Physical exercise for the management of systemic autoimmune myopathies: recent findings, and future perspectives.

PURPOSE OF REVIEW: The aim of this review is to present the main pieces of evidence, recent literature and to present future perspectives on the use of exercise/physical training in the treatment and improvement of the quality of life of patients with systemic autoimmune myopathies. RECENT FINDINGS: In the last decades, knowledge about the relevance of physical exercise training in preventing and treating chronic diseases and improving quality of life has grown. Following the global trend exemplified by the expression 'exercise is medicine', the importance of exercise/physical training has also grown in myopathies. However, the science of exercise has a lot to collaborate on and improve patients' quality of life with myopathies by appropriating new technological tools, including accessible and low-cost devices and smartphone apps. SUMMARY: Physical exercise, as already consolidated in the literature, is an effective, well tolerated, and low-cost strategy for patients with myopathies. The use of wearable devices, smartphone apps, and online training prescriptions must accompany the global scenario, bringing new research fields and expanding the options for access to training for the individualized basis, and prescribed by qualified professionals.

Mild-cold water swimming does not exacerbate white adipose tissue browning and brown adipose tissue activation in mice.

The present study investigated the effects of swimming physical training either thermoneutral or below thermoneutral water temperature on white (WAT) and brown (BAT) adipose tissue metabolism, morphology, and function. C57BL/6J male mice (n = 40; weight 25.3 ± 0.1 g) were divided into control (CT30), cold control (CT20), trained (TR30), and cold trained (TR20) groups. Swimming training consisted of 30-min exercise at 30°C (control) or 20°C (cold) water temperature. After 8-week training, adipose tissues were excised and inguinal (ingWAT) and BAT were processed for histology, lipolysis, and protein contents of total OXPHOS, PGC1α, and UCP1 by western blotting analysis. Swimming training reduced body weight gain independently of water temperature (P < 0.05). ingWAT mass was decreased for TR30 in comparison to other groups (P < 0.05), while for BAT, there was a significant increase in CT20 in relation to CT30, and both trained groups were significantly increased in relation to control groups (P < 0.05). ingWAT mean adipocyte area was smaller for trained groups, and seemed to present multilocular adipocytes. Lipolytic activity and protein content of UCP1, PGC1α, and mitochondrial markers were increased in trained groups for ingWAT (P < 0.05), independent of water temperature (P > 0.05), and these patterns were not observed for BAT (P > 0.05). Our findings suggest that mild-cold water exposure and swimming physical exercise seem to, independently, promote browning in ingWAT with no effects on BAT; however, the association of exercise and mild-cold water did not exacerbate these effects.

Gut Microbiota and Intestinal Epithelial Myd88 Signaling Are Crucial for Renal Injury in UUO Mice.

Increasing evidence shows the essential participation of gut microbiota in human health and diseases by shaping local and systemic immunity. Despite an accumulating body of studies showing that chronic kidney disease (CKD) is closely associated with disturbances in the composition of gut microbiota, it remains unclear the importance of gut microbiota in the onset and development of CKD. For the purpose of untangling the role of gut microbiota in CKD, gut microbiota was depleted with a pool of broad-spectrum antibiotics in mice submitted to unilateral ureteral obstruction (UUO). Depletion of gut microbiota significantly decreased levels of proinflammatory cytokines and fibrosis markers, attenuating renal injury. Additionally, to study whether the pathogenic role of gut microbiota is dependent of microbial-host crosstalk, we generated mice lacking Myd88 (myeloid differentiation primary response gene 8) expression in intestinal epithelial cells (IECs) and performed UUO. The absence of Myd88 in IECs prevented a bacterial burden in mesenteric lymph nodes as observed in WT mice after UUO and led to lower expression of proinflammatory cytokines and chemokines, reducing deposition of type I collagen and, ultimately, attenuating renal damage. Therefore, our results suggest that the presence of gut microbiota is crucial for the development of CKD and may be dependent of Myd88 signaling in IECs, which appears to be essential to maturation of immune cells intimately involved in aggravation of inflammatory scenarios.

Effects of Walking Training with Restricted Blood Flow on HR and HRV Kinetics and HRV Recovery.

