Intermittent claudication and physical exercise: effectiveness of a home-based program

Peripheral arterial disease (PAD) as a high incidence in general population and 12% to 20% of population with more than 60 years has already clinical symptoms, such as intermittent claudication (IC), pain, loss of strength and functional incapacity. There are already some studies who refer the possible positive effects of physical exercise in functional consequences of PAD.

Effects of physical exercise training in DNA damage and repair - could the difference be in hOGG1 Ser326Cys polymorphism?

Acute physical exercise is associated with increased oxygen consumption, which could result in an increased formation of reactive oxygen species (ROS). ROS can react with several organic structures, namely DNA, causing strand breaks and a variety of modified bases in DNA. Physical exercise training seems to decrease the incidence of oxidative stress-associated diseases, and is considered as a key component of a healthy lifestyle. This is a result of exercise-induced adaptation, which has been associated with the possible increase in antioxidant activity and in oxidative damage repair enzymes, leading to an improved physiological function and enhanced resistance to oxidative stress (Radak et al. 2008). Human 8-oxoguanine DNA glycosylase 1 (hOGG1) is involved in the base excision repair (BER) pathway and encodes an enzyme responsible for removing the most common product of oxidative damage in DNA, 8-hydroxyguanine (8-OH-G). The genetic polymorphism of hOGG1 at codon 326 results in a serine (Ser) to cysteine (Cys) amino acid substitution (Ser326Cys). It has been suggested that the carriers of at least one hOGG1Cys variant allele exhibit lower 8-OH-G excision activity than the wild-type (Wilson et al. 2011). The aim of this study was to investigate the possible influence of hOGG1 Ser326Cys polymorphism on DNA damage and repair activity in response to 16 weeks of combined physical exercise training, in thirty healthy Caucasian men. Comet assay was carried out using peripheral blood lymphocytes and enabled the evaluation of DNA damage, both strand breaks and FPG-sensitive sites, and DNA repair activity. Genotypes were determined by PCR-RFLP analysis. The subjects with Ser/Ser genotype were considered as wild-type group (n=20), Ser/Cys and Cys/Cys genotype were analyzed together as mutant group (n=10). Regarding differences between pre and post-training in the wild-type group, the results showed a significant decrease in DNA strand breaks (DNA SBs) (p=0.002) and also in FPG-sensitive sites (p=0.017). No significant differences were observed in weight (p=0.389) and in lipid peroxidation (MDA) (p=0.102). A significant increase in total antioxidant capacity (evaluated by ABTS) was observed (p=0.010). Regarding mutant group, the results showed a significant decrease in DNA SBs (p=0.008) and in weight (p=0.028). No significant differences were observed in FPG-sensitive sites (p=0.916), in ABTS (p=0.074) and in MDA (p=0.086). No significant changes in DNA repair activity were observed in both genotype groups. This preliminary study suggests the possibility of different responses in DNA damage to physical exercise training, considering the hOGG1 Ser326Cys polymorphism.

Wound healing and cancer progression in Opisthorchis viverrini associated cholangiocarcinoma

Letter to the editor

Intermittent claudication and physical exercise: effectiveness of a home-based program

Peripheral arterial disease (PAD) as a high incidence in general population and 12% to 20% of population with more than 60 years has already clinical symptoms, such as intermittent claudication (IC), pain, loss of strength and functional incapacity. There are already some studies that refer the possible positive effects of physical exercise in functional consequences of PAD. The purpose of this study was to verify the results of a home-based (HB) weekly supervised physical exercise program in patients with IC in consequence of PAD in lower limbs, and observe the medium number of diary steps walked by the subjects of our study.

Evidências de validade da versão brasileira do Exercise Motivation Inventory-2 em contexto de academia e personal training

Este estudo teve como objetivos verificar a validade fatorial e a validade interna da versão brasileira do Exercise Motivation Inventory-2 (EMI-2) e comparar os principais motivos para prática de exercício tendo em conta os contextos de academia e personal training. Um total de 588 praticantes de exercício da cidade de Pelotas/RS/Brasil (405 de academia e 183 de personal training) preencheram o EMI-2, o qual é constituído por 51 itens, agrupados em 14 motivos (fatores) para prática de exercício físico. A validade fatorial do EMI-2 foi testada através da realização de análises fatoriais confirmatórias e a validade interna através do alfa de Cronbach. Para a verificar o efeito do contexto nos motivos foi utilizada a MANOVA e calculado o tamanho do efeito. Os resultados obtidos dão suporte à estrutura original do EMI-2 com 14 fatores, nesta amostra. Verificou-se um efeito multivariado significativo do contexto sobre os motivos de prática [Wilks’ λ = 0.912, F (14, 573.000) = 3.9, p < 0.001, η² = 0.088]. Os motivos de “Prazer”, “Força e resistência”, “Desafio”, “Socialização”, “Competição” e “Reconhecimento Social” foram significativamente superiores no contexto de academia e os motivos de “Agilidade” e “Prevenção de Doenças” foram significativamente superiores no contexto de personal training.

