Neuromuscular electrical stimulation changes glucose, but not its variability in type 2 diabetes: a randomized clinical trial.

Neuromuscular electrical stimulation (NMES) can be an alternative to conventional exercising. This randomized clinical trial evaluated the effect of NMES in type 2 diabetes patients. Twenty-eight individuals with type 2 diabetes were assigned to NMES (n=14) or NMES-placebo (n=14) applied to knee extensor muscles for 60 minutes. Glucose variability, microvascular function and endothelial function were evaluated through continuous glucose monitoring system, near infrared spectroscopy and flow-mediated dilatation, respectively. Glucose levels (mg/dl) decreased 2h (184 ± 11 vs 223 ±15), 3h (179 ± 12 vs 219 ±14) and 4h (177 ± 12 vs 212 ±12) after NMES, in comparison to NMES-placebo. No differences in glucose variability were found: coefficient of variation (%) at 0-6h (11.4±1.3 vs 11.4±1.2), 6-12h (9.8±1.0 vs 11.6±1.6), 12-18h (15.5±2.0 vs 11.4±2.1), 18-24h (12.8±2.3 vs 10.0±1.6); standard deviation (mg/dl) at 0-6h (21.6±2 vs 24.6±3.5), 6-12h (19.5±1.8 vs 20.3±2.8), 12-18h (29.9±3.5 vs 21.3±2.8),18-24h (22.8±4.1 vs 16.6±2.0) and mean amplitude of glycemic excursions (mg/dl) 54.9±25.0 vs 70.3±35.7. Endothelial and microvascular functions did not change. In conclusion, one acute NMES session was strong enough to trigger glucose reduction in individuals with type 2 DM, but it failed to induce any significant change in glucose variability, endothelial and microvascular functions.

Effects of photobiomodulation on oxidative stress in rats with type 2 diabetes mellitus.

The present study aimed to evaluate photobiomodulation effects on oxidative stress in type 2 diabetes mellitus (DM2). Thirty-one male Wistar rats were used and divided into 4 groups: group 1 - animals without diabetes mellitus 2 without laser 21 J/cm2 (C-SHAM), group 2 - animals with diabetes mellitus 2 without laser 21 J/cm2 (C-DM2), group 3 - animals without diabetes mellitus 2 with laser 21 J/cm2 (L-SHAM), group 4 - animals with diabetes mellitus 2 with laser 21 J/cm2 (L-DM2). The protocol was performed 5 days/week, for 6 weeks. The animals that received photobiomodulation had one dose irradiated at two spots in the right gastrocnemius muscle. Twenty-four hours after the last intervention, the animals were euthanized. Heart, diaphragm, liver, right gastrocnemius, plasma, kidneys, weighed, and stored for further analysis. In rats with DM2, photobiomodulation promoted a decrease in thiobarbituric acid reactive substance assay (TBARS) in plasma levels. On the other hand, photobiomodulation demonstrated an increase in non-protein thiol levels (NPSH) in the heart, diaphragm and gastrocnemius. Moreover, photobiomodulation produced in the heart, diaphragm and plasma levels led to an increase in superoxide dismutase (SOD). Interestingly, photobiomodulation was able to increase superoxide dismutase in rats without DM2 in the heart, diaphragm, gastrocnemius and kidneys. These findings suggested that 6 weeks of photobiomodulation in rats with DM2 promoted beneficial adaptations in oxidative stress, with a decrease in parameters of oxidant activity and an increase in antioxidant activity.

Baseline Characteristics of Subjects with Chronic Obstructive Pulmonary Disease Associated to the Improvement in Activities of Daily Living after Exercise Training.

