Influence of Angiotensin Converting Enzyme I/D Polymorphism on Hemodynamic and Antioxidant Response to Long-Term Intradialytic Resistance Training in Patients With Chronic Kidney Disease: A Randomized Controlled Trial.

ABSTRACT: Corrêa, HdL, Deus, LA, Neves, RVP, Reis, AL, de Freitas, GS, de Araújo, TB, da Silva Barbosa, JM, Prestes, J, Simões, HG, Amorim, CE, dos Santos, MAP, Haro, A, de Melo, GF, Gadelha, AB, Neto, LS, and Rosa, TdS. Influence of angiotensin converting enzyme I/D polymorphism on hemodynamic and antioxidant response to long-term intradialytic resistance training in patients with chronic kidney disease: a randomized controlled trial. J Strength Cond Res 35(10): 2902-2909, 2021-The aim of the study was to verify the influence of Angiotensin-converting enzyme (ACE) I/D genotype on blood pressure, muscle mass, and redox balance response to long-term resistance training (RT) in end-stage renal disease patients. Three hundred and twenty subjects were randomized into 4 groups: II + ID control (II + ID CTL, n = 80), II + ID RT (II + ID RT, n = 79), DD control (DD CTL n = 83), and DD RT (DD RT, n = 78). The RT lasted 24 weeks with a frequency of 3 times per week, on alternative days. Each section consisted of 3 sets of 8-12 repetitions in 11 exercises, with training loads at 6 point (somewhat hard) to 8 point (hard) based on OMNI-RES scale and was prescribed during dialysis (intradialytic). Statistical significance was accepted with p < 0.05. The most relevant benefits in blood pressure were found for DD homozygotes (p < 0.0001), whereas allele I carriers displayed a higher increase in muscle mass (p < 0.0001). Hemodialysis clinics that already use RT for their patients could include the genotyping of ACE to identify the predisposal of the patients to respond to RT and to counteract kidney disease-related comorbidities.

Phosphate and IL-10 concentration as predictors of long-covid in hemodialysis patients: A Brazilian study.

Background: The global burden of persistent COVID-19 in hemodialysis (HD) patients is a worrisome scenario worth of investigation for the critical care of chronic kidney disease (CKD). We performed an exploratory post-hoc study from the trial U1111-1237-8231 with two specific aims: i) to investigate the prevalence of COVID-19 infection and long COVID symptoms from our Cohort of 178 Brazilians HD patients. ii) to identify whether baseline characteristics should predict long COVID in this sample. Methods: 247 community-dwelling older (>60 years) patients (Men and women) undergoing HD (glomerular filtration rate < 15 mL/min/1.73m2) with arteriovenous fistula volunteered for this study. All patients presented hypertension and diabetes. Patients were divided in two groups: without long-COVID and with long-COVID. Body composition, handgrip strength, functional performance, iron metabolism, phosphate, and inflammatory profile were assessed. Patients were screened for 11-months after COVID-19 infection. Results were considered significant at P < 0.05. Results: We found that more than 85% of the COVID-19 infected patients presented a severe condition during the infection. In our sample, the mortality rate over 11-month follow was relatively low (8.4%) when compared to worldwide (approximately 36%). Long COVID was highly prevalent in COVID-19 survivors representing more than 80% of all cases. Phosphate and IL-10 were higher in the long COVID group, but only phosphate higher than 5.35 mg/dL appears to present an increased prevalence of long COVID, dyspnea, and fatigue. Conclusion: There was a high prevalence of COVID-19 infection and long COVID in HD patients from the Brazilian trial 'U1111-1237-8231'. HD clinics should be aware with phosphate range in HD patients as a possible target for adverse post-COVID events.

Obesity and falls in older women: Mediating effects of muscle quality, foot loads and postural control.

