Increased vascular function and superoxide dismutase activity in physically active vs inactive adults living with HIV.

This study compared macro- and microvascular endothelial function and redox status in active vs inactive HIV-infected patients (HIVP) under antiretroviral therapy. Using a cross-sectional design, macro- and microvascular reactivity, systemic microvascular density, and oxidative stress were compared between 19 HIVP (53.1 ± 6.1 year) enrolled in a multimodal training program (aerobic, strength and flexibility exercises) for at least 12 months (60-minutes sessions performed 3 times/wk with moderate intensity) vs 25 sedentary HIVP (51.2 ± 6.3 year). Forearm blood flow during reactive hyperemia (521.7 ± 241.9 vs 361.4% ± 125.0%; P = 0.04) and systemic microvascular density (120.8 ± 21.1 vs 105.6 ± 25.0 capillaries/mm2 ; P = 0.03) was greater in active than inactive patients. No significant difference between groups was detected for endothelium-dependent and independent skin microvascular vasodilation (P > 0.05). As for redox status, carbonyl groups (P = 0.22), lipid peroxidation (P = 0.86), catalase activity (P = 0.99), and nitric oxide levels (P = 0.72) were similar across groups. However, superoxide dismutase activity was greater in active vs inactive HIVP (0.118 ± 0.013 vs 0.111 ± 0.007 U/mL; P = 0.05). Immune function reflected by total T CD4 and T CD8 counts (cell/mm3 ) did not differ between active and inactive groups (P > 0.82). In conclusion, physically active HIVP exhibited similar immune function, but greater macrovascular reactivity, systemic microvascular density, and superoxide dismutase activity than inactive patients of similar age.

A Simple Model to Identify Risk of Sarcopenia and Physical Disability in HIV-Infected Patients.

Farinatti, P, Paes, L, Harris, EA, Lopes, GO, and Borges, JP. A simple model to identify risk of sarcopenia and physical disability in HIV-infected patients. J Strength Cond Res 31(9): 2542-2551, 2017-Early detection of sarcopenia might help preventing muscle loss and disability in HIV-infected patients. This study proposed a model for estimating appendicular skeletal muscle mass (ASM) to calculate indices to identify "sarcopenia" (SA) and "risk for disability due to sarcopenia" (RSA) in patients with HIV. An equation to estimate ASM was developed in 56 patients (47.2 ± 6.9 years), with a cross-validation sample of 24 patients (48.1 ± 6.6 years). The model validity was determined by calculating, in both samples: (a) Concordance between actual vs. estimated ASM; (b) Correlations between actual/estimated ASM vs. peak torque (PT) and total work (TW) during isokinetic knee extension/flexion; (c) Agreement of patients classified with SA and RSA. The predictive equation was ASM (kg) = 7.77 (sex; F = 0/M = 1) + 0.26 (arm circumference; cm) + 0.38 (thigh circumference; cm) + 0.03 (Body Mass Index; kg·m) - 8.94 (R = 0.74; Radj = 0.72; SEE = 3.13 kg). Agreement between actual vs. estimated ASM was confirmed in validation (t = 0.081/p = 0.94; R = 0.86/p < 0.0001) and cross-validation (t = 0.12/p = 0.92; R = 0.87/p < 0.0001) samples. Regression characteristics in cross-validation sample (Radj = 0.80; SEE = 3.65) and PRESS (RPRESS = 0.69; SEEPRESS = 3.35) were compatible with the original model. Percent agreements for the classification of SA and RSA from indices calculated using actual and estimated ASM were of 87.5% and 77.2% (gamma correlations 0.72-1.0; p < 0.04) in validation, and 95.8% and 75.0% (gamma correlations 0.98-0.97; p < 0.001) in cross-validation sample, respectively. Correlations between actual/estimated ASM vs. PT (range 0.50-0.73, p ≤ 0.05) and TW (range 0.59-0.74, p ≤ 0.05) were similar in both samples. In conclusion, our model correctly estimated ASM to determine indices for identifying SA and RSA in HIV-infected patients.

Corrigendum: Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): a study protocol for a randomized clinical trial.

[This corrects the article DOI: 10.3389/fmed.2022.1087188.].

Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): A study protocol for a randomized clinical trial.

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].

Assessment of vascular function in HIV-infected patients.

PURPOSE: The vascular function in HIV-infected persons under HAART and non-HIV-infected persons was investigated. METHOD: 18 HIV-positive patients and 23 HIV-negative subjects (14 younger group and 9 older group) were evaluated for microvascular vasodilatation during postocclusive reactive hyperemia (PORH) and during prolonged local thermal hyperemia; overall microvascular flux increase induced by iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) and large artery stiffness (SI(DVP)). RESULTS: Cutaneous vascular conductance (CVC) responses to ACh were lower in HIV patients compared to both HIV-negative groups (mean [SEM]) (HIV positive: 878.2 [99.5]; older HIV negative: 1129.3 [231.6]; younger HIV negative: 1366.5 [172.6] % baseline). Regarding SNP iontophoresis, HIV-positive and older HIV-negative groups showed lower CVC responses than younger HIV-negative group (HIV positive: 1043.0 [164.6]; older HIV-negative: 980.8 [108.3]; younger HIV-negative: 1757.3 [245.1] % baseline). Vasodilatation induced by thermal hyperemia (HIV positive: 1.63 [0.11]; older HIV negative: 1.48 [0.08]; younger HIV negative: 1.85 [0.27] perfusion units/mm Hg) and PORH (HIV positive: 0.374 [0.025]; older HIV negative: 0.326 [0.025]; younger HIV negative: 0.326 [0.037] PU/mm Hg) were similar between all groups. SIDVP was greater in HIV and older healthy groups than younger healthy group (HIV positive: 9.17 [0.42]; older HIV negative: 8.19 [0.43]; younger HIV negative: 6.42 [0.22] m/s). CONCLUSION: HIV-infected patients under HAART exhibited slight but nonsignificant lower microvascular reactivity to pharmacological stimuli and increased arterial stiffness compared to age-matched HIV-negative subjects. Comparison of both HIV-positive and older HIV-negative groups with younger HIV-negative subjects suggests that age plays a major role in microvascular reactivity regardless the HIV-infection.

Time course of cardiomyopathy induced by doxorubicin in rats.

BACKGROUND: Doxorubicin (DOX)-related cardiotoxicity may expose cancer survivors to increased risk of cardiovascular morbidity and mortality. Here, we characterized the time course of DOX-induced cardiomyopathy in rats. METHODS: Sprague-Dawley male rats (12 wk old) received doxorubicin hydrochloride (1 mg/kg/d, ip) during 10 consecutive days and they were euthanized one (DOX1), two (DOX2) or four (DOX4) weeks after the last drug injection. Control group received NaCl 0.9% (ip). Hearts were mounted on a Langendorff perfusion system, left ventricle fragments were processed for microscopy and oxidative stress-related assays, and blood was collected for cardiac troponin I assay. RESULTS: All DOX-treated groups showed swollen and vacuolated cardiomyocytes with myofilaments disarray and mitochondrial damage. These changes were already evident after one week and became more pronounced after four weeks. Cardiac troponin I plasma levels were significantly increased in DOX1 and further increased in DOX4 compared to control group. Increased oxidative damage to lipids was observed in DOX1, and to proteins in DOX4. Glutathione peroxidase activity increased in DOX4. The morphological changes resulted in cardiac remodeling, including interstitial fibrosis, apoptosis and significant impairment of both contractile and relaxation function in DOX 4 compared to control group. Hearts from all animals displayed an early reduction in the responsiveness to norepinephrine. CONCLUSIONS: These findings support the view that DOX cardiotoxicity occurs in a "continuum", and as the hypothesis of an irreversible cardiac injury is being challenged, understanding the progression of morphological and functional changes caused by DOX may allow proper timing of initiation of prophylactic treatment.

The impact of exercise frequency upon microvascular endothelium function and oxidative stress among patients with coronary artery disease.

