Publications by authors named "Aparecida Maria Catai"

78 Publications

Cardiovascular benefits of a home-based exercise program in patients with sickle cell disease.

PLoS One 2021 12;16(5):e0250128. Epub 2021 May 12.

Department of Internal Medicine, Sao Paulo State University Julio de Mesquita Filho-Unesp, Botucatu, Sao Paulo, Brazil.

Background: Physical inactivity is an important risk factor for cardiovascular disease. The benefits of exercise in patients with chronic diseases, including cardiovascular diseases, are well established. For patients with sickle cell disease, medical recommendation was to avoid physical exercise for fear of triggering painful crises or increasing the impairment of the cardiopulmonary function. Only recently, studies have shown safety in exercise programs for this population. Despite that, there is no report that assess the effects of physical exercise on cardiac parameters in patients with sickle cell disease.

Objective: This study aimed to evaluate the impact of regular physical exercise (a home-based program) on cardiovascular function in patients with sickle cell disease.

Design: A quasi-randomized prospective controlled trial.

Setting: During the years 2015 and 2016, we started recruiting among adult patients treated at a Brazilian Center for Patients with Sickle Cell Disease to participate in a study involving a home exercise program. The experimental (exercise) and control groups were submitted to clinical evaluation and cardiovascular tests before and after the intervention. Analysis of variance was applied to compare groups, considering time and group factors.

Participants: Twenty-seven adult outpatients with a sickle cell disease diagnosis.

Interventions: Exercise group (N = 14): a regular home-based aerobic exercise program, three to five times per week not exceeding give times per week, for eight weeks; no prescription for the control group (N = 13).

Main Outcome Measures: Echocardiographic and treadmill test parameters.

Results: The exercise group showed significant improvement in cardiovascular tests, demonstrated by increased distance traveled on a treadmill (p<0.01), increased ejection fraction (p < 0.01) and improvement of diastolic function assessed by mitral tissue Doppler E' wave on echocardiography (p = 0.04). None of the patients presented a sickle cell crisis or worsening of symptoms during the exercise program.

Conclusion: The selected home-based exercise program is safe, feasible, and promotes a favorable impact on functional capacity and cardiovascular function in sickle cell disease patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250128PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115779PMC
May 2021

Cardiac Autonomic Modulation of Heart Rate Recovery in Children with Spina Bifida.

Int J Sports Med 2021 Apr 22. Epub 2021 Apr 22.

Departamento Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.

We aimed to analyse cardiac autonomic control by assessing the post-exercise heart rate recovery (HRR) and physical fitness in children and adolescents with spina bifida (SB), compared to participants with typical development. A total of 124 participants, 42 with spina bifida (SB group) and 82 typical developmental controls (CO group) performed the arm cranking exercise test with a gas analysis system. HRR was determined at the first (HRR_1) and second (HRR_2) minute at recovery phase. Data are shown as [mean difference (95% CI)]. The SB group showed reduced HR reserve [14.5 (7.1-22.0) bmp, P<0.01], slower HRR_1 [12.4 (7.4-17.5) bpm, P<0.01] and HRR_2 [16.3 (10.6-21.9) bpm; P<0.01], lower VO [VO relative: 7.3 (4.2-10.3) mL·min·kg, P<0.01; VO absolute: 0.42 (0.30-0.54) L·min, P<0.01], and lower O pulse [2.5 (1.8-3.2) mL·bpm, P<0.01] and ventilatory responses [13.5 (8.8-18.1) L·min, P<0.01] than the CO group. VE/VO was not different between groups [-2.82 (-5.77- -0.12); P=0.06], but the VE/VCO [-2.59 (-4.40-0.78); P<0.01] and the values of the anaerobic threshold corrected by body mass [-3.2 (-5.8- -0.6) mL·min·kg, P=0.01] were higher in the SB group than in the CO group. We concluded that children and adolescents with SB have reduced physical fitness and a slower HRR response after maximal effort.
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http://dx.doi.org/10.1055/a-1393-6472DOI Listing
April 2021

Noninvasive Intracranial Pressure Monitoring in Chronic Stroke Patients with Sedentary Behavior: A Pilot Study.

Acta Neurochir Suppl 2021 ;131:55-58

Department of Physical Therapy, Federal University of São Carlos-UFSCar, São Carlos, São Paulo, Brazil.

Objective: This study aimed to correlate the P2/P1 ratio of intracranial pressure waveforms with sedentary behavior during the chronic stage of stroke.

Materials And Methods: Eight patients from São Carlos, Brazil, who had hemiparesis and stroke onset within the previous 6 months, participated in this study. To monitor their intracranial pressure, we used noninvasive Brain4Care intracranial pressure monitoring during a postural change maneuver involving 15 min in a supine position and 15 min in an orthostatic position. The patients' sedentary behavior was continually monitored at home using a StepWatch Activity Monitor™ for 1 week. Moreover, the patients completed the International Physical Activity Questionnaire before and after using the StepWatch Activity Monitor™.

Results: In the supine and orthostatic positions, the P2/P1 ratios were 0.84 ± 0.14 and 0.98 ± 0.17, respectively. The percentage of time spent in inactivity was 71 ± 11%, and the number of steps walked per day was 4220 ± 2239. We found a high positive correlation (r = 0.881, p = 0.004) between the P2/P1 ratio and the percentage of time spent in inactivity.

Conclusion: This preliminary study showed a correlation between sedentary behavior and cerebral compliance. Thus, monitoring of intracranial pressure during the late stage of a stroke could guide the clinician's treatment to reduce sedentary behavior and the risks of recurrent stroke and cardiovascular diseases.
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http://dx.doi.org/10.1007/978-3-030-59436-7_12DOI Listing
June 2021

Ten-year follow-up of cardiac function and neural regulation in a group of amateur half-marathon runners.

Open Heart 2021 02;8(1)

Department of Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Milano, Italy

Objective: In the last years, a debate exists about type, intensity and frequency of physical exercise that is really indicated to protect healthy subjects from cardiovascular disease. Regular physical training has been associated with an improved cardiovascular risk profile, but it has also been demonstrated that strenuous and uncontrolled physical exercise could be dangerous, in terms of increased cardiovascular morbidity and mortality. In the present study, we evaluated a group of 35 amateur half-marathon runners, who were likewise studied 10 years before (B). The results of B suggested that an increased cardiac sympathetic modulation could potentially represent a negative prognostic factor. The aim of this follow-up was to assess the medium-long-term effects of moderate to vigorous physical training on the cardiovascular neural control, cardiac function and occurrence of cardiovascular diseases.

Methods: Each enrolled subject underwent: (1) an interview and physical examination to ascertain the presence of cardiovascular disease; (2) standing test to evaluate the cardiovascular neural control by means of heart rate variability (HRV), arterial blood pressure (AP) variability and baroreflex sensitivity (BRS); (3) transthoracic echocardiography to evaluate cardiac function.

Results: At 10-year follow-up (FU), in this group of middle-aged athletes the occurrence of cardiovascular diseases was low, not unlike that of the overall population. The results of HRV analysis showed a decreased sympathetic and increased vagal modulation directed to the heart, compared with B. In addition, HRV, AP variability and BRS indices showed a physiological response to active standing. Finally, athletes had normal echocardiographic measures.