BACKGROUND: Obesity is associated with an increased risk of falls in older women. However, it is not certain whether factors commonly associated with obesity and falls mediate this risk. RESEARCH QUESTION: Do lower-limb muscle quality, foot loads and postural control mediate the relationship between obesity and falls in women aged 60 years and older? METHODS: At baseline, 246 female participants underwent obesity screening (BMI≥30 kg/m²), and measurements of muscle quality (isokinetic dynamometer and dual-energy X-ray absorptiometry), foot loads (pressure platform) and postural balance (force platform). Incident falls were recorded at the end of the 18-month follow-up period via participant recall. To test whether, and to what extent, biomechanical factors mediated the relationship between obesity and falls, the Natural Indirect Effects (NIE), Natural Direct Effect (NDE) and proportion mediated were calculated using the counterfactual approach. Significance level was set at p < .05. RESULTS: 204 participants (83 %) completed the follow-up. As expected, obesity was associated with a higher risk of being a faller (RR: 2.13, 95 % CI: 1.39-3.27). Using the counterfactual approach, only specific torque (NIE: 1.11, 95 % CI: 1.01-1.38) and flatfoot (NIE: 1.10, 95 % CI: 1.01-1.32) were significant mediators of the relationship between obesity and falls. Specific torque and flatfoot mediated 19 % and 21 % of the relationship, respectively. SIGNIFICANCE: Lower-limb muscle quality (specific torque) and foot loads (flatfoot) mediate the relationship between obesity and falls in older women. The inclusion of muscle strengthening and podiatry interventions as part of a fall prevention program may benefit this population.

Comparative Evaluation of Adiposity Indices as Predictors of Hypertension among Brazilian Adults.

PURPOSE: To compare several anthropometric indices in the prediction of hypertension among adults. METHODS: This is a cross-sectional study. Five hundred and eighteen adult men and women (40.9 ± 10.5 years; 1.62 ± .09 m; 72.3 ± 15.6 kg) volunteered to participate and underwent blood pressure and anthropometric measures. Anthropometric assessments were used to calculate body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), body adiposity index (BAI), and conicity index (C). Comparisons between men and women were carried out by independent t-test and chi-square test. Cut-off points for each adiposity index to predict hypertension were obtained using Receiver Operating Characteristic (ROC) curve analyses. The significance level was set at P ≤ .05. RESULTS: All adiposity indices regarding both genders showed significant odds ratios, except BAI (odds ratio: 1.534; CI: 0.916-2.571) for women. In men, WHR and WSR were considered as more balanced indices regarding their sensitivity (AUC: 73.8 and 71.4, respectively) and specificity (AUC: 77.6 and 73.1, respectively). In women, WHR and WSR presented areas under the ROC curves higher than C index (P = .007) and BAI (P = .03), respectively. CONCLUSION: Indices that consider abdominal adiposity such as WC, WHR, and WSR have a stronger relationship with hypertension compared to others.

Session Perceived Exertion Following Traditional and Circuit Resistance Exercise Methods in Older Hypertensive Women.

This study compared session ratings of perceived exertion (SRPE) between traditional multiple-set (TR) and circuit (CI) resistance exercise methods in treated hypertensive women. Fourteen volunteers (69.9 ± 5.6 years) performed two training sessions (TR and CI) in a random order, with the same number of sets, exercises, and loads. SRPE was obtained 30 minutes following each session using Foster's scale. OMNI-resistance exercise scale (OMNI-RES) measures were subsequently taken. Foster's SRPE was not significantly different between sessions (3.8 ± 0.9 TR vs. 3.4 ± 1.0 CI; p = .125), but OMNI-RES values were significantly higher following TR than following CI (5.2 ± 1.3 vs. 4.6 ± 1.5; p = .033). Total session duration was longer for TR (29.3 ± 1.2 vs. 20.0 ± 0.9 minutes; p < .001). Using moderate loads, the CI method did not elicit higher SRPE when compared with TR. Conversely, significantly lower OMNI-RES values follow CI. These results will be useful for prescribing exercise regimens for older hypertensive women.

Blood pressure reactivity to mental stress is attenuated following resistance exercise in older hypertensive women.