The aim of this study was to investigate the effects of walking training with and without blood flow restriction (BFR) on heart rate (HR) and heart rate variability (HRV) kinetics and HRV recovery. Twenty-one men (53.5±3.2 years; 82.4±13.5 kg; 168.5±7.2 cm) were randomly assigned to two training groups: walk training group with (BFR-W; n=11) and without (NOR-W; n=10) BFR. Before and after training, all subjects underwent body composition evaluation, incremental test, and one constant load test. Walking training was performed 3 times/week, during 6 weeks. Each session was composed by 5 sets of 3-min walking and 1-min rest between the sets. All parameters of HR on- and off-kinetics and RMSSD15 0 parameter of HRV on-kinetics were improved for BFR-W group after training (p<0.05), with an interaction effect for HR on-kinetics parameters and RMSSD15 0 parameter (p<0.05). Also, parameters of time and frequency domain of HRV recovery were also improved in BFR-W after training (p<0.05), with no interaction effect (p>0.05). Additionally, in BFR-W group, RMSSD60s values were improved in some moments after training (p<0.05). Therefore, this study demonstrates that a 6-week walking training with BFR improved cardiac autonomic responses on the onset and recovery of exercise.

TLR2 and TLR4 play opposite role in autophagy associated with cisplatin-induced acute kidney injury.

Acute kidney injury (AKI) is considered an inflammatory disease in which toll-like receptors (TLRs) signaling pathways play an important role. The activation of TLRs results in production of several inflammatory cytokines leading to further renal damage. In contrast, TLRs are key players on autophagy induction, which is associated with a protective function on cisplatin-induced AKI. Hence, the present study aimed to evaluate the specific participation of TLR2 and TLR4 molecules on the development of cisplatin-induced AKI. Complementarily, we also investigated the link between TLRs and heme oxygenase-1 (HO-1), a promisor cytoprotective molecule. First, we observed that only the absence of TLR2 but not TLR4 in mice exacerbated the renal dysfunction, tissue injury and mortality rate, even under an immunologically privileged microenvironment. Second, we demonstrated that TLR2 knockout (KO) mice presented lower expression of autophagy-associated markers when compared with TLR4 KO animals. Similar parameter was confirmed in vitro, using tubular epithelial cells derived from both KO mice. To test the cross-talking between HO-1 and TLRs, hemin (an HO-1 internal inducer) was administrated in cisplatin-treated TLR2 and TLR4 KO mice and it was detected an improvement in the global renal tissue parameters. However, this protection was less evident at TLR2 KO mice. In summary, we documented that TLR2 plays a protective role in cisplatin-induced AKI progression, in part, by a mechanism associated with autophagy up-regulation, considering that its interplay with HO-1 can promote renal tissue recover.

Chronic inflammation in skeletal muscle impairs satellite cells function during regeneration: can physical exercise restore the satellite cell niche?

Chronic inflammation impairs skeletal muscle regeneration. Although many cells are involved in chronic inflammation, macrophages seem to play an important role in impaired muscle regeneration since these cells are associated with skeletal muscle stem cell (namely, satellite cells) activation and fibro-adipogenic progenitor cell (FAP) survival. Specifically, an imbalance of M1 and M2 macrophages seems to lead to impaired satellite cell activation, and these are the main cells that function during skeletal muscle regeneration, after muscle damage. Additionally, this imbalance leads to the accumulation of FAPs in skeletal muscle, with aberrant production of pro-fibrotic factors (e.g., extracellular matrix components), impairing the niche for proper satellite cell activation and differentiation. Treatments aiming to block the inflammatory pro-fibrotic response are partially effective due to their side effects. Therefore, strategies reverting chronic inflammation into a pro-regenerative pattern are required. In this review, we first describe skeletal muscle resident macrophage ontogeny and homeostasis, and explain how macrophages are replenished after muscle injury. We next discuss the potential role of chronic physical activity and exercise in restoring the M1 and M2 macrophage balance and consequently, the satellite cell niche to improve skeletal muscle regeneration after injury.

Acute exercise elicits differential expression of insulin resistance genes in the skeletal muscle of patients with polycystic ovary syndrome.

