André Luiz Lopes

Intensive practical lifestyle intervention improves endothelial function in metabolic syndrome independent of weight loss: a randomized controlled trial

The objective was to evaluate the metabolic and vascular effects of lifestyle interventions involving a healthy diet and either a moderate- or a high-intensity exercise regimen in nondiabetic subjects with metabolic syndrome. The effects of these interventions on flow-mediated vasodilation (FMD) and risk profiles were compared with a standard low-fat diet and engaging in daily walking (standard of care). Seventy-five healthy adults with metabolic syndrome (30-55 years old) were randomized to a 10,000-steps-a-day exercise program, a 3-times-a-week fitness (>75% peak VO(2)) program, or a 1-hour-walking-a-day program for 12 weeks. The first 2 interventions were combined with an accessible healthy, no-sugar diet; and the third was combined with a tailored low-fat diet. The outcomes, including FMD and risk factors, were examined at 12 weeks and at 1-year reassessment. Significant increase in FMD (mean difference = 1.51%, 95% confidence interval = 1.05%-3.017%, P = .0007) and decrease in arterial pressure (mean difference = 19.3 ± 2.3/-12.6 ± 1.8 mm Hg, P = .0001) were observed in all groups. However, the FMD changed most favorably in the high-intensity, low-sugar group (mean difference = 1.56%, 95% confidence interval = 0.1%-3.02%, P = .036). Significant improvements in body mass index, waist, insulin-like growth factor-1, homeostasis model assessment of insulin resistance, insulin, glucose, urinary albumin excretion, and lipid profiles occurred in all groups. Metabolic syndrome was resolved in 64%. One year later, weight loss (-9.1 ± 2.3 kg, P = .0001) and arterial pressure decrease (-18.5 ± 2.3/-12.3 ± 2.1 mm Hg, P = .0001) were maintained. Practical, health-centered diet combined with high-intensity exercise is associated with enhanced vascular protection. These data suggest that more intense exercise combined with a low-sugar diet modulates endothelium-dependent vasodilation.

Effect of biological maturation on maximal oxygen uptake and ventilatory thresholds in soccer players: An allometric approach

Abstract In this study, we investigated the effect of biological maturation on maximal oxygen uptake ([Vdot]O2max) and ventilatory thresholds (VT1 and VT2) in 110 young soccer players separated into pubescent and post-pubescent groups.. Maximal oxygen uptake and [Vdot]O2 corresponding to VT1 and VT2 were expressed as absolute values, ratio standards, theoretical exponents, and experimentally observed exponents. Absolute [Vdot]O2 (ml · min−1) was different between groups for VT1, VT2, and [Vdot]O2max. Ratio standards (ml · kg−1 · min−1) were not significantly different between groups for VT1, VT2, and [Vdot]O2max. Theoretical exponents (ml · kg−0.67 · min−1 and ml · kg−0.75 · min−1) were not properly adjusted for the body mass effects on VT1, VT2, and [Vdot]O2max. When the data were correctly adjusted using experimentally observed exponents, VT1 (ml · kg−0.94 · min−1) and VT2 (ml · kg−0.95 · min−1) were not different between groups. The experimentally observed exponent for [Vdot]O2max (ml · kg−0.90 · min−1) was different between groups (P = 0.048); however, this difference could not be attributed to biological maturation. In conclusion, biological maturation had no effect on VT1, VT2 or [Vdot]O2max when the effect of body mass was adjusted by experimentally observed exponents. Thus, when evaluating the physiological performance of young soccer players, allometric scaling needs to be taken into account instead of using theoretical approaches.

Impact of weight loss with or without exercise on abdominal fat and insulin resistance in obese individuals: a randomised clinical trial.

Evidence supports an important contribution of abdominal obesity and inflammation to the development of insulin resistance (IR) and CVD. Weight loss in obese individuals can reduce inflammation and, consequently, IR, but the role of training remains unclear. The aim of this study was to evaluate the effects of body weight reduction with and without exercise over abdominal fat tissue (primary outcome) and IR. In this randomised clinical trial, forty-eight obese individuals (age 31·8 (SD 6·0) years, BMI 34·8 (SD 2·7) kg/m2) were randomised to either a diet-only group (DI) or a diet and exercise group (DI þ EXE). Treatment was maintained until 5% of the initial body weight was lost. At baseline and upon completion, the following parameters were analysed: biochemical parameters such as glycaemia and insulin for the determination of homeostasis model assessment of insulin resistance (HOMA-IR), high-sensitivity C-reactive protein (hs-CRP) and abdominal computed tomography for the determination of visceral and subcutaneous adipose tissue. A total of thirteen individuals dropped out before completing the weight-loss intervention and did not repeat the tests. In both the DI (n 18) and DI þ EXE (n 17) groups, we observed significant and similar decreases of visceral adipose tissue (difference between means: 7·9 (95% CI 29·5, 25·2) cm2, P¼0·36), hs-CRP (difference between means: 20·06 (95% CI 20·19, 0·03) mg/l, P¼0·39) and HOMA (difference between means: 20·04 (95% CI 20·17, 0·08), P¼0·53). In the present study, 5% weight loss reduced abdominal fat and IR in obese individuals and exercise did not add to the effect of weight loss on the outcome variables.