Conclusion: We conclude that in our group of athletes a regular moderate-vigorous physical training through the 10 years was quite beneficial as the prevalence of sympathetic cardiac modulation observed at B was not accompanied by increased cardiovascular risk, on the contrary a slight prevalence of vagal indices was observed at FU.
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http://dx.doi.org/10.1136/openhrt-2020-001561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875294PMC
February 2021

Underlying mechanisms of oxygen uptake kinetics in chronic post-stroke individuals: A correlational, cross-sectional pilot study.

PLoS One 2020 9;15(11):e0241872. Epub 2020 Nov 9.

Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.

Post-stroke individuals presented deleterious changes in skeletal muscle and in the cardiovascular system, which are related to reduced oxygen uptake ([Formula: see text]) and take longer to produce energy from oxygen-dependent sources at the onset of exercise (mean response time, MTRON) and during post-exercise recovery (MRTOFF). However, to the best of our knowledge, no previous study has investigated the potential mechanisms related to [Formula: see text] kinetics response (MRTON and MRTOFF) in post-stroke populations. The main objective of this study was to determine whether the MTRON and MRTOFF are related to: 1) body composition; 2) arterial compliance; 3) endothelial function; and 4) hematological and inflammatory profiles in chronic post-stroke individuals. Data on oxygen uptake ([Formula: see text]) were collected using a portable metabolic system (Oxycon Mobile®) during the six-minute walk test (6MWT). The time to achieve 63% of [Formula: see text] during a steady state (MTRON) and recovery (MRTOFF) were analyzed by the monoexponential model and corrected by a work rate (wMRTON and wMRTOFF) during 6MWT. Correlation analyses were made using Spearman's rank correlation coefficient (rs) and the bias-corrected and accelerated bootstrap method was used to estimate the 95% confidence intervals. Twenty-four post-stroke participants who were physically inactive took part in the study. The wMRTOFF was correlated with the following: skeletal muscle mass (rs = -0.46), skeletal muscle mass index (rs = -0.45), augmentation index (rs = 0.44), augmentation index normalized to a heart rate of 75 bpm (rs = 0.64), reflection magnitude (rs = 0.43), erythrocyte (rs = -0.61), hemoglobin (rs = -0.54), hematocrit (rs = -0.52) and high-sensitivity C-reactive protein (rs = 0.58), all p < 0.05. A greater amount of oxygen uptake during post-walking recovery is partially related to lower skeletal muscle mass, greater arterial stiffness, reduced number of erythrocytes and higher systemic inflammation in post-stroke individuals.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241872PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652273PMC
January 2021

Preclinical validation of occupational and environmental safety of an isolation system for noninvasive ventilation in COVID-19 and other aerosol-transmitted infections.

Expert Rev Med Devices 2020 Nov 15;17(11):1211-1220. Epub 2020 Nov 15.

Department of Chemistry, São Carlos Federal University , São Carlos, São Paulo, Brazil.

: The current SARS-CoV-2 pandemic has provoked the collapse of some health systems due to insufficient intensive care unit capacity. The use of continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) therapies has been limited in consideration of the risk of occupational infection in health-care professionals. : In preclinical experimental simulations, evaluate occupational and environmental safety of the newly developed isolation system for aerosol-transmitted infections (ISATI). : Simulations were conducted to test ISATI's capability to isolate aerosolized molecular (caffeine), and biological (SARS-CoV-2 synthetic RNA) markers. Caffeine deposition was analyzed on nitrocellulose sensor discs by proton nuclear magnetic resonance spectroscopy. Synthetic SARS-CoV-2 detection was performed by reverse transcription-polymerase chain reaction. : ISATI demonstrated efficacy in isolating molecular and biological markers within the enclosed environment in simulated conditions of CPAP, HFNO and mechanical ventilation therapy. Neither the molecular marker nor substantial amounts of synthetic SARS-CoV-2 RNA were detected in the surrounding environment, outside ISATI, indicating appropriate occupational safety for health-care professionals. : Aerosolized markers were successfully contained within ISATI in all experimental simulations, offering occupational and environmental protection against the dissemination of aerosolized microparticles under CPAP or HFNO therapy conditions, which are indicated for patients with acute respiratory infections.
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http://dx.doi.org/10.1080/17434440.2020.1842190DOI Listing
November 2020

Non-invasive ventilation improves exercise tolerance and peripheral vascular function after high-intensity exercise in COPD-HF patients.

Respir Med 2020 11 25;173:106173. Epub 2020 Sep 25.

Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil. Electronic address:

Aim: Evaluate the acute effects of non-invasive positive pressure ventilation (NiPPV) during high-intensity exercise on endothelial function in patients with coexisting chronic obstructive pulmonary disease (COPD) and heart failure (HF).

Methods: This is a randomized, double blinded, sham-controlled study involving 14 COPD-HF patients, who underwent a lung function test and Doppler echocardiography. On two different days, patients performed incremental cardiopulmonary exercise testing (CPET) and two constant-work rate tests (80% of CPET peak) receiving Sham or NiPPV (bilevel mode - Astral 150) in a random order until the limit of tolerance (Tlim). Endothelial function was evaluated by flow mediated vasodilation (FMD) at three time points: 1) Baseline; 2) immediately post-exercise with NiPPV; and 3) immediately post-exercise with Sham.

Results: Our patients had a mean age of 70 ± 7 years, FEV 1.9 ± 0.7 L and LVEF 41 ± 9%. NIPPV resulted in an increased Tlim (NiPPV: 130 ± 29s vs Sham: 98 ± 29s p = 0.015) and SpO (NiPPV: 94.7 ± 3.5% vs Sham: 92.7 ± 5.2% p = 0.03). Also, NiPPV was able to produce a significant increase in FMD (%) (NiPPV: 9.2 ± 3.1 vs Sham: 3.6 ± 0.7, p < 0.05), FMD (mm) (NiPPV: 0.41 ± 0.18 vs Sham: 0.20 ± 0.11, p < 0.05), Blood flow velocity (NiPPV: 33 ± 18 vs Baseline: 20 ± 14, p < 0.05) and Shear Stress (SS) (NiPPV: 72 ± 38 vs Baseline: 43 ± 25, p < 0.05). We found correlation between Tlim vs. ΔSS (p = 0.03; r = 0.57). Univariate-regression analysis revealed that increased SS influenced 32% of Tlim during exercise with NiPPV.

Conclusion: NiPPV applied during high-intensity exercise can acutely modulate endothelial function and improve exercise tolerance in COPD-HF patients. In addition, the increase of SS positively influences exercise tolerance.
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http://dx.doi.org/10.1016/j.rmed.2020.106173DOI Listing
November 2020

Cardiac autonomic responses to different tasks in office workers with access to a sit-stand table - a study in real work setting.

Ergonomics 2021 Mar 8;64(3):354-365. Epub 2020 Oct 8.

Department of Physical Therapy, Clinical and Occupational Kinesiology Laboratory, Federal University of São Carlos, Sao Carlos, Brazil.