OBJECTIVE: This study aimed to explore the role of acute exercise on skeletal muscle gene expression related to insulin resistance in patients with polycystic ovary syndrome (PCOS) and controls. METHODS: Four obese women with PCOS and four body mass index (BMI)-matched controls (CTRL) participated in this study. After an overnight fast, the subjects underwent a single 40-min bout of aerobic exercise. Muscle samples were obtained from vastus lateralis at baseline and 60 min after exercise. The expression of a panel of insulin resistance genes was evaluated by a quantitative PCR array system. Network-based analyses were performed to interpret transcriptional changes occurring before and after the exercise challenge. RESULTS: Overall, differentially expressed genes associated with mitochondria function and peroxisome proliferator-activated receptor signalling were identified. At baseline, there was a significant upregulation of six genes exclusively in PCOS (i.e. NFKBIA, MAPK3, PPARGC1A, GAPDH, ACTB and PPARA). Twelve genes were upregulated in CTRL after a single bout of aerobic exercise (i.e. LEPR, CXCR4, CCR5, IL-18R1, CRLF2, ACACA, CEBPA, PPARGC1A, UCP1, TNFRSF1B, TLR4 and IKBKB). After the exercise session, three genes were upregulated in PCOS (i.e. SOCS3, NAMPT and IL-8), whilst IL-6 was upregulated in both groups after exercise. CONCLUSIONS: This study provides novel evidence on the effects of acute exercise on insulin resistance genes in skeletal muscle of PCOS. The differentially expressed genes reported herein could be further investigated as targets for therapeutic interventions aimed at improving insulin resistance in this syndrome.

GLUT4 translocation is not impaired after acute exercise in skeletal muscle of women with obesity and polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to examine the effects of acute exercise on insulin signaling in skeletal muscle of women with polycystic ovary syndrome (PCOS) and controls (CTRL). METHODS: Fifteen women with obesity and PCOS and 12 body mass index-matched CTRL participated in this study. Subjects performed a 40-min single bout of exercise. Muscle biopsies were performed before and 60 min after exercise. Selected proteins were assessed by Western blotting. RESULTS: CTRL, but not PCOS, showed a significant increase in PI3-k p85 and AS160 Thr 642 after a single bout of exercise (P = 0.018 and P = 0.018, respectively). Only PCOS showed an increase in Akt Thr 308 and AMPK phosphorylation after exercise (P = 0.018 and P = 0.018, respectively). Total GLUT4 expression was comparable between groups (P > 0.05). GLUT4 translocation tended to be significantly higher in both groups after exercise (PCOS: P = 0.093; CTRL: P = 0.091), with no significant difference between them (P > 0.05). CONCLUSIONS: A single bout of exercise elicited similar GLUT4 translocation in skeletal muscle of PCOS and CTRL, despite a slightly differential pattern of protein phosphorylation. The absence of impairment in GLUT4 translocation suggests that PCOS patients with obesity and insulin resistance may benefit from exercise training.

Safety and feasibility of maximal physical testing in rheumatic diseases: a cross-sectional study with 5,910 assessments.

The purpose of the study was to report on the safety and feasibility of the application of maximal physical tests in a heterogeneous cohort of rheumatic patients. This is a 5-year retrospective descriptive report on the incidence of events associated with maximal physical testing from 536 patients, totalizing 5,910 tests. Tests were classified as cardiopulmonary, muscle strength, and physical functioning tests. Any adverse events during the tests and limiting factors incurring in tests cancellation were reported. Eighteen out of 641 cardiopulmonary exercise tests had an adverse occurrence, with cardiac disturbance (1.4% of total tests) being the most prevalent. Moreover, 14 out of 641 tests were not feasible. Out of 3,478 tests comprising leg press, bench press, knee extension, and handgrip tests, 15 tests had an adverse event. The most common occurrence was joint pain (0.4% of total tests), which was also the most frequent factor precluding testing (0.5% of total tests). Forty-five out of 3,478 (1.3%) of the tests were not feasible. There was a very low incidence of events (0.2%) during the physical functioning tests. Joint pain was the only adverse event during the tests, whereas physical limitations were the most important barriers for the execution of the tests (1.1% of total tests). The incidence of limiting events in this test was 1.6% (n = 29). This report brings new data on the safety and feasibility of maximal physical testing in rheumatic patients. The physical tests described in this study may be applied for testing rheumatic patients both in research and clinical setting.