This study aimed to identify baseline variables predicting improvement in ADLs following an exercise training program in subjects with COPD. Sixty-seven patients with COPD underwent assessment of spirometry, modified Medical Research Council scale, COPD Assesment Test (CAT), Six Minute Walk Test (6MWT), London Chest Activity of Daily Living (LCADL) scale and Glittre-ADL test (TGlittre). After 24 sessions, they were reassessed for limitation in ADLs (LCADL and TGlittre). The main outcome was the achieving of minimal important difference (MID) of TGlittre, LCADL and both (ADLs). The cut-off points to discriminate the subjects who achieved the MID of TGlittre, LCADL and ADLs were established using the ROC curve. A cut-off point of 3.7 min in baseline TGlittre was able to discriminate subjects who achieved the MID of TGlittre (AUC = 0.77). Subjects with baseline TGlittre ≥3.7 min were 6.92 (95%CI 2.2-20.9) times more likely to achieve the MID of TGlittre post-exercise training. A cut-off point of 32% in LCADL was able to discriminate subjects who achieved the MID of LCADL (AUC = 0.81) and in ADLs (AUC = 0.78). Subjects with baseline LCADL ≥32% were 12.3 (95% CI 2.50 - 60.7) times more likely to achieve the MID of LCADL. In conclusion, the baseline variables that best predict the improvement of individuals after exercise training are TGlittre and LCADL, showing that subjects with significant functional impairment are more likely to clinically significantly improve their ADLs.

Reliability and Learning Effect of the Glittre ADL-Test in Patients with Chronic Obstructive Pulmonary Disease.

The Glittre ADL-test (TGlittre) is a multiple-task test designed to assess functional limitation in patients with chronic obstructive pulmonary disease (COPD). Although few studies have investigated the TGlittre learning effect, the results are still conflicting. This study aimed to investigate the test-retest reliability and learning effect on TGlittre and to identify predicting factors of the learning effect in patients with COPD. Patients performed the TGlittre twice with a 30-minutes resting period between trials. TGlittre consists in measuring the time to complete five laps of a multiple ADL-like activities circuit: walking stairs, carrying a backpack, lifting objects, bending down and rising from a seated position. 124 patients with COPD were assessed [81 men; 66 ± 8 years, forced expiratory volume in one second (FEV1) 37.1 ± 15.0%pred; TGlittre 120 ± 60%pred; six-minute walking test 75.5 ± 17.4%pred]. The time spent in TGlittre presented excellent reliability (ICC = 0.96; 95%CI 0.92 - 0.98; p < 0.001; SEM 0.46 min; MDC 1.28 min) and decreased in the retest (5.24 ± 2.31 min to 4.85 ± 2.02 min; p < 0.001). Patients presented a learning effect of 6.11 ± 11.1% in TGlittre. A lower FEV1 (r2=0.10; p < 0.001) and a worse performance in the first TGlittre (r2=0.28; p < 0.001) are related to the improvement in performance of the second TGlittre. Although the TGlittre is reliable, patients improve their performance when performing the second test probably because they underestimate their functional capacity. These results should encourage professionals to assess TGlittre twice when using this test as an outcome measure.

Home-based inspiratory muscle training in pediatric patients after kidney transplantation: a randomized clinical trial.

BACKGROUND: Chronic kidney disease (CKD) represents the irreversible stages of renal failure and is a growing worldwide public health issue associated with increases in morbidity, mortality, and decreased quality of life. Kidney transplantation is considered one of the best treatment options in this population. However, even after surgery, respiratory muscle strength is below normal values, and inspiratory muscle training (IMT) improves respiratory muscle function, strength, and endurance. This study aimed to evaluate the effects of IMT regarding respiratory muscle strength, functional capacity, and pulmonary function in pediatric kidney transplant recipients with CKD, and secondarily, to assess the biochemical profile of patients after intervention. METHODS: This is a randomized, double-blind, placebo-controlled trial. Patients were randomized into two groups, intervention (IG) and control (CG) and performed IMT home-based training for 6 weeks. In the IG, the load was adjusted to 40% of the maximal inspiratory pressure and in the CG was adjusted to a minimum placebo load (9 cm H2O). RESULTS: Thirty-one patients were randomly allocated to the intervention (n = 16) or control (n = 15) groups. There were no differences at baseline between groups. Increase of 35% in the maximal inspiratory pressure predicted and 26% in the maximal expiratory pressure predicted in the IG were found, compared with 5 and 4% in the CG. There was an increase in hemoglobin and hematocrit values in the IG. CONCLUSIONS: Home-based IMT provides a significant increase in respiratory muscle strength, without changes in functional capacity and pulmonary function. Benefits regarding biochemical markers (hemoglobin and hematocrit) were also observed.

Maximal oxygen uptake and exercise tolerance are improved in rats with heart failure subjected to low-level laser therapy associated with resistance training.

