Effects of a multi-professional intervention on body composition, physical fitness and biochemical markers in overweight COVID-19 survivors: a clinical trial.

Introduction: The sequelae post-COVID can affect different systems. In this sense, considering the multi-factorial etiology of COVID-19, multi-professional interventions could be a relevant strategy for recovery health indicators. Objective: This study aimed to investigate the effects of multi-professional intervention on body composition, physical fitness, and biomarkers in overweight COVID-19 survivors with different symptomatology. Methodology: A non-randomized parallel group intervention included 69 volunteers (BMI ≥25 kg/m2), divided into three groups according to SARS CoV-2 symptomatology, but only 35 finished the longitudinal protocol [control group (n = 11); moderate group (n = 17) and severe group (n = 7)]. The groups were submitted to a multi-professional program (nutritional intervention, psychoeducation, and physical exercise intervention) for 8 weeks, and the volunteers underwent body composition assessments (primary outcome) and physical and biochemical tests (secondary outcome) in pre- and post-intervention. This study was registered on the Clinical Trials Registration Platform number: RBR-4mxg57b and with the local research ethics committee protocol under number: 4,546,726/2021. Results: After the 8-week multi-professional intervention, the following results were observed for the moderate COVID-19 group: improved dynamic strength of lower- and (p = 0.003), upper-limbs (p = 0.008), maximal isometric lumbar-traction strength (p = 0.04), flexibility (p = 0.0006), and albumin (p = 0.0005), as well as a reduction in the C reactive protein (CRP) (p = 0.003) and fasting glucose (p = 0.001); for the severe COVID-19 group: an improvement in dynamic lower-body strength (p = 0.001), higher values of albumin (p = 0.005) and HDL-c (p = 0.002), and lower values of CRP (p = 0.05), and for the control group: an improvement in sit-up repetitions (p = 0.008), and a reduction of CRP (p = 0.01), fasting glucose (p = 0.001) and total cholesterol (p = 0.04) were identified. All experimental groups reduced triglycerides after intervention (p < 0.05). Conclusion: Finally, 8 weeks of multiprofessional intervention can be an efficient tool for reversing the inflammatory process and promoting improvements in daily activities and quality of life, although it is believed that the severe COVID-19 group needs longer interventions to improve different health indicators. Clinical Trial Registration: https://ensaiosclinicos.gov.br/, identifier: RBR-4mxg57b.

Body composition and cardiorespiratory fitness in overweight or obese people post COVID-19: A comparative study.

The present study aimed to evaluate the body composition and cardiorespiratory fitness of overweight or obese people after COVID-19. 171 volunteers of both sexes (men, n = 93 and women, n = 78) between 19 and 65 years old were allocated into three groups according to the severity of their symptoms of COVID-19: non-hospitalized people/mild symptoms (n = 61), hospitalized (n = 58), and hospitalized in an intensive care unit-ICU (n = 52). Two laboratory visits were carried out 24 h apart. First, a medical consultation was carried out, with subsequent measurement of body weight and height (calculation of body mass index) and body composition assessment via electrical bioimpedance. After 24 h, a cardiorespiratory test was performed using the Bruce protocol, with a direct gas exchange analysis. Hospitalized individuals had significantly higher values for fat mass and body fat percentage than non-hospitalized individuals (p < 0.05). Significantly higher values were found for heart rate (HR) and peak oxygen consumption (VO2peak) for individuals who were not hospitalized when compared to those hospitalized in the ICU (p < 0.05). Significantly higher values for distance, ventilation, and the relationship between respiratory quotient were found for non-hospitalized individuals compared to hospitalized individuals and those in the ICU (p < 0.05). After the cardiorespiratory test, higher values for peripheral oxygen saturation (SpO2) were observed for non-hospitalized individuals than for all hospitalized individuals (p < 0.05). Diastolic blood pressure was significantly higher at the tenth and fifteenth minute post-Bruce test in hospitalized than in non-hospitalized participants (p < 0.05). Based on these results, proposals for cardiopulmonary rehabilitation are indispensable for hospitalized groups considering the responses of blood pressure. Monitoring HR, SpO2, and blood pressure are necessary during rehabilitation to avoid possible physical complications. Volume and intensity of exercise prescription should respect the physiologic adaptation. Given lower physical conditioning among all the groups, proposals for recovering from health conditions are urgent and indispensable for COVID-19 survivors.

Resistance exercise training induces subcutaneous and visceral adipose tissue browning in Swiss mice.

