Body Mass Index but not Physical Activity Level Moderates Lowered Cardiac Baroreflex Sensitivity in People Living with HIV.

Reduced cardiac baroreflex sensitivity (cBRS) is an autonomic marker associated with a worse cardiovascular prognosis. Whether cBRS is lowered in people living with HIV (PLHIV) is yet unclear, as well as potential moderator effects of body mass index (BMI) or physical activity (PA) level. The present study aims to compare the spontaneous cBRS in PLHIV vs. HIV-uninfected controls, and to determine among PLHIV the relationship between cBRS vs. body mass index (BMI) and PA level. Total, upward (cBRS+), and downward (cBRS-) cBRS gains were assessed using the sequential method from beat-to-beat blood pressure at rest in 16 PLHIV (46.5±8.4 years) under antiretroviral therapy for at least 6 months, and 16 HIV-uninfected controls (CTL; 42.1±8.0 years). PA level was assessed by the Physical Activity Questionnaire (IPAQ short version) overall score. PLHIV showed lower total cBRS (8.7±3.1 vs. 15.3±7.7 ms.mmHg-1; p < 0.01), cBRS+ (9.2±4.9 vs. 16.0±6.8 ms.mmHg-1; p < 0.01) and cBRS- (9.5±4.9 vs. 15.3±9.3 ms.mmHg-1; p < 0.01) vs. CTL. No between-group difference was found for BMI (PLHIV: 25.2±2.6 vs. CTL: 26.8±3.2 kg.m-2; p > 0.05) or IPAQ score (PLHIV: 2.4±1.0 vs. CTL: 2.0±1.4; p > 0.05). In PLHIV, total cBRS was inversely correlated vs. BMI (r = -0.44; p = 0.04), but not vs. IPAQ score (r = 0.17; p = 0.26). HIV infection may reduce spontaneous cBRS, which seemed to be moderated by higher BMI, but not PA level of PLHIV.

The burden of physical inactivity for the public health care system in Brazil.

OBJECTIVE: To update the estimated cost of physical inactivity for the Brazilian Unified Health System (SUS). METHODS: The hospitalization costs were accessed via a database of the Ministry of Health - Informatics Department of the Brazilian SUS. Physical inactivity for the year 2017 was accessed via the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel - Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey). Seven chronic non-communicable diseases (NCD) were selected via the international classification of disease (ICD-10). The population fraction attributable to physical inactivity was calculated based on relative risk reported in previous studies and the prevalence of physical inactivity. RESULTS: In 2017, the seven NCD considered in the analysis were responsible for 154,017 hospital admissions in adults older than 40 years old, residing in the state capitals and the Federal District, which corresponded to 6.5% of hospitalizations and 10.6% of SUS costs at an estimated US$ 112,524,914.47. Considering the group of individuals with insufficient physical activity in their leisure time, the percentage cost attributed to physical inactivity reached 17.4% of the estimated costs with NCD. At a national level, NCD were responsible for approximately 740 thousand hospitalizations, costing US$ 482 million, from which 17.4%, US$ 83 million were attributed to physical inactivity. CONCLUSION: This study provides evidence to conclude that physical inactivity exerts an economic impact on the SUS due to NCD hospitalization. Physical inactivity is a modifiable lifestyle and compelling evidence, including that of this article, supports the promotion of a more active community as one of the major targets of public health care policies.

Effects of alpha-adrenergic receptor blockade on coronary circulation in postmenopausal women.

We sought to investigate the effect of the α1-adrenergic receptor blockade during handgrip exercise (Grip), isolated metaboreflex activation (Metabo), and cold pressor test (CPT) on coronary circulation in young (YW) and postmenopausal women (PMW). Ten YW and 9 PMW underwent two protocols: (1) 3 min of baseline followed by 3 min of CPT and (2) 3 min of rest, 3 min of Grip followed by 3 min of Metabo. Protocols were carried out under control conditions and α1-adrenergic receptor blockade (oral prazosin 0.03 mg·kg-1). Coronary blood velocity (CBV) and vascular conductance (CCI) were lower in PMW. Grip increased CBV only in YW (YW: Δ18.0 ± 21.1% vs. PMW: Δ4.2 ± 10.1%; p < 0.05), and the blockade did not change the CBV response to Grip in YW and PMW. During the Metabo, CBV returned to resting levels in YW and was unchanged from rest in PMW, before (YW:Δ1.7 ± 8.7% vs. PMW: Δ- 1.5 ± 8.6) and under the blockade (YW: Δ4.5 ± 14.8% vs. PMW: Δ9.1 ± 29.5%). CPT did not change CBV in both groups (YW: Δ3.9 ± 8.0 vs. PMW: Δ- 4.1 ± 6.2%), following the α1-blockade, CPT increased CBV only in YW (YW: Δ11.2 ± 12.8% vs. PMW: Δ2.2 ± 7.1%; p < 0.05 for group and condition). CCI decreased during Grip, Metabo, and CPT in YW and PMW, while the blockade prevented that decrease only in YW. The α1-adrenergic receptor plays a role in the control of coronary circulation in young women, evoking stronger vasoconstriction during CPT than Grip and Metabo in YW. PMW have impaired vasomotor control in the coronary circulation, which seems not to be caused by the α1-adrenergic receptor.

