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Guimarães AP, Seidel H, Pires LVDM, Trindade CO, Baleeiro RDS, Souza PMD, Silva FGDE, Coelho DB, Becker LK, Oliveira ECD. GABA Supplementation, Increased Heart-Rate Variability, Emotional Response, Sleep Efficiency and Reduced Depression in Sedentary Overweight Women Undergoing Physical Exercise: Placebo-Controlled, Randomized Clinical Trial. J Diet Suppl 2024:1-15. [PMID: 38321713 DOI: 10.1080/19390211.2024.2308262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Gamma-aminobutyric acid (GABA) serves as a pivotal neurotransmitter implicated in the pathogenesis of stress, anxiety, sleep-related disorders, and heart rate (HR) reactions. Heart-rate variability (HRV), modulated by the sympathetic and parasympathetic branches of the autonomic nervous system (ANS), offers insights into cardiac autonomic control and cardiovascular well-being. The present study aimed to explore the impact of GABA supplementation on emotional metrics, sleep quality, and HRV in sedentary women with overweight or obesity partaking in physical exercise. A randomized, double-blind, placebo-controlled clinical trial was undertaken involving 30 sedentary women with overweight or obesity. Volunteers were assigned randomly to two groups: the intervention group receiving GABA (200 mg) once daily for a total of 90 supplementation doses, and the placebo group. Both groups engaged in physical exercise, while the supplementation regimen spanned 90 days. Assessments were conducted at three intervals: baseline (T0), midway through the study (T45), and study culmination (T90). Following 90 days of GABA supplementation, the intervention group demonstrated enhancements in habitual sleep efficiency, as indicated by reductions in Pittsburgh Sleep Quality Index (PSQI) scores. Moreover, an improved emotional response was observed, characterized by diminished negative affect. GABA supplementation yielded ameliorations in depression scores as per the Depression, Anxiety, and Stress Scale (DASS-21). Notably, an augmented HRV was noted, attributed to heightened parasympathetic autonomic nervous system predominance. GABA supplementation elicited noteworthy enhancements in heart rate variability, emotional response, depression mitigation, and sleep efficiency following a 90-day supplementation.
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Affiliation(s)
| | - Helen Seidel
- Medicine Department, Medicine School, Federal University of Ouro Preto, Ouro Preto, Brazil
| | | | - Cristina Oliveira Trindade
- Postgraduate Program in Health and Nutrition/PPGSN, Federal University of Ouro Preto, Ouro Preto, Brazil
| | | | | | | | - Daniel Barbosa Coelho
- Postgraduate Program in Health and Nutrition/PPGSN, Federal University of Ouro Preto, Ouro Preto, Brazil
- Physical Education Department, Physical Education School, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Lenice Kappes Becker
- Postgraduate Program in Health and Nutrition/PPGSN, Federal University of Ouro Preto, Ouro Preto, Brazil
- Physical Education Department, Physical Education School, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Emerson Cruz de Oliveira
- Postgraduate Program in Health and Nutrition/PPGSN, Federal University of Ouro Preto, Ouro Preto, Brazil
- Physical Education Department, Physical Education School, Federal University of Ouro Preto, Ouro Preto, Brazil
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Lee JB, Thompson KMA, Teixeira AL, Burr JF, Millar PJ. Cardiovascular responses to combined mechanoreflex and metaboreflex activation in healthy adults: effects of sex and low- versus high-hormone phases in females. J Appl Physiol (1985) 2023; 135:1102-1114. [PMID: 37795529 DOI: 10.1152/japplphysiol.00775.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/08/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