Aerobic exercise training (AER) may promote several adaptations in white adipose tissue (WAT), including a phenotypic change known as browning. The present study aimed at assessing if resistance exercise training (RES) would be as efficient as AER in inducing a brown-like adipocyte reprogramming in WAT. Thirty Swiss male mice were randomly divided into 3 groups with 10 animals each: 1) sedentary (SED), 2) AER, and 3) RES. After the adaptation training, an incremental test was performed at the beginning of each week to adjust training load. Mice were submitted to 8 wk of AER or RES. After the experimental period, inguinal and retroperitoneal WAT (iWAT and rpWAT) and brown adipose tissue (BAT) were collected. The prescription of AER and RES was effective in increasing the performance of both groups. Also, RES presented a lower body weight than AER/SED. AER and RES reduced the area of iWAT and rpWAT adipocytes and the lipid area of BAT, induced an increase of vascular endothelial growth factor (VEGF) and cluster of differentiation 31 (CD31) and uncoupling protein 1 (UCP-1), and increased the expression of selective genes of brown and beige phenotype in adipocytes after 8 wk. In general, we demonstrated here that AER and RES training similarly induced the browning of iWAT and rpWAT.NEW & NOTEWORTHY Aerobic exercise training (AER) induces the browning of white adipose tissue, turning adipocytes multilocular, highly vascularized and expressing uncoupling protein 1 (UCP-1). The current study compared the efficiency of resistance to aerobic exercise training to promote a brown-like phenotype. Our results suggest that both types of training similarly induce subcutaneous and visceral adipose tissue browning.

Homocysteine-lowering exercise effect is greater in hyperhomocysteinemic people living with HIV: a randomized clinical trial.

Elevated concentration of homocysteine has been identified as an independent risk factor for the development of cardiovascular disease and is frequently associated with oxidative stress. Moreover, studies have shown that people living with human immunodeficiency virus (PLHIV) present elevated concentration of homocysteine and oxidative stress compared with people without HIV. Our purpose was to describe blood homocysteine and oxidative stress markers in PLHIV and those without HIV infection, and to examine the effects of a 16-week combined training exercise program (CTE) on oxidative stress and homocysteine concentrations of PLHIV. We included 49 PLHIV (21 men, 28 women) and 33 people without HIV infection (13 men, 20 women). After baseline evaluations, 30 PLHIV were randomized to either CTE (trained group, n = 18) or the control group (n = 12); CTE consisted of aerobic and strength exercise sessions during 16 weeks, 3 times a week. Plasma homocysteine, oxidative damage markers, folate, and vitamin B12 were assessed pre- and post-training and by hyperhomocysteinemia (homocysteine ≥ 15 µmol/L) status. At baseline, PLHIV had higher levels of homocysteine and malondialdehyde, as well as reduced circulating folate when compared with people without HIV infection. CTE resulted in a 32% reduction (p < 0.05) in homocysteine concentration and a reduction in lipid hydroperoxide in PLHIV with hyperhomocysteinemia, which was not observed in those without hyperhomocysteinemia. Hyperhomocysteinemic participants experienced a 5.6 ± 3.2 µmol/L reduction in homocysteine after CTE. In summary, 16 weeks of CTE was able to decrease elevated homocysteine concentration and enhance redox balance of PLHIV with hyperhomocysteinemia, which could improve their cardiovascular risk.

Effect of combined training on body composition and metabolic variables in people living with HIV: A randomized clinical trial.

PURPOSE: The aim of this study was to conduct a randomized clinical trial to assess the effects of 16 weeks of combined training on body composition, lipid profile, adiponectin, C-reactive protein (CRP), and leptin levels in people living with HIV/AIDS (PLWHA). METHODS: Fifty-eight HIV-infected individuals were randomized into a training group (T) or a control group (C). Combined training consisted of aerobic and resistance exercises performed at the same training session, applied at a frequency of three times a week for a total of 16 weeks. Waist circumference, body mass, body fat percentage (%fat), fat mass, lipid profile, adiponectin, CRP, and leptin levels were measured pre- and post-training in both groups. RESULTS: Sixteen weeks of combined training decreased (P < 0.05) body fat in different body segments in PLWHA. Lipodystrophic PLWHA experienced greater reduction in body fat in the android region than non-lipodystrophic PLWHA after combined training. Lipid profile and circulating levels of adiponectin, leptin, and CRP remained unchanged. CONCLUSIONS: Sixteen weeks of combined training was effective to reduce body fat in different body segments, without altering plasma lipid and cytokine levels.

Exercise improves cytokine profile in HIV-infected people: A randomized clinical trial.