Feasibility of Left Ventricle Lead Implantation in Cardiac Resynchronization Therapy Guided by Gated SPECT and Ventricular Remodeling. / Viabilidade do Implante de Eletrodo Ventricular Esquerdo na Terapia de Ressincronização Cardíaca Guiada por Gated SPECT e Remodelamento Ventricular.

BACKGROUND: Cardiac resynchronization therapy (CRT) may benefit patients with advanced heart failure (HF). Abnormal eccentricity index by gated SPECT is related to structural and functional alterations of the left ventricle (LV). OBJECTIVE: The aim of this study is to evaluate the feasibility of LV lead implantation guided by phase analysis and its relationship to ventricular remodeling. METHODS: Eighteen patients with indication for CRT underwent myocardial scintigraphy for implant orientation, and eccentricity and ventricular shape parameters were evaluated. P < 0.05 was adopted as statistical significance. RESULTS: At baseline, most patients were classified as NYHA 3 (n = 12). After CRT, 11 out of 18 patients were reclassified to a lower degree of functional limitation. In addition, patients' quality of life was improved post-CRT. Significant reductions were observed in QRS duration, PR interval, end-diastolic shape index, end-systolic shape index, stroke volume, and myocardial mass post-CRT. The CRT LV lead was positioned concordant, adjacent, and discordant in 11 (61.1%), 5 (27.8%), and 2 (11.1%) patients, respectively. End-systolic and end-diastolic eccentricity demonstrated reverse remodeling post-CRT. CONCLUSIONS: LV lead implantation in CRT guided by gated SPECT scintigraphy is feasible. The placement of the electrode concordant or adjacent to the last segment to contract was a determinant of reverse remodeling.

FUNDAMENTO: A terapia de ressincronização cardíaca (TRC) pode beneficiar pacientes com insuficiência cardíaca (IC) avançada. O índice de excentricidade anormal por gated SPECT está relacionado a alterações estruturais e funcionais do ventrículo esquerdo (VE). OBJETIVO: O objetivo do presente estudo foi avaliar a viabilidade do implante de eletrodos do VE guiado por análise de fase e sua relação com o remodelamento ventricular. MÉTODOS: Dezoito pacientes com indicação de TRC foram submetidos à cintilografia miocárdica para orientar o implante, avaliando-se os parâmetros de excentricidade e forma ventricular. P < 0,05 foi adotado como significância estatística. RESULTADOS: Na linha de base do estudo, a maioria dos pacientes foi classificada como NYHA 3 (n = 12). Após a TRC, 11 dos 18 pacientes foram reclassificados para um menor grau de limitação funcional. Além disso, a qualidade de vida dos pacientes melhorou após a TRC. Foram observadas reduções significativas na duração do QRS, intervalo PR, índice de forma diastólica final, índice de forma sistólica final, volume sistólico e massa miocárdica pós-TRC. O eletrodo do VE da TRC foi posicionado concordante, adjacente e discordante em 11 (61,1%), 5 (27,8%) e 2 (11,1%) pacientes, respectivamente. A excentricidade sistólica e diastólica final demonstrou remodelamento reverso após a TRC. CONCLUSÕES: O implante de eletrodo do VE em TRC guiado por cintilografia gated SPECT é viável. A colocação do eletrodo concordante ou adjacente ao último segmento a se contrair foi um determinante do remodelamento reverso.

The COVID-19 curtain: Can past communist regimes explain the vaccination divide in Europe?

As of December 2021, all former Communist countries from Central and Eastern Europe were still lagging behind in terms of COVID-19 vaccination rates in Europe. Can institutional legacy explain, at least in part, this heterogeneity in vaccination decisions across Europe? To study this question we exploit novel data from the second wave of the SHARE (Survey of Health, Ageing and Retirement in Europe) COVID-19 Survey fielded in Summer (2021) that covers older individuals in 27 European countries. First, we document lower COVID-19 vaccine take-up amongst those who were born under Communism in Europe. Next, we turn to reunified Germany to get closer to a causal effect of having lived behind the Iron Curtain. We find that exposure to the Communist regime in East Germany decreased one's probability to get vaccinated against COVID-19 by 8 percentage points and increased that of refusing the vaccine by 4 percentage points. Both effects are large and statistically significant, and they hold when controlling for individual socio-economic and demographic characteristics. We explore several possible mechanisms. The East-West Germany gap does not seem to be explained by differences in the impact of the first wave of the pandemic or in general exposure to vaccines. We find that East Germans have lower social capital than West Germans and that social capital correlates negatively with Covid-10 vaccine uptake, but only a small fraction of the East-West Germany Covid-19 vaccination gap can be explained by our measures of social capital.

Robinson Crusoe: less or more depressed? With whom and where to live in a pandemic if you are above 50.

