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1.
Muscle Quality in Older Adults: A Scoping Review.
de Lucena Alves, CP, de Almeida, SB, Lima, DP, Neto, PB, Miranda, AL, Manini, T, Vlietstra, L, Waters, DL, Bielemann, RM, Correa-de-Araujo, R, et al
Journal of the American Medical Directors Association. 2023;(4):462-467.e12
Abstract
OBJECTIVE This scoping review aimed to map out currently available definitions and assessment methods of muscle quality in older adults. DESIGN Scoping review. SETTING AND PARTICIPANTS All available studies. METHODS Four databases (PubMed, EMBASE, Web of Science, and Cochrane Library) were searched from inception to May 2022. Title, abstract, and full-text screening were undertaken by 2 reviewers independently. Observational and experimental studies were eligible for inclusion if there was a clear description of muscle quality assessment in individuals aged 60+ years. RESULTS A total of 96 articles were included. Several definitions and assessment methods of muscle quality were identified and divided into 2 main domains: (1) functional domain, and (2) morphological domain. A total of 70% and 30% of the included studies assessed muscle quality in the functional and morphological domains, respectively. In the functional domain, most studies defined muscle quality as the ratio of knee extension strength by leg lean mass (45.9%). In the morphological domain, most studies defined muscle quality as the echo intensity of quadriceps femoris by ultrasound (50.0%). CONCLUSIONS AND IMPLICATIONS There is a substantial heterogeneity of definitions and assessment methods of muscle quality in older adults. Herein, we propose a standardized definition of muscle quality to include terminology, domain, and assessment methods (tests, tools, and body sites). Such standardization may help researchers, clinicians, and decision makers use muscle quality as a potential marker of "skeletal muscle health" in older adults.
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Polypharmacy, physical activity, and sedentary time in older adults: A scoping review.
de Souza, IKC, Rosa-Souza, FJ, de Lucena Alves, CP, Duhamel, TA, Waters, DL, Martins, RR, Costa, EC
Experimental gerontology. 2023;:112317
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OBJECTIVE To map out the studies that have investigated the associations of polypharmacy and/or potentially inappropriate medication (PIM) use with physical activity and sedentary time in older adults. METHODS We conducted a literature search from inception to December 2022 in PubMed, Embase, Web of Science, and Scopus. INCLUSION CRITERIA observational studies including older adults (≥60 years); English, Portuguese, and Spanish languages; any definition of polypharmacy; implicit and explicit criteria of PIM use; physical activity and/or sedentary time data. RESULTS Fourteen cross-sectional studies were included; 11 defined polypharmacy as ≥5 medications (prevalence ranging from 9.5 % to 57 %). No study reported information on PIM use. Most studies included participants aged <80 years. Twelve studies included self-reported measures of physical activity, while two studies used accelerometer-measured physical activity. Ten studies included analyses adjusted for confounders, and nine considered polypharmacy as an outcome. All of them demonstrated an inverse association between physical activity and polypharmacy, irrespective of the definition of polypharmacy and the assessment method employed (self-reported or accelerometry). One study reported an inverse association between polypharmacy (as the exposure) and physical activity (as the outcome). None of the studies investigated the association between sedentary time and polypharmacy. CONCLUSIONS Limited evidence suggests an inverse association between physical activity and polypharmacy in older adults. However, the relationship between PIM use, physical activity, and sedentary time remains unknown. Longitudinal studies utilizing objectively-measured physical activity and sedentary time are needed to better clarify the relationship between these movement behaviors and polypharmacy and/or PIM use in older adults.
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Nanoformulations for the Delivery of Dietary Anthocyanins for the Prevention and Treatment of Diabetes Mellitus and Its Complications.
Nunes, AR, Costa, EC, Alves, G, Silva, LR
Pharmaceuticals (Basel, Switzerland). 2023;(5)
Abstract
Diabetes mellitus (DM) is a metabolic disease characterized by abnormal blood glucose levels-hyperglycemia, caused by a lack of insulin secretion, impaired insulin action, or a combination of both. The incidence of DM is increasing, resulting in billions of dollars in annual healthcare costs worldwide. Current therapeutics aim to control hyperglycemia and reduce blood glucose levels to normal. However, most modern drugs have numerous side effects, some of which cause severe kidney and liver problems. On the other hand, natural compounds rich in anthocyanidins (cyanidin, delphinidin, malvidin, pelargonidin, peonidin, and petunidin) have also been used for the prevention and treatment of DM. However, lack of standardization, poor stability, unpleasant taste, and decreased absorption leading to low bioavailability have hindered the application of anthocyanins as therapeutics. Therefore, nanotechnology has been used for more successful delivery of these bioactive compounds. This review summarizes the potential of anthocyanins for the prevention and treatment of DM and its complications, as well as the strategies and advances in the delivery of anthocyanins using nanoformulations.