Females generally have smaller blood pressure (BP) responses to isolated muscle mechanoreflex and metaboreflex activation compared with males, which may explain sex differences in BP responses to voluntary exercise. The mechanoreflex may be sensitized during exercise, but whether mechanoreflex-metaboreflex interactions differ by sex or variations in sex hormones remains unknown. Thirty-one young healthy subjects (females, n = 16) performed unilateral passive cycling (mechanoreflex), active cycling (40% peak Watts), postexercise circulatory occlusion (PECO; metaboreflex), and passive cycling combined with PECO (combined mechanoreflex and metaboreflex activation). Beat-to-beat BP, heart rate, inactive leg vascular conductance, and active leg muscle oxygenation were measured. Ten females underwent exploratory testing during low- and high-hormone phases of their self-reported menstrual cycle or oral contraceptive use. Systolic BP and heart rate responses did not differ between sexes during active cycling [Δ30 ± 9 vs. 29 ± 11 mmHg (males vs. females), P = 0.9; Δ33 ± 8 vs. 35 ± 6 beats/min, P = 0.4] or passive cycling with PECO (Δ26 ± 11 vs. 21 ± 10 mmHg, P = 0.3; Δ14 ± 7 vs. 18 ± 15 beats/min, P = 0.3). Passive cycling with PECO revealed additive, not synergistic, effects for systolic BP [males: Δ23 ± 14 vs. 26 ± 11 mmHg (sum of isolated passive cycling and PECO vs. combined activation); females: Δ26 ± 11 vs. 21 ± 12 mmHg, interaction P = 0.05]. Results were consistent in subset analyses with sex differences in active cycling BP (P > 0.1) and exploratory analyses of hormone phase (P > 0.4). Despite a lack of statistical equivalence, no differences in cardiovascular responses were found during combined mechanoreflex-metaboreflex activation between sexes or hormone levels. These results provide preliminary data regarding the involvement of muscle mechanoreflex-metaboreflex interactions in mediating sex differences in voluntary exercise BP responses.NEW & NOTEWORTHY The muscle mechanoreflex may be sensitized by metabolites during exercise. We show that cardiovascular responses to combined mechanoreflex (passive cycling) and metaboreflex (postexercise circulatory occlusion) activation are primarily additive and do not differ between males and females, or across variations in sex hormones in females. Our findings provide new insight into the contributions of muscle mechanoreflex-metaboreflex interactions as a cause for prior reports that females have smaller blood pressure responses to voluntary exercise.
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Affiliation(s)
- Jordan B Lee
- Human Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Kyle M A Thompson
- Human Performance and Health Research Lab, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, Ontario, Canada
| | - André L Teixeira
- Human Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jamie F Burr
- Human Performance and Health Research Lab, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Philip J Millar
- Human Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, Ontario, Canada
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3
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Wang H, Cheng L, Han Y. Effect of oral administration of GABA on thermoregulation in athletes during exercise in cold environments: A preliminary study. Front Nutr 2022; 9:883571. [PMID: 35911099 PMCID: PMC9335056 DOI: 10.3389/fnut.2022.883571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background γ-aminobutyric acid (GABA), a common ingredient in sports supplements and other health products, regulates body temperature in the preoptic area and anterior hypothalamus (PO/AH). To date, no study has examined the effect of GABA on thermoregulation during exercise in humans in a cold temperature environment (11 ± 0.3°C, 45% ± 2% relative humidity). Methods We performed a randomized, double-blind study. Ten trained male athletes consumed either a drink (3 ml/kg weight) containing GABA (1,000 mg, trial G) or an equivalent amount of placebo drink (trial C) before exercise. They rested for 20 min and then cycled at 60% of maximum output power for 40 min, pedaling at 60 rpm, and recovered for 20 min. Core temperature (Tc), skin temperature (upper arm, chest, thigh, calf), and heart rate (HR) were monitored at rest (T0), exercise begins (T20), 20 min of exercise (T40), the exercise ends (T60), and at recovery (T80). Results Compared to T0, Tc decreased significantly at T20 and increased significantly at T40, T60 and T80 (p < 0.01). From 35–80 min, the Tc was higher in trial G (peaked at 37.96 ± 0.25°C) than in trial C (37.89 ± 0.37°C), but it failed to reach significant difference (p > 0.05); Tsk continued to increase during exercise and was significantly higher than T0 at T40 (p < 0.05), T60 and T80 (p < 0.01). There was no significant difference in Tsk between the two trials (p > 0.05). Conclusion Our findings provide initial evidence that oral administration of GABA does not affect thermoregulation and has no adverse effects on the body as an ergogenic exercise supplement during exercise in cold environments.