Did the first wave of the COVID-19 epidemic and the various lockdown measures taken by European governments in the spring of 2020 impact individuals aged 50 and over differently according to their living arrangements and housing conditions? Focusing on three indicators of mental well-being, depression, loneliness and trouble sleeping, this paper answers the question using data on Europeans interviewed in the SHARE Corona Survey, fielded right after the first wave of the pandemic in summer 2020, linked longitudinally with two previous waves of SHARE (2013 and 2015). We find that the first wave of the pandemic changed the association between mental health and living arrangements and housing conditions. New to this pandemic period, the mental well-being of those who lived only with a spouse declined relative to the general population aged 50+. Relatedly, there was a protective impact for parents of having (adult) children in the same building as opposed to children, however close, who were not co-residing. Finally, living in cities and in multi-unit housing also led to a decrease in mental well-being relative to the general population aged 50+.

The burden of physical inactivity for the public health care system in Brazil

ABSTRACT OBJECTIVE To update the estimated cost of physical inactivity for the Brazilian Unified Health System (SUS). METHODS The hospitalization costs were accessed via a database of the Ministry of Health - Informatics Department of the Brazilian SUS. Physical inactivity for the year 2017 was accessed via the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel - Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey). Seven chronic non-communicable diseases (NCD) were selected via the international classification of disease (ICD-10). The population fraction attributable to physical inactivity was calculated based on relative risk reported in previous studies and the prevalence of physical inactivity. RESULTS In 2017, the seven NCD considered in the analysis were responsible for 154,017 hospital admissions in adults older than 40 years old, residing in the state capitals and the Federal District, which corresponded to 6.5% of hospitalizations and 10.6% of SUS costs at an estimated US$ 112,524,914.47. Considering the group of individuals with insufficient physical activity in their leisure time, the percentage cost attributed to physical inactivity reached 17.4% of the estimated costs with NCD. At a national level, NCD were responsible for approximately 740 thousand hospitalizations, costing US$ 482 million, from which 17.4%, US$ 83 million were attributed to physical inactivity. CONCLUSION This study provides evidence to conclude that physical inactivity exerts an economic impact on the SUS due to NCD hospitalization. Physical inactivity is a modifiable lifestyle and compelling evidence, including that of this article, supports the promotion of a more active community as one of the major targets of public health care policies.

Hemodynamic responses during inspiratory muscle exercise in healthy young adults / Respuestas hemodinámicas durante el ejercicio de los músculos inspiratorios en adultos jóvenes sanos / Respostas hemodinâmicas durante exercício muscular inspiratório em jovens saudáveis

ABSTRACT The literature on hemodynamic responses during inspiratory muscle exercise (IME) lacks a consensus. To evaluate and compare hemodynamic responses during an IME session with and without resistive load, 15 sedentary men were subjected to two randomized IME sessions: one with 40% of maximal inspiratory pressure (IME 40%) and another without a resistive load (Sham), both of which were performed for two minutes over eight sessions with one-minute intervals. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), total peripheral resistance (TPR), stroke volume (SV), cardiac output (CO), and heart rate (HR) were measured by infrared digital photoplethysmography during five basal minutes and during the IME sessions. One-way analysis of variance and the Student's t test for paired data were used to analyze hemodynamic response and delta values between sessions. Effect size was evaluated by Cohen's D. A 5% significance level was adopted. SBP responses (sham: ∆−1±2 vs. 40%: ∆−4±2mmHg, p=0.27), DBP (sham: ∆2±1 vs. 40%: ∆1±2mmHg, p=0.60) and MBP (sham: ∆2±1 vs. 40%: ∆0±2mmHg, p=0.28) were similar between sessions. HR increases were higher in the 40% IME session than in the sham session (sham: ∆9±2 vs. 40%: ∆3±2bpm, p=0.001). SV only decreased during the sham session but responses were similar between sessions (sham: ∆−2±2 vs. IME 40%: ∆−6±2ml, p=0.13). Both sessions did not change SBP, DBP, MBP, CO, and TPR, but we observed a greater increase in HR in the IME 40% session. Only the Sham session decreased SV.