Inflammatory markers, endothelial function and cardiovascular risk

The need to study cardiovascular diseases (CVD) has become more and more relevant as their prevalence has increased over the years. An intact endothelial wall is essential to vascular health. Certain factors are responsible for maintaining this tissue intact, including nitric oxide (NO), which provokes dilation of blood vessels in response to shear stress. Expression of the endothelial nitric oxide synthase (eNOS) enzyme, which produces nitric oxide in response to increases in blood flow, is of fundamental importance to maintenance of the vascular system. When this enzyme is inhibited, nitric oxide production is reduced, causing endothelial dysfunction. Since C-reactive protein inhibits production of nitric oxide by the eNOS enzyme, it is one of the causes of endothelial dysfunction and cardiovascular events. The objective of the present study was to review scientific articles in the literature related to the subject ‘inflammatory markers and endothelial function’. A wide-ranging review of the current literature was conducted, using systematic analysis of bibliographic references indexed in PubMed, Scielo, Medline and LILACS database, for the years 1992 to 2013. The studies reviewed show that increases in inflammation causes reductions in NO and increases in cardiovascular events. Increased inflammation is associated with higher incidence of cardiovascular diseases.

Gaucher disease type I: Assessment of basal metabolic rate in patients from southern Brazil

INTRODUCTION Gaucher disease (GD) is characterized by clinical heterogeneity and is associated with metabolic abnormalities such as increased resting energy expenditure. OBJECTIVES To assess the basal metabolic rate (BMR) of patients with GD type I followed at the Gaucher Disease Reference Center of Rio Grande do Sul, Brazil. PATIENTS AND METHODS Fourteen patients (male=6) and 14 healthy controls matched by gender, age and body mass index (BMI) were included in the study. The nutritional status of patients was assessed by BMI. The BMR was measured by indirect calorimetry. In two patients, it was possible to perform BMR in the pre- and the post-treatment periods. RESULTS Mean age and BMI of patients and controls were, respectively, 32.8 ± 17.6 and 32.1 ± 16.6 years and 23.3 ± 3.1 and 22.4 ± 3.1 kg/m(2). Twelve patients were receiving enzyme replacement therapy (ERT) with imiglucerase (mean duration of treatment=5.2 ± 4.3 years; mean dosage of imiglucerase=24.2 ± 7.3 UI/kg/inf). Five patients (36%) were overweight, and nine (64%) were normal weight. Mean BMR of patients on ERT was 27.1% higher than that of controls (p=0.007). There was no difference between the BMR of patients on ERT and not on ERT (n=4) (p=0.92). Comparing the BMR of patients on ERT and their controls with the BMR estimated by the Harris-Benedict equation, the BMR of patients was 6.3% higher than the estimated (p = 0.1), while the BMR of their controls was 17.0% lower than the estimated (p = 0.001). CONCLUSION Most treated GD type I patients were normal weight. The patients including those on ERT showed higher BMR when compared to controls. Imiglucerase is probably unable to normalize the hypermetabolism presented by GD type I patients. Additional studies should be performed to confirm our findings.

Maturity Status Does Not Exert Effects on Aerobic Fitness in Soccer Players After Appropriate Normalization for Body Size.

The present study investigated the effects of pubertal status on peak oxygen uptake (VO2peak), respiratory compensation point (RCP), and ventilatory threshold (VT) in young soccer players using different body size descriptors. Seventy-nine soccer players (14 prepubescent, 38 pubescent and 27 postpubescent) participated in this study. A maximal exercise test was performed to determine the VO2peak, RCP, and VT. Ultrasonography was used to measure lower limb muscle volume (LLMV). LLMV (mL-b) was rated as the most effective body size descriptor to normalize VO2peak (mLO2·mL-0.43·min-1), RCP (mLO2·mL-0.48·min-1), and VT (mLO2·mL- 0.40·min-1). The values of VO2peak, RCP, and VT relative to allometric exponents derived by LLMV were similar among groups (p > .05; 0.025 < η2 < 0.059) when the effect of chronological age was controlled. Allometric VO2peak, RCP, and VT values were: 100.1 ± 7.9, 107.5 ± 9.6, and 108.0 ± 10.3 mLO2.mL-0.43·min-1; 51.8 ± 5.3, 54.8 ± 4.7, and 57.3 ± 5.8 mLO2·mL-0.48·min-1; and 75.7 ± 7.1, 79.4 ± 7.0, and 80.9 ± 8.3 mLO2·mL- 0.40·min-1 for prepubertal, pubertal, and postpubertal groups, respectively. Maturity status showed no positive effect on VO2peak, RCP, and VT when the data were properly normalized by LLMV in young soccer players. Allometric normalization using muscle volume as a body size descriptor should be used to compare aerobic fitness between soccer players heterogeneous in chronological age, maturity status, and body size.