The impact of exercise training on liver transplanted familial amyloidotic polyneuropathy (FAP) patients

Liver transplantation is nowadays the only effective answer to adjourn the outcome of functional limitations associated with familial amyloidotic polyneuropathy (FAP), a neurodegenerative disease characterized by sensory and motor polyneuropathies. Nevertheless, there is a detrimental impact associated with the after-surgery period on the fragile physical condition of these patients. Exercise training has been proven to be effective on reconditioning patients after transplantation. However, the effects of exercise training in liver transplanted FAP patients have not been scrutinized yet.

Influence of environmental temperature and humidity on the acute ventilatory response to exercise in asthmatic adolescents

Asthma is a chronic inflammatory disorder of the respiratory airways affecting people of all ages, and constitutes a serious public health problem worldwide (6). Such a chronic inflammation is invariably associated with injury and repair of the bronchial epithelium known as remodelling (11). Inflammation, remodelling, and altered neural control of the airways are responsible for both recurrent exacerbations of asthma and increasingly permanent airflow obstruction (11, 29, 34). Excessive airway narrowing is caused by altered smooth muscle behaviour, in close interaction with swelling of the airway walls, parenchyma retractile forces, and enhanced intraluminal secretions (29, 38). All these functional and structural changes are associated with the characteristic symptoms of asthma – cough, chest tightness, and wheezing –and have a significant impact on patients’ daily lives, on their families and also on society (1, 24, 29). Recent epidemiological studies show an increase in the prevalence of asthma, mainly in industrial countries (12, 25, 37). The reasons for this increase may depend on host factors (e.g., genetic disposition) or on environmental factors like air pollution or contact with allergens (6, 22, 29). Physical exercise is probably the most common trigger for brief episodes of symptoms, and is assumed to induce airflow limitations in most asthmatic children and young adults (16, 24, 29, 33). Exercise-induced asthma (EIA) is defined as an intermittent narrowing of the airways, generally associated with respiratory symptoms (chest tightness, cough, wheezing and dyspnoea), occurring after 3 to 10 minutes of vigorous exercise with a maximal severity during 5 to 15 minutes after the end of the exercise (9, 14, 16, 24, 33). The definitive diagnosis of EIA is confirmed by the measurement of pre- and post-exercise expiratory flows documenting either a 15% fall in the forced expiratory volume in 1 second (FEV1), or a ≥15 to 20% fall in peak expiratory flow (PEF) (9, 24, 29). Some types of physical exercise have been associated with the occurrence of bronchial symptoms and asthma (5, 15, 17). For instance, demanding activities such as basketball or soccer could cause more severe attacks than less vigorous ones such as baseball or jogging (33). The mechanisms of exercise-induced airflow limitations seem to be related to changes in the respiratory mucosa induced by hyperventilation (9, 29). The heat loss from the airways during exercise, and possibly its post-exercise rewarming may contribute to the exercise-induced bronchoconstriction (EIB) (27). Additionally, the concomitant dehydration from the respiratory mucosa during exercise leads to an increased interstitial osmolarity, which may also contribute to bronchoconstriction (4, 36). So, the risk of EIB in asthmatically predisposed subjects seems to be higher with greater ventilation rates and the cooler and drier the inspired air is (23). The incidence of EIA in physically demanding coldweather sports like competitive figure skating and ice hockey has been found to occur in up to 30 to 35% of the participants (32). In contrast, swimming is often recommended to asthmatic individuals, because it improves the functionality of respiratory muscles and, moreover, it seems to have a concomitant beneficial effect on the prevalence of asthma exacerbations (14, 26), supporting the idea that the risk of EIB would be smaller in warm and humid environments. This topic, however, remains controversial since the chlorified water of swimming pools has been suspected as a potential trigger factor for some asthmatic patients (7, 8, 20, 21). In fact, the higher asthma incidence observed in industrialised countries has recently been linked to the exposition to chloride (7, 8, 30). Although clinical and epidemiological data suggest an influence of humidity and temperature of the inspired air on the bronchial response of asthmatic subjects during exercise, some of those studies did not accurately control the intensity of the exercise (2, 13), raising speculation of whether the experienced exercise overload was comparable for all subjects. Additionally, most of the studies did not include a control group (2, 10, 19, 39), which may lead to doubts about whether asthma per se has conditioned the observed results. Moreover, since the main targeted age group of these studies has been adults (10, 19, 39), any extrapolation to childhood/adolescence might be questionable regarding the different lung maturation. Considering the higher incidence of asthma in youngsters (30) and the fact that only the works of Amirav and coworkers (2, 3) have focused on this age group, a scarcity of scientific data can be identified. Additionally, since the main environmental trigger factors, i.e., temperature and humidity, were tested separately (10, 28, 39) it would be useful to analyse these two variables simultaneously because of their synergic effect on water and heat loss by the airways (31, 33). It also appears important to estimate the airway responsiveness to exercise within moderate environmental ranges of temperature and humidity, trying to avoid extreme temperatures and humidity conditions used by others (2, 3). So, the aim of this study was to analyse the influence of moderate changes in air temperature and humidity simultaneously on the acute ventilatory response to exercise in asthmatic children. To overcome the above referred to methodological limitations, we used a 15 minute progressive exercise trial on a cycle ergometer at 3 different workload intensities, and we collected data related to heart rate, respiratory quotient, minute ventilation and oxygen uptake in order to ensure that physiological exercise repercussions were the same in both environments. The tests were done in a “normal” climatic environment (in a gymnasium) and in a hot and humid environment (swimming pool); for the latter, direct chloride exposition was avoided.