RESUMEN No hay consenso en la literatura sobre las respuestas hemodinámicas durante el ejercicio muscular inspiratorio (EMI). El objetivo de este estudio fue evaluar y comparar las respuestas hemodinámicas durante una sesión de EMI con y sin carga resistiva. Para ello, quince hombres sedentarios recibieron dos sesiones aleatorias de EMI: el 40% de la presión inspiratoria máxima (EMI 40%) y sin carga resistiva (sham), realizadas durante dos minutos, ocho sesiones y a intervalos de un minuto. La presión arterial sistólica (PAS), la presión arterial diastólica (PAD), la presión arterial media (PAM), la resistencia periférica total (RPT), el volumen sistólico (VS), el gasto cardíaco (GC) y la frecuencia cardíaca (FC) se midieron mediante fotopletismografía infrarroja digital durante cinco minutos al inicio y durante las sesiones de EMI. Se utilizaron ANOVA unidireccional y la prueba t de Student a datos emparejados para analizar la respuesta hemodinámica y los valores delta entre las sesiones. El tamaño del efecto se evaluó por el d de Cohen. El nivel de significancia adoptado fue de 5%. Las respuestas de PAS (sham: Δ−1±2 vs. 40%: ∆−4±2mmHg, p=0,27), PAD (sham: ∆2±1 vs. 40%: ∆1±2mmHg, p=0,60) y PAM (sham: ∆2±1 vs. 40%: ∆0±2mmHg, p=0,28) fueron similares entre las sesiones. El incremento de la FC fue mayor en la sesión de EMI 40% comparada con la sesión sham (sham: Δ9±2 vs. 40%: ∆3±2bpm, p=0,001). El VS tuvo una disminución exclusiva durante la sesión sham, pero la respuesta fue similar entre las sesiones (sham: Δ−2±2 vs. EMI 40%: ∆−6±2ml, p=0,13). Ambas sesiones no tuvieron cambios en las variables PAS, PAD, PAM, DC y RPT, pero se observó un mayor incremento de la FC en la sesión EMI 40%. Solamente en la sesión sham hubo una reducción del VS.

RESUMO A literatura carece de um consenso sobre respostas hemodinâmicas durante o exercício muscular inspiratório (EMI). Este estudo buscou avaliar e comparar as respostas hemodinâmicas durante uma sessão de EMI com e sem carga resistiva. Para tanto, 15 homens sedentários foram submetidos a duas sessões randomizadas de EMI: 40% da pressão inspiratória máxima (EMI 40%) e sem carga resistiva (sham), realizadas por dois minutos em oito sessões e com intervalos de um minuto. A pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), pressão arterial média (PAM), resistência periférica total (RPT), volume sistólico (VS), débito cardíaco (DC) e frequência cardíaca (FC) foram medidos por fotopletismografia infravermelha digital por cinco minutos basais e durante as sessões de EMI. Anova de uma via e o teste t de Student para dados pareados foram usados para analisar a resposta hemodinâmica e os valores delta entre as sessões. O tamanho do efeito foi avaliado pelo d de Cohen. Adotou-se nível de significância de 5%. As respostas de PAS (sham: ∆−1±2 vs. 40%: ∆−4±2mmHg, p=0,27), PAD (sham: ∆2±1 vs. 40%: ∆1±2mmHg, p=0,60) e PAM (sham: ∆2±1 vs. 40%: ∆0±2mmHg, p=0,28) foram semelhantes entre as sessões. Os aumentos da FC foram maiores na sessão de EMI 40% do que nas sessões sham (sham: ∆9±2 vs. 40%: ∆3±2bpm, p=0,001). O VS diminuiu exclusivamente durante a sessão sham mas a resposta foi semelhante entre as sessões (sham: ∆−2±2 vs. EMI 40%: ∆−6±2ml, p=0,13). Ambas as sessões não causaram alteração nas variáveis PAS, PAD, PAM, DC e RPT, mas notamos um aumento maior da FC na sessão EMI 40%. Apenas a sessão sham reduziu o VS.

Viabilidade do Implante de Eletrodo Ventricular Esquerdo na Terapia de Ressincronização Cardíaca Guiada por Gated SPECT e Remodelamento Ventricular / Feasibility of Left Ventricle Lead Implantation in Cardiac Resynchronization Therapy Guided by Gated SPECT and Ventricular Remodeling

Resumo Fundamento A terapia de ressincronização cardíaca (TRC) pode beneficiar pacientes com insuficiência cardíaca (IC) avançada. O índice de excentricidade anormal por gated SPECT está relacionado a alterações estruturais e funcionais do ventrículo esquerdo (VE). Objetivo O objetivo do presente estudo foi avaliar a viabilidade do implante de eletrodos do VE guiado por análise de fase e sua relação com o remodelamento ventricular. Métodos Dezoito pacientes com indicação de TRC foram submetidos à cintilografia miocárdica para orientar o implante, avaliando-se os parâmetros de excentricidade e forma ventricular. P < 0,05 foi adotado como significância estatística. Resultados Na linha de base do estudo, a maioria dos pacientes foi classificada como NYHA 3 (n = 12). Após a TRC, 11 dos 18 pacientes foram reclassificados para um menor grau de limitação funcional. Além disso, a qualidade de vida dos pacientes melhorou após a TRC. Foram observadas reduções significativas na duração do QRS, intervalo PR, índice de forma diastólica final, índice de forma sistólica final, volume sistólico e massa miocárdica pós-TRC. O eletrodo do VE da TRC foi posicionado concordante, adjacente e discordante em 11 (61,1%), 5 (27,8%) e 2 (11,1%) pacientes, respectivamente. A excentricidade sistólica e diastólica final demonstrou remodelamento reverso após a TRC. Conclusões O implante de eletrodo do VE em TRC guiado por cintilografia gated SPECT é viável. A colocação do eletrodo concordante ou adjacente ao último segmento a se contrair foi um determinante do remodelamento reverso.