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Teixeira AL, Vianna LC. The exercise pressor reflex: An update. Clin Auton Res 2022; 32:271-290. [PMID: 35727398 DOI: 10.1007/s10286-022-00872-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/25/2022] [Indexed: 02/07/2023]
Abstract
The exercise pressor reflex is a feedback mechanism engaged upon stimulation of mechano- and metabosensitive skeletal muscle afferents. Activation of these afferents elicits a reflex increase in heart rate, blood pressure, and ventilation in an intensity-dependent manner. Consequently, the exercise pressor reflex has been postulated to be one of the principal mediators of the cardiorespiratory responses to exercise. In this updated review, we will discuss classical and recent advancements in our understating of the exercise pressor reflex function in both human and animal models. Particular attention will be paid to the afferent mechanisms and pathways involved during its activation, its effects on different target organs, its potential role in the abnormal cardiovascular response to exercise in diseased states, and the impact of age and biological sex on these responses. Finally, we will highlight some unanswered questions in the literature that may inspire future investigations in the field.
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Affiliation(s)
- André L Teixeira
- NeuroV̇ASQ̇, Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, DF, Brasília, Brazil
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Lauro C Vianna
- NeuroV̇ASQ̇, Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, DF, Brasília, Brazil.
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Teixeira AL, Nardone M, Samora M, Fernandes IA, Ramos PS, Sabino-Carvalho JL, Ricardo DR, Millar PJ, Vianna LC. Potentiation of GABAergic synaptic transmission by diazepam acutely increases resting beat-to-beat blood pressure variability in young adults. Am J Physiol Regul Integr Comp Physiol 2022; 322:R501-R510. [PMID: 35348021 DOI: 10.1152/ajpregu.00291.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resting beat-to-beat blood pressure variability is a powerful predictor of cardiovascular events and end-organ damage. However, its underlying mechanisms remain unknown. Herein, we tested the hypothesis that a potentiation of GABAergic synaptic transmission by diazepam would acutely increase resting beat-to-beat blood pressure variability. In 40 (17 females) young, normotensive subjects, resting beat-to-beat blood pressure (finger photoplethysmography) was continuously measured for 5 to 10 min, 60 min after the oral administration of either diazepam (10 mg) or placebo. The experiments were conducted in a randomized, double-blinded, and placebo-controlled design. Stroke volume was estimated from the blood pressure waveform (ModelFlow) permitting the calculation of cardiac output and total peripheral resistance. Direct recordings of muscle sympathetic nerve activity (MSNA, microneurography) were obtained in a subset of subjects (N=13) and spontaneous cardiac and sympathetic baroreflex sensitivity calculated. Compared to placebo, diazepam significantly increased the standard deviation of systolic (4.7±1.4 vs. 5.7±1.5 mmHg, P=0.001), diastolic (3.8±1.2 vs. 4.5±1.2 mmHg, P=0.007) and mean blood pressure (3.8±1.1 vs. 4.5±1.1 mmHg, P=0.002), as well as cardiac output (469±149 vs. 626±259 ml/min, P<0.001) and total peripheral resistance (1.0±0.3 vs. 1.4±0.6 mmHg/l/min, P<0.001). Similar results were found using different indices of variability. Furthermore, diazepam reduced MSNA burst frequency (placebo: 22±6 vs. diazepam: 18±8 bursts/min, P=0.025) without affecting the arterial baroreflex control of heart rate (placebo: 18.6±6.7 vs. diazepam: 18.8±7.0 ms/mmHg, P=0.87) and MSNA (placebo: -3.6±1.2 vs. diazepam: -3.4±1.5 bursts/100Hb/mmHg, P=0.55). These findings suggest that GABAA receptors modulate resting beat-to-beat blood pressure variability in young adults.