The aim of this study was to characterise the cardiac autonomic modulation of different office tasks performed by office workers with access to a sit-stand table. Heart rate variability (HRV) of 24 office workers was measured for two hours during three days in the last week of sit-stand table use. HRV indexes and the percentage of heart rate reserve (%HRR) were calculated during computer and non-computer work tasks while sitting or standing, non-computer tasks away from the work desk, and informal work breaks. All cardiac autonomic responses demonstrated a statistically significant interaction effect between the tasks (all  < 0.05) except for the logarithmically-transformed high frequency power (ln HF ms;  = 0.14). Tasks performed while standing and away from the desk had higher sympathetic modulation; in addition, the observed higher %HRR demonstrated that these tasks were more physically demanding in comparison to other tasks. Prior reports indicated benefits based on alternated body postures using sit-stand table. Nevertheless, the cardiac autonomic responses of different tasks performed by office workers are unknown. This cross-sectional study showed that different tasks stimulate the cardiac autonomic nervous system in different ways, which could bring positive effects to the cardiovascular system.
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http://dx.doi.org/10.1080/00140139.2020.1830184DOI Listing
March 2021

Relationship between maximal aerobic power with aerobic fitness as a function of signal-to-noise ratio.

J Appl Physiol (1985) 2020 09 30;129(3):522-532. Epub 2020 Jul 30.

Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.

Efforts to better understand cardiorespiratory health are relevant for the future development of optimized physical activity programs. We aimed to explore the impact of the signal quality on the expected associations between the ability of the aerobic system in supplying energy as fast as possible during moderate exercise transitions with its maximum capacity to supply energy during maximal exertion. It was hypothesized that a slower aerobic system response during moderate exercise transitions is associated with a lower maximal aerobic power; however, this relationship relies on the quality of the oxygen uptake data set. Forty-three apparently healthy participants performed a moderate constant work rate (CWR) followed by a pseudorandom binary sequence (PRBS) exercise protocol on a cycle ergometer. Participants also performed a maximum incremental cardiopulmonary exercise testing (CPET). The maximal aerobic power was evaluated by the peak oxygen uptake during the CPET, and the aerobic fitness was estimated from different approaches for oxygen uptake dynamics analysis during the CWR and PRBS protocols at different levels of signal-to-noise ratio. The product moment correlation coefficient was used to evaluate the correlation level between variables. Aerobic fitness was correlated with maximum aerobic power, but this correlation increased as a function of the signal-to-noise ratio. Aerobic fitness is related to maximal aerobic power; however, this association appeared to be highly dependent on the data quality and analysis for aerobic fitness evaluation. Our results show that simpler moderate exercise protocols might be as good as maximal exertion exercise protocols to obtain indexes related to cardiorespiratory health. Optimized methods for cardiorespiratory health evaluation are of great interest for public health. Moderate exercise protocols might be as good as maximum exertion exercise protocols to evaluate cardiorespiratory health. Pseudorandom or constant workload moderate exercise can be used to evaluate cardiorespiratory health.
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http://dx.doi.org/10.1152/japplphysiol.00310.2020DOI Listing
September 2020

Effect of high-intensity exercise on cerebral, respiratory and peripheral muscle oxygenation of HF and COPD-HF patients.

Heart Lung 2021 Jan - Feb;50(1):113-120. Epub 2020 Jul 21.

Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil. Electronic address:

Objective: To investigate cerebral oxygenation (Cox) responses as well as respiratory (Res) and active peripheral muscle (Pm) O delivery during high-intensity cycling exercise and contrast responses between patients with coexistent chronic obstructive pulmonary disease (COPD)-heart failure (HF) and HF alone.

Methods: Cross-sectional study involving 11 COPD-HF and 11 HF patients. On two different days, patients performed maximal incremental cardiopulmonary exercise testing (CPET) and constant load exercise on a cycle ergometer until the limit of tolerance (Tlim). The high-intensity exercise session was 80% of the peak CPET work rate. Relative blood concentrations of oxyhemoglobin ([OHb]), deoxyhemoglobin ([HHb]) of Res, Pm (right vastus lateralis) and Cox (pre-frontal) were measured using near infrared spectroscopy.

Results: We observed a greater decrease in [OHb] at a lower Tlim in COPD-HF when compared to HF (P < 0.05). [HHb] of Res was higher (P < 0.05) and Tlim was lower in COPD-HF vs. HF. Pm and Cox were lower and Tlim was higher in (P < 0.05) HF vs. COPD-HF. In HF, there was a lower ∆[OHb] and higher ∆ [HHb] of Pm when contrasted to Cox observed during exercise, as well as a lower ∆ [OHb] and higher ∆ [HHb] of Res when contrasted with Cox (P < 0.05). However, COPD-HF patients presented with a higher ∆ [HHb] of Res and Pm when contrasted with Cox (P < 0.05).

Conclusion: The coexistence of COPD in patients with HF produces negative effects on Cox, greater deoxygenation of the respiratory and peripheral muscles and higher exertional dyspnea, which may help to explain an even lower exercise tolerance in this multimorbidity phenotype.
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http://dx.doi.org/10.1016/j.hrtlng.2020.06.013DOI Listing
April 2021

Non-linear analysis of the heart rate variability in characterization of manic and euthymic phases of bipolar disorder.

J Affect Disord 2020 10 10;275:136-144. Epub 2020 Jul 10.

Transdisciplinary Nucleus for the Study of Chaos and Complexity, NUTECC, São José do Rio Preto Medical School, FAMERP, Avenida Brigadeiro Faria Lima, 54-16 CEP, 15090-000 São José do Rio Preto, SP, Brazil; Department of Cardiology and Cardiovascular Surgery, São José do Rio Preto Medical School, FAMERP, Avenida Brigadeiro Faria Lima, 5416 CEP, 15090-000 São José do Rio Preto, SP, Brazil.

Background: - Bipolar Disorder (BD) has been associated with autonomic nervous system (ANS) dysregulation, with a consequent increase in mortality. Recent work highlights the non-linear analysis of ANS function. Our objective was to compare ANS modulation using recurrence plots (RP) and symbolic analysis (SA) in manic and euthymic phases of BD to controls.

Methods: - Eighteen male patients (33.1 ± 12.0 years) were assessed during mania and at discharge in the euthymic phase compared and to a healthy group matched by age (33.9 ± 10.8 years). Electrocardiographic series (1000 RR intervals, at rest, in supine position) were captured using Polar Advantage RS800CX equipment and Heart Rate Variability (HRV) was analysed using RP and SA. Statistical analysis was performed using ANOVA with Tukey's post-test. The threshold for statistical significance was set at P < 0.05 and Cohen's d effect size was also quantified considering d > 0.8 as an important effect. The study was registered into the Clinical Trials Registration (ClinicalTrials.gov: NCT01272518).

Results: Manic group presented significantly higher linearity before treatment (P<0.05) compared to controls considering RP variables. Cohen's d values had a large effect size ranging from 0.888 to 1.227. In the manic phase, SA showed predominance of the sympathetic component (OV%) with reduction of the parasympathetic component (2LV% and 2UV%) with reversion post treatment including higher Shannon Entropy (SE) indicating higher complexity.

Limitations: - short follow-up (1 month) and small number of patients.

Conclusions: - Non-linear analyzes may be used as supplementary tools for understanding autonomic function in BD during mania and after drug treatment.
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http://dx.doi.org/10.1016/j.jad.2020.07.012DOI Listing
October 2020

Expiratory Flow Limitation at Different Exercise Intensities in Coronary Artery Disease.

Cardiol Res Pract 2020 21;2020:4629548. Epub 2020 May 21.

Department of Physical Therapy, Cardiovascular Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Carlos, São Paulo, Brazil.