Safety and possible effects of low-intensity resistance training associated with partial blood flow restriction in polymyositis and dermatomyositis.

INTRODUCTION: Our aim was to evaluate the safety and efficacy of a low-intensity resistance training program combined with partial blow flow restriction (BFR training) in a cohort of patients with polymyositis (PM) and dermatomyositis (DM). METHODS: In total, 13 patients with PM and DM completed a 12-week twice a week low-intensity (that is, 30% one-repetition-maximum (1RM)) resistance exercise training program combined with partial blood flow restriction (BFR). Assessments of muscle strength, physical function, quadriceps cross sectional (CSA) area, health-related quality of life, and clinical and laboratory parameters were assessed at baseline and after the intervention. RESULTS: The BFR training program was effective in increasing the maximal dynamic strength in both the leg-press (19.6%, P <0.001) and knee-extension exercises (25.2% P <0.001), as well as in the timed-stands (15.1%, P <0.001) and timed-up-and-go test (-4.5%, P =0.002). Quadriceps CSA was also significantly increased after the intervention (4.57%, P =0.01). Similarly, all of the components of the Short Form-36 Health Survey, the Health Assessment Questionnaire scores, and the patient- and physician reported Visual Analogue Scale were significantly improved after training (P <0.05). Importantly, no clinical evidence or any other self-reported adverse event were found. Laboratory parameters (creatine kinase and aldolase) were also unchanged (P >0.05) after the intervention. CONCLUSIONS: We demonstrated that a 12-week supervised low-intensity resistance training program associated with partial blood flow restriction may be safe and effective in improving muscle strength and function as well as muscle mass and health-related quality of life in patients with PM and DM. TRIAL REGISTRATION: Clinicaltrials.gov NCT01501019. Registered November 29, 2011.

Acute physical exercise is safe in patients with primary antiphospholipid syndrome with exclusive venous thrombosis and under oral anticoagulation with warfarin.

The purpose of present study was to evaluate the effects of maximal acute physical exercise on prothrombin time/international normalized ratio (PT/INR) in patients with primary antiphospholipid syndrome (PAPS) under oral anticoagulation with warfarin and the safety of acute exercise in regard to thrombosis and bleeding risk. Eighteen physically inactive women with PAPS (Sydney criteria) with exclusive venous events and without thrombocytopenia were included. All patients were under stable warfarin therapy (PT/INR target: 2.0-3.0). Eighteen age-matched healthy sedentary women without thrombosis/bleeding disorders were selected as controls. All subjects performed a maximal exercise test, and capillary blood samples were obtained pre-, post- and at 1-h post-exercise (recovery time) for PT/INR analysis using a portable CoaguCheck. PAPS patients and controls had similar mean age (31.50 ± 8.06 vs. 29.61 ± 7.05 years, p = 0.46) and body mass index (24.16 ± 3.67 vs. 24.66 ± 2.71 kg/m(2), p = 0.65). PAPS had a mild but significant increase in PT/INR value at 1-h post-exercise (recovery) compared with pre- (2.33 ± 0.34 vs. 2.26 ± 0.29, p = 0.001) and post-exercise (2.33 ± 0.34 vs. 2.26 ± 0.32, p = 0.001) that was observed in 61.11 % of these patients. None of the subjects had thrombotic or bleeding complications related to the acute exercise. Acute exercise in patients with PAPS with exclusive venous thrombosis was safe with a minor increase in PT/INR. This is an important step to introduce regular exercise training as a therapeutic tool in the management of these patients.

Exercise as an adjuvant treatment in persistent active polymyositis.

OBJECTIVES: A growing number of studies have suggested that exercise may promote therapeutic effects in patients with idiopathic inflammatory myopathy. This prospective case series study aimed to report on the effects of exercise in patients with persistent active myositis. METHODS: Three patients with persistent active polymyositis were submitted to a 12-week supervised exercise program comprising both aerobic and strength exercises. RESULTS: After the intervention, the patients presented improvements in selected parameters of muscle function and aerobic conditioning. In addition, an overall improvement was detected in the quality of life, as measured by both the 36-item Short-Form Health Survey and the Health Assessment Questionnaire questionnaires. Importantly, exercise did not increase serum levels of creatine kinase and aldolase. CONCLUSIONS: The findings herein suggest that a combined aerobic and strength training program may be tolerable and potentially effective in improving muscle function, aerobic conditioning, and quality of life in patients with persistent active polymyositis.