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Affiliation(s)
- André L Teixeira
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.,NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Massimo Nardone
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Milena Samora
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Igor Alexandre Fernandes
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Plinio Santos Ramos
- Maternity Hospital Therezinha de Jesus, Faculty of Health and Medical Sciences (SUPREMA), Juiz de Fora, MG, Brazil
| | - Jeann L Sabino-Carvalho
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Djalma Rabelo Ricardo
- Maternity Hospital Therezinha de Jesus, Faculty of Health and Medical Sciences (SUPREMA), Juiz de Fora, MG, Brazil
| | - Philip J Millar
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Lauro C Vianna
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
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Teixeira AL, Fernandes IA, Millar PJ, Vianna LC. GABA A receptor activation modulates the muscle sympathetic nerve activity responses at the onset of static exercise in humans. J Appl Physiol (1985) 2021; 131:1138-1147. [PMID: 34410847 DOI: 10.1152/japplphysiol.00423.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise is a well-known sympathoexcitatory stimulus. However, muscle sympathetic nerve activity (MSNA) can decrease during the onset of muscle contraction. Yet, the underlying mechanisms and neurotransmitters involved in the sympathetic responses at the onset of exercise remain unknown. Herein, we tested the hypothesis that GABAA receptors may contribute to the MSNA responses at the onset of static handgrip in humans. Thirteen young, healthy individuals (4 females) performed 30 s of ischemic static handgrip at 30% of maximum volitional contraction before and following oral administration of either placebo or diazepam (10 mg), a benzodiazepine that enhances GABAA activity. MSNA (microneurography), beat-to-beat blood pressure (finger photopletysmography), heart rate (electrocardiogram), and stroke volume (ModelFlow) were continuously measured. Cardiac output (CO = stroke volume × heart rate) and total vascular conductance (TVC = CO/mean blood pressure) were subsequently calculated. At rest, MSNA was reduced while hemodynamic variables were unchanged after diazepam administration. Before diazepam, static handgrip elicited a significant decrease in MSNA burst frequency (Δ-7 ± 2 bursts/min, P < 0.01 vs. baseline) and MSNA burst incidence (Δ-16 ± 2 bursts/100 heart beats, P < 0.01 vs. baseline); however, these responses were attenuated following diazepam administration (Δ-1 ± 2 bursts/min and Δ-7 ± 2 bursts/100 heart beats, respectively; P < 0.01 vs. before diazepam). Diazepam did not affect the increases in heart rate, blood pressure, CO, and TVC at the exercise onset. Importantly, the placebo had no effect on any variable at rest or exercise onset. These findings suggest that GABAA receptor activation modulates the MSNA responses at the onset of static exercise in young, healthy humans.NEW & NOTEWORTHY In this study, we found that the reduction in muscle sympathetic nerve activity at the onset of static handgrip exercise was blunted following GABAA receptor activation with oral administration of diazepam in young, healthy individuals. The present findings provide novel insight into neural circuitry mechanisms controlling muscle sympathetic outflow during exercise in humans.
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Affiliation(s)
- André L Teixeira
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.,NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | - Igor A Fernandes
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | - Philip J Millar
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Lauro C Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
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Mizuno M, Hotta N, Ishizawa R, Kim HK, Iwamoto G, Vongpatanasin W, Mitchell JH, Smith SA. The Impact of Insulin Resistance on Cardiovascular Control During Exercise in Diabetes. Exerc Sport Sci Rev 2021; 49:157-167. [PMID: 33965976 PMCID: PMC8195845 DOI: 10.1249/jes.0000000000000259] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Patients with diabetes display heightened blood pressure response to exercise, but the underlying mechanism remains to be elucidated. There is no direct evidence that insulin resistance (hyperinsulinemia or hyperglycemia) impacts neural cardiovascular control during exercise. We propose a novel paradigm in which hyperinsulinemia or hyperglycemia significantly influences neural regulatory pathways controlling the circulation during exercise in diabetes.
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Affiliation(s)
- Masaki Mizuno
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Norio Hotta
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
- College of Life and Health Sciences, Chubu University, Kasugai 487-850, Japan
| | - Rie Ishizawa
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Han-Kyul Kim
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Gary Iwamoto
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Wanpen Vongpatanasin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Jere H. Mitchell
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
| | - Scott A. Smith
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9174, USA
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8
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Teixeira AL, Fernandes IA, Vianna LC. Cardiovascular Control During Exercise: The Connectivity of Skeletal Muscle Afferents to the Brain. Exerc Sport Sci Rev 2020; 48:83-91. [PMID: 32000180 DOI: 10.1249/jes.0000000000000218] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The exercise pressor reflex (EPR) is engaged upon the activation of group III/IV skeletal muscle afferents and is one of the principal mediators of cardiovascular responses to exercise. This review explores the hypothesis that afferent signals from EPR communicate via GABAergic contacts within the brain stem to evoke parasympathetic withdrawal and sympathoexcitation to increase cardiac output, peripheral resistance, and blood pressure during exercise.