Ghrelin, leptin and adiponectin levels in Gaucher disease type I patients on enzyme replacement therapy

BACKGROUND Gaucher disease type I (GD type I) is characterized by clinical heterogeneity and is associated with metabolic abnormalities such as increased basal metabolic rate. OBJECTIVE To evaluate ghrelin, leptin and adiponectin levels in patients with GD type I on enzyme replacement therapy (ERT). SUBJECTS AND METHODS A cross-sectional study of patients with GD type I (n = 15), matched for sex, age and BMI with healthy controls. The levels of glucose, insulin, ghrelin, leptin and adiponectin were assessed in both groups. Insulin resistance was defined by the index HOMA-IR. RESULTS Eight patients had adequate weight, seven were overweight (4 preobese, 3 obese class I). Eight patients presented metabolic syndrome, five of whom with insulin resistance. The median levels of ghrelin, leptin and adiponectin of the patients did not differ from those of the controls. Ghrelin and adiponectin levels were correlated with each other; inversely correlated with BMI, waist circumference and triglyceride levels; and directly correlated with HDL-cholesterol. Leptin levels were inversely correlated with LDL-cholesterol and directly correlated with BMI, waist circumference, enzyme dosage, triglycerides, insulin, and HOMA-IR. CONCLUSIONS Metabolic syndrome and overweight appear to be common in patients with GD type I on ERT. As leptin was strongly associated with insulin and HOMA index, it could become a biomarker to assess early evidence of insulin resistance in patients with GD. Further studies are needed to investigate the associations found.

Acylated ghrelin: A potential marker for fibromyalgia?

Fibromyalgia is characterized by chronic widespread pain and sleep disturbances. Overweight and obesity, which lead to metabolic changes, are additional comorbidities that are rarely explored, although they are highly prevalent in patients with fibromyalgia.

Six-minute walk distance and work relationship with incremental treadmill cardiopulmonary exercise test in COPD

Introduction:  Cardiopulmonary exercise testing (CPET) is increasingly used to evaluate the overall impact of the illness on patients with chronic obstructive pulmonary disease (COPD). While laboratory tests of exercise performance are costly, the 6‐min walk test (6‐MWT) can be more easily performed. Although the main outcome commonly used in this field test is the distance walked in 6 min (6‐MWD), this measure does not account for differences in body weight. Previous studies showed a good correlation between the work performed during the 6‐MWT with incremental cycling CPET, an exercise modality more associated with quadriceps fatigability and with lower peak oxygen consumption than incremental walking tests.

Muscle Damage and Muscle Activity Induced by Strength Training Super-sets in Physically Active Men

Abstract Brentano, MA, Umpierre, D, Santos, LP, Lopes, AL, Radaelli, R, Pinto, RS, and Kruel, LFM. Muscle damage and muscle activity induced by strength training super-sets in physically active men. J Strength Cond Res 31(7): 1847–1858, 2017—In strength training, muscle activity is often analyzed by surface electromyography (EMG) and muscle damage through indirect markers, such as plasma concentrations of creatine kinase (CK) after exercise. However, there is little information about the influence of the strength exercises order on these parameters. The purpose of this study is to analyze the effect of strength exercises order (super-sets) in muscle activity and indirect markers of muscle damage. Twenty men were randomly assigned to one of the strength training sessions (TS). Each TS (5 sets × 8–10 repetition maximum) consisted of 2 exercises for the knee extensor muscles and 2 exercises for the horizontal shoulder flexors performed in a different order: exercises for the same muscle group grouped (grouped exercises [GE]: n = 10; 26.6 ± 3.4 years; 17.4 ± 3.4 body fat) or separated (separated exercises [SE]: n = 10; 24.9 ± 2.6 years; 15.4 ± 5.9 body fat). Muscle activity was analyzed by surface EMG (vastus lateralis [VL], vastus medialis [VM], rectus femoris [RF], pectoralis major [PM], and anterior deltoid [AD]), and the main indirect marker of muscle damage was the CK, evaluated immediately before and after the first 5 days of each TS. There was a higher EMG activity of GE in the RF (GE: 88.4% × SE: 73.6%) and AD (GE: 176.4% × SE: 100.0%), in addition to greater concentration of CK (GE: 632.4% × SE: 330.5%) after exercise. Our findings suggest that, in physically active men, implementing super-sets with GE promotes greater muscle effort and muscle damage, wherein 5 days are not enough to recover the trained muscle groups.