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Silva TC, Aidar FJ, Zanona ADF, Matos DG, Pereira DD, Rezende PEN, Ferreira ARP, Junior HA, dos Santos JL, Silva DDS, Barbosa FDS, Thuany M, de Souza RF. The Acute Effect of Hyperoxia on Onset of Blood Lactate Accumulation (OBLA) and Performance in Female Runners during the Maximal Treadmill Test. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094546. [PMID: 33922940 PMCID: PMC8123303 DOI: 10.3390/ijerph18094546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
The objective of this study was to analyze the acute effect of hyperoxia during the maximal treadmill test (MTT) of runners. Participants included 10 female street runners who performed the MTT under two different conditions: hyperoxia (HYPX), inhaling oxygen (60% O2) every 3 min; and normoxia (NORM), without additional oxygen inhalation. Both groups performed the MTT with increases in the slope of the run every 3 min until voluntary exhaustion. The variables of lactate concentration, the onset of blood lactate accumulation (OBLA), peripheral oxygen saturation (SpO2), heart rate (HR), and Borg scale were evaluated. It was verified after the comparison (HYPX vs. NORM) that stage 3 (p = 0.012, Cohen’s d = 1.76) and stage 4 (p < 0.001; Cohen’s d = 5.69) showed a reduction in lactate under the HYPX condition. OBLA under the HYPX condition was identified at a later stage than NORM. There were no differences in Borg scale, SpO2, and HR between the different conditions. It was concluded that the HYPX condition contributed to a reduction in lactate concentration and delayed OBLA in runners.
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Affiliation(s)
- Thays C. Silva
- Department of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (T.C.S.); (F.J.A.); (P.E.N.R.); (D.d.S.S.)
| | - Felipe J. Aidar
- Department of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (T.C.S.); (F.J.A.); (P.E.N.R.); (D.d.S.S.)
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (D.G.M.); (D.D.P.)
- Post-Graduation Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (J.L.d.S.); (M.T.)
| | | | - Dihogo Gama Matos
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (D.G.M.); (D.D.P.)
| | - Danielle D. Pereira
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (D.G.M.); (D.D.P.)
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Pernambuco 50670-901, Brazil
| | - Paulo Emmanuel Nunes Rezende
- Department of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (T.C.S.); (F.J.A.); (P.E.N.R.); (D.d.S.S.)
| | | | - Heleno Almeida Junior
- Post Graduate Program in Physiology Sciences, Department of Physiology, Federal University of Sergi, pe—UFS, São Cristóvão 49100-000, Brazil;
| | - Jymmys Lopes dos Santos
- Post-Graduation Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (J.L.d.S.); (M.T.)
| | - Devisson dos Santos Silva
- Department of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (T.C.S.); (F.J.A.); (P.E.N.R.); (D.d.S.S.)
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (D.G.M.); (D.D.P.)
- Post-Graduation Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (J.L.d.S.); (M.T.)
| | | | - Mabliny Thuany
- Post-Graduation Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (J.L.d.S.); (M.T.)
| | - Raphael F. de Souza
- Department of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (T.C.S.); (F.J.A.); (P.E.N.R.); (D.d.S.S.)
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (D.G.M.); (D.D.P.)
- Post-Graduation Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão, Sergipe 49100-000, Brazil; (J.L.d.S.); (M.T.)
- Correspondence: ; Tel.: +55-79-3194-6537
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Sarcopenic Obesity in Liver Cirrhosis: Possible Mechanism and Clinical Impact. Int J Mol Sci 2021; 22:ijms22041917. [PMID: 33671926 PMCID: PMC7919019 DOI: 10.3390/ijms22041917] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
The picture of chronic liver diseases (CLDs) has changed considerably in recent years. One of them is the increase of non-alcoholic fatty liver disease. More and more CLD patients, even those with liver cirrhosis (LC), tend to be presenting with obesity these days. The annual rate of muscle loss increases with worsening liver reserve, and thus LC patients are more likely to complicate with sarcopenia. LC is also characterized by protein-energy malnutrition (PEM). Since the PEM in LC can be invariable, the patients probably present with sarcopenic obesity (Sa-O), which involves both sarcopenia and obesity. Currently, there is no mention of Sa-O in the guidelines; however, the rapidly increasing prevalence and poorer clinical consequences of Sa-O are recognized as an important public health problem, and the diagnostic value of Sa-O is expected to increase in the future. Sa-O involves a complex interplay of physiological mechanisms, including increased inflammatory cytokines, oxidative stress, insulin resistance, hormonal disorders, and decline of physical activity. The pathogenesis of Sa-O in LC is diverse, with a lot of perturbations in the muscle-liver-adipose tissue axis. Here, we overview the current knowledge of Sa-O, especially focusing on LC.