Introduction: Expiratory flow limitation (EFL) during moderate intensity exercise is present in patients with myocardial infarction (MI), whereas in healthy subjects it occurs only at a high intensity. However, it is unclear whether this limitation already manifests in those with stable coronary artery disease (CAD) (without MI).

Materials And Methods: Forty-one men aged 40-65 years were allocated into (1) recent MI (RMI) group ( = 8), (2) late MI (LMI) group ( = 12), (3) stable CAD group ( = 9), and (4) healthy control group (CG) ( = 12). All participants underwent two cardiopulmonary exercise tests at a constant workload (moderate and high intensity), and EFL was evaluated at the end of each exercise workload.

Results: During moderate intensity exercise, the RMI and LMI groups presented with a significantly higher number of participants with EFL compared to the CG ( < 0.05), while no significant difference was observed among groups at high intensity exercise ( > 0.05). Moreover, EFL was only present in MI groups during moderate intensity exercise, whereas at high intensity all groups presented EFL. Regarding the degree of EFL, the RMI and LMI groups showed significantly higher values at moderate intensity exercise in relation to the CG. At high intensity exercise, significantly higher values for the degree of EFL were observed only in the LMI group.

Conclusion: The ventilatory limitation at moderate intensity exercise may be linked to the pulmonary consequences of the MI, even subjects with preserved cardiac and pulmonary function at rest, and not to CAD per se.
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http://dx.doi.org/10.1155/2020/4629548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260653PMC
May 2020

A Transfer Entropy Approach for the Assessment of the Impact of Inspiratory Muscle Training on the Cardiorespiratory Coupling of Amateur Cyclists.

Front Physiol 2020 25;11:134. Epub 2020 Feb 25.

Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.

The strength of cardiorespiratory interactions diminishes with age. Physical exercise can reduce the rate of this trend. Inspiratory muscle training (IMT) is a technique capable of improving cardiorespiratory interactions. This study evaluates the effect of IMT on cardiorespiratory coupling in amateur cyclists. Thirty male young healthy cyclists underwent a sham IMT of very low intensity (SHAM, = 9), an IMT of moderate intensity at 60% of the maximal inspiratory pressure (MIP60, = 10) and an IMT of high intensity at the critical inspiratory pressure (CIP, = 11). Electrocardiogram, non-invasive arterial pressure, and thoracic respiratory movement (RM) were recorded before (PRE) and after (POST) training at rest in supine position (REST) and during active standing (STAND). The beat-to-beat series of heart period (HP) and systolic arterial pressure (SAP) were analyzed with the RM signal via a traditional non-causal approach, such as squared coherence function, and via a causal model-based transfer entropy (TE) approach. Cardiorespiratory coupling was quantified via the HP-RM squared coherence at the respiratory rate (), the unconditioned TE from RM to HP (TE) and the TE from RM to HP conditioned on SAP (TE). In PRE condition we found that STAND led to a decrease of TE. After SHAM and CIP training this tendency was confirmed, while MIP60 inverted it by empowering cardiorespiratory coupling. This behavior was observed in presence of unvaried SAP mean and with usual responses of the baroreflex control and HP mean to STAND. TE and were not able to detect the post-training increase of cardiorespiratory coupling strength during STAND, thus suggesting that conditioning out SAP is important for the assessment of cardiorespiratory interactions. Since the usual response of HP mean, SAP mean and baroreflex sensitivity to postural stressor were observed after MIP60 training, we conclude that the post-training increase of cardiorespiratory coupling during STAND in MIP60 group might be the genuine effect of some rearrangements at the level of central respiratory network and its interactions with sympathetic drive and vagal activity.
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http://dx.doi.org/10.3389/fphys.2020.00134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052290PMC
February 2020

Complexity analysis of heart rate variability in chronic obstructive pulmonary disease: relationship with severity and symptoms.

Clin Auton Res 2020 04 14;30(2):157-164. Epub 2020 Jan 14.

Cardiopulmonary Physical Therapy Laboratory (LACAP), Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rodovia, Washington Luís, km 235, Bairro Monjolinho, São Carlos, SP, CEP 13565-905, Brazil.

Purpose: Chronic obstructive pulmonary disease (COPD) negatively impacts autonomic control of the heart rate, as assessed by time and frequency domains of heart rate variability (HRV) analysis. However, it is unknown whether symbolic dynamic analysis may identify cardiac autonomic impairment, and whether such nonlinear indices may be associated with disease severity, prognostic markers, perceived dyspnea and functional capacity in patients with COPD. The current study assessed cardiac autonomic modulation by symbolic analysis of HRV in patients with COPD compared with healthy controls.

Methods: We recruited 54 COPD patients and 20 healthy controls. The interval between two successive R-wave peaks was calculated in the resting supine position. HRV was analyzed using symbolic markers and Shannon entropy (SE). The six-minute walk test (6MWT) was applied in a 30-m corridor.

Results: We found a lower 6MWT distance in patients with COPD compared with healthy controls (p < 0.05). We found increased SE and decreased percentage of no variation patterns (0V%) in COPD patients compared with the control group (p = 0.001). Significant correlations were found between the percentage of one variation pattern (1V%) and the Medical Research Council dyspnea scale (r = 0.38, p = 0.01), BODE index (r = 0.38, p = 0.01), forced expiratory volume in the first second (FEV) [L] (r = -0.44, p = 0.003) and FEV [%] (r = -0.35, p = 0.02). It was found that SE was inversely associated with 0V% (r = -0.87, p < 0.0001).

Conclusion: COPD patients present with depressed sympathetic modulation of HR and higher SE compared with healthy controls. This increased irregularity was inversely associated with 0V%. These results suggested that COPD patients seem to have a cardiac control shifted towards a parasympathetic predominance compared with controls. Symbolic dynamic and complexity index of HRV are related to disease severity, symptoms and functional impairment in these patients.
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http://dx.doi.org/10.1007/s10286-019-00659-zDOI Listing
April 2020

Concomitant Evaluation of Heart Period and QT Interval Variability Spectral Markers to Typify Cardiac Control in Humans and Rats.

Front Physiol 2019 29;10:1478. Epub 2019 Nov 29.

Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.

The variability of heart period, measured as the time distance between two consecutive QRS complexes from the electrocardiogram (RR), was exploited to infer cardiac vagal control, while the variability of the duration of the electrical activity of the heart, measured as the time interval from Q-wave onset to T-wave end (QT), was proposed as an indirect index of cardiac sympathetic modulation. This study tests the utility of the concomitant evaluation of RR variability (RRV) and QT variability (QTV) markers in typifying cardiac autonomic control of humans under different experimental conditions and of rat groups featuring documented differences in resting sympatho-vagal balance. We considered: (i) 23 healthy young subjects in resting supine position (REST) undergoing head-up tilt at 45° (T45) and 90° (T90) followed by recovery to the supine position; (ii) 9 Wistar (WI) and 14 wild-type Groningen (WT) rats in unstressed conditions, where the WT animals were classified as non-aggressive (non-AGG, = 9) and aggressive (AGG, = 5) according to the resident intruder test. In humans, spectral analysis of RRV and QTV was performed over a single stationary sequence of 250 consecutive values. In rats, spectral analysis was iterated over 10-min recordings with a frame length of 250 beats with 80% overlap and the median of the distribution of the spectral markers was extracted. Over RRV and QTV we computed the power in the low frequency (LF, from 0.04 to 0.15 Hz in humans and from 0.2 to 0.75 Hz in rats) band (LF and LF) and the power in the high frequency (HF, from 0.15 to 0.5 Hz in humans and from 0.75 to 2.5 Hz in rats) band (HF and HF). In humans the HF power was lower during T90 and higher during recovery compared to REST, while the LF power was higher during T90. In rats the HF power was lower in WT rats compared to WI rats and the LF power was higher in AGG than in non-AGG animals. We concluded that RRV and QTV provide complementary information in describing the functioning of vagal and sympathetic limbs of the autonomic nervous system in humans and rats.
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http://dx.doi.org/10.3389/fphys.2019.01478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6897045PMC
November 2019

Evaluation of Cardiac Autonomic Modulation Using Symbolic Dynamics After Cardiac Transplantation.