Efeito do exercício físico aeróbico agudo e crônico nos níveis séricos de citocinas e na expressão gênica em leucócitos circulantes de pacientes com lúpus eritematoso sistêmico / Effects of acute and chronic aerobic exercise in serum levels of cytokines and in gene expression of circulating leukocytes in patients with systemic lupus erythematosus

Introdução: O lúpus eritematoso sistêmico (LES) é uma doença autoimune caracterizada por uma alteração no sistema imunológico e uma inflamação crônica. O exercício físico agudo e crônico têm sido apontados como uma estratégia capaz de atenuar os acometimentos da doença e os fatores de risco cardiovasculares em pacientes com LES. Entretanto, ainda não se sabe se o exercício físico poderia piorar o quadro inflamatório e imunológico de pacientes com LES em remissão (LESREM) e atividade da doença (LESATIV). Objetivos: Avaliar o efeito agudo e crônico do exercício aeróbio na resposta das citocinas (IFN-y, IL-10, IL-6 e TNF-alfa) e receptores solúveis de TNF (sTNFR1 e sTNFR2) séricos e na expressão gênica em leucócitos circulantes de pacientes com LESREM e LESATIV. Métodos: A resposta das citocinas e dos sTNFRs às sessões agudas de exercício moderado (~50% do VO2pico) e intenso (~70% do VO2pico) foram avaliadas em 11 pacientes com LESATIV, 12 pacientes com LESREM e 10 controles saudáveis (GC), os quais foram pareados por sexo, idade e índice de massa corporal. A resposta da expressão gênica em leucócitos circulantes à sessão aguda intensa de exercício foi avaliada em quatro voluntárias por grupo (LESATIV, LESREM e GC). O treinamento aeróbio (12 semanas, 2x/semana, 30 a 50 minutos, FC entre os limiares ventilatórios) foi realizado por oito pacientes com LESREM. As citocinas e os sTNFRs foram avaliados por multiplex e a expressão gênica pelo método de PCRarray, com subsequente análise bioinformática. Resultados: Em resposta a sessão aguda moderada de exercício não houve alteração na resposta das citocinas e receptores solúveis de TNF (P > 0,05), com exceção da redução da IL-6 e do sTNFR1 na recuperação nos grupos LESATIV e GC (P < 0,05), respectivamente. Após o exercício agudo intenso, apenas o sTNFR1 reduziu durante a recuperação (P < 0,05) no grupo LESREM. No GC, a IL-10, o TNF-alfa, o sTNFR1 e o sTNFR2 permaneceram inalterados (P > 0,05)...

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by an altered immune system and a chronic inflammation. Acute and chronic physical exercise has been emerged as a strategy to attenuate the disease outcomes and the cardiovascular risk factors in SLE patients. However, it is not known yet if physical exercise could dysregulate the inflammatory process and immune system in active (SLEACTIVE) and inactive SLE patients (SLEINACTIVE). Aims: to assess the effects of acute and chronic aerobic exercise training on the serum cytokines (IFN-y, IL-10, IL-6 e TNF-?) and soluble TNF receptors (sTNFR1 and sTNFR2) levels and in the gene expression of circulating leukocytes in SLEACTIVE and SLEINACTIVE patients. Methods: Cytokines and sTNFRs responses to acute moderate (~50% of VO2peak) and intense (~70% of VO2peak) aerobic exercise were assessed in 11 SLEACTIVE patients, 12 SLEINACTIVE patients and 10 healthy controls (HC), who were matched for age, sex and body mass index. Leucocytes gene expression responses to acute intense exercise were assessed in four subjects of each group (SLEACTIVE, SLEINACTIVE, and HC). Aerobic exercise training (12 weeks, twice a week, 30 to 50 minutes, HR between ventilatory thresholds) was performed by eight SLEINACTIVE patients. Cytokines and sTNFRs were assessed by multiplex technique and the gene expression by a PCRarray method, followed by bioinformatics analysis. Results: In response to an acute moderate exercise there were no significant differences in cytokines and sTNFRs (P > 0.05), except for the reduction in IL-6 and sTNFR1 during recovery in SLEACTIVE and HC (P < 0.05), respectively. After acute intense exercise, only sTNFR1 levels reduced during recovery (P < 0.05) in the SLEINACTIVE. In HC group, IL-10, TNF-?, sTNFR1 and sTNFR2 remained unchanged (P > 0.05), while IFN-y reduced at the end of exercise (P = 0.05) and IL-6 increased transitorily at the end of exercise (P = 0.028)...

