional study that included 94 women with PCOS. Hormonal, metabolic, and inflammatory parameters were analyzed in all women. Free androgen index (FAI) and homeostasis model assessment (HOMA-IR), as well as LAP, VAI, and anthropometric indices, were calculated. The regions of interest (ROIs) in body composition and body composition indices were evaluated using a dual X-ray absorptiometry (DXA). Overall, 32 variables were selected as markers of body fat distribution. Results Among the 32 markers evaluated, 29 correlated with LAP, whereas 25 correlated with VAI, 19 with body fat (%), and 30 with A/G ratio. Additionally, some markers correlated with the four adiposity indices evaluated: ROIs, except for total mass and leg fat (%); body composition (body mass index, waist circumference, and hip circumference) indices; fasting insulin; and C-reactive protein. Conclusion LAP and VAI may be sensitive measures for screening and preventing metabolic syndrome and insulin resistance in PCOS, with LAP being more sensitive than VAI, and the A/G ratio may be more sensitive than body fat percentage.

Body image and its relationships with sexual functioning, anxiety, and depression in women with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is associated with lower levels of satisfaction with body image, which can affect sexuality and social well-being. Thus, we evaluated body image in women with PCOS and its association with body dis(satisfaction), anthropometric indices, sexual function, anxiety, and depression. METHODS: In this cross-sectional study, 94 women of reproductive age were grouped by body mass index (BMI) and sexual function. The Female Sexual Function Index (FSFI), Body Shape Questionnaire (BSQ), Figure Rating Scale (FRS), hospital anxiety (HADS-A) and depression (HADS-D) measurement scales, and anthropometric indices were used for data collection. RESULTS: Women with PCOS presented with perceptual distortions of self-image independent of sexual function and BMI. There were negative correlations between HADS-A and HADS-D scores and the FSFI total score, and HADS-D scores had positive correlations with weight, anthropometric indices, and BSQ total score. The degree of dis(satisfaction) was a predictor of FSFI total score, depression, and anxiety, and the FSFI total score was predicted by HADS-D. Desired and ideal-gender BMIs were risk factors for sexual dysfunction, and overweight and obesity were risk factors for the degree of dis(satisfaction). LIMITATIONS: This study had the limitations of using a cross-sectional design and it investigated a restricted number of clinical/biochemical parameters, as well as lacked objective measures of acne and hirsutism, and a control group. CONCLUSIONS: Perception and cognitive-affective dimensions appear to play important roles in body image dysfunction in women with PCOS, and impact sexual dysfunction and depression associated the syndrome. Furthermore, these results provide additional treatment considerations for women with PCOS.

Comparison of the Effect of Intermittent and Continuous Aerobic Physical Training on Sexual Function of Women With Polycystic Ovary Syndrome: Randomized Controlled Trial.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common condition characterized by hyperandrogenism, anthropometric changes (increased weight and waist-to-hip ratio [WHR]), behavioral changes (sexual dysfunction, anxiety, and depression), and reduced quality of life. Physical exercise may reduce many of the adverse effects of PCOS. However, no studies have yet evaluated the effects of aerobic exercise on the sexual function of women with PCOS. AIM: To compare the effects of continuous and intermittent aerobic physical training on the sexual function and mood of women with PCOS. METHODS: This is a secondary analysis of a controlled clinical trial in which women with PCOS (18-39 years of age) were randomly allocated to 1 of 3 groups for 16 weeks: continuous aerobic training (CAT, n = 23), intermittent aerobic training (IAT, n = 22), or no training (control group, n = 24). The Female Sexual Function Index (FSFI) was used to assess sexual function, and the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. MAIN OUTCOME MEASURE: The main outcome measure used was the FSFI. OUTCOMES: The primary outcomes were changes from baseline in total FSFI score and HAD scores at week 16 to prove the superiority of intermittent aerobic exercise compared with continuous aerobic exercise. RESULTS: After 16 weeks, the CAT group had a significant increase in the total FSFI score, improvements in the FSFI domains of satisfaction and pain, and a reduction in the WHR. The CAT and IAT groups also had significantly lower levels of testosterone after 16 weeks. The IAT group had a significant increase in the total FSFI score and improvements in the desire, excitation, lubrication, orgasm, and satisfaction FSFI domains. The CAT and IAT groups both had significant reductions in anxiety and depression scores after 16 weeks. CLINICAL IMPLICATIONS: Aerobic physical training protocols could be indicated to promote mental and sexual health in women with PCOS. STRENGTH & LIMITATIONS: This is one of the first studies to examine the effects of different physical training protocols on the sexual function of women with PCOS. The limitations of this study are that we did not consider diet or the frequency of sexual relations of participants with their partners. These factors could have interfered with the outcomes. CONCLUSION: The CAT and IAT protocols improved the sexual function and reduced the anxiety and depression of women with PCOS. Both protocols were similar to improve FSFI domain scores. Lopes IP, Ribeiro VB, Reis RM, et al. Comparison of the Effect of Intermittent and Continuous Aerobic Physical Training on Sexual Function of Women With Polycystic Ovary Syndrome: Randomized Controlled Trial. J Sex Med 2018;15:1609-1619.