Braz J Cardiovasc Surg 2019 12 1;34(5):572-580. Epub 2019 Dec 1.

Federal University of São Carlos Cardiovascular Physiotherapy Laboratory Physiotherapy Department São Carlos SP Brazil Physiotherapy Department, Cardiovascular Physiotherapy Laboratory (LFCV), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.

Objective: To characterize the behavior of cardiac autonomic modulation in individuals with different times after orthotopic heart transplantation (HTx) using symbolic dynamics analysis.

Methods: Sixty patients were evaluated after HTx. We recorded their instantaneous R-R intervals (RRi) by cardiac monitor Polar® RS800CX™ (Polar Electro Oy, Kempele, Finland) for 10 minutes. The same sequence of RRi with 256 consecutive beats was used to perform spectral analysis and symbolic dynamics analysis. We used hierarchical clustering to form groups. One-way analysis of variance (ANOVA) (with Holm-Sidak method) or one-way Kruskal-Wallis test (with Dunn´s post-hoc test) was used to analyze the difference between groups. Linear correlation analysis between variables was performed using Pearson's or Spearman's tests. P-value < 0.05 was considered statistically significant.

Results: The 0V% index increased, the 2UV% index and the normalized complexity index decreased with an increase of HTx postoperative time. There were a negative correlation between complexity indexes and 0V% and a positive correlation between complexity indexes and 2UV%.

Conclusion: Symbolic dynamics indexes were able to show a specific cardiac autonomic modulation pattern for HTx recipients with different postoperative times.
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http://dx.doi.org/10.21470/1678-9741-2019-0236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852456PMC
December 2019

Acute Effects of the 6-Minute Pegboard and Ring Test in COPD.

Respir Care 2020 Feb 5;65(2):198-209. Epub 2019 Nov 5.

Spirometry and Respiratory Physiotherapy Laboratory.

Background: There are few reports in the literature supporting the understanding of the physiological mechanisms of intolerance in patients with COPD to perform unsupported upper limb activities. The aims of this study were to quantify the electrical activity and oxygenation of inspiratory and upper limb muscles, and to investigate whether electromyographic manifestations of muscle fatigue are related to upper limb function as assessed by the 6-min pegboard and ring test (6PBRT) in subjects with COPD and in healthy subjects.

Methods: Thirty subjects with COPD (FEV 42.1 ± 16.4% predicted; 68.0 ± 7.6 y old) comprised the COPD group, and 34 healthy subjects (66.8 ± 8.0 y old) comprised the control group. Both groups were assessed for body composition with dual-energy radiograph absorptiometry and spirometry. The 6PBRT was performed with simultaneous assessment of electromyography, near-infrared spectroscopy, and gas analyses (expiratory minute volume).

Results: Differences were observed between groups for performance (number of rings) in the 6PBRT, with the COPD group achieving lower values than the control group ( < .001). The ventilatory demand (expiratory minute volume/maximum voluntary ventilation) and root mean square amplitude of the sternocleidomastoid muscle were higher in the COPD group than in the control group ( < .04). Lower values for oxyhemoglobin and total hemoglobin were found in intercostal muscles of the COPD group compared to the control group. The root mean square amplitude of the intercostal muscles was lower in the COPD group, while it was similar between groups for anterior deltoid and trapezius muscles. Median frequency of anterior deltoid muscles presented a decreased in both groups.

Conclusions: Our results indicate that the 6PBRT was performed at a higher electrical activity in the accessory inspiratory muscles, such as the sternocleidomastoid muscle, and a lower oxygenation profile in the intercostal muscles in subjects with COPD compared with healthy controls, but without muscle fatigue signs. These findings suggest that the higher ventilatory demand presented in subjects with COPD could have contributed to the worse performance in this group without signals of peripheral muscle limitation.
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http://dx.doi.org/10.4187/respcare.06948DOI Listing
February 2020

Impact of a Supervised Twelve-Week Combined Physical Training Program in Heart Failure Patients: A Randomized Trial.

Cardiol Res Pract 2019 3;2019:1718281. Epub 2019 Sep 3.

Medical Department, São Carlos Federal University (UFSCar), São Carlos, São Paulo State, Brazil.

Purpose: The aim of this study was to compare the effects of supervised combined physical training and unsupervised physician-prescribed regular exercise on the functional capacity and quality of life of heart failure patients.

Methods: This is a longitudinal prospective study composed of 28 consecutive heart failure with reduced ejection fraction patients randomly divided into two age- and gender-matched groups: trained group ( = 17) and nontrained group ( = 11). All patients were submitted to clinical evaluation, transthoracic echocardiography, the Cooper walk test, and a Quality of Life questionnaire before and after a 12-week study protocol. Categorical variables were expressed as proportions and compared with the chi-square test. Two-way ANOVA was performed to compare the continuous variables considering the cofactor groups and time of intervention, and Pearson correlation tests were conducted for the associations in the same group.

Results: No significant differences between groups were found at baseline. At the end of the protocol, there were improvements in the functional capacity and ejection fraction of the trained group in relation to the nontrained group ( < 0.05). There was time and group interaction for improvement in the quality of life in the trained group.

Conclusions: In patients with heart failure with reduced ejection fraction, supervised combined physical training improved exercise tolerance and quality of life compared with the unsupervised regular exercise prescribed in routine medical consultations. Left ventricular systolic function was improved with supervised physical training.
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http://dx.doi.org/10.1155/2019/1718281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766120PMC
September 2019

Effects of inspiratory muscle-training intensity on cardiovascular control in amateur cyclists.

Am J Physiol Regul Integr Comp Physiol 2019 12 9;317(6):R891-R902. Epub 2019 Oct 9.

Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.