Exercise as a therapeutic tool to counteract inflammation and clinical symptoms in autoimmune rheumatic diseases.

Chronic inflammation is a common feature shared by several autoimmune rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, idiopathic inflammatory myopathies, systemic sclerosis, and ankylosing spondylitis. Therefore, blocking or reducing inflammation is one of the major treatment strategies in these diseases. In this context, exercise training has emerged as a potential therapeutic tool in counteracting systemic inflammation, thereby leading to better clinical outcomes. The aims of this review are i) to provide a summary of the clinical effects of exercise training in selected autoimmune rheumatic diseases; and ii) to discuss the potential anti-inflammatory role of exercise training in autoimmune rheumatic diseases, stressing the gaps in literature and the clinical and scientific perspectives in the field.

Autonomic correlates of Yo-Yo performance in soccer referees / Correlatos autonômicos do desempenho no Yo-Yo em árbitros de futebol

We tested the hypothesis that: basal cardiac autonomic modulation (i.e. heart rate variability, HRV) was associated with the parasympathetic withdrawal during, and overall Yo-Yo IR1 performance; and therefore HRV could be used as a simple tool for specific fitness assessment. Nine sub-elite soccer referees performed the Yo-Yo IR1 until exhaustion with simultaneous recording of heart rate with the autonomic response during exercise calculated as the area under the curve (AUC). In the same week but with at least 48 hrs between days, a night-time HR recording was obtained from participants for determination of basal HRV. Correlation analysis demonstrated strong (r>0.83) relationships among Yo-Yo IR1 performance, AUC and basal HRV. These results indicate that both nocturnal HRV and AUC can be utilised as simple and valid monitoring tools of soccer referees' fitness.

Nós testamos a hipótese de: que a modulação autonômica cardíaca (i.e. variabilidade da freqüência cardíaca, VFC) está associada com a retirada parassimpática durante a execução do Yo-Yo IR1; e que, portanto, a VFC poderia ser usada como uma ferramenta simples para a avaliação do desempenho físico específico. Nove árbitros sub-elite de futebol executaram o Yo-Yo IR1 até a exaustão com registro simultâneo da freqüência cardíaca e VFC para o cálculo da área sob a curva (ASC). Na mesma semana, mas com mínimo de 48 horas entre dias, obteve-se um registro noturno da FC dos participantes para a determinação da VFC basal. As análises de correlação demonstraram elevados coeficientes (r>0,83) entre o desempenho no Yo-Yo IR1, a ASC e a VFC basal. Estes resultados indicam que a VFC noturna e a ASC podem ser empregadas como ferramentas simples e válidas para o monitoramento do desempenho de árbitros de futebol.

Using exercise training to counterbalance chronotropic incompetence and delayed heart rate recovery in systemic lupus erythematosus: a randomized trial.

OBJECTIVE: To evaluate the efficacy of a 3-month exercise training program in counteracting the chronotropic incompetence and delayed heart rate recovery in patients with systemic lupus erythematosus (SLE). METHODS: A 12-week randomized trial was conducted. Twenty-four inactive SLE patients were randomly assigned into 2 groups: trained (T; n = 15, 3-month exercise program) and nontrained (NT; n = 13). A sex-, body mass index-, and age-matched healthy control (C) group (n = 8) also underwent the exercise program. Subjects were assessed at baseline and at 12 weeks after training. Main measurements included the chronotropic reserve (CR) and the heart rate (HR) recovery (ΔHRR) as defined by the difference between HR at peak exercise and at both the first (ΔHRR1) and second (ΔHRR2) minutes after the exercise test. RESULTS: Neither the NT SLE patients nor the C group presented any change in the CR or in ΔHRR1 and ΔHRR2 (P > 0.05). The exercise training program was effective in promoting significant increases in CR (P = 0.007, effect size [ES] 1.15) and in ΔHRR1 and ΔHRR2 (P = 0.009, ES 1.12 and P = 0.002, ES 1.11, respectively) in the SLE T group when compared with the NT group. Moreover, the HR response in SLE patients after training achieved parameters comparable to the C group, as evidenced by the analysis of variance and by the Z score analysis (P > 0.05, T versus C). Systemic Lupus Erythematosus Disease Activity Index scores remained stable throughout the study. CONCLUSION: A 3-month exercise training program was safe and capable of reducing the chronotropic incompetence and the delayed ΔHRR observed in physically inactive SLE patients.