Exercise tolerance and maximal oxygen uptake (VO2max) are reduced in heart failure (HF). The influence of combined resistance training (RT) and low-level laser therapy (LLLT) on exercise tolerance and VO2max in HF has not yet been explored. The aim of this study was to evaluate the influence of combined RT and LLLT on VO2max and exercise tolerance in rats with HF induced by myocardial infarction (MI). Rats were allocated to sedentary sham (Sed-Sham, n = 12), sedentary heart failure (Sed-HF, n = 9), RT heart failure (RT-HF, n = 7) and RT associated with LLLT heart failure (RT + LLLT-HF, n = 7) groups. After MI or sham surgery, rats underwent a RT and LLLT protocol (applied immediately after RT) for 8 weeks. VO2max and exercise tolerance were evaluated at the end of protocol. HF rats subjected to LLLT combined with RT showed higher VO2basal (41 %), VO2max (40 %), VO2reserve (39 %), run distance (46 %), time to exhaustion (30 %) and maximal velocity (22 %) compared with HF rats that underwent RT alone. LLLT associated with RT improved oxygen uptake and exercise tolerance compared with RT alone in HF rats.

Inspiratory muscle training in patients with diabetic autonomic neuropathy: a randomized clinical trial.

AIMS AND METHODS: We evaluated the effects of an 8-week inspiratory muscle training (IMT, n = 5) or placebo IMT (P-IMT, n = 5) on maximal respiratory pressures, pulmonary function, functional capacity, and cardiac autonomic control in patients with type 2 diabetes and diabetic autonomic neuropathy (DAN). RESULTS AND CONCLUSIONS: The IMT group had a greater increase in maximum inspiratory pressure as compared to P-IMT (p < 0.05). The IMT improved inspiratory muscle strength in patients with DAN.

Experimental lung injury promotes alterations in energy metabolism and respiratory mechanics in the lungs of rats: prevention by exercise.

In the present study we investigated the effects of lung injury on energy metabolism (succinate dehydrogenase, complex II, cytochrome c oxidase, and ATP levels), respiratory mechanics (dynamic and static compliance, elastance and respiratory system resistance) in the lungs of rats, as well as on phospholipids in bronchoalveolar lavage fluid. The protective effect of physical exercise on the alterations caused by lung injury, including lung edema was also evaluated. Wistar rats were submitted to 2 months of physical exercise. After this period the lung injury was induced by intratracheal instillation of lipopolysaccharide. Adult Wistar rats were submitted to 2 months of physical exercise and after this period the lung injury was induced by intratracheal instillation of lipopolysaccharide in dose 100 µg/100 g body weight. The sham group received isotonic saline instillation. Twelve hours after the injury was performed the respiratory mechanical and after the rats were decapitated and samples were collected. The rats subjected to lung injury presented a decrease in activities of the enzymes of the electron transport chain and ATP levels in lung, as well as the formation of pulmonary edema. A decreased lung dynamic and static compliance, as well as an increase in respiratory system resistance, and a decrease in phospholipids content were observed. Physical exercise was able to totally prevent the decrease in succinate dehydrogenase and complex II activities and the formation of pulmonary edema. It also partially prevented the increase in respiratory system resistance, but did not prevent the decrease in dynamic and static compliance, as well as in phospholipids content. These findings suggest that the mitochondrial dysfunction may be one of the important contributors to lung damage and that physical exercise may be beneficial in this pathology, although it did not prevent all changes present in lung injury.

Perceived dyspnea and experience of hospitalized patients with acute decompensated heart failure undergoing an early MObilization protocol with immersive Virtual rEality: MOVE study protocol for a parallel superiority randomized clinical trial.

BACKGROUND: Immersive virtual reality (VR) is an innovative strategy for inpatient rehabilitation programs. Using immersive VR in early mobilization protocols has not yet been investigated in the setting of hospitalized patients with acute decompensated heart failure (ADHF), especially to improve perceived dyspnea, a common symptom of heart failure (HF). METHODS: This is a single-center parallel superiority randomized clinical trial. The study will be conducted at a public teaching hospital in Brazil from January 2023 to January 2024. The sample will include adult patients with ADHF hospitalized for at least 24 h, randomly assigned in a 1:1 ratio to the control (standard early mobilization protocol conducted in the intensive care unit (ICU)) or intervention group (the same standard early mobilization protocol but associated with immersive VR). The primary outcome will be assessing perceived dyspnea, and the secondary outcome will be assessing patient experience. DISCUSSION: Using immersive VR in early mobilization protocols in the ICU is expected to improve perceived dyspnea in patients with ADHF as well as patient experience regarding care. This study has the potential to increase patient adherence to early mobilization protocols in the setting of ADHF as well as to promote a positive patient experience. Filling this gap could promote the rational incorporation of technologies in health care. TRIAL REGISTRATION: This study protocol is in its first version. CLINICALTRIALS: gov NCT05596292. Registered on 1 December 2022.