PURPOSE: This study compared the effects of low and high weekly exercise frequencies on microvascular endothelium function and oxidative stress among patients with coronary artery disease. METHODS: Thirty-four male patients completed a 6-month cardiac rehabilitation programme, from which 23 performed exercise with a high frequency (HF) and 11 with a low frequency (LF). Systemic microvascular blood flow, maximal aerobic capacity, blood lipids, oxidative stress and anthropometric data were assessed prior to and after the cardiac rehabilitation programme. Microvascular blood flow was assessed in the skin of the forearm using laser speckle contrast imaging coupled with iontophoresis of acetylcholine. RESULTS: Maximal aerobic capacity, biochemical analysis and anthropometric data were similar between groups prior to and after the cardiac rehabilitation programme (P>0·05). However, after 6 months of cardiac rehabilitation performed with HF, there was an increase in the peak response to acetylcholine compared with LF (83·5 ± 58·5 versus 21·8 ± 22·4%; P<0·05). Changes in lipid peroxidation (HF: -5·5 ± 9·4 versus LF: 2·2 ± 12·0 pmol MDA mg-1 ; P = 0·19), catalase activity (HF: 0·07 ± 0·17 versus LF: 0·04 ± 0·08 U mg-1 ; P = 0·74) and nitric oxide levels (HF: 1·8 ± 15·3 versus LF: -3·2 ± 12·3 µM; P = 0·36) were similar between groups after cardiac rehabilitation. CONCLUSION: Six months of aerobic exercise training performed with high frequency is preferable to low frequency aiming endothelium microvascular function increases in patients with coronary artery disease. The mechanisms involved in this response are unclear and warrant additional research.

Delta opioid receptors: the link between exercise and cardioprotection.

This study investigated the role of opioid receptor (OR) subtypes as a mechanism by which endurance exercise promotes cardioprotection against myocardial ischemia-reperfusion (IR) injury. Wistar rats were randomly divided into one of seven experimental groups: 1) control; 2) exercise-trained; 3) exercise-trained plus a non-selective OR antagonist; 4) control sham; 5) exercise-trained plus a kappa OR antagonist; 6) exercise-trained plus a delta OR antagonist; and 7) exercise-trained plus a mu OR antagonist. The exercised animals underwent 4 consecutive days of treadmill training (60 min/day at ∼70% of maximal oxygen consumption). All groups except the sham group were exposed to an in vivo myocardial IR insult, and the myocardial infarct size (IS) was determined histologically. Myocardial capillary density, OR subtype expression, heat shock protein 72 (HSP72) expression, and antioxidant enzyme activity were measured in the hearts of both the exercised and control groups. Exercise training significantly reduced the myocardial IS by approximately 34%. Pharmacological blockade of the kappa or mu OR subtypes did not blunt exercise-induced cardioprotection against IR-mediated infarction, whereas treatment of animals with a non-selective OR antagonist or a delta OR antagonist abolished exercise-induced cardioprotection. Exercise training enhanced the activities of myocardial superoxide dismutase (SOD) and catalase but did not increase the left ventricular capillary density or the mRNA levels of HSP72, SOD, and catalase. In addition, exercise significantly reduced the protein expression of kappa and delta ORs in the heart by 44% and 37%, respectively. Together, these results indicate that ORs contribute to the cardioprotection conferred by endurance exercise, with the delta OR subtype playing a key role in this response.

Effects of physical exercise in the perception of life satisfaction and immunological function in HIV-infected patients: Non-randomized clinical trial.

BACKGROUND: there is a lack of research about the relationship between exercise and the psychological well-being of HIV-infected (Human Immunodeficiency Virus) patients. OBJECTIVE: the objective of this study was to investigate the influence of a physical training program on life satisfaction and on the immunological function in HIV-patients. METHODS: a total of 29 HIV-seropositive patients [age: 45 ± 2 yrs; Body Mass Index (BMI): 22.8 ± 1.0 kg/m² ; TCD4: 20.5 ± 2.0%] were allocated to the control (CG, n=10) and to the experimental groups (EG, n=19). The EG participated in an exercise program combining aerobic, strength, and flexibility exercises for a period of 12 weeks [3 times/week of 30 min of aerobic exercise (workload corresponding to 150 bpm-PWC150); 50 min of strength exercises (3 sets of 12 repetitions in 5 exercises at 60-80% 12 RM); and 10 min of flexibility exercises (2 sets of 30 seconds at maximal range of motion of 8 exercises)]. The immunological function was assessed by flow citometry [absolute and relative TCD4 cells counting] and the life satisfaction was assessed by the Life Satisfaction Index (LSI). RESULTS: the analysis of variance (ANOVA) showed no significant differences for relative and absolute CD4 T counts for both groups, however, a slight enhancement trend in the EG [16%, p=0.19] was observed. There was a significant improvement of LSI [approximately 15%; P<0.05] in EG, but not for CG. CONCLUSION: a physical activity program of moderate intensity improved life satisfaction perception in HIV-infected patients with no immunological function impairment.