Cardiac autonomic impairment and chronotropic incompetence in fibromyalgia.

INTRODUCTION: We aimed to gather knowledge on the cardiac autonomic modulation in patients with fibromyalgia (FM) in response to exercise and to investigate whether this population suffers from chronotropic incompetence (CI). METHODS: Fourteen women with FM (age: 46 ± 3 years; body mass index (BMI): 26.6 ± 1.4 kg/m2) and 14 gender-, BMI- (25.4 ± 1.3 kg/m2), and age-matched (age: 41 ± 4 years) healthy individuals (CTRL) took part in this cross-sectional study. A treadmill cardiorespiratory test was performed and heart-rate (HR) response during exercise was evaluated by the chronotropic reserve. HR recovery (deltaHRR) was defined as the difference between HR at peak exercise and at both first (deltaHRR1) and second (deltaHRR2) minutes after the exercise test. RESULTS: FM patients presented lower maximal oxygen consumption (VO2 max) when compared with healthy subjects (22 ± 1 versus CTRL: 32 ± 2 mL/kg/minute, respectively; P < 0.001). Additionally, FM patients presented lower chronotropic reserve (72.5 ± 5 versus CTRL: 106.1 ± 6, P < 0.001), deltaHRR1 (24.5 ± 3 versus CTRL: 32.6 ± 2, P = 0.059) and deltaHRR2 (34.3 ± 4 versus CTRL: 50.8 ± 3, P = 0.002) than their healthy peers. The prevalence of CI was 57.1% among patients with FM. CONCLUSIONS: Patients with FM who undertook a graded exercise test may present CI and delayed HR recovery, both being indicative of cardiac autonomic impairment and higher risk of cardiovascular events and mortality.

Relationship between vagal withdrawaland reactivation indices and aerobic capacityin taekwondo athletes / Relação entre a retirada e reativação vagal com a capacidade aeróbia em atletas de taekwondo

The aim of this study was to evaluate the relationship between vagal withdrawal and reactivation indices and maximal running velocity (Vmax) in taekwondo athletes. Eleven elite taekwondo athletes (seven men: 23.7±2.2 years, 72.4±7.0 kg, 178.8±7.5 cm, 51.9±2.9 ml.kg-1.min-1, and four women: 18.8±1.5 years, 61.8±1.8 kg, 168.0±4.4 cm, 41.6±2.4 ml.kg-1.min-1) performed a graded exercise test until exhaustion, with the last complete stage performed corresponding to Vmax. Heart rate variability (HRV) parameters were calculated at 1-minute intervals until 85% of maximum HR and plotted against time for the estimation of vagal withdrawal indices (?, amplitude (A) and area under the curve (AUC)). Vagal reactivation indices were determined based on HR recovery during the first 60 s (HRR60s) and negative reciprocal of the slope of the regression line obtained during the first 30 s of HRR (T30). The vagal withdrawal parameters A and AUC were moderately and significantly correlated with Vmax (r = 0.61-0.71, P < 0.05), whereas ? presented a low correlation (r = 0.22-0.40, P > 0.05). T30 and HRR60s were also significantly correlated with Vmax (r = -0.77 and 0.64, P < 0.05, respectively). The present results showed that vagal withdrawal (A and AUC) and vagal reactivation (T30 and HRR60s) indices were significantly correlated with Vmax, suggesting that these indices can be used for the evaluation and monitoring of aerobic fitness in taekwondo athletes.