Impact of vertical positioning on lung aeration among mechanically ventilated intensive care unit patients: a randomized crossover clinical trial.

OBJECTIVE: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. METHODS: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). RESULTS: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). CONCLUSION: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients.ClinicalTrials.gov registry: NCT04176445.

The 6-Minute Walk Test predicts long-term physical improvement among intensive care unit survivors: a prospective cohort study. / O Teste de Caminhada de 6 Minutos prevê a melhora física em longo prazo de sobreviventes à unidade de terapia intensiva: um estudo de coorte prospectiva.

OBJECTIVE: To evaluate the ability of the 6-Minute Walk Test to predict long-term physical functional status improvement among intensive care unit survivors. METHODS: Thirty-two intensive care unit survivors were prospectively evaluated from February 2017 to August 2018 in a post-intensive care unit outpatient clinic in Brazil. Individuals with intensive care unit stays > 72 hours (emergency admissions) or > 120 hours (elective admissions) attending the post-intensive care unit clinic four months after intensive care unit discharge were consecutively enrolled. The association between the 6-Minute Walk Test distance at baseline and physical functional status was assessed over 8 months using the Barthel Index. RESULTS: The mean 6-Minute Walk Test distance was significantly lower in intensive care unit survivors than in the general population (405m versus 557m; p < 0.001). Age (ß = -4.0; p < 0.001) and muscle weakness (ß = -99.7; p = 0.02) were associated with the 6-Minute Walk Test distance. A 6-Minute Walk Test distance was associated with improvement in physical functional status over the 8-month follow-up (odds ratio for each 10m of 1.07; 95%CI 1.01 - 1.16; p = 0.03). The area under the Receiver Operating Characteristic curve for the 6-Minute Walk Test prediction of physical functional status improvement was 0.72 (95%CI 0.53 - 0.88). CONCLUSION: The 6-Minute Walk Test performed 4 months after intensive care unit discharge predicted long-term physical functional status among intensive care unit survivors with moderate accuracy.

OBJETIVO: Avaliar a capacidade do Teste de Caminhada de 6 Minutos para predizer a melhora do estado funcional físico em longo prazo de pacientes sobreviventes à unidade de terapia intensiva. MÉTODOS: Foram avaliados, de forma prospectiva, entre fevereiro de 2017 e agosto de 2018, em um ambulatório pós-unidade de terapia intensiva, 32 sobreviventes à unidade de terapia intensiva. Foram inscritos consecutivamente os pacientes com permanência na unidade de terapia intensiva acima de 72 horas (para admissões emergenciais) ou acima de 120 horas (para admissões eletivas) que compareceram ao ambulatório pós-unidade de terapia intensiva 4 meses após receberem alta da unidade de terapia intensiva. A associação entre a distância percorrida no Teste de Caminhada de 6 Minutos realizado na avaliação inicial e a evolução do estado funcional físico foi avaliada durante 8 meses, com utilização do Índice de Barthel. RESULTADOS: A distância média percorrida no Teste de Caminhada de 6 Minutos foi significantemente mais baixa nos sobreviventes à unidade de terapia intensiva do que na população geral (405m versus 557m; p < 0,001). A idade (ß = -4,0; p < 0,001) e a fraqueza muscular (ß = -99,7; p = 0,02) se associaram com a distância percorrida no Teste de Caminhada de 6 Minutos. A distância percorrida no Teste de Caminhada de 6 Minutos se associou com melhora do estado funcional físico no período de 8 meses de acompanhamento desses pacientes (razão de chance para cada 10m: 1,07; IC95% 1,01 - 1,16; p = 0,03). A área sob a curva Característica de Operação do Receptor para predição da melhora funcional física pelo Teste de Caminhada de 6 Minutos foi de 0,72 (IC95% 0,53 - 0,88). CONCLUSÃO: O Teste de Caminhada de 6 Minutos, realizado 4 meses após a alta da unidade de terapia intensiva, predisse com precisão moderada a melhora do estado funcional físico de sobreviventes à unidade de terapia intensiva.

