Mauro Felippe Felix Mediano

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

INTRODUCTION The benefit of a cardiac rehabilitation (CR) program for patients with Chagas heart failure (CHF) remains unclear. Therefore, we aimed to investigate the effects of CR for CHF patients. METHODS A single-arm pilot study, including 12 patients with CHF, was performed. Patients participated in an 8-month physical exercise intervention, comprising aerobic, strength, and stretching exercises (3 times per week, 60 minutes per session). Nutritional and pharmaceutical counseling were also performed. Functional capacity (cardiopulmonary exercise test), muscle respiratory strength (manovacuometry), and body composition (anthropometry and skinfolds) were evaluated at baseline, and after 4 and 8 months of intervention. Cardiac function (echocardiography), biomarkers (lipid profile, glucose, and glycated hemoglobin) and quality of life (Minnesota Living with Heart Failure Questionnaire) were assessed at baseline and at the end of the intervention. RESULTS Seven of 12 patients included in the study completed the 8-month follow-up period. Only 2 moderate adverse events occurred during the exercise training. Functional capacity improved after 4 months of CR, while left ventricular ejection fraction (LVEF) and respiratory strength improved after 8 months. Patients with right ventricular (RV) dysfunction at baseline exhibited an improvement in functional capacity after 4 months, and improvements in left ventricular (LV) diastolic pressure, respiratory strength, and quality of life at the end of follow-up. Conversely, those with normal baseline RV function demonstrated LVEF increases that were not observed in patients with RV dysfunction. CONCLUSIONS CR was feasible, safe, and has important clinical benefits for patients with CHF, specifically for cardiac function and muscle respiratory strength.

Effect of Exercise Intensity on Spontaneous Physical Activity Energy Expenditure in Overweight Boys: A Crossover Study.

Objective Evaluate the effect of different exercise intensities on spontaneous physical activity energy expenditure in overweight adolescents. Methods A crossover study was developed with a control session, followed by moderate and vigorous exercise sessions, with six days of monitoring each. Twenty-four adolescents, 11–13 years old, male and overweight were selected. Spontaneous physical activity energy expenditure was assessed by accelerometers. Linear mixed effects models were used to evaluate the differences per session across time. Results Energy expenditure during the 1st hour was different between all three sessions, with averages of 82, 286 and 343 kcal to the control, moderate and vigorous sessions, respectively (p <0.001). The same pattern of difference in energy expenditure between the sessions remained after 24 hours (704 vs 970 vs 1056 kcal, p <0.001). However, energy expenditure during the six days indicates compensation from second to the sixth day, although small differences remained at the end of the 6-day period (5102 vs 5193 vs 5271 kcal, p <0.001). Conclusions A single aerobic session seems to modify the spontaneous physical activities in overweight adolescents but still keeping the vigorous session with higher total energy expenditure during the follow-up period. Despite the observed compensatory effect, the greater energy expenditure observed in both moderate and vigorous exercise sessions indicates that physical activity should be recommended to promote an increased energy expenditure in adolescents. Trial Registration ClinicalTrials.gov NCT 02272088

Reducao do uso de acucar em escolas publicas: ensaio randomizado por conglomerados

OBJECTIVE To test the efficacy of nutritional guidelines for school lunch cooks aiming to reduce added sugar in school meals and their own sugar intake. METHODS A controlled randomized cluster trial was carried out in twenty public schools in the municipality of Niteroi in Rio de Janeiro, Southeastern Brazil, from March to December 2007. A nutrition educational program was implemented in the schools in question through messages, activities and printed educational materials encouraging reduced levels of added sugar in school meals and in the school lunch cooks’ own intake. The reduced availability of added sugar in schools was evaluated using spreadsheets including data on the monthly use of food item supplies. The cooks’ individual food intake was evaluated by a Food Frequency Questionnaire. Anthropometric measurements were taken according to standardized techniques and variation in weight was measured throughout the duration of the study. RESULTS There was a more marked reduction in the intervention schools compared to the control schools (-6.0 kg versus 0.34 kg), but no statistically significant difference (p = 0.21), although the study power was low. Both groups of school lunch cooks showed a reduction in the consumption of sweets and sweetened beverages, but the difference in sugar intake was not statistically significant. Weight loss and a reduction in total energy consumption occurred in both groups, but the difference between them was not statistically significant, and there was no alteration in the percentages of adequacy of macronutrients in relation to energy consumption. CONCLUSIONS The strategy of reducing the use and consumption of sugar by school lunch cooks from public schools could not be proved to be effective.