O objetivo deste estudo foi verificar em atletas de taekwondo a relação entre a retirada e reativação vagal com a velocidade aeróbia máxima (Vmax). Onze atletas de elite de taekwondo (sete homens: 23,7±2,2 anos, 72,4±7,0 kg, 178,8±7,5 cm, 51,9±2,9 ml.kg-1.min-1; e quatro mulheres: 18,8±1,5 anos, 61,8±1,8 kg, 168,0±4,4 cm, 41,6±2,4 ml.kg-1.min-1) realizaram um teste progressivo até exaustão, sendo a Vmax considerada o último estágio completo realizado. Os parâmetros da variabilidade da freqüência cardíaca (VFC) foram calculados a cada minuto do teste até o atingimento de 85% da FC máxima, e plotados contra o tempo para a estimativa dos indicadores de retirada vagal (?, amplitude (A) e área sob a curva (ASC)). Os indicadores de reativação vagal foram determinados pela recuperação da FC nos primeiros 60 s (RFC60s) e recíproca negativa da reta de regressão linear obtida pela RFC dos primeiros 30 s (T30). Os parâmetros de retirada vagal A e ASC foram moderado e significativamente correlacionados à Vmax (r = 0,61-0,71, P < 0,05), enquanto o ? apresentou baixa correlação (r = 0,22-0,40, P > 0,05). O T30 e RFC60s apresentaram correlação significante com a Vmax (r = -0,77 e 0,64, P < 0,05, respectivamente). Os resultados do presente estudo mostraram que os indicadores da retirada (A e ASC) e reativação vagal (T30 e RFC60s) foram significativamente correlacionados com a Vmax, sugerindo que esses indicadores poderiam ser utilizados na avaliação aeróbia e monitoramento do treinamento de atletas de taekwondo.

Atividade física habitual e variabilidade da frequência cardíaca de repouso em nipo-brasileiros praticantes e não praticantes de PARK / Habitual physical activity and resting heart rate variability in nipo-brazilians practitioners and non practitioners of PARK GOLF

Os objetivos deste estudo foram comparar o nível de atividade física habitual (AFH) por meio do número de passos.dia-1 e os parâmetros da variabilidade da frequência cardíaca (VFC) de repouso em nipo-brasileiros praticantes (GPG) e não praticantes (GNP) de Park Golf e verificar as correlações entre o nível de AFH e a VFC. Trinta e três indivíduos de ambos os gêneros (68,2±6,3 anos) fizeram parte do estudo, sendo 20 sujeitos no GPG (68,3±6,3 anos) e 13 no GNP (68,2±6,4 anos). Os sujeitos utilizaram o pedômetro por uma semana para mensurar a AFH. A VFC foi analisada batimento-a-batimento no repouso em decúbito dorsal por meio de um cardiofrequencímetro. Durante a avaliação da VFC, houve controle da frequência respiratória em 12 respirações por minuto. A AFH foi maior no GPG quando comparado ao GNP. Não foram observadas diferenças nos indicadores da VFC entre os grupos. Em relação aos gêneros, as mulheres apresentaram maiores médias de passos.dia-1 e valores de índices parassimpáticos pela VFC. Os homens obtiveram maiores índices simpáticos. O nível de AFH apresentou correlação significante com o índice de massa corporal (IMC) e com a média dos intervalos R-R. O maior nível de AFH encontrado no GPG não foi suficiente para promover VFC de repouso mais favorável em relação ao GNP.

The aims of this study were to compare the habitual physical activity (HPA) level by means of steps.day-1 and the resting heart rate variability (HRV) parameters of nipo-brazilians practitioners (GPG) and non-practitioners (GNP) of Park Golf and verify the correlations between HPA and HRV. Thirty three subjects of both genders (68.2±6.3 years) participated of this study, being 20 subjects in GPG (68.3±6.3 years) and 13 in GNP (68.2±6.4 years). The subjects wore the pedometer for one week to measure the HPA. The HRV was analyzed beat-to-beat at rest in the supine position using a heart rate monitor and the respiratory frequency was controlled in 12 respiratory cycles per minute. The HPA level was higher in GPG when compared to GNP. There were no differences in the HRV between groups. Regarding gender, women presented higher mean steps.day-1 and parasympathetic indices of HRV. Men presented higher sympathetic indices. The HPA level was significantly correlated with body mass index (BMI) and with the mean R-R intervals. The greater HPA level reported in GPG was not sufficient to induce a more favorable resting HRV than in GNP.