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Bellar A, Welch N, Dasarathy S. Exercise and physical activity in cirrhosis: opportunities or perils. J Appl Physiol (1985) 2020; 128:1547-1567. [PMID: 32240017 DOI: 10.1152/japplphysiol.00798.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Reduced exercise capacity and impaired physical performance are observed in nearly all patients with liver cirrhosis. Physical activity and exercise are physiological anabolic stimuli that can reverse dysregulated protein homeostasis or proteostasis and potentially increase muscle mass and contractile function in healthy subjects. Cirrhosis is a state of anabolic resistance, and unlike the beneficial responses to exercise reported in physiological states, there are few systematic studies evaluating the response to exercise in cirrhosis. Hyperammonemia is a mediator of the liver-muscle axis with net skeletal muscle ammonia uptake in cirrhosis causing signaling perturbations, mitochondrial dysfunction with decreased ATP content, modifications of contractile proteins, and impaired ribosomal function, all of which contribute to anabolic resistance in cirrhosis and have the potential to impair the beneficial responses to exercise. English language-publications in peer-reviewed journals that specifically evaluated the impact of exercise in cirrhosis were reviewed. Most studies evaluated responses to endurance exercise, and readouts included peak or maximum oxygen utilization, grip strength, and functional capacity. Endurance exercise for up to 12 wk is clinically tolerated in well-compensated cirrhosis. Data on the safety of resistance exercise are conflicting. Nutritional supplements enhance the benefits of exercise in healthy subjects but have not been evaluated in cirrhosis. Whether the beneficial physiological responses with endurance exercise and increase in muscle mass with resistance exercise that occur in healthy subjects also occur in cirrhotics is not known. Specific organ-system responses, changes in body composition, or improved long-term clinical outcomes with exercise in cirrhosis need evaluation.
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Affiliation(s)
- Annette Bellar
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicole Welch
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Gastroenterology, Hepatology Cleveland Clinic, Cleveland, Ohio
| | - Srinivasan Dasarathy
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Gastroenterology, Hepatology Cleveland Clinic, Cleveland, Ohio
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Walcott-Sapp S, Billingsley KG. Preoperative optimization for major hepatic resection. Langenbecks Arch Surg 2017; 403:23-35. [PMID: 29150719 DOI: 10.1007/s00423-017-1638-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/06/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Major hepatic resections are performed for primary hepatobiliary malignancies, metastatic disease, and benign lesions. Patients with chronic liver disease, including cirrhosis and steatosis, are at an elevated risk of malnutrition and impaired strength and exercise capacity, deficits which cause increased risk of postoperative complications and mortality. The aims of this report are to discuss the pathophysiology of changes in nutrition, exercise capacity, and muscle strength in patient populations likely to require major hepatectomy, and review recommendations for preoperative evaluation and optimization. METHODS Nutritional and functional impairment in preoperative hepatectomy patients, especially those with underlying liver disease, have a complex and multifactorial physiologic basis that is not completely understood. RESULTS Recognition of malnutrition and compromised strength and exercise tolerance preoperatively can be difficult, but is critical in providing the opportunity to intervene prior to major hepatic resection and potentially improve postoperative outcomes. There is promising data on a variety of nutritional strategies to ensure adequate intake of calories, proteins, vitamins, and minerals in patients with cirrhosis and reduce liver size and degree of fatty infiltration in patients with hepatic steatosis. Emerging evidence supports structured exercise programs to improve exercise tolerance and counteract muscle wasting. CONCLUSIONS The importance of nutrition and functional status in patients indicated for major liver resection is apparent, and emerging evidence supports structured preoperative preparation programs involving nutritional intervention and exercise training. Further research is needed in this field to develop optimal protocols to evaluate and treat this heterogeneous cohort of patients.
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Affiliation(s)
- Sarah Walcott-Sapp
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code: L223, Portland, OR, 97239, USA.
| | - Kevin G Billingsley
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code: L223, Portland, OR, 97239, USA
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Mancuzo EV, Pereira RM, Sanches MD, Mancuzo AV. Pre-Transplant Aerobic Capacity and Prolonged Hospitalization After Liver Transplantation. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:87-92. [PMID: 28868384 PMCID: PMC5580179 DOI: 10.1016/j.jpge.2015.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/01/2015] [Indexed: 12/22/2022]
Abstract
Introduction Patients with end stage liver disease (ESLD) referred for liver transplantation (LT) are forwarded to pulmonary evaluation before being operated. ESLD is associated with muscle wasting, reduced exercise tolerance and aerobic capacity. Objectives We assessed the association between aerobic capacity (AC), liver disease severity and postoperative LT outcomes in a series of LT candidates in a university affiliated hospital in Brazil. Methods Pre-LT oxygen uptake at peak (pre-VO2peak), liver disease severity, and early pos-LT outcomes such as length of intensive care unit (ICU) stay, <5 and ≥5 days and hospitalization, <20 and ≥20 days and postoperative mortality were compared. Pre-VO2peak was measured through the cardiopulmonary exercise testing (CPET). Severity of liver disease was estimated by the Model for End-Stage Liver Disease (MELD) categorization into MELD < 18 and MELD ≥ 18 groups. Student's t-test was used to compare these groups. A logistic regression model was built to verify the effect of those variables on the length of ICU stay, length of hospitalization and postoperative mortality. Results A total of 47 patients were include in analysis. Pre-VO2peak was similar to that of healthy sedentary individuals (75 ± 18%) and worse in the MELD ≥ 18 group as compared to the MELD < 18 group (19.51 ± 7.87 vs 25.21 ± 8.76 mL/kg/min, respectively; p = 0.048). According to the multivariate analysis, only a lower pre-VO2peak (<20.09 ± 4.83 mL/kg/min) was associated to a greater length of hospitalization (p = 0.01). Conclusions In LT candidates, a reduced pre-VO2peak may predict a higher risk of greater pos-LT length of hospitalization. The length of ICU stay and postoperative mortality were not associated with variables studied. This finding should be evaluated in other studies before making specific recommendations about a routine use of CPET in LT candidates.
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Affiliation(s)
- Eliane Viana Mancuzo
- Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rossana Martins Pereira
- Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Dias Sanches
- Surgery, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandra Viana Mancuzo
- Clinical Research Center, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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