Reducing the use of sugar in public schools: a randomized cluster trial

OBJECTIVE To test the efficacy of nutritional guidelines for school lunch cooks aiming to reduce added sugar in school meals and their own sugar intake. METHODS A controlled randomized cluster trial was carried out in twenty public schools in the municipality of Niteroi in Rio de Janeiro, Southeastern Brazil, from March to December 2007. A nutrition educational program was implemented in the schools in question through messages, activities and printed educational materials encouraging reduced levels of added sugar in school meals and in the school lunch cooks’ own intake. The reduced availability of added sugar in schools was evaluated using spreadsheets including data on the monthly use of food item supplies. The cooks’ individual food intake was evaluated by a Food Frequency Questionnaire. Anthropometric measurements were taken according to standardized techniques and variation in weight was measured throughout the duration of the study. RESULTS There was a more marked reduction in the intervention schools compared to the control schools (-6.0 kg versus 0.34 kg), but no statistically significant difference (p = 0.21), although the study power was low. Both groups of school lunch cooks showed a reduction in the consumption of sweets and sweetened beverages, but the difference in sugar intake was not statistically significant. Weight loss and a reduction in total energy consumption occurred in both groups, but the difference between them was not statistically significant, and there was no alteration in the percentages of adequacy of macronutrients in relation to energy consumption. CONCLUSIONS The strategy of reducing the use and consumption of sugar by school lunch cooks from public schools could not be proved to be effective.

Reassessment of quality of life domains in patients with compensated Chagas heart failure after participating in a cardiac rehabilitation program

INTRODUCTION: We evaluated the effects of a cardiac rehabilitation program on quality of life. METHODS This secondary analysis of a single-arm study included 12 patients with Chagas heart failure. The cardiac rehabilitation program comprised exercise training and nutritional and pharmaceutical counseling. Quality of life was assessed using the SF-36 questionnaire. RESULTS: The program promoted improved physical functioning (β= +5.7; p=0.003), role-physical (β= +1.9; p=0.03), and bodily pain (β= +3.5; p=0.02) scores. Moreover, the summary physical health score (β= +1.4; p=0.001) improved. CONCLUSION: The cardiac rehabilitation program significantly improved the physical quality of life of patients with Chagas heart failure.

Comment on: “Effect of Exercise Training on Non-exercise Physical Activity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials”

Physical exercise is widely regarded as an important component in obesity prevention programs, mainly because of its effects on energy expenditure [1], though some studies do not support this idea [2, 3]. Fedewa et al. [4] evaluated the effect of exercise training on non-exercise physical activity (NEPA) in a systematic review with metaanalysis of randomized controlled trials. The results showed no statistically significant change in NEPA in response to exercise training, though duration of the exercise sessions and intervention length were significantly associated with change in NEPA. Longer training sessions led to a decrease in NEPA, while a longer intervention was associated with an increase in NEPA. While interesting, some important limitations of the findings of this review require clarification. Although recognized by the authors as a limitation of the review, information about the search strategy was poorly depicted. A combination of only five search terms was used to describe exposure/outcome, and only two search terms were used as a filter for identifying randomized trials. This is an important issue because the review’s conclusions could be over-influenced by studies that are simply the easiest to find. Therefore, for an exhaustive search of the literature, a better search strategy is necessary. The most critical issue regards the meta-analysis. The authors described data from 11 studies, yielding a total of 44 effects in quantitative synthesis. The overall effect shown in the forest plot indicated that no significant change in NEPA occurred during exercise training. However, it is not clear in the article how the results were combined in just one forest plot. Thereafter, the authors identified the dependencies between the effect sizes within the multiple-treatment studies and multiple-endpoints studies included in the review and performed a multilevel linear regression. A serious limitation for a multilevel meta-analysis is related to correlations between measures [5, 6]. According to Gleser and Olkin [6], the correlations between estimated effect sizes in multiple-endpoints studies are intrinsic to such studies, whereas the correlations between the effects sizes from multiple-treatment studies are an artifact of the design. Therefore, covariances between estimated effect & Vitor Barreto Paravidino vparavidino@gmail.com

Discouraging soft drink consumption reduces blood glucose and cholesterol of Brazilian elementary students: Secondary analysis of a randomized controlled trial☆

The objective of this study was to evaluate the effect of an educational program aimed at discouraging sugar-sweetened carbonated beverages intake on blood fasting glucose and total cholesterol. Forty-seven fourth grade classes in twenty-two schools have participated in a randomized controlled trial aimed at discouraging soft drink intake in order to prevent excessive weight gain during a school year, in the city of Niterói, Rio de Janeiro. Of 1140 randomized students, 478 (238 in intervention group and 240 in control group) aged 9-12years old had at least one result on biochemical data and were analyzed to evaluate the effect of the intervention on changes in fasting glucose and total cholesterol at the end of follow-up. Intention-to-treat analysis was performed taking into account the cluster (classes) effect. Statistically significant decrease in fasting glucose (-9.12mg/dL vs. +0.51mg/dL, p<0.001) and total cholesterol (-10.34mg/dL vs. +2.14mg/dL, p<0.001) were observed among students in the intervention group in comparison with controls. In addition, the prevalence of impaired fasting glucose and hypercholesterolemia decreased in interventions and increased in controls (-2.4% vs. +8.8%, p=0.04 and -10.0% vs. +2.7%, p=0.03, respectively). Discouraging soft drink consumption among children has led to a reduction in fasting glucose and total cholesterol, suggesting that these beverages may play a role in the development of cardiometabolic risk in childhood.