The evidence of conventional physiotherapeutic interventions after exercise-induced muscle damage: systematic review and meta-analysis

Abstract Introduction: Exhaustive and/or unaccustomed exercise, mainly those involving eccentric muscle actions, induces temporary muscle damage, evidenced by Delayed Onset Muscle Soreness. Different strategies to recover the signs and symptoms of this myogenic condition have been studied by researchers, as a result a significant number of articles on this issue have been published. Purpose: A systematic review was conducted to assess the evidence of the physiotherapeutic interventions of exercise-induced muscle damage. Methods: The electronic data bases were searched, including MEDLINE (1996-2011), CINHAL (1982- 2011), EMBASE (1988-2011), PEDro (1950-2011), and SPORTDiscus (1985-2011). Systematic review was limited to randomized control trials (RCTs) studies, written in English or Portuguese, which included physiotherapeutic interventions, namely massage, cryotherapy, stretching and low-intensity exercise, on adult human subjects (18-60 years old) of either gender. Studies were excluded when the intervention could not be assessed independently. The methodological quality of RCTs was independently assessed with the PEDro Scale by three reviewers. Results: Thirty-three studies were included in the systematic review; eight analyzed the effects of the massage, ten analyzed the effects of the cryotherapy, eight the effect of stretching and seventeen focused low-intensity exercise intervention. The results suggest that massage is the most effective intervention and that there is inconclusive evidence to support the use of cryotherapy; whereas the other conventional, namely stretching and low-intensity exercise, there is no evidence to prove their efficacy. Conclusion: The results allow the conclusion that massage is the physiotherapeutic intervention that demonstrated to be the most effective in the relief of symptoms and signs of exercise-induced muscle damage, as a result, massage should still be used in the muscular recovery after sports activities.

Response of high-risk of recurrence/progression bladder tumours expressing sialyl-Tn and sialyl-6-T to BCG immunotherapy

High risk of recurrence/progression bladder tumours is treated with Bacillus Calmette-Guérin (BCG) immunotherapy after complete resection of the tumour. Approximately 75% of these tumours express the uncommon carbohydrate antigen sialyl-Tn (Tn), a surrogate biomarker of tumour aggressiveness. Such changes in the glycosylation of cell-surface proteins influence tumour microenvironment and immune responses that may modulate treatment outcome and the course of disease. The aim of this work is to determine the efficiency of BCG immunotherapy against tumours expressing sTn and sTn-related antigen sialyl-6-T (s6T). METHODS: In a retrospective design, 94 tumours from patients treated with BCG were screened for sTn and s6T expression. In vitro studies were conducted to determine the interaction of BCG with high-grade bladder cancer cell line overexpressing sTn. RESULTS: From the 94 cases evaluated, 36 had recurrence after BCG treatment (38.3%). Treatment outcome was influenced by age over 65 years (HR=2.668; (1.344-5.254); P=0.005), maintenance schedule (HR=0.480; (0.246-0.936); P=0.031) and multifocality (HR=2.065; (1.033-4.126); P=0.040). sTn or s6T expression was associated with BCG response (P=0.024; P<0.0001) and with increased recurrence-free survival (P=0.001). Multivariate analyses showed that sTn and/or s6T were independent predictive markers of recurrence after BCG immunotherapy (HR=0.296; (0.148-0.594); P=0.001). In vitro studies demonstrated higher adhesion and internalisation of the bacillus to cells expressing sTn, promoting cell death. CONCLUSION: s6T is described for the first time in bladder tumours. Our data strongly suggest that BCG immunotherapy is efficient against sTn- and s6T-positive tumours. Furthermore, sTn and s6T expression are independent predictive markers of BCG treatment response and may be useful in the identification of patients who could benefit more from this immunotherapy.