Quantification of DNA Damage in Different Tissues in Rats with Heart Failure.

BACKGROUND: Chronic heart failure (CHF) is a complex syndrome which comprises structural and functional alterations in the heart in maintaining the adequate blood demand to all tissues. Few investigations sought to evaluate oxidative DNA damage in CHF. OBJECTIVE: To quantify the DNA damage using the comet assay in left ventricle (LV), lungs, diaphragm, gastrocnemius and soleus in rats with CHF. METHODS: Twelve male Wistar rats (300 to 330 g) were selected for the study: Sham (n = 6) and CHF (n = 6). The animals underwent myocardial infarction by the ligation of the left coronary artery. After six weeks, the animals were euthanized. It was performed a cell suspension of the tissues. The comet assay was performed to evaluate single and double strand breaks in DNA. Significance level (p) considered < 0.05. RESULTS: The CHF group showed higher values of left ventricle end-diastolic pressure (LVEDP), pulmonary congestion, cardiac hypertrophy and lower values of maximal positive and negative derivatives of LV pressure, LV systolic pressure (p < 0.05). CHF group showed higher DNA damage (% tail DNA, tail moment and Olive tail moment) compared to Sham (p < 0.001). The tissue with the highest damage was the soleus, compared to LV and gastrocnemius in CHF group (p < 0.05). CONCLUSION: Our results indicates that the CHF affects all tissues, both centrally and peripherically, being more affected in skeletal muscle (soleus) and is positively correlated with LV dysfunction.

Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial.

BACKGROUND: The effects of adding moderate-to-high intensity inspiratory muscle training (IMT) to short-term aerobic and resistance exercise (combined training [CT]), after coronary artery bypass grafting (CABG) are not established. This study aimed to determine the effects of moderate-to-high intensity IMT + CT on exercise capacity, respiratory muscle strength, inspiratory muscle endurance, quality of life (QoL), and laboratory biomarkers in patients after CABG who were participants of a phase II cardiac rehabilitation program. METHODS: Twenty-four patients were randomly assigned to either the IMT + CT group (n = 12), who performed moderate-to-high intensity IMT with CT or the sham-IMT + CT group (n = 12). Patients completed two sessions per week for 12 weeks. Each patient underwent a cardiopulmonary exercise test, six-minute walk test (6MWT), respiratory muscle strength and endurance evaluation, QoL questionnaire, and serum advanced oxidation protein products, ferric reducing antioxidant power [FRAP], nitrate/nitrate, and high-sensitivity C-reactive protein, before and after the 12-week intervention. RESULTS: The IMT + CT group showed significantly greater improvements in peak oxygen uptake (1.3 mL∙kg-1∙min-1; 95% confidence interval [95% CI], 0.5 to 2.2), distance covered during the 6MWT (78.8 m; 95% CI, 28.1 to 129.5), maximal inspiratory pressure (23.0 cmH2O; 95% CI, 9.3 to 36.7), QoL (-15.1 points; 95% CI, -26.9 to -3.3), and FRAP (83.7 µmol/L; 95% CI, 20.2 to 147.1) compared to the sham-IMT + CT group as a result of the intervention. CONCLUSIONS: Short-term moderate-to-high intensity IMT with CT provided additional benefits in exercise capacity, inspiratory muscle strength, QoL, and antioxidant profile in patients after CABG. Trial Registration clinicaltrials.gov Identifier: NCT02885077.

[Dietary intake and cardiovascular risk among people living with HIV/AIDS]. / Consumo alimentar e risco cardiovascularem pessoas vivendo com HIV/AIDS.