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Affiliation(s)
- André L Teixeira
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
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9
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Samora M, Teixeira AL, Sabino-Carvalho JL, Vianna LC. Sex differences in cardiac vagal reactivation from the end of isometric handgrip exercise and at the onset of muscle metaboreflex isolation. Auton Neurosci 2020; 228:102714. [PMID: 32829151 DOI: 10.1016/j.autneu.2020.102714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 11/18/2022]
Abstract
A parasympathetic reactivation is an underlying mechanism mediating the rapid fall in heart rate (HR) at the onset of post-exercise ischemia (PEI) in humans. Herein, we tested the hypothesis that, compared to men, women present a slower HR recovery at the cessation of isometric handgrip exercise (i.e., onset of PEI) due to an attenuated cardiac vagal reactivation. Forty-seven (23 women) young and healthy volunteers were recruited. Subjects performed 90s of isometric handgrip exercise at 40% of maximal voluntary contraction followed by 3-min of PEI. The onset of PEI was analyzed over the first 30s in 10s windows. Cardiac vagal reactivation was indexed using the HR fall and by HR variability metrics (e.g., RMSSD and SDNN) immediately after the cessation of the exercise. HR was significantly increased from rest during exercise in men and women and increases were similar between sexes. However, following the cessation of exercise, the HR recovery was significantly slower in women compared to men regardless of the time point (women vs. men: ∆-14 ± 8 vs. ∆-18 ± 6 beats.min-1 at 10s; ∆-20 ± 9 vs. ∆-25 ± 8 beats.min-1 at 20s; ∆-22 ± 10 vs. ∆-27 ± 9 beats.min-1 at 30s; P = .027). RMSSD and SDNN increased at the cessation of exercise in greater magnitude in men compared to women. These findings demonstrate that women had a slower HR recovery at the cessation of isometric handgrip exercise and onset of PEI compared to men, suggesting a sex-related difference in cardiac vagal reactivation in healthy young humans.
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Affiliation(s)
- Milena Samora
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - André L Teixeira
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Jeann L Sabino-Carvalho
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Lauro C Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil; Graduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, DF, Brazil.
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10
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Limberg JK, Casey DP, Trinity JD, Nicholson WT, Wray DW, Tschakovsky ME, Green DJ, Hellsten Y, Fadel PJ, Joyner MJ, Padilla J. Assessment of resistance vessel function in human skeletal muscle: guidelines for experimental design, Doppler ultrasound, and pharmacology. Am J Physiol Heart Circ Physiol 2019; 318:H301-H325. [PMID: 31886718 DOI: 10.1152/ajpheart.00649.2019] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The introduction of duplex Doppler ultrasound almost half a century ago signified a revolutionary advance in the ability to assess limb blood flow in humans. It is now widely used to assess blood flow under a variety of experimental conditions to study skeletal muscle resistance vessel function. Despite its pervasive adoption, there is substantial variability between studies in relation to experimental protocols, procedures for data analysis, and interpretation of findings. This guideline results from a collegial discussion among physiologists and pharmacologists, with the goal of providing general as well as specific recommendations regarding the conduct of human studies involving Doppler ultrasound-based measures of resistance vessel function in skeletal muscle. Indeed, the focus is on methods used to assess resistance vessel function and not upstream conduit artery function (i.e., macrovasculature), which has been expertly reviewed elsewhere. In particular, we address topics related to experimental design, data collection, and signal processing as well as review common procedures used to assess resistance vessel function, including postocclusive reactive hyperemia, passive limb movement, acute single limb exercise, and pharmacological interventions.