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Treatment of congenital adrenal hyperplasia in children aged 0-3 years: a retrospective multicenter analysis of salt supplementation, glucocorticoid and mineralocorticoid medication, growth and blood pressure.
Neumann, U, van der Linde, A, Krone, RE, Krone, NP, Güven, A, Güran, T, Elsedfy, H, Poyrazoglu, S, Darendeliler, F, Bachega, TASS, et al
European journal of endocrinology. 2022;(5):587-596
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OBJECTIVES International guidelines recommend additional salt supplementation during infancy in classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The influence of corticoid medication and growth has not been assessed. AIM: To investigate the current use of salt supplementation, fludrocortisone (FC) and hydrocortisone (HC) dosage as well as weight, height, BMI and blood pressure (BP) in CAH children aged 0-3 years. METHODS Retrospective multicentre analysis using data from the I-CAH registry. Salt-treated (ST) and non-salt-treated (NST) children were compared regarding FC and HC dosage, weight, height and BP at 0, 3, 6, 9, 12, 18, 24, 30, and 36 months. RESULTS We analysed 2483 visits of 331 patients born after year 2000 in 13 countries (male, n = 145) with 203 ST patients (61%). NST children had significantly higher FC dosages at 1.5-4.5 months and higher HC dosages until 1.5 months of age. No differences in weight, length and BP between subgroups were observed. Children of the whole cohort showed increased BMI-SDS during the study period and about half of the reported BP readings were >P95. CONCLUSION In children treated with additional salt supplementation, FC and HC dosages are lower during the first months of life but without differences in weight, length and BP until 3 years of age compared to NST children. All children showed an increase in BMI-SDS and a high rate of BP readings >P95 until 3 years, indicating the start of weight gain and negative effects on blood pressure already in very early life.
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Initial impact of the COVID-19 pandemic on physical activity and sedentary behavior in hypertensive older adults: An accelerometer-based analysis.
Browne, RAV, Macêdo, GAD, Cabral, LLP, Oliveira, GTA, Vivas, A, Fontes, EB, Elsangedy, HM, Costa, EC
Experimental gerontology. 2020;:111121
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BACKGROUND This study reports the accelerometer-based physical activity (PA) and sedentary behavior (SB) before and during the COVID-19 pandemic in hypertensive older adults. METHODS Thirty-five hypertensive older adults were included in this observational study. Accelerometer-based PA and SB measures were assessed before (January to March 2020) and during (June 2020) the COVID-19 pandemic. Linear mixed models were used to assess within-group changes in PA and SB measures, adjusted by accelerometer wear time. RESULTS Before COVID-19 pandemic participants presented: 5809 steps/day (SE = 366), 303.1 min/day (SE = 11.9) of light PA, 15.5 min/day (SE = 2.2) of moderate-vigorous PA, and 653.0 min/day (SE = 12.6) of SB. During COVID-19 pandemic there was a decrease in steps/day (β = -886 steps/day, SE = 361, p = 0.018), in moderate-vigorous PA (β = -2.8 min/day, SE = 2.4, p = 0.018), and a trend in light PA (β = -26.6 min/day, SE = 13.4, p = 0.053). In addition, SB increased during the COVID-19 pandemic (β = 29.6 min/day, SE = 13.4, p = 0.032). The magnitude of changes was greater on the weekend, mainly for steps/day (β = -1739 steps/day, SE = 424, p < 0.001) and the SB pattern (more time spent in bouts of ≥10 and 30 min, less breaks/day and breaks/h). CONCLUSIONS The COVID-19 pandemic may elicit unhealthy changes in movement behavior in hypertensive older adults. Lower PA, higher and more prolonged SB on the weekend are the main features of the behavioral changes.
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Physical Activity Counseling for Adults with Hypertension: A Randomized Controlled Pilot Trial.