This cross-sectional study evaluated the food intake patterns related to cardiovascular risk disease among people living with HIV/AIDS (PLWHA) with viral suppression and receiving highly active antiretroviral therapy (HAART). Food intake was obtained by the annual food frequency questionnaire, separated into two groups, healthy and unhealthy food related intake and cardiovascular disease. Data were analyzed using Student's t Test for independent samples or the Mann-Whitney U Test and Fisher's exact test, with a significance level of p < 0.05. The sample consisted of 45 individuals with HIV/AIDS (60% female). The intake of unhealthy foods for cardiovascular risk was greater compared to the intake of healthy foods, both in men (3.91 ± 0.26 vs. 2.79 ± 0.32 p = 0.01) and women (3.40 ± 0.23 vs. 2.60 ± 0.29 p = 0.04). Metabolic syndrome prevalence was 33.3% in men and 37% in women. Men presented hypertriglyceridemia (50%) and low HDL (44%) and women presented central obesity (54%, p = 0.05 vs. men) hypercholesterolemia (66.7% p = 0.02 vs. men) and hypertriglyceridemia (46%). Study results indicate the presence of unhealthy food intake patterns and a high prevalence of cardiovascular risk factors in the evaluated subjects.

O presente estudo analisou o consumo alimentar e a presença de fatores de risco cardiovasculares em pessoas vivendo com HIV/AIDS (PVHA) em uso regular de antirretrovirais. O consumo alimentar foi avaliado por meio de questionário de frequência alimentar anual, dividido em alimentos protetores e não protetores para doença cardiovascular (DCV). Os dados foram calculados pelo Teste t de Student para amostras independentes, pelo Teste U de Mann-Whitney e pelo teste exato de Fischer, considerando significativo p < 0,05. A amostra consistiu de 45 PVHA (60% do sexo feminino). O consumo de alimentos não protetores para o risco cardiovascular foi maior do que o de alimentos protetores nos homens (3,91 ± 0,26 vs. 2,79 ± 0,32 p = 0,01) e nas mulheres (3,40 ± 0,23 vs. 2,60 ± 0,29 p = 0,04). A prevalência de síndrome metabólica foi 33,3% nos homens e 37% nas mulheres. Os homens apresentaram hipertrigliceridemia (50%) e baixas concentrações de HDL-c (44%), enquanto que as mulheres apresentaram hipertrigliceridemia (46%), hipercolesterolemia (66,7%, p < 0,02 vs. homens) e obesidade central (54%, p < 0,05 vs. homens). Os resultados deste estudo indicam a presença de padrão de consumo alimentar inadequado e elevada prevalência de fatores de risco relacionados às DCV nos indivíduos avaliados.

Aerobic training reduces oxidative stress in skeletal muscle of rats exposed to air pollution and supplemented with chromium picolinate.

OBJECTIVE: The purpose of this study was to investigate the effects of chromium picolinate (CrPic) supplementation associated with aerobic exercise using measures of oxidative stress in rats exposed to air pollution. METHODS: Sixty-one male Wistar rats were divided into eight groups: residual oil fly ash (ROFA) exposure and sedentary (ROFA-SED); ROFA exposure, sedentary and supplemented (ROFA-SED-CrPic); ROFA exposure and trained (ROFA-AT); ROFA exposure, supplemented and trained (ROFA-AT-CrPic); sedentary (Sal-SED); sedentary and supplemented (Sal-SED-CrPic); trained (Sal-AT); and supplemented and trained (Sal-AT-CrPic). Rats exposed to ROFA (air pollution) received 50 µg of ROFA daily via intranasal instillation. Supplemented rats received CrPic (1 mg/kg/day) daily by oral gavage. Exercise training was performed on a rat treadmill (5×/week). Oxidative parameters were evaluated at the end of protocols. RESULTS: Trained groups demonstrated lower gain of body mass (P < .001) and increased exercise tolerance (P < .0001). In the gastrocnemius, trained groups demonstrated increased SOD activity (P < .0001) and decrease levels of TBARS (P = .0014), although CAT activity did not differ among groups (P = .4487). CONCLUSION: Air pollution exposure did not lead to alterations in oxidative markers in lungs and heart, and exercise training was responsible for decreasing oxidative stress of the gastrocnemius.