Chronic effects of inspiratory muscle training (IMT) on autonomic function and baroreflex regulation are poorly studied. This study aims at evaluating chronic effects of different IMT intensities on cardiovascular control in amateur cyclists. A longitudinal, randomized, controlled blind study was performed on 30 recreational male cyclists undergoing IMT for 11 wk. Participants were randomly allocated into sham-trained group (SHAM, = 9), trained group at 60% of the maximal inspiratory pressure (MIP60, = 10), and trained group at critical inspiratory pressure (CIP, = 11). Electrocardiogram, finger arterial pressure, and respiratory movements were recorded before (PRE) and after (POST) training at rest in supine position (REST) and during active standing (STAND). From the beat-to-beat series of heart period (HP) and systolic arterial pressure (SAP), we computed time domain markers, frequency domain indexes in the low frequency (0.04-0.15 Hz) and high frequency (HF, 0.15-0.4 Hz) bands, an entropy-based complexity index (CI), and baroreflex markers estimated from spontaneous HP-SAP sequences. Compared with SHAM, the positive effect of MIP60 over the HP series led to the HF power increase during REST (PRE: 521.2 ± 447.5 ms; POST: 1,161 ± 878.9 ms) and the CI rise during STAND (PRE: 0.82 ± 0.18; POST: 0.97 ± 0.13). Conversely, the negative effect of CIP took the form of the decreased HP mean during STAND (PRE: 791 ± 71 ms; POST: 737 ± 95 ms). No effect of IMT was visible over SAP and baroreflex markers. These findings suggest that moderate-intensity IMT might be beneficial when the goal is to limit cardiac sympathetic hyperactivity at REST and/or in response to STAND.
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http://dx.doi.org/10.1152/ajpregu.00167.2019DOI Listing
December 2019

Cardiovascular responses to low-intensity isometric handgrip exercise in coronary artery disease: effects of posture.

Braz J Phys Ther 2020 Sep - Oct;24(5):449-457. Epub 2019 Aug 31.

Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil. Electronic address:

Background: Coronary artery disease (CAD) lead to cardiovascular autonomic control disfunctions that can worsen exercise and/or posture adjustments.

Objectives: To verify the cardiovascular responses to low-intensity isometric handgrip exercise performed in different postures in CAD patients. This study tested the hypothesis that the posture influences the cardiovascular responses during isometric handgrip exercise and that the presence of CAD leads to greater cardiovascular stress during this type of exercise.

Methods: We investigated cardiovascular responses to isometric handgrip exercise in 15 CAD patients (CADG) and 15 health matched-control (CG). The subjects performed isometric handgrip exercise at 30% of maximum voluntary contraction until exhaustion in SUPINE, SITTING and STANDING positions. Systolic arterial pressure, diastolic arterial pressure, mean blood pressure, heart rate, peripheral vascular resistance, cardiac output, stroke volume and double product were measured during rest (baseline), exercise (peak value) and recovery in the 1st minute (REC1). Delta PB (ΔPB, peak minus baseline) and PR1 (ΔPR1, peak minus REC1) were calculated.

Results: Higher ΔPB and ΔPR1 of systolic and mean arterial pressure and double product were observed in STANDING when compared to SITTING and/or SUPINE. CADG showed higher ΔPB of systolic and mean arterial pressure in all postures and higher ΔPR1 of strove volume in the SITTING.

Conclusion: We concluded that the posture during isometric handgrip exercise influences the cardiovascular responses with STANDING leading to higher cardiovascular stress. CAD promoted higher arterial pressure responses however these responses were physiological and expected due to the presence of disease and type of exercise.
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http://dx.doi.org/10.1016/j.bjpt.2019.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564016PMC
April 2021

Correction to: Effect of aerobic exercise prior to modified constraint-induced movement therapy outcomes in individuals with chronic hemiparesis: a study protocol for a randomized clinical trial.

BMC Neurol 2019 Sep 13;19(1):225. Epub 2019 Sep 13.

Department of Physiotherapy, Laboratory of Neurological Physiotherapy Research, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil.

Following publication of the original article [1], the authors reported an error in Table 2 wherein the item numbering in the first column is wrong.
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http://dx.doi.org/10.1186/s12883-019-1454-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743167PMC
September 2019

Photobiomodulation effect on local hemoglobin concentration assessed by near-infrared spectroscopy in humans.

Lasers Med Sci 2020 Apr 16;35(3):641-649. Epub 2019 Aug 16.

Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.

Exposure of biological tissue to photobiomodulation therapy (PBMT) seems to increase the oxygen availability and mitochondrial electrochemical activity. With the advancement of new technologies, such as near-infrared spectroscopy (NIRS), information can be obtained about the balance between oxygen utilization and delivery by assessing local oxy- ([OHb]) and deoxy-myohemoglobin ([HHb]) concentrations, both measured in micromolars (μM). Consequently, NIRS can be used to study ("in vivo") PBMT effects on the oxidative system, including oxygen availability. Thus, the main objective of the present study was to use NIRS to investigate the acute effects of PBMT by light-emitting diode (LED) on the oxygen delivery and utilization in humans. Twelve healthy young participants were treated with a LED device (850 nm, 50 mW, 2 J) and placebo applied over the proximal third of the flexor carpi ulnaris muscle of the left or right forearm selected in a random order. The LED was applied in direct contact with skin and the device was switched on for 40 s in 4 different interventions (I, I, I and I) with a 3-min interval between interventions. The placebo condition was considered as the period before the first PBMT. The NIRS device was used to evaluate the relative changes in [OHb] and [HHb] before and after placebo and interventions. We found that PBMT statistically increased the [OHb] in 0.39 μM. These results demonstrate the potential of PBMT to increase oxygen availability.
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http://dx.doi.org/10.1007/s10103-019-02861-xDOI Listing
April 2020

Effect of aerobic exercise prior to modified constraint-induced movement therapy outcomes in individuals with chronic hemiparesis: a study protocol for a randomized clinical trial.

BMC Neurol 2019 Aug 15;19(1):196. Epub 2019 Aug 15.

Department of Physiotherapy, Laboratory of Neurological Physiotherapy Research, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil.

Background: Recovery of upper limb function in individuals after a stroke remains challenging. Modified constraint-induced movement therapy (m-CIMT) has strong evidence for increasing the use and recovery of sensorimotor function of the paretic upper limb. Recent studies have shown that priming with aerobic exercise prior to task-specific training potentiates upper limb recovery in individuals with stroke. This protocol describes a randomized clinical trial designed to determine whether priming with moderate-high intensity aerobic exercise prior to m-CIMT will improve the manual dexterity of the paretic upper limb in individuals with chronic hemiparesis.

Methods: Sixty-two individuals with chronic hemiparesis will be randomized into two groups: Aerobic exercise + m-CIMT or Stretching + m-CIMT. m-CIMT includes 1) restraint of the nonparetic upper limb for 90% of waking hours, 2) intensive task-oriented training of the paretic upper limb for 3 h/day for 10 days and 3) behavior interventions for improving treatment adherence. Aerobic exercise will be conducted on a stationary bicycle at intervals of moderate to high intensity. Participants will be evaluated at baseline, 3, 30, and 90 days postintervention by the following instruments: Motor Activity Log, Nottingham Sensory Assessment, Wolf Motor Function Test, Box and Block Test, Nine-Hole Peg Test, Stroke Specific Quality of Life Scale and three-dimensional kinematics. The data will be tested for normality and homogeneity. Parametric data will be analyzed by two-way ANOVA with repeated measures and Bonferroni's adjustment. For nonparametric data, the Friedman test followed by the Wilcoxon test with Bonferroni's adjustment will be used to compare the ratings for each group. To compare the groups in each assessment, the Mann-Whitney test will be used.

Discussion: This study will provide valuable information about the effect of motor priming for fine upper limb skill improvement in people with chronic poststroke hemiparesis, bringing new evidence about the association of two therapies commonly used in clinical practice.

Trial Registration: This trial was retrospectively registered (registration number RBR-83pwm3 ) on 07 May 2018.
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http://dx.doi.org/10.1186/s12883-019-1421-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694597PMC
August 2019

Cardiac baroreflex hysteresis is one of the determinants of the heart period variability asymmetry.