Efeito do exercício físico na percepção de satisfação de vida e função imunológica em pacientes infectados pelo HIV: Ensaio clínico não randomizado / Effects of physical exercise in the perception of life satisfaction and immunological function in HIV-infected patients: Non-randomized clinical trial

CONTEXTUALIZAÇÃO: Os estudos sobre a relação entre prática de exercícios e bem-estar psicológico de pacientes com vírus da imunodeficiência humana (HIV) são raros. OBJETIVO: Investigar a influência de programa de condicionamento físico sobre a satisfação com a própria vida e sobre a função imunológica. MÉTODOS: Para tal análise, 29 pacientes soropositivos (idade: 45±2 anos; índice de massa corporal (IMC): 22,8±1,0 kg/m2; TCD4: 20,5±2,0 por cento), foram divididos em grupo controle (GC, n=10) e grupo experimental (GE, n=19). O GE participou durante 12 semanas de programa de exercícios que combinavam exercícios aeróbios, força e flexibilidade (três vezes/semana; aeróbio-30min: carga em watts equivalente a 150bpm-PWC150; força-50min: três séries de 12 repetições em cinco exercícios a 60-80 por cento 12 RM; flexibilidade-10min: duas séries de 30s na máxima amplitude em oito exercícios). A função imunológica foi avaliada por contagem absoluta e relativa das células TCD4 (citometria de fluxo),e a satisfação de vida, por meio do Índice de Satisfação de Vida (ISV). RESULTADOS: A análise de variância (ANOVA) não identificou alteração significativa para os linfócitos TCD4 em ambos os grupos, apesar da tendência à elevação no GE (16 por cento, p=0,19). Houve melhora significativa no ISV (≈15 por cento, P<0,05) para o GE, mas não para o GC. CONCLUSÃO: Um programa de condicionamento físico de intensidade moderada melhorou a percepção de satisfação de vida dos pacientes com HIV observados, sem acarretar prejuízos imunológicos.

BACKGROUND: There is a lack of research about the relationship between exercise and the psychological well-being of HIV-infected (Human Immunodeficiency Virus) patients. OBJECTIVE: The objective of this study was to investigate the influence of a physical training program on life satisfaction and on the immunological function in HIV-patients. METHODS: A total of 29 HIV-seropositive patients [age: 45±2 yrs; Body Mass Index (BMI): 22.8±1.0 kg/m² ; TCD4: 20.5±2.0 percent] were allocated to the control (CG, n=10) and to the experimental groups (EG, n=19). The EG participated in an exercise program combining aerobic, strength, and flexibility exercises for a period of 12 weeks [3 times/week of 30 min of aerobic exercise (workload corresponding to 150 bpm-PWC150); 50 min of strength exercises (3 sets of 12 repetitions in 5 exercises at 60-80 percent 12 RM); and 10 min of flexibility exercises (2 sets of 30 seconds at maximal range of motion of 8 exercises)]. The immunological function was assessed by flow citometry [absolute and relative TCD4 cells counting] and the life satisfaction was assessed by the Life Satisfaction Index (LSI). RESULTS: The analysis of variance (ANOVA) showed no significant differences for relative and absolute CD4 T counts for both groups, however, a slight enhancement trend in the EG [16 percent, p=0.19] was observed. There was a significant improvement of LSI [approximately 15 percent; P<0.05] in EG, but not for CG. CONCLUSION: A physical activity program of moderate intensity improved life satisfaction perception in HIV-infected patients with no immunological function impairment.