PURPOSE: Verify the effects of concurrent training on cytokines in people living with HIV under antiretroviral therapy (ART) treatment. METHODS: This was a blinded, parallel-group, clinical trial, where 49 participants, divided in two groups, either control group or concurrent training group, took part in the intervention. The control group performed recreational activities and concurrent training group participated of 16-week, 3 times per week of heart rate guided-aerobic plus resistance training for major muscular groups. Cytokines (interleukins 4, 5, 6, 8, 10, tumor necrosis factor-α, interferon-γ, and granulocyte-macrophage colony-stimulating factor) were measured before and after 16-week experimental period using flow cytometry. RESULTS: From 49 participants who took part in the intervention, 28 completed the program and had data analyzed. There was a significant interaction for IL-8, which increased for control group: 7.1±5.1 vs. 8.1±6.0 and a decrease for concurrent training: 8.0±4.4 vs. 5.4±2.3. In addition, magnitude-based inference showed a likely beneficial effect for the training group when compared to the control group for IL-8, IL-5, and IL-10. The difference perceptual: mean and [CI 90%] between delta of difference within groups was -43.1 [-64.0 to -10.0] and -6.6 [-14.7 to 2.3], respectively. CONCLUSION: Short-term exercise is able to decrease the levels of IL-5, IL-8, and IL-10 in HIV-infected people undergoing ART.

Infecção experimental pelo Trypanosoma cruzi em camundongos: influência do exercício físico versus linhagens e sexos / Experimental infection with Trypanosoma cruzi in mice: influence of exercise versus strains and sexes

INTRODUÇÃO: A doença de Chagas é uma infecção causada pelo Trypanosoma cruzi que afeta oito milhões de pessoas na América Latina. Um fator ligado ao estilo de vida que interfere significativamente na resposta à infecção é o exercício físico, dependendo do tipo, intensidade e frequência da atividade praticada. OBJETIVO: Avaliar a influência do exercício físico aeróbio moderado crônico pré-infecção na evolução da infecção experimental pelo T. cruzi em camundongos de duas linhagens distintas pertencentes aos dois sexos. MÉTODOS: Camundongos Swiss e BALB/c (machos e fêmeas) com 30 dias de idade foram divididos em quatro grupos para cada linhagem e sexo (total de 16) e nomeados como segue: SM (Swiss machos), SF (Swiss fêmeas), BM (BALB/c machos) e BF (BALB/c fêmeas). Os grupos foram: NT+NI (não treinado+não infectado), T+NI (treinado+não infectado), NT+I (não treinado+infectado) e T+I (treinado+infectado). O programa de exercício físico aeróbio moderado crônico pré-infecção foi realizado durante oito semanas, com uma sessão diária de treinamento, cinco vezes na semana. O inóculo foi de 1.400 tripomastígotas sanguíneos da cepa Y do T. cruzi, via intraperitoneal. Foi avaliado o pico de parasitos, parasitemia total média e as medidas das atividades séricas de CK e CK-MB. RESULTADOS E CONCLUSÃO: O treinamento físico promoveu nas duas linhagens e em ambos os sexos redução no pico de parasitos e na parasitemia total média em animais infectados pelo T. cruzi. O treinamento físico promoveu redução nas atividades séricas de CK e CK-MB em animais infectados pelo T. cruzi, de ambos os sexos, das duas linhagens, exceto para fêmeas Swiss na atividade de CK e CK-MB.

BACKGROUND: Chagas disease is an infection caused by Trypanosoma cruzi that affects eight million people in Latin America. One factor linked to the lifestyle that significantly interferes in the response to infection is physical exercise, depending on the kind, intensity and frequency of the activity practiced. OBJECTIVE: To evaluate the influence of pre-infection chronic moderate aerobic exercise in the development of experimental infection with T. cruzi in mice of two distinct lineages from both sexes. METHODS: 30-day old Swiss and BALB/c mice (male and female) were divided into four groups for each strain and sex (total 16) and named as follows: SM (Swiss males), SF (Swiss females) BM (BALB/c mice) and BF (BALB/c mice). The groups were: NT NI (untrained uninfected) T NI (trained not infected); NT I (untrained infected), TI (trained infected). The aerobic exercise pre-moderate chronic infection training was performed with one daily session for eight weeks, five times a week. The inoculum was 1,400 blood trypomastigotes of Y strain of T. cruzi intraperitoneally. The peak of parasites, parasitemia total and average measurements of the serum activities of CK and CK-MB were evaluated. RESULTS AND CONCLUSIONS: The physical training promoted reduction in peak, parasitemia parasites and total average in animals infected with T. cruzi in both strains and sexes. Physical training induced reduction in serum activities of CK and CK-MB in animals infected with T. cruzi of both sexes and from the two strains, except for females in the Swiss CK activity.