Sousa Junior, AE, Macêdo, GAD, Schwade, D, Sócrates, J, Alves, JW, Farias-Junior, LF, Freire, YA, Lemos, TMAM, Browne, RAV, Costa, EC
International journal of environmental research and public health. 2020;(17)
Abstract
The effect of physical activity counseling (PAC) in hypertensive adults is unclear. This study investigated the effect of PAC on blood pressure (BP), physical activity level, sitting time, metabolic profile, and body composition in hypertensive adults. Twenty-two hypertensive adults (48.8 ± 7.3 years) participated in this pilot trial. The 12-week PAC was based on the 5 A's model considering the FITT principle (Frequency, Intensity, Time, and Type) of physical activity. The control group received instructions about FITT in one face-to-face meeting at baseline. Pedometer-measured physical activity, sitting time, resting and ambulatory BP, metabolic profile (cholesterol, triglycerides, fasting glucose), and body composition (fat mass, abdominal fat, fat free mass) were assessed. The PAC group showed higher steps per day (5839 ± 992 vs. 5028 ± 902; p = 0.044) and a trend for lower sitting time (5.6 ± 1.3 vs. 8.0 ± 4.0 h/day; p = 0.059) than the control group. No changes were observed in BP, metabolic profile, and body composition (p > 0.05). In conclusion, 12 weeks of a PAC program based on the 5 A's model resulted in a modest increase of ~800 steps per day and a trend to decrease ~2 h/day in sitting time, but there were no associated reduction in BP and improvements in metabolic and body composition.
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Effect of Breaks in Prolonged Sitting or Low-Volume High-Intensity Interval Exercise on Markers of Metabolic Syndrome in Adults With Excess Body Fat: A Crossover Trial.
Freire, YA, Macêdo, GAD, Browne, RAV, Farias-Junior, LF, Bezerra, ÁDL, Fayh, APT, Farias Júnior, JC, Boreskie, KF, Duhamel, TA, Costa, EC
Journal of physical activity & health. 2019;(9):727-735
Abstract
BACKGROUND This study analyzed the effect of walking breaks or low-volume high-intensity interval exercise (LV-HIIE) on markers of metabolic syndrome relative to a day of prolonged sitting. METHODS Twenty-five adults with excess body fat participated in this crossover trial: (1) 10-hour sitting day (SIT), (2) LV-HIIE followed by a sitting day (EX+SIT), and (3) sitting day with 5-minute walking breaks for every 20 minutes (SIT+WB). Glucose and blood pressure (BP) were measured before and 1 hour after 4 meals and 2 hours after lunch. Triglycerides were measured at baseline, 2, and 3.5 hours after lunch. Generalized mixed models were used to identify differences in the area under the curve (AUC) of BP and incremental AUC (iAUC) of glucose and triglycerides among the sessions. RESULTS iAUC-glucose was lower in SIT+WB than SIT (β = -35.3 mg/dL·10 h; 95% confidence interval, -52.5 to -8.2). AUC-diastolic BP was lower in SIT+WB than SIT (β = -14.1 mm Hg·10 h; 95% confidence interval, -26.5 to -1.6) and EX+SIT (β = -14.5 mm Hg·10 h; 95% confidence interval, -26.9 to -2.1). There were no differences in triglycerides and systolic BP levels among the sessions. CONCLUSION Adults with excess body fat present lower glucose and diastolic BP during a day with breaks in sitting time compared with a prolonged sitting day with or without an LV-HIIE session.
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Effect of Acute Dietary Nitrate Supplementation on the Post-Exercise Ambulatory Blood Pressure in Obese Males: A Randomized, Controlled, Crossover Trial.
de Lima Bezerra, ÁD, Costa, EC, Pacheco, DA, Souza, DC, Farias-Junior, LF, Ritti-Dia, RM, Grigolo, GB, de Bittencourt Júnior, PIH, Krause, M, Fayh, APT
Journal of sports science & medicine. 2019;(1):118-127
Abstract
This study aimed to verify the effect of beetroot juice on post-exercise ambulatory blood pressure (BP) in obese individuals. Fourteen non-hypertensive obese males were randomly assigned to three experimental sessions: 1) Beetroot juice with exercise (BJE, 200ml with ≈ 800mg nitrate and 40 minutes of moderate-intensity aerobic exercise at an intensity of 50% of the heart rate reserve), 2) fruit soda with exercise (FSE, 200ml of a low-nitrate drink and the same exercise session) and 3) control (CON, 200ml of water, an insignificant nitrate drink without exercise). The concentration of total nitrites and nitrates in plasma (NOx) after the drinks and the 24-hour ambulatory BP were evaluated. A two-way (condition vs. time) ANOVA for repeated measures, with a Bonferroni post hoc was used to analyze variables. The plasma NOx concentration increased significantly after ingestion of beetroot juice (from 9.9 ± 8.4 μM to 47.0 ± 16.9 μM, p < 0.001) and remained elevated until 1 hour post-intervention (54.7 ± 10.1 μM, p < 0.001), while it did not change in FSE and CON groups. The BJE session decreased ambulatory systolic BP in 5.3 mmHg (IC95%, -10.1 to -0.6, p = 0.025) in the period of 1-6 h after the BJE session compared to the CON session and reduction of 3.8 mmHg (IC95%, -7.5 to -0.007, p = 0.05) compared to the FSE session. No significant changes were observed for ambulatory diastolic BP (p > 0.05). BJE enhanced the reduction of systolic ambulatory BP up to 6 hours following a moderate-intensity aerobic exercise in obese individuals with an elevated cardiovascular risk profile.