Non invasive ventilation during exercise in COPD patients: a systematic review with meta-analysis

COPD is a major cause of morbidity and mortality worldwide, representing a major public health problem due to the high health and economic resource consumption. Pulmonary rehabilitation is a standard care recommendation for these patients, in order to control the symptoms and optimize the functional capacity, reducing health care costs associated with exacerbations and activity limitations and participation. However, in patients with severe COPD exercise performance can be difficult, due to extreme dyspnea, decreased muscle strength and fatigue. In addition, hypoxemia and dyspnea during efforts and daily activities may occur, limiting their quality of life. Thus, NIV have been used as adjunct to exercise, in order to improve exercise capacity in these patients. However, there is no consensus for this technique recommendation. Our objective was to verify whether the use of NIV during exercise is effective than exercise without NIV in dyspnea, walked distance, blood gases and health status in COPD patients, through a systematic review and meta-analysis.

Evidence based for exercise program in physical therapy in patients with multiple sclerosis

Background: Multiple sclerosis is a disease of the central nervous system that affects more frequently young women. It is a progressive and unpredictable disease, resulting in some cases of disabilities and limitations to physical, psychological and social level. Purpose: To review the literature for evidence based of the effectiveness of physiotherapy intervention in multiple sclerosis.

Factors associated with dietary supplement use by people who exercise at gyms

OBJECTIVE To assess the factors associated with the use of dietary supplements by people who exercise at gyms.METHODS A cross-sectional study with a sample defined by convenience, considering the number of gyms registered in the Conselho Regional de Educação Física (Regional Council of Physical Education) of Sao Luis, MA, Northeastern Brazil, from July 2011 to July 2012. The final sample comprised 723 individuals who exercise at gyms. The dependent variable was supplement use, and the explanatory variables were length of time and motivation of the physical exercises, duration, goal and self-perception of training, weekly frequency of gym attendance, sex, age, educational attainment, self-perception of body weight, smoking and self-perception of diet. The association between variables was analysed by hierarchical Poisson regression based on a theoretical model.RESULTS Supplement use was reported by 64.7% of the participants. Most of the sample was male (52.6%). The most frequent age group was 20 to 39 years (74.4%). Most participants (46.1%) had been exercising for over a year. The following variables were associated with supplement use: self-perceiving body weight as below ideal (p < 0.001), smoking (p < 0.001), exercising for 7 to 12 months (p = 0.028) or more than one year (p < 0.001), spending more than two hours at the gym (p = 0.051), and perceiving training as moderate (p = 0.024) or intense (p = 0.001).CONCLUSIONS The use of supplements lacks proper professional guidance, being motivated by individuals unsatisfied with their low body weight and who perceive their workout as intense, which raises the need for monitoring this population.

A contribution to the e-framework: a specification of a programming exercise evaluation service

This work is a contribution to the e-Framework, arguably the most prominent e-learning framework today, and consists of the definition of a service for the automatic evaluation of programming exercises. This evaluation domain differs from trivial evaluations modelled by languages such as the IMS Question & Test Interoperability (QTI) specification. Complex evaluation domains justify the development of specialized evaluators that participate in several business processes. These business processes can combine other type of systems such as Programming Contest Management Systems, Learning Management Systems, Integrated Development Environments and Learning Object Repositories where programming exercises are stored as Learning Objects. This contribution describes the implementation approaches used, more precisely, behaviours & requests, use & interactions, applicable standards, interface definition and usage scenarios.

Progression of Salmonella Enteritidis phage type 4 strains in São Paulo State, Brazil

A total of 574 S. Enteritidis strains (383 from human sources and 191 from non-human sources) isolated between 1975-95, in São Paulo State, Brazil, were phagetyped. Among the strains isolated during the period of 1975-92, 80.9% of them belonged to phage type 8 (PT-8), but in 1993 strains of PT-4 accounted for 65.2% of all the S. Enteritidis isolates. In the following years, PT-4 strains accounted for 99.7% and 98.4% of phagetyped S. Enteritidis strains. The results obtained suggested that the current epidemic of S. Enteritidis in São Paulo State is clearly associated with the progression of PT-4 strains.