Abstract Background Cardiac resynchronization therapy (CRT) may benefit patients with advanced heart failure (HF). Abnormal eccentricity index by gated SPECT is related to structural and functional alterations of the left ventricle (LV). Objective The aim of this study is to evaluate the feasibility of LV lead implantation guided by phase analysis and its relationship to ventricular remodeling. Methods Eighteen patients with indication for CRT underwent myocardial scintigraphy for implant orientation, and eccentricity and ventricular shape parameters were evaluated. P < 0.05 was adopted as statistical significance. Results At baseline, most patients were classified as NYHA 3 (n = 12). After CRT, 11 out of 18 patients were reclassified to a lower degree of functional limitation. In addition, patients' quality of life was improved post-CRT. Significant reductions were observed in QRS duration, PR interval, end-diastolic shape index, end-systolic shape index, stroke volume, and myocardial mass post-CRT. The CRT LV lead was positioned concordant, adjacent, and discordant in 11 (61.1%), 5 (27.8%), and 2 (11.1%) patients, respectively. End-systolic and end-diastolic eccentricity demonstrated reverse remodeling post-CRT. Conclusions LV lead implantation in CRT guided by gated SPECT scintigraphy is feasible. The placement of the electrode concordant or adjacent to the last segment to contract was a determinant of reverse remodeling.

Cardiovascular adjustments to cold pressor test in postmenopausal women and the impact of α1-adrenergic blockade.

PURPOSE: We investigate the impact of menopause on cardiovascular adjustments to the cold pressor test (CPT) and the role of the α1-adrenergic receptor. METHODS: Ten young women (YW) and nine postmenopausal women (MW) underwent 1 min of CPT in control and α1-blockade conditions (0.03 mg‧kg-1 of oral prazosin). RESULTS: CPT increased heart rate (HR) (YW: ∆20 ± 3 bpm; MW: ∆13 ± 2 bpm) and stroke volume (SV; YW: ∆15 ± 8 ml; MW: ∆9 ± 6 ml; p = 0.01 for time) and evoked a greater increase in cardiac output (CO) in YW (YW: ∆2.1 ± 0.2 l‧m-1; MW: ∆1.3 ± 0.5 l‧m-1; p = 0.01). α1-Blockade increased baseline HR and did not change HR, SV, and CO responses to CPT. MW presented an exaggerated systolic blood pressure (BP) response (YW: ∆38 ± 9 mmHg; MW: ∆56 ± 24 mmHg; p = 0.03). The α1-blockade did not change baseline BP while blunting its response. Total vascular resistance (TVR) was similar between groups at baseline and increased during CPT only in MW (YW: ∆2.3 ± 1.4 mmHg‧L-1‧min; MW:∆6.8 ± 5.9 mmHg‧L-1‧min). Under α1-blockade, the TVR increase during CPT was attenuated in MW and abolished in YW (YW: ∆0.3 ± 1.2 mmHg‧L-1‧min and MW: ∆3.0 ± 2.0 mmHg‧L-1‧min). CPT did not change femoral vascular conductance (FVC) in either group before the blockade (YW: ∆-0.3 ± 4.0 ml‧min-1‧mmHg-1; MW: ∆-0.2 ± 0.8 ml‧min-1‧mmHg-1); however, FVC tended to increase in young women (YW: ∆1.3 ± 1.0 ml‧min-1‧mmHg-1; MW: ∆0.1 ± 1.5 ml‧min-1‧mmHg-1; p = 0.06) after the α1-blockade. CONCLUSION: In postmenopausal women, the cardiac ability to adjust to CPT is blunted and α1-adrenergic receptor stimulation is important for the increase in stroke volume. In addition, the peripheral effect of α1-adrenergic receptor stimulation seems to be increased in postmenopausal women.

Effects of Different Types of Resistance Training and Detraining on Functional Capacity, Muscle Strength, and Power in Older Women: A Randomized Controlled Study.

ABSTRACT: Filho, MM, Venturini, GRdO, Moreira, OC, Leitão, L, Mira, PA, Castro, JB, Aidar, FJ, Novaes, JdS, Vianna, JM, and Caputo Ferreira, ME. Effects of different types of resistance training and detraining on functional capacity, muscle strength, and power in older women: A randomized controlled study. J Strength Cond Res 36(4): 984-990, 2022-Resistance training (RT) increases muscle strength, power, and functional capacity (FC) of older women. However, these benefits can be lost partially or totally with detraining. This study aimed to compare the effect of 20 weeks of different types of RT and 4 weeks of detraining on muscle strength, power, and FC in older women. Ninety-five older women were randomly divided into 4 experimental groups (strength endurance, power, absolute strength, and relative strength training) and 1 control group (CG). We assessed muscle strength (10RM test) and muscle power of the lower (countermovement jump) and upper limbs (medicine ball pitch). Functional capacity was assessed by the Senior Fitness Test, which comprises the following tests: 30-second arm curl, 30-second chair stand, back scratch, chair sit and reach, 8-foot up and go, and 6-minute walk. The experiment lasted 24 weeks (familiarization: 2 weeks; neural adaptation: 6 weeks; specific training: 12 weeks; and detraining: 4 weeks). Muscle strength, lower and upper limb power (all p < 0.05), 30-second arm curl, 30-second chair stand, 8-foot up and go, 6-minute walk (all p < 0.001), and lower limb flexibility (p = 0.002) improved in all experimental groups after training and CG showed no differences in any of these variables. After detraining, muscle strength, lower and upper limb power (p < 0.05 for all), and FC decreased in comparison to the end of RT (30-second arm curl, 30-second chair stand, 8-foot up and go, 6-minute walk, and lower limb flexibility, p < 0.05 for all). Although the FC of the subjects has been reduced after 4 weeks of detraining, it was maintained at higher levels in comparison to baseline. These results suggested that older women can be submitted to different types of RT to achieve improvements in general fitness.