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Aerobic Training Improves Quality of Life in Women with Polycystic Ovary Syndrome.
Costa, EC, DE Sá, JCF, Stepto, NK, Costa, IBB, Farias-Junior, LF, Moreira, SDNT, Soares, EMM, Lemos, TMAM, Browne, RAV, Azevedo, GD
Medicine and science in sports and exercise. 2018;(7):1357-1366
Abstract
PURPOSE To investigate the effects of a supervised aerobic exercise training intervention on health-related quality of life (HRQL), cardiorespiratory fitness, cardiometabolic profile, and affective response in overweight/obese women with polycystic ovary syndrome (PCOS). METHODS Twenty-seven overweight/obese inactive women with PCOS (body mass index, ≥ 25 kg·m; age 18 to 34 yr) were allocated into an exercise group (n = 14) and a control group (n = 13). Progressive aerobic exercise training was performed three times per week (~150 min·wk) over 16 wk. Cardiorespiratory fitness, HRQL, and cardiometabolic profile were evaluated before and after the intervention. Affective response (i.e., feeling of pleasure/displeasure) was evaluated during the exercise sessions. RESULTS The exercise group improved 21% ± 12% of cardiorespiratory fitness (P < 0.001) and HRQL in the following domains: physical functioning, general health, and mental health (P < 0.05). Moreover, the exercise group decreased body mass index, waist circumference, systolic and diastolic blood pressure, and total cholesterol level (P < 0.05). The affective response varied from "good" to "fairly good" (i.e., positive affective response) in an exercise intensity-dependent manner during the exercise training sessions. CONCLUSIONS Progressive aerobic exercise training improved HRQL, cardiorespiratory fitness, and cardiometabolic profile of overweight/obese women with PCOS. Moreover, the participants reported the exercise training sessions as pleasant over the intervention. These results reinforce the importance of supervised exercise training as a therapeutic approach for overweight/obese women with PCOS.
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Protocol for the HAPPY Hearts study: cardiovascular screening for the early detection of future adverse cardiovascular outcomes in middle-aged and older women: a prospective, observational cohort study.
Boreskie, KF, Kehler, DS, Costa, EC, Cortez, PC, Berkowitz, I, Hamm, NC, Moffatt, TL, Stammers, AN, Kimber, DE, Hiebert, BM, et al
BMJ open. 2017;(11):e018249
Abstract
INTRODUCTION Efforts to identify individuals at a higher risk for adverse cardiovascular outcomes focus on traditional risk factors, such as age, sex, smoking status, blood pressure and and cholesterol; however, this approach does not directly assess cardiovascular function and may underestimate the risk of experiencing adverse cardiovascular outcomes in women. This prospective, observational cohort study will examine the ability of the Heart Attack Prevention Program for You (HAPPY) Hearts screening protocol, a series of non-invasive procedures to identify middle-aged and older women who are at an elevated risk for experiencing an adverse cardiovascular event in the 5-year period after screening. The predictive value of the HAPPY Hearts protocol will also be compared with the Framingham Risk Score to determine the sensitivity for estimating risk for an adverse cardiovascular outcome. METHODS AND ANALYSIS One thousand women 55 years of age or older will be recruited to be screened by the HAPPY Hearts protocol. This involves the cardiovascular assessment of resting blood pressure, blood pressure response to 3 min of moderate intensity exercise and large and small arterial elasticity. The participants will be classified into risk categories based on these measures. The incidence of the following adverse cardiovascular outcomes will be assessed in the 5-year period after screening in both groups: ischaemic heart disease, acute myocardial infarction, stroke, percutaneous coronary intervention, coronary bypass surgery, congestive heart failure and new hypertension. ETHICS AND DISSEMINATION Information gathered in this research will be published in peer-reviewed journals and presented in a programme evaluation report to inform Manitoba Health and key stakeholders about the outcomes of the study. The University of Manitoba Health Research Ethics Board has approved the study protocol V.2.0, dated 29 September 2014 (H2014:224). TRIAL REGISTRATION NUMBER NCT02863211.