Pre-exercise meal on oxidation of energy substrates during maximal exercise test in non-trained individuals

ABSTRACT Objective: This study aimed to compare the influence of a high carbohydrate meal versus high-fat meal on the oxidation of substrates during an exercise incremental test. Materials and methods: Ten untrained male subjects underwent two days of the protocol. Randomly, they received a high carbohydrate meal or a high-fat meal, receiving the other one in the next protocol. On both days, they performed an incremental treadmill test, with heart rate and maximal oxygen consumption to estimate the oxidation of substrates. Results: The high-fat meal showed an increase in the absolute amount of oxidized fat along with the incremental test (P < 0.05; effect size = 0.9528), and a reduction in the respiratory exchange ratio at low intensities (P < 0.05; effect size = 0.7765). Conclusions: The meals presented no difference when compared to maximum oxidation point of substrates, the oxidation rate of substrates over time, and heart rate. A pre-test high-fat meal in untrained individuals was shown to be a modulating factor of total oxidized fats throughout the exercise, although it did not exert a significant effect on the rate of this oxidation over time.

Functional capacity and ventilatory efficiency are preserved in well-controlled people living with human immunodeficiency virus/acquired immunodeficiency syndrome.

To verify and compare the responses of the cardiopulmonary variables to the incremental test in physically inactive people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLWHA) with well-controlled disease and physically inactive healthy subjects (non-HIV/AIDS). Participants performed a cardiopulmonary exercise test (CPX) on a treadmill. Data were analyzed using the Mann-Whitney test and Spearman correlation. Nine PLWHA (5 women) and 9 non-HIV/AIDS gender and activity level-matched controls were included in the data analysis. Data are expressed in median (range). No difference was shown in the PLWHA group when compared to the control group in functional capacity (peak oxygen consumption [VO2peak]: 29.9 (20.9-36.4) mL/kg/min vs. 32.2 (24.5-39.4) mL/kg/min) and ventilatory efficiency (oxygen uptake efficiency slope [OUES]: 2,058 [1,474-3,204] vs. 2,612 [1,383-4,119]; minute ventilation carbon dioxide production slope: 27.4 [22.5-33.6] vs. 27.5 [20.4-38.1]). The results are also similar to maximal heart rate, oxygen pulse, gas exchange threshold, respiratory compensation point, heart rate recovery, and half-time of VO2peak recovery. OUES had a strong correlation with VO2peak in the PLWHA group (r s =0.70, P=0.04) and control group (r s =0.78, P=0.02). The results of this study indicate that functional capacity and ventilatory efficiency in PLWHA with well-controlled disease are preserved and are not different from sedentary subjects. In this sense, when CPX is unavailable, the aerobic assessment and prescription could be based on simpler procedures used in healthy subjects.

Impact of vertical positioning on lung aeration among mechanically ventilated intensive care unit patients: a randomized crossover clinical trial / Impacto do posicionamento vertical na aeração pulmonar em pacientes de unidades de terapia intensiva ventilados mecanicamente: um estudo clínico transversal randomizado

ABSTRACT Objective: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. Methods: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). Results: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). Conclusion: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients. ClinicalTrials.gov registry: NCT04176445

RESUMO Objetivo: Avaliar o impacto de diferentes posicionamentos verticais na aeração pulmonar em pacientes em ventilação mecânica invasiva. Métodos: Trata-se de ensaio clínico aberto, randomizado e transversal, realizado entre janeiro e julho de 2020. Adultos em ventilação mecânica invasiva por mais de 24 horas e menos de 7 dias com estabilidade hemodinâmica, respiratória e neurológica foram distribuídos aleatoriamente em uma proporção de 1:1 à postura sentada seguida da condição de ortostatismo passivo ou o ortostatismo passivo seguido de postura sentada. O desfecho primário foi a aeração pulmonar avaliada pelo lung ultrasound score. O escore varia de zero (melhor) a 36 (pior). Resultados: Foram selecionados 186 indivíduos; destes, 19 foram incluídos (57,8% do sexo masculino; média idade de 73,2 anos). Todos os participantes foram selecionados para receber pelo menos um protocolo de verticalização. O ortostatismo passivo resultou em escores médios de aeração pulmonar por ultrassonografia que não diferiram significativamente da postura sentada (11,0 versus 13,7; diferença média, -2,7; IC95% -6,1 a 0,71; p = 0,11). Ocorreram eventos adversos em três indivíduos no grupo ortostatismo passivo e em um no grupo postura sentada (p = 0,99). Conclusão: Esta análise não encontrou diferenças significativas na aeração pulmonar entre os grupos ortostatismo passivo e postura sentada. É factível conduzir um estudo clínico transversal randomizado para avaliar o impacto do posicionamento vertical na aeração pulmonar em pacientes em ventilação mecânica invasiva. Infelizmente, o estudo foi interrompido devido à necessidade de tratar pacientes com COVID-19. Registro ClinicalTrials.gov: NCT04176445

Long-term intake of saccharin decreases post-absortive energy expenditure at rest and is associated to greater weight gain relative to sucrose in wistar rats.