Sympathetic regulation of coronary circulation during handgrip exercise and isolated muscle metaboreflex activation in men.

NEW FINDINGS: What is the central question of this study? What is the role of ß- and α-adrenergic receptors in the control of the coronary circulation during handgrip exercise and isolated muscle metaboreflex activation in humans? What is the main finding and its importance? ß-Adrenergic receptor, but not α-adrenergic receptor, blockade significantly blunted the increases in coronary blood velocity observed during handgrip. Coronary blood velocity was unchanged from baseline during isolated muscle metaboreflex activation. This highlights the important role of ß-adrenergic receptors in the coronary circulation during handgrip in humans, and the more limited involvement of the α-adrenergic receptors. ABSTRACT: We sought to investigate the role of ß- and α-adrenergic receptors in coronary circulation during static handgrip exercise and isolated muscle metaboreflex activation in humans. Seventeen healthy young men underwent two experimental sessions, consisting of 3 min of static handgrip exercise at a target force of 40% maximum voluntary force (not achieved for the full 3 min), and 3 min of metaboreflex activation (post-exercise ischaemia) in two conditions: (1) control and ß-blockade (oral propranolol), and (2) control and α-blockade (oral prazosin). In both sessions, coronary blood velocity (CBV, echocardiography) was increased during handgrip (Δ8.0 ± 7.4 cm s-1 ) but unchanged with metaboreflex activation (Δ2.5 ± 3.2 cm s-1 ) under control conditions. ß-Blockade abolished the increase in CBV during handgrip, while CBV was unchanged from control with α-blockade. Cardiac work, estimated from rate pressure product (RPP; systolic blood pressure multiplied by heart rate), increased during handgrip and metaboreflex in control conditions in both sessions. ß-Blockade reduced RPP responses to handgrip and metaboreflex, whereas α-blockade increased RPP, but the responses to handgrip and metaboreflex were unchanged. CBV and RPP were only significantly correlated during handgrip under control (r = 0.71, P < 0.01) and ß-blockade (r = 0.54, P = 0.03) conditions, and the slope of this relationship was unaltered with ß-blockade. Collectively, these findings indicate that ß-adrenergic receptors play the primary role to the increase of coronary circulation during handgrip exercise, but CBV is unchanged with metaboreflex activation, while α-adrenergic receptor stimulation seems to exert no effect in the control of the coronary circulation during handgrip exercise and isolated muscle metaboreflex activation in humans.

REDUCED PERIPHERAL AND INSPIRATORY MUSCLE ENDURANCE IN PATIENTS WITH LIVER CIRRHOSIS: A CROSS-SECTIONAL STUDY.

BACKGROUND: Liver cirrhosis (LC) causes several musculoskeletal changes. OBJECTIVE: To test the hypothesis that the peripheral and inspiratory muscle endurance are reduced in patients with liver cirrhosis. METHODS: Twenty-one patients with LC (LC group; 61±14 years) and 18 age-matched subjects (control group; 56±17 years) had accepted to participate in this cross-sectional observational study. To assess peripheral muscle endurance, all volunteers performed a rhythmic handgrip exercise at 45% of their maximum voluntary contraction. A metronome was used to control the contraction-relaxation cycles at 60/min. The inspiratory muscle endurance was assessed using PowerBreath®. Participants underwent inspiratory muscle exercise at 60% of their maximal inspiratory muscle strength. The time until failure characterized the muscle endurance for both handgrip and inspiratory muscle exercises. Additionally, the quality of life of the participants was assessed. RESULTS: The muscle endurance was lower in the LC group when compared to the control group for both handgrip (67 vs 130 s, P<0.001) and inspiratory muscle exercises (40 vs 114 s, P<0.001). The peripheral muscle endurance was directly correlated with the total quality of life score (r=0.439, P=0.01) and to the following domains: fatigue (r=0.378 e P=0.030), activity (r=0.583, P=0.001), systemic symptoms (r=0.316, P=0.073) and preoccupation (r=0.370, P=0.034). The inspiratory muscle endurance was inversely correlated with the total quality of life score (r=0.573, P=0.001) and the following domains: fatigue (r=0.503, P=0.002), activity (r=0.464, P=0.004), systemic symptoms (r=0.472, P=0.004), abdominal symptoms (r=0.461, P=0.005), emotional function (r=0.387, P=0.02) and preoccupation (r=0.519, P=0.001). CONCLUSION: Both peripheral and inspiratory muscle endurance were lower in LC patients when compared to the control group.