PURPOSE: This study aimed to investigate the effects of resistance exercise (RE) on autonomic control and blood pressure (BP) reactivity during mental stress (MS) in treated older hypertensive women. METHODS: Ten older hypertensive women (age =71.1±5.5 years; body mass index =24.2±3.9; mean BP [MBP] =85.4±3.5) underwent a protocol consisting of BP and heart rate variability (HRV) output assessments at baseline and during MS, and these measurements were taken before and 60 minutes after two bouts of RE (traditional and circuit). MS was induced through a computerized 3-minute Stroop color-word test before and 1 hour after each exercise session; BP was measured every minute during MS, and HRV was monitored as a measure of cardiac autonomic control. RESULTS: A significant effect of time on systolic BP (Δpre =17.4±12.8 versus Δpost =12.5±9.6; P=0.01), diastolic BP (Δpre =13.7±7.1 versus Δpost =8.8±4.5; P=0.01), and MBP (Δpre =14.0±7.7 versus Δpost =9.3±5.4; P<0.01) after RE was observed, with no differences between the two sessions. In addition, a significant effect of time on log-normalized low-frequency component of HRV (ms2; 5.3±0.8 pre-exercise MS versus 4.8±1.0 baseline value; P=0.023) was also observed, showing a significant change from baseline to MS before RE, but not after RE sessions. These results may be related to a lessened RE-mediated cardiac sympathetic activity during MS. CONCLUSION: RE is an effective tool to reduce BP reactivity to MS, which could therefore be associated with an acute reduction in cardiovascular risk. This result presents relevant clinical implications, combining previous evidence that recommends this exercise modality as an important component of an exercise program designed for the older and hypertensive subjects.

Comparison of adiposity indices and cut-off values in the prediction of metabolic syndrome in postmenopausal women.

AIMS: To compare adiposity indices and to assess their various cut-off values for the prediction of metabolic syndrome (MetS) in postmenopausal women. METHODS: One hundred forty nine volunteers (67.17±6.12 years) underwent body composition assessment using DXA and had 5 anthropometric indices measured (Waist Circumference, WC; Waist-to-Height Ratio, WHtR; Body Mass Index, BMI; Body Adiposity Index, BAI; and Conicity Index). Blood pressure was assessed using an oscillometric device and fasting blood samples were collected. MetS was classified according NCEP-ATP III. Cut-off values to predict MetS were obtained using Receiver Operating Characteristic (ROC) curve analyses and odds ratios were also calculated. RESULTS: MetS prevalence was 29.5% and subjects who were classified with MetS showed worse cardiometabolic outcomes and higher anthropometric indices values (p<0.05). With the exception of total- and LDL-cholesterol, all remaining variables were significantly correlated with at least one of the adiposity indices, with the strongest relationships observed for the indices reflecting central body fat. The cut-off values were 88cm, 0.57cm/cm, 26.85kg/m(2), 43.7%, 36.34%, and 1.24 units for WC, WHtR, BMI, DXA-derived body fat percentage, BAI, and conicity index, respectively. Significant greater risks for MetS were found for volunteers who had WHtR (odds=9.08; CI: 1.81-45.47) or WC (odds=5.20; CI: 1.30-20.73) measurements above cut-off values. CONCLUSION: Adiposity indices are associated with MetS in postmenopausal women in different degrees. Indices which consider central adiposity such as WC and WHtR have a stronger relationship with MetS compared to DXA-derived body fat percentage, which is considered a gold standard.

Session rating of perceived exertion following resistance exercise with blood flow restriction.

Session ratings of perceived exertion (SRPE) provide a valid and reliable indicator of resistance exercise session intensity. However, there is a lack of studies on the effects of resistance exercise with blood flow restriction (BFR) on SRPE. Thus, the aim of this study is to compare the effects of resistance exercise at high intensity versus low intensity with BFR on internal training load measured by SRPE. Thirteen young (22.2 ± 3.8 years) resistance-trained men (training experience 3.2 ± 2.4 years) participated in the study protocol. After determining one maximum repetition (1-RM), the subjects were assigned to two groups in a counterbalanced design (i) high-intensity exercise (HIE, performed one training session at 80% of 1-RM) and (ii) low intensity with BFR (BFR, performed an exercise session at 50% of 1-RM with BFR). During each session, subjects performed three sets of unilateral elbow flexion leading to concentric failure with a 1-min rest interval between sets. A cuff around the arm, inflated at 110 mmHg, was used continuously for BFR. The SRPE was reported 30 min after the end of the session. The low intensity with BFR showed lower total work (197.13 ± 63.49 versus 300.92 ± 71.81 kg; P = 0.002) and higher SRPE (9 versus 6; P = 0.007) than high-intensity resistance exercise. The present results indicate that BFR is an important factor to increase internal training load. Future studies should investigate the physiological stress imposed by different training methods rather than just quantify the external training load such as intensity or volume.