BACKGROUND: Non-nutritive sweeteners (NNS) have been associated with increased prevalence of obesity. In previous studies, we demonstrated that saccharin could induce an increase in weight gain either when compared to sucrose or to a non-sweetened control at a similar total caloric intake. These data raised the hypothesis that reduced energy expenditure (EE) could be a potential mechanism explaining greater weight gain with saccharin use in rats. The aim of the present study was to compare long-term energy expenditure at rest between rats using saccharin or sucrose and correlate it with weight gain. . METHODS: In the present study, we examine the potential impact of saccharin compared to sucrose in the EE of Wistar rats. In a controlled experiment of 17 weeks, 24 Wistar rats were divided into 2 groups: saccharin-sweetened yogurt (SAC) or sucrose-sweetened yogurt (SUC), plus a free chow diet. Only rats that consumed at least 70% of the offered yogurt were included. EE (kcal/day) was determined at rest through open circuit indirect calorimetry system in the early post-absorptive period with determinations of both VO2 consumption and CO2 production. Measurements were evaluated at baseline, 5 and 12 weeks of dietary intervention. Weight gain, caloric intake (from yogurt, from chow and total) were determined weekly. RESULTS: Body weight and EE were similar between groups at baseline: (p = .35) and (p = .67) respectively. At the end of the study, SAC increased total weight gain significantly more in relation to SUC (p = .03). Cumulative total caloric intake (yogurt plus chow) was similar between groups during the whole period (p = .54). At 12 weeks, the EE was smaller in SAC compared to SUC (p = .009). Considering both groups, there was a strong negative correlation between total weight gain and change in EE observed [r(20) = -.61, p = .003]. However, when analyzing the groups separately we found that SUC maintained this inverse correlation [r(8) = -.68, p = .03], while SAC did not [r(10) = -.33, p = .29]. CONCLUSION: These data support the hypothesis that long-term use of saccharin may blunt post-absorptive EE at rest in Wistar rats, which is related to weight gain. On the other hand, long-term sucrose intake can increase energy expenditure in rats. This effect combined can explain, at least partially, the weight gain increases associated to saccharin in relation to sucrose in these animals.

Respiratory Muscle Training Improves Diaphragm Citrate Synthase Activity and Hemodynamic Function in Rats with Heart Failure.

INTRODUCTION:: Enhanced respiratory muscle strength in patients with heart failure positively alters the clinical trajectory of heart failure. In an experimental model, respiratory muscle training in rats with heart failure has been shown to improve cardiopulmonary function through mechanisms yet to be entirely elucidated. OBJECTIVE:: The present report aimed to evaluate the respiratory muscle training effects in diaphragm citrate synthase activity and hemodynamic function in rats with heart failure. METHODS:: Wistar rats were divided into four experimental groups: sedentary sham (Sed-Sham, n=8), trained sham (RMT-Sham, n=8), sedentary heart failure (Sed-HF, n=7) and trained heart failure (RMT-HF, n=7). The animals were submitted to a RMT protocol performed 30 minutes a day, 5 days/week, for 6 weeks. RESULTS:: In rats with heart failure, respiratory muscle training decreased pulmonary congestion and right ventricular hypertrophy. Deleterious alterations in left ventricular pressures, as well as left ventricular contractility and relaxation, were assuaged by respiratory muscle training in heart failure rats. Citrate synthase activity, which was significantly reduced in heart failure rats, was preserved by respiratory muscle training. Additionally, a negative correlation was found between citrate synthase and left ventricular end diastolic pressure and positive correlation was found between citrate synthase and left ventricular systolic pressure. CONCLUSION:: Respiratory muscle training produces beneficial adaptations in the diaphragmatic musculature, which is linked to improvements in left ventricular hemodynamics and blood pressure in heart failure rats. The RMT-induced improvements in cardiac architecture and the oxidative capacity of the diaphragm may improve the clinical trajectory of patients with heart failure.