Produção de fator de necrose tumoral-alfa e peróxido de hidrogênio na infecção pelo Trypanosoma cruzi em camundongos submetidos ao exercício / Production of tumoral necrosis factor-alpha and hydrogen peroxide during Trypanosoma cruzi infection in mice submitted to exercise

Este trabalho teve como objetivo determinar os níveis de fator de necrose tumoral alfa (TNF-alfa) sérico e produção de peróxido de hidrogênio (H2O2) por macrófagos peritoneais em camundongos experimentalmente infectados pelo Trypanosoma cruzi e submetidos ao treinamento físico realizado antes da infecção ou ao exercício físico durante o período de infecção. Foram utilizados camundongos BALB/c fêmeas com 30 dias de idade, inoculados com 1.400 tripomastígotas sanguíneos da cepa Y. O exercício físico consistia em atividade de intensidade moderada em esteira rolante. As dosagens foram realizadas com material coletado no 13º dia de infecção. Para a dosagem de TNF-alfa, foi utilizada a técnica de ELISA de captura. A produção de H2O2 foi expressa por coloração produzida após a incubação de macrófagos peritoneais com peroxidase e a leitura realizada em aparelho de ELISA. Não foram encontradas diferenças significativas nas concentrações de TNF-alfa e produção de H2O2 entre os grupos infectados. O treinamento físico realizado antes da infecção e o exercício físico realizado após a infecção não foram capazes de alterar significativamente os níveis de TNF-alfa e a produção de H2O2 na infecção pelo T. cruzi.

This study aimed to determine the levels of seric tumor necrosis factor-alpha (TNF-alpha) and production of hydrogen peroxide (H2O2) by peritoneal macrophages in mice experimentally infected with T. cruzi and submitted to pre-infection exercise training and to post-infection acute exercise. Female 30-day-old BALB/c mice were inoculated with 1,400 blood trypomastigotes of Y-strain T. cruzi. Exercise programs consisted in moderate-intensity activity and were carried out in a treadmill. The measurements were performed with material collected at the 13th day after infection Serum TNF-alpha was evaluated using capture ELISA. H2O2 production was expressed by coloration produced after incubation of peritoneal macrophages and the measurement was performed using an ELISA reader. There were no statistically significant differences in TNF-alpha levels and H2O2 production between the trained and non-trained infected groups. Thus, the physical training performed before infection and physical exercise performed after the infection were not able to change the levels of TNF-alpha and production of H2O2 in the infection by T. cruzi.

Preinfection aerobic treadmill training improves resistance against Trypanosoma cruzi infection in mice.

Exercise performed before infections has been linked to improvement of the immune response against infections. The purpose of this study was to evaluate the influence of preinfection moderate-intensity treadmill training on acute Trypanosoma cruzi infection in mice. Ninety-nine female BALB/c mice were divided into 4 groups, as follows: training + infection (T+I) (n = 41); no training + infection (NT+I) (n = 38); training + no infection (T+NI) (n = 10); and no training + no infection (NT+NI) (n = 10). The exercise program for trained groups was carried out on a motorized treadmill for 8 weeks. Infected groups were inoculated with the Y strain of T. cruzi. Infectivity, prepatent period, patent period, parasitemia peak, mortality, survival time, weight, food intake, tumor necrosis factor-alpha serum levels, and peritoneal macrophage hydrogen peroxide production were evaluated. We found that preinfection training induced statistically significant reductions in parasitemia peak (p < 0.03) and weight loss (p < 0.04). However, no statistically significant differences were found for the other parameters evaluated when trained and nontrained infected groups were compared. We conclude that preinfection aerobic training induces some improvement in the immune response to T. cruzi infection in female BALB/c mice.

Técnicas cirúrgicas no combate obesidade mórbida / Surgical techniques against morbid obesity

O objetivo deste estudo foi focalizar as técnicas cirúrgicas aplicáveis no tratamento da obesidade mórbida, relatando as indicações e contra-indicações de cada técnica. Dentre estes tratamentos cirúrgicos estão as técnicas: 1) restritivas, que restringem a ingestão alimentar por diminuição do volume do estômago e que são compostas pela cerclagem dentária, pelo balão intragástrico, pela gastroplastia restritiva de Mason e pela banda gástrica ajustável por laparoscopia; 2) as técnicas disabsortivas (má absortivas), que permite o paciente comer, no entanto, atrapalham a absorção dos nutrientes, através do desvio de uma boa parte do caminho que os alimentos tem que cursar e, por fim, 3) as técnicas mistas (hídricas), que associam um pouco de restrição a ingestão do bolo alimentar com um pouco de disabsorção, ou seja, um desvio intestinal menor, sendo as técnicas de Capella e Fobbi as mais utilizadas neste tratamento e também consideradas o “padrão ouro” das operações para obesidade mórbida...