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Affiliation(s)
- Jacqueline K Limberg
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Darren P Casey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa.,François M. Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa.,Fraternal Order of Eagles Diabetes Research, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | | | - D Walter Wray
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Michael E Tschakovsky
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | | | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri
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11
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Campos MO, Mansur DE, Mattos JD, Paiva ACS, Videira RLR, Macefield VG, da Nóbrega ACL, Fernandes IA. Acid-sensing ion channels blockade attenuates pressor and sympathetic responses to skeletal muscle metaboreflex activation in humans. J Appl Physiol (1985) 2019; 127:1491-1501. [PMID: 31545154 DOI: 10.1152/japplphysiol.00401.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In animals, the blockade of acid-sensing ion channels (ASICs), cation pore-forming membrane proteins located in the free nerve endings of group IV afferent fibers, attenuates increases in arterial pressure (AP) and sympathetic nerve activity (SNA) during muscle contraction. Therefore, ASICs play a role in mediating the metabolic component (skeletal muscle metaboreflex) of the exercise pressor reflex in animal models. Here we tested the hypothesis that ASICs also play a role in evoking the skeletal muscle metaboreflex in humans, quantifying beat-by-beat mean AP (MAP; finger photoplethysmography) and muscle SNA (MSNA; microneurography) in 11 men at rest and during static handgrip exercise (SHG; 35% of the maximal voluntary contraction) and postexercise muscle ischemia (PEMI) before (B) and after (A) local venous infusion of either saline or amiloride (AM), an ASIC antagonist, via the Bier block technique. MAP (BAM +30 ± 6 vs. AAM +25 ± 7 mmHg, P = 0.001) and MSNA (BAM +14 ± 9 vs. AAM +10 ± 6 bursts/min, P = 0.004) responses to SHG were attenuated under ASIC blockade. Amiloride also attenuated the PEMI-induced increases in MAP (BAM +25 ± 6 vs. AAM +16 ± 6 mmHg, P = 0.0001) and MSNA (BAM +16 ± 9 vs. AAM +8 ± 8 bursts/min, P = 0.0001). MAP and MSNA responses to SHG and PEMI were similar before and after saline infusion. We conclude that ASICs play a role in evoking pressor and sympathetic responses to SHG and the isolated activation of the skeletal muscle metaboreflex in humans. NEW & NOTEWORTHY We showed that regional blockade of the acid-sensing ion channels (ASICs), induced by venous infusion of the antagonist amiloride via the Bier block anesthetic technique, attenuated increases in arterial pressure and muscle sympathetic nerve activity during both static handgrip exercise and postexercise muscle ischemia. These findings indicate that ASICs contribute to both pressor and sympathetic responses to the activation of the skeletal muscle metaboreflex in humans.
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Affiliation(s)
- Monique O Campos
- Laboratory of Exercise Sciences, Fluminense Federal University, Niterói, Brazil
| | - Daniel E Mansur
- Laboratory of Exercise Sciences, Fluminense Federal University, Niterói, Brazil
| | - João D Mattos
- Laboratory of Exercise Sciences, Fluminense Federal University, Niterói, Brazil
| | - Adrielle C S Paiva
- Laboratory of Exercise Sciences, Fluminense Federal University, Niterói, Brazil
| | | | - Vaughan G Macefield
- School of Medicine, Western Sydney University, Sydney, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - Igor A Fernandes
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
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12
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Teixeira AL, Fernandes IA, Vianna LC. GABA A receptors modulate sympathetic vasomotor outflow and the pressor response to skeletal muscle metaboreflex activation in humans. J Physiol 2019; 597:4139-4150. [PMID: 31247674 DOI: 10.1113/jp277929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/24/2019] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS The activation of the group III/IV skeletal muscle afferents is one of the principal mediators of cardiovascular responses to exercise; however, the neuronal circuitry mechanisms that are involved during the activation of group III/IV muscle afferents in humans remain unknown. Recently, we showed that GABAergic mechanisms are involved in the cardiac vagal withdrawal during the activation of mechanically sensitive (predominantly mediated by group III fibres) skeletal muscle afferents in humans. In the present study, we found that increases in muscle sympathetic nerve activity and mean blood pressure during isometric handgrip exercise and postexercise ischaemia were significantly greater after the oral administration of diazepam, a benzodiazepine that increases GABAA activity, but not after placebo administration in young healthy subjects. These findings indicate for the first time that GABAA receptors modulate sympathetic vasomotor outflow and the pressor responses to