Respostas anti-inflamatórias ao exercício terapêutico na osteoartrite de joelho: uma revisão sistemática / Anti-inflammatory responses to therapeutic exercise in knee osteoarthritis: a systematic review

Introdução: A osteoartrite (OA) de joelho atinge 10% da população mundial com idade de 60 anos ou mais. Citocinas, prostaglandinas e enzimas como IL-6, TNF-α, PCR, metaloproteínases, entre outras, são responsáveis por desencadear o processo inflamatório na articulação, degradação da cartilagem, formação de edema, incapacidades funcionais e dor. Embora o processo de degradação da cartilagem articular seja considerado de difícil reversão, sabe-se que pode ser estabilizado ou prevenido com o exercício físico. Objetivo: realizar uma revisão sistemática acerca dos efeitos de exercícios terapêuticos sobre o processo inflamatório em indivíduos com osteoartrite de joelho. Métodos: Foi realizada uma busca por artigos originais e em inglês e publicados em periódicos com fator de impacto indexados na base de dados Pubmed. Resultados: Foram encontrados 211 artigos originais, e 16 foram selecionados por se enquadrarem nos critérios de inclusão estabelecidos. Conclusão: O exercício terapêutico promoveu redução dos níveis séricos de citocinas pró-inflamatórias, em especial IL-6, TNF e PCR. Protocolos de exercícios de fortalecimento associados a exercícios aeróbios e dieta alimentar mostraram ser a combinação mais eficaz na redução da resposta inflamatória. O uso de medicamentos associados não interfere nos benefícios do exercício terapêutico na OA de joelho. (AU)

Introduction: Knee Osteoarthritis (OA) reaches 10% of the population aged 60 or older. Cytokines, prostaglandins and enzymes such as IL-6, TNF-α, PCR, metalloproteinases, and others are responsible for triggering the inflammatory process in joint, cartilage degradation, edema formation, functional disability and pain. Although the process of articular cartilage degradation is considered difficult to reverse, it is known that may be stabilized or prevented with physical exercise. Objective: to perform a systematic review about the effects of exercise therapy on the inflammatory process in individuals with knee osteoarthritis. Methods: A search was performed for original articles in English and published in journals with impact factor indexed in Pubmed database. Results: 211 original articles found, 16 were selected since they fit the established inclusion criteria. Conclusion: The exercise therapy promoted reduction of serum levels of pro-inflammatory cytokines, especially IL-6, TNF and PCR. Strengthening exercises protocols associated with aerobic and diet, showed to be the most effective combination in reducing the inflammatory response. The use of associated medications does not interfere with the therapeutic benefits of exercise on knee OA. (AU)