Am J Physiol Regul Integr Comp Physiol 2019 10 31;317(4):R539-R551. Epub 2019 Jul 31.

Department of Cardiothoracic, Vascular Anesthesia, and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy.

In heart period (HP) variability (HPV) recordings the percentage of negative HP variations tends to be greater than that of positive ones and this pattern is referred to as HPV asymmetry (HPVA). HPVA has been studied in several experimental conditions in healthy and pathological populations, but its origin is unclear. The baroreflex (BR) exhibits an asymmetric behavior as well given that it reacts more importantly to positive than negative arterial pressure (AP) variations. We tested the hypothesis that the BR asymmetry (BRA) is a HPVA determinant over spontaneous fluctuations of HP and systolic AP (SAP). We studied 100 healthy subjects (age from 21 to 70 yr, 54 men) comprising 20 subjects in each age decade. Electrocardiogram and noninvasive AP were recorded for 15 min at rest in supine position (REST) and during active standing (STAND). The HPVA was evaluated via Porta's index and Guzik's index, while the BRA was assessed as the difference, and normalized difference, between BR sensitivities computed over positive and negative SAP variations via the sequence method applied to HP and SAP variability. HPVA significantly increased during STAND and decreased progressively with age. BRA was not significantly detected both at REST and during STAND. However, we found a significant positive association between BRA and HPVA markers during STAND persisting even within the age groups. This study supports the use of HPVA indexes as descriptors of BRA and identified a challenge soliciting the BR response like STAND to maximize the association between HPVA and BRA markers.
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http://dx.doi.org/10.1152/ajpregu.00112.2019DOI Listing
October 2019

Acute effect of photobiomodulation using light-emitting diodes (LEDs) on baroreflex sensitivity during and after constant loading exercise in patients with type 2 diabetes mellitus.

Lasers Med Sci 2020 Mar 15;35(2):329-336. Epub 2019 Jun 15.

Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.

To evaluate the photobiomodulation (PBM) effect on the cardiovascular autonomic control, analyzed by baroreflex sensitivity (sequence method), during constant load exercise and recovery in diabetic men, we evaluated 11 men with type 2 diabetes (DM2) (40-64 years). The constant workload exercise protocol (TECC) was performed on two different days, 14 days apart from each other, to guarantee PBM washout period. After PBM by light-emitting diode (LED) irradiation (150 J or 300 J or placebo), 10 min of rest (REST) was performed. After this period, the volunteer was positioned on a cycloergometer to start the test (1-min rest, 3-min free-load heating, 6-min constant workload-EXERCISE, 6-min free-load cool-down, 1-min rest) followed by a sitting period of 10 min (RECOVERY). The constant workload corresponded to 80%VO (gas exchange threshold) identified by a previous cardiopulmonary exercise test (CPET). PBM was applied in continuous mode, contact technique, bilaterally, on both femoral quadriceps and gastrocnemius muscle groups. The electrocardiogram R-R intervals (BioAmp FE132) and the peripheral pulse pressure signals (Finometer PRO) were collected continuously throughout the protocol. Stable sequences of 256 points were chosen at REST, EXERCISE, and RECOVERY. The baroreflex sensitivity (BRS) was computed in time domain according to the sequence method (α). The comparison between therapies (150 J/300 J/placebo) and condition (REST, EXERCISE, and RECOVERY) was performed using the ANOVA two-way repeated measures test. There was no interaction between therapy and conditions during the TECC. There was only the condition effect (p < 0.001), showing that the behavior of α was similar regardless of the therapy. Photobiomodulation with 150 J or 300 J applied previously to a moderate-intensity TECC in DM2 was not able to promote cardiovascular autonomic control changes leading to an improvement in BRS.
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http://dx.doi.org/10.1007/s10103-019-02815-3DOI Listing
March 2020

Cardiovascular autonomic modulation and baroreflex control in the second trimester of pregnancy: A cross sectional study.

PLoS One 2019 14;14(5):e0216063. Epub 2019 May 14.

Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.

Purpose: The aim is to evaluate and characterize cardiovascular autonomic control and baroreflex function and their response to an orthostatic stressor in the second trimester of pregnancy via time, frequency, information and symbolic analyses.

Methods: We evaluated 22 women at 18 weeks of pregnancy, labeled as pregnant group (PG) (30.8±4.4 years), and 22 non-pregnant women (29.8±5.4 years), labeled as control group (CG). Electrocardiogram, non-invasive photoplethysmographic arterial pressure (AP) and respiratory signals were recorded at rest at left lateral decubitus (REST) and during active standing (STAND) for 10 minutes. The heart period (HP) variability and systolic AP (SAP) variability were assessed in the frequency domain. High frequency (HF) and low frequency (LF) spectral indexes were computed. Nonlinear indexes such as symbolic markers (0V%, 1V%, 2LV% and 2UV% indexes), Shannon entropy (SE) and normalized complexity index (NCI) were calculated as well. Baroreflex control was assessed by cross-spectral HP-SAP analysis. We computed baroreflex sensitivity (BRS), HP-SAP squared coherence (K2) and phase in LF and HF bands.

Results: At REST, the PG had lower mean, variance and HF power of HP series and lower K2(LF), BRS(LF) and BRS(HF) than the CG. During STAND, CG and PG decreased the mean, CI, NCI and 2UV% and increased 0V% of the HP series and augmented the SAP variance. LFabs of SAP series increased during STAND solely in CG. BRS(HF) was reduced during in both PG and CG, while HFabs of HP series did not diminish during STAND either in PG or CG. Complexity of the autonomic control was similar in PG and CG regardless of the experimental condition.

Conclusion: We conclude that the second trimester of pregnancy was characterized by a lower parasympathetic modulation and reduced BRS at REST, preserved complexity of cardiac and vascular controls, limited sympathetic response to STAND and general conservation of the baroreflex responses to posture changes.

Trial Registration: Begistro Brasileiro de Ensaios clínicos, Number: RBR-9s8t88.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216063PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516729PMC
January 2020

Critical inspiratory pressure - a new methodology for evaluating and training the inspiratory musculature for recreational cyclists: study protocol for a randomized controlled trial.

Trials 2019 May 7;20(1):258. Epub 2019 May 7.

Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil.

Background: Inspiratory muscle training (IMT) has brought great benefits in terms of improving physical performance in healthy individuals. However, there is no consensus regarding the best training load, as in most cases the maximal inspiratory pressure (MIP) is used, mainly the intensity of 60% of MIP. Therefore, prescribing an IMT protocol that takes into account inspiratory muscle strength and endurance may bring additional benefits to the commonly used protocols, since respiratory muscles differ from other muscles because of their greater muscular resistance. Thus, IMT using critical inspiratory pressure (PThC) can be an alternative, as the calculation of PThC considers these characteristics. Therefore, the aim of this study is to propose a new IMT protocol to determine the best training load for recreational cyclists.