Resistência muscular periférica e inspiratória reduzida em pacientes com cirrose hepática: um estudo transversal / Reduced peripheral and inspiratory muscle endurance in patients with liver cirrhosis: a cross-sectional study

ABSTRACT BACKGROUND: Liver cirrhosis (LC) causes several musculoskeletal changes. OBJECTIVE: To test the hypothesis that the peripheral and inspiratory muscle endurance are reduced in patients with liver cirrhosis. METHODS: Twenty-one patients with LC (LC group; 61±14 years) and 18 age-matched subjects (control group; 56±17 years) had accepted to participate in this cross-sectional observational study. To assess peripheral muscle endurance, all volunteers performed a rhythmic handgrip exercise at 45% of their maximum voluntary contraction. A metronome was used to control the contraction-relaxation cycles at 60/min. The inspiratory muscle endurance was assessed using PowerBreath®. Participants underwent inspiratory muscle exercise at 60% of their maximal inspiratory muscle strength. The time until failure characterized the muscle endurance for both handgrip and inspiratory muscle exercises. Additionally, the quality of life of the participants was assessed. RESULTS: The muscle endurance was lower in the LC group when compared to the control group for both handgrip (67 vs 130 s, P<0.001) and inspiratory muscle exercises (40 vs 114 s, P<0.001). The peripheral muscle endurance was directly correlated with the total quality of life score (r=0.439, P=0.01) and to the following domains: fatigue (r=0.378 e P=0.030), activity (r=0.583, P=0.001), systemic symptoms (r=0.316, P=0.073) and preoccupation (r=0.370, P=0.034). The inspiratory muscle endurance was inversely correlated with the total quality of life score (r=0.573, P=0.001) and the following domains: fatigue (r=0.503, P=0.002), activity (r=0.464, P=0.004), systemic symptoms (r=0.472, P=0.004), abdominal symptoms (r=0.461, P=0.005), emotional function (r=0.387, P=0.02) and preoccupation (r=0.519, P=0.001). CONCLUSION: Both peripheral and inspiratory muscle endurance were lower in LC patients when compared to the control group.

RESUMO CONTEXTO: A cirrose hepática (CH) causa várias alterações musculoesqueléticas. OBJETIVO: Testar a hipótese de que as resistências dos músculos periféricos e inspiratórios estão reduzidas em pacientes com CH. MÉTODOS: Vinte e um pacientes com CH (grupo CH; 61±14 anos) e 18 indivíduos pareados por idade (grupo controle; 56±17 anos) aceitaram participar deste estudo observacional transversal. Para avaliar a resistência muscular periférica, todos os voluntários realizaram um exercício de preensão manual rítmica a 45% de sua contração voluntária máxima. Um metrônomo foi usado para controlar os ciclos de contração-relaxamento a 60/min. A resistência muscular inspiratória foi avaliada com o PowerBreath®. Os participantes foram submetidos a exercícios musculares inspiratórios a 60% de sua força muscular inspiratória máxima. O tempo até a falha caracterizou a resistência muscular para os exercícios de preensão manual e de músculos inspiratórios. Além disso, foi avaliada a qualidade de vida dos participantes. RESULTADOS: A resistência muscular foi menor no grupo CH quando comparada ao grupo controle tanto para os exercícios de preensão manual (67 vs 130 s, P<0,001) quanto para os músculos inspiratórios (40 vs 114 s, P<0,001). A resistência muscular periférica foi diretamente correlacionada com o escore total de qualidade de vida (r=0,439, P=0,01) e com os seguintes domínios: fadiga (r=0,030, P=0,378), atividade (r=0,378 e P=0,030), sintomas sistêmicos (r=0,316, P=0,073) e preocupação (r=0,370, P=0,034). A resistência muscular inspiratória foi inversamente correlacionada com o escore total de qualidade de vida (r=0,573, P=0,001) e com os seguintes domínios: fadiga (r=0,503, P=0,002), atividade (r=0,464, P=0,004), sintomas sistêmicos (r=0,472, P=0,004), sintomas abdominais (r=0,461, P=0,005), função emocional (r=0,387, P=0,02) e preocupação (r=0,519, P=0,001). CONCLUSÃO: As resistências musculares periférica e inspiratória foram menores nos pacientes com CH quando comparados ao grupo controle.

Factors associated with the perceived benefits and barriers to physical activity in liver cirrhosis.