Omega-3 supplementation on inflammatory markers in patients with chronic Chagas cardiomyopathy: a randomized clinical study

BackgroundSeveral studies have been focusing on the effect of omega-3 polyunsaturated fatty acids on modulation of inflammatory markers in several cardiopathies. Although immunoregulatory dysfunction has been associated to the chronic cardiac involvement in Chagas disease, there is no study examining the effects of omega-3 supplementation in these patients. We investigated the effects of omega-3 PUFAs on markers of inflammation and lipid profile in chronic Chagas cardiomyopathy patients.MethodsThe present study was a single-center double-blind clinical trial including patients with chronic Chagas cardiomyopathy. Patients were randomly assigned to receive omega-3 PUFAs capsules (1.8g EPA and 1.2g DHA) or placebo (corn oil) during an 8-week period. Cytokines, fasting glucose, lipid, and anthropometric profiles were evaluated.ResultsForty-two patients (23 women and 19 men) were included in the study and there were only two losses to follow-up during the 8-week period. Most of sociodemographic and clinical characteristics were similar between the groups at baseline, except for the cytokines IL-1β, IL-6, IL-8, IL-10, IL-17α, and IFNγ. The omega-3 PUFAs group demonstrated greater improvements in serum triglycerides (−21.1 vs. −4.1; p = 0.05) and IL-10 levels (−10.6 vs. −35.7; p = 0.01) in comparison to controls after 8 weeks of intervention. No further differences were observed between groups.ConclusionOmega-3 PUFAs supplementation may favorably affect lipid and inflammatory profile in chronic Chagas cardiomyopathy patients, demonstrated by a decrease in triglycerides and improvements on IL-10 concentration. Further studies examining the clinical effects of omega-3 fatty acids supplementation in chronic Chagas cardiomyopathy are necessary.Trial registrationNCT01863576.

Effectiveness of a home-based exercise program on anthropometric and metabolic changes among school cooks

The scope of this study was to evaluate the anthropometric and metabolic changes after low intensity home-based exercise. In the school year of 2007, 95 school cooks in the city of Niteroi (State of Rio de Janeiro, Brazil) were randomly assigned to one of the following groups: home-based exercise (n = 47) or control group (n = 48). The home-based exercise program was performed three times a week, during 40 minutes at moderate intensity. Anthropometric variables were collected at the baseline and after 4 and 8 months, whereas biochemical and individual food intake were measured at the baseline and after 8 months. Energy expenditure was evaluated only at the baseline. The home-based exercise group exhibited a greater weight loss (-0.9 vs. -0.2; p = 0.05) in comparison with controls during the follow-up and the same pattern was found for BMI (-0.1 vs. +0.1; p = 0.07), although without statistical significance. Exercise showed no effects on waist circumference, lipid profile and glucose. In conclusion, greater weight loss was observed in the group that performed low intensity home-based exercise and this strategy can assist in body weight control even without alterations in terms of lipids and glucose.

Does a single bout of exercise influence subsequent physical activity and sedentary time in overweight boys

OBJECTIVE To assess the influence of a single bout of exercise on subsequent physical activity and sedentary time among overweight boys. METHODS A crossover study on 24 overweight boys (11-13years old) was conducted with three different experimental sessions: control, one bout of moderate exercise, and one bout of vigorous exercise. Physical activity was measured using triaxial accelerometers and time spent in light, moderate, vigorous, and sedentary activities was assessed during six days of follow-up. Differences in daily percentage of time spent in sedentary, light, moderate, and vigorous activities among experimental sessions were analyzed using linear mixed-effect models. RESULTS Time spent in sedentary behavior was greater after moderate and vigorous sessions compared to the control, with statistically significant differences in trajectories between moderate (p=0.04) and vigorous sessions (p=0.006) compared to controls. Similarly, the time spent in moderate physical activity was smaller after moderate (p=0.02) and vigorous sessions (p=0.02) compared to the control. No differences in sedentary (p=0.50) and moderate (p=0.97) activities were observed between moderate and vigorous sessions. The percentage of time spent in vigorous physical activity showed a greater reduction in vigorous condition compared to moderate and control (p<0.01) conditions, while time spent in light physical activities was not different between sessions. CONCLUSIONS Our results indicate a compensatory effect after a single bout of exercise due to decreases in moderate and vigorous physical activity and increases in sedentary time during the following six days.