Methods: Thirty recreational cyclists (between 20 and 40 years old) will be randomized into three groups: sham (SG), PThC (CPG) and 60% of MIP, according to age and aerobic functional capacity. All participants will undergo the following evaluations: pulmonary function test (PFT), respiratory muscle strength test (RMS), cardiopulmonary exercise test (CPET), incremental inspiratory muscle endurance test (iIME) (maximal sustained respiratory pressure for 1 min (PTh)) and constant load test (CLT) (95%, 100% and 105% of PTh) using a linear load inspiratory resistor (PowerBreathe K5). The PThC will be calculated from the inspiratory muscle endurance time (T) and inspiratory loads of each CLT. The IMT will last 11 weeks (3 times/week and 55 min/session). The session will consist of 5-min warm-up (50% of the training load) and three sets of 15-min breaths (100% of the training load), with a 1-min interval between them. RMS, iIME, CLT and CPET will be performed beforehand, at week 5 and 9 (to adjust the training load) and after training. PFT will be performed before and after training. The data will be analyzed using specific statistical tests (parametric or non-parametric) according to the data distribution and their respective variances. A p value <0.05 will be considered statistically significant.

Discussions: It is expected that the results of this study will enable the training performed with PThC to be used by health professionals as a new tool to evaluate and prescribe IMT.

Trial Registration: ClinicalTrials.gov, NCT02984189 . Registered on 6 December 2016.
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http://dx.doi.org/10.1186/s13063-019-3353-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505302PMC
May 2019

Heart rate variability: are you using it properly? Standardisation checklist of procedures.

Braz J Phys Ther 2020 Mar - Apr;24(2):91-102. Epub 2019 Feb 26.

School of Technology and Sciences, São Paulo State University (UNESP), Presidente Prudente, SP, Brazil.

Background: Heart rate variability is used as an assessment method for cardiac autonomic modulation. Since the Task Force's publication on heart rate variability in 1996, the European Heart Rhythm Association Position Paper in 2015 and a recent publication in 2017, attention has been paid to recommendations on using heart rate variability analysis methods, as well as their applications in different physiological conditions and clinical studies. This analysis has proved to be useful as a complementary tool for clinical evaluation and to assess the effect of non-pharmacological therapeutic interventions, such as physical exercise programmes, on cardiac autonomic modulation.

Objective: The aim of this article is to make recommendations and to develop a checklist of normalisation procedures regarding the use of heart rate variability data collection and analysis methodology, focusing on the cardiology area and cardiac rehabilitation.

Methods: Based on previous heart rate variability publications, this paper provides a description of the most common shortcomings of using the analysis methods and considers recommendations and suggestions on how to minimise these occurrences by using a specific checklist.

Conclusions: This article includes recommendations and a checklist regarding the use of heart rate variability collection and analysis methods. This work could help improve reporting on clinical evaluation and therapeutic intervention results and consequently, disseminate heart rate variability knowledge.
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http://dx.doi.org/10.1016/j.bjpt.2019.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082649PMC
July 2020

The additional impact of type 2 diabetes on baroreflex sensitivity of coronary artery disease patients might be undetectable in presence of deterioration of mechanical vascular properties.

Med Biol Eng Comput 2019 Jul 7;57(7):1405-1415. Epub 2019 Mar 7.

Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.

Both deterioration of the mechanical vascular properties of barosensitive vessels and autonomic derangement lead to modification of baroreflex sensitivity (BRS) in coronary artery disease (CAD) individuals. Type 2 diabetes (T2D) reduces BRS as well even in absence of cardiac autonomic neuropathy. The aim of the study is to clarify whether, assigned the degree of mechanical vascular impairment and without cardiac autonomic neuropathy, the additional autonomic dysfunction imposed in CAD patients by T2D (CAD-T2D) decreases BRS further. We considered CAD (n = 18) and CAD-T2D (n = 19) males featuring similar increases of average carotid intima media thickness (ACIMT) and we compared them to age- and gender-matched healthy (H, n = 19) subjects. BRS was computed from spontaneous beat-to-beat variability of heart period (HP) and systolic arterial pressure (SAP) at supine resting (REST) and during active standing (STAND). BRS was estimated via methods including time domain, spectral, cross-spectral, and model-based techniques. We found that (i) at REST BRS was lower in CAD and CAD-T2D groups than in H subjects but no difference was detected between CAD and CAD-T2D individuals; (ii) STAND induced an additional decrease of BRS visible in all the groups but again BRS estimates of CAD and CAD-T2D patients were alike; (iii) even though with different statistical power, BRS markers reached similar conclusions with the notable exception of the BRS computed via model-based approach that did not detect the BRS decrease during STAND. In presence of a mechanical vascular impairment, indexes estimating BRS from spontaneous HP and SAP fluctuations might be useless to detect the additional derangement of the autonomic control in CAD-T2D without cardiac autonomic neuropathy compared to CAD, thus limiting the applications of cardiovascular variability analysis to typify CAD-T2D individuals. Graphical abstract Graphical representation of the baroreflex sensitivity (BRS) estimated from spontaneous fluctuations of heart period and systolic arterial pressure via transfer function (TF) in low frequency (LF) band (from 0.04 to 0.15 Hz). BRS was reported as a function of the group (i.e., healthy (H), coronary artery disease (CAD) and CAD with type 2 diabetes (CAD-T2D) groups) at REST (black bars) and during STAND (white bars). Values are shown as mean plus standard deviation. The symbol "*" indicates a significant difference between conditions within the same group (i.e., H, CAD, or CAD-T2D) and the symbol "§" indicates a significant difference between groups within the same experimental condition (i.e., REST or STAND). BRS cannot distinguish CAD and CAD-T2D groups both at REST and during STAND, while it is useful to distinguish experimental conditions and separate pathological groups from H subjects.
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http://dx.doi.org/10.1007/s11517-019-01966-3DOI Listing
July 2019

Effects of light-emitting diode therapy (LEDT) on cardiopulmonary and hemodynamic adjustments during aerobic exercise and glucose levels in patients with diabetes mellitus: A randomized, crossover, double-blind and placebo-controlled clinical trial.

Complement Ther Med 2019 Feb 15;42:178-183. Epub 2018 Nov 15.

Federal University of São Carlos, Cardiovascular Physical Therapy Laboratory, Department of Physiotherapy, Rod. Washington Luís, km 235, São Carlos, 13.565-905, Brazil. Electronic address:

The aim of this study was to evaluate the acute effects of light-emitting diode therapy (LEDT) on cardiopulmonary adjustments and muscle oxygenation dynamics during transition to moderate exercise, as well as in glucose and lactate levels in patients with type 2 diabetes mellitus (T2DM). Sixteen individuals with T2DM (age 55.1±5.4 years) performed four separate tests receiving LEDT or placebo in random order, at intervals of at least 14 days. A light-emitting diode array (50GaAIAs LEDs, 850nm, 75mW per diode) was used to perform LEDT bilaterally on the quadriceps femoris and triceps surae muscles for 40s at each site. After, a moderate cycling exercise was performed and oxygen uptake, muscular deoxyhemoglobin, heart rate and cardiac output were measured. Lactate and glucose levels were measured before LEDT/placebo and after the exercise. The LEDT decreased the glucose levels after the exercise compared with values before LEDT (173.7±61.0 to 143.5±53.5 mg/dl, P=0.02) and it did not affect the cardiopulmonary and hemodynamic adjustments in exercise, as well as lactate levels in both groups. In conclusion, the LEDT in combination with moderate exercise acutely decreased the glucose levels in men with T2DM.
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http://dx.doi.org/10.1016/j.ctim.2018.11.015DOI Listing
February 2019