OBJECTIVE: To analyze the sociodemographic and clinical factors associated with the perceived benefits and barriers to physical activity (PA) in subjects with liver cirrhosis. METHODS: This cross-sectional study assessed 102 outpatients with liver cirrhosis regarding the clinical and sociodemographic profile and the perceived benefits and barriers to PA by the Exercise Benefits and Barriers Scale and muscle strength. A Generalized Step-Forward linear regression analysis was used to identify the factors associated. RESULTS: The participants were 59±10 years and 60.8% were men. Around 29.4% had ascites decompensation. Perceived benefits and barriers were associated with the presence of ascites (95%CI -0.079 - 0.03; p=0.06 and 95%CI 0.003 - 0.217; p=0.045, respectively). In the group with ascites, both benefits and barriers were associated with muscle strength. In the group without ascites, benefits were associated with cardiovascular risks and no association was observed with barriers to physical activity. CONCLUSIONS: Perceived benefits and barriers to physical activity are associated with intrinsic factors such as the presence of ascites and cardiovascular risk in individuals with liver cirrhosis. The results of this study highlight key elements that must be considered for increasing physical activity in this population.

Muscle metaboreflex adaptations to exercise training in health and disease.

Abnormalities in the muscle metaboreflex concur to exercise intolerance and greater cardiovascular risk. Exercise training benefits neurocardiovascular function at rest and during exercise, but its role in favoring muscle metaboreflex in health and disease remains controversial. While some authors demonstrated that exercise training enhanced the sensitization of muscle metabolically afferents and improved neurocardiovascular responses to muscle metaboreflex activation, others reported unaltered responses. This narrative review aimed to: (a) highlight the current evidence on the effects of exercise training upon cardiovascular and autonomic responses to muscle metaboreflex activation; (b) analyze the role of training components and indicate potential mechanisms of metaboreflex adaptations; and (c) address key methodological features for future research. Though limited, accumulated evidence suggests that muscle metaboreflex adaptations depend on the individual clinical status, exercise modality, and training duration. In healthy populations, most trials negated the hypothesis of metaboreflex improvement due to chronic exercise, irrespective of the training duration. Favorable changes in patients with impaired metaboreflex, particularly chronic heart failure, mostly resulted from long-term interventions (> 16 weeks) including aerobic exercise of moderate to high intensity, performed in isolation or within multimodal training. Potential mechanisms of metaboreflex improvements include enhanced sensitivity of channels and receptors, greater antioxidant capacity, lower metabolite accumulation, increased functional sympatholysis, and muscle perfusion. Future research should investigate: (1) the dose-response relationship of training components within different exercise modalities to elicit improvements in individuals showing intact or impaired muscle metaboreflex; and (2) potential and specific underlying mechanisms of metaboreflex improvements in individuals with different medical conditions.

Inequality in life expectancies across Europe and the US.

We use harmonized household panel data from Europe and the US and a three-state survival model to provide comparable measurements of education and gender inequalities in total, healthy, and unhealthy life expectancies at age 50. Common across countries, the education advantage in total life expectancy is larger for males but the education advantage in (fewer) unhealthy years is larger for females. Counterfactual decompositions show that these results arise because the education advantage in conditional survival rates is relatively more important for males, while the education advantage in better health transitions is relatively more important for females. Across countries, the US stands out with the largest education gradient in healthy life expectancy.

Displasia torácica asfixiante / Suffocating thoracic dysplasia

El síndrome de Jeune o displasia torácica asfixiante es una enfermedad genética de herencia autosómica recesiva, que se caracteriza por presentar un fenotipo característico. El diagnóstico es clínico y radiológico. Se han descrito mutaciones en genes (IFT80, DYNC2H1, WDR19, IFT140 y TTC21B) que codifican proteínas de transporte intraflagelares responsables de la enfermedad

Jeune syndrome or suffocating thoracic dysplasia is a genetic disease with autosomal recessive inheritance, characterized by presenting a quirky phenotype. The diagnosis is clinical-radiological. Mutations in genes IFT80, DYNC2H1, WDR19, IFT140 and TTC21B that encode intraflagellar transport proteins responsible for the disease have been described

A longitudinal study on public policy and the health of in-house caregivers in Europe.

Caregiving has negative effects on the health of informal caregivers. The current aging of the population predicts an increase in the number of informal caregivers worldwide. The effect of available public policies that support informal caregivers in their self-perceived health is an understudied topic. We analyzed the differences in the effects of public support policies in 11 European countries using longitudinal data from waves 5 and 6 of the Survey of Health Ageing and Retirement in Europe. In this cohort, 2303 respondents were in-house informal caregivers. Logistic regression models were fitted adjusting for the main determinants of caregiving. Respite care and caregiver allowances emerged as the most effective measures of support for caregivers' health maintenance (relative risk [RR] = 0.2; 95 % CI = 0.1-0.8 and RR = 0.5; 95 % CI = 0.3-0.9). Despite the differences in the welfare systems of Scandinavian and Mediterranean countries, informal caregivers in these countries were less likely than those living in Continental or Eastern countries to have declined health two years later. Our results indicate that public support policies are significantly related to caregivers' subsequent health, but the effects vary by country. Country-specific studies should be performed to take into account the determinants of caregiving linked to the social context of each country.