activation of metabolically sensitive (predominantly mediated by group IV fibres) skeletal muscle afferents in humans. ABSTRACT Animal studies have indicated that GABAA receptors are involved in the neuronal circuitry of the group III/IV skeletal muscle afferent activation-induced neurocardiovascular responses to exercise. In the present study, we aimed to determine whether GABAA receptors modulate the neurocardiovascular responses to activation of metabolically sensitive (predominantly mediated by group IV fibres) skeletal muscle afferents in humans. In a randomized, double-blinded, placebo-controlled and cross-over design, 17 healthy subjects (eight women) performed 2 min of ischaemic isometric handgrip exercise at 30% of the maximal voluntary contraction followed by 2 min of postexercise ischaemia (PEI). Muscle sympathetic nerve activity (MSNA), blood pressure (BP) and heart rate (HR) were continuously measured and trials were conducted before and 60 min after the oral administration of either placebo or diazepam (10 mg), a benzodiazepine that enhances GABAA activity. At rest, MSNA was reduced, whereas HR and BP did not change after diazepam administration. During ischaemic isometric handgrip, greater MSNA (pre: ∆13 ± 9 bursts min-1 vs. post: ∆29 ± 15 bursts min-1 , P < 0.001), HR (pre: ∆23 ± 11 beats min-1 vs. post: ∆31 ± 17 beats min-1 , P < 0.01) and mean BP (pre: ∆33 ± 12 mmHg vs. post: ∆37 ± 12 mmHg, P < 0.01) responses were observed after diazepam. During PEI, MSNA and mean BP remained elevated from baseline before diazepam (∆10 ± 8 bursts min-1 and ∆25 ± 14 mmHg, respectively) and these elevations were increased after diazepam (∆17 ± 12 bursts min-1 and ∆28 ± 13 mmHg, respectively) (P ≤ 0.05). Importantly, placebo pill had no effect on neural, cardiac and pressor responses. These findings demonstrate for the first time that GABAA receptors modulate MSNA and the pressor responses to skeletal muscle metaboreflex activation in humans.
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Affiliation(s)
- André L Teixeira
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Igor A Fernandes
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Lauro C Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
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13
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Teixeira AL, Samora M, Vianna LC. Muscle metaboreflex activation via postexercise ischemia as a tool for teaching cardiovascular physiology for undergraduate students. ADVANCES IN PHYSIOLOGY EDUCATION 2019; 43:34-41. [PMID: 30540204 DOI: 10.1152/advan.00174.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The cardiovascular responses to exercise are mediated by several interactive neural mechanisms, including central command, arterial baroreflex, and skeletal muscle mechano- and metaboreflex. In humans, muscle metaboreflex activation can be isolated via postexercise ischemia (PEI), which increases sympathetic nerve activity and partially maintains the exercise-induced increase in arterial blood pressure. Here, we describe a practical laboratory class using PEI as a simple and useful technique to teach cardiovascular physiology. In an undergraduate exercise physiology class ( n = 47), a traditional 4-h lecture was conducted discussing the neural control mechanisms of cardiovascular regulation during exercise. Thereafter, eight students (4 men and 4 women) were selected to participate as a volunteer of a practical laboratory class. Each participant performed 90 s of isometric handgrip exercise at 40% of maximal voluntary contraction, followed by 3 min of PEI. Arterial blood pressure and heart rate were measured by digital monitors at rest and during isometric handgrip, PEI, and recovery. In addition, blood samples were collected from the tip of the exercising finger for blood lactate analyses. After the laboratory class, a survey was given to determine the perceptions of the students. The findings demonstrate that this laboratory class has proved to be highly popular with students, who self-reported a significant improvement in their understanding of several aspects of cardiovascular regulation during exercise.
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Affiliation(s)
- André L Teixeira
- NeuroV̇ASQ̇, Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília , Brasília , Brazil
| | - Milena Samora
- NeuroV̇ASQ̇, Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília , Brasília , Brazil
| | - Lauro C Vianna
- NeuroV̇ASQ̇, Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília , Brasília , Brazil
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14
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Spontaneous cardiac baroreflex sensitivity is enhanced during post-exercise ischemia in men but not in women. Eur J Appl Physiol 2018; 119:103-111. [DOI: 10.1007/s00421-018-4004-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/01/2018] [Indexed: 01/04/2023]
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15
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Sabino-Carvalho JL, Teixeira AL, Samora M, Daher M, Vianna LC. Blunted cardiovascular responses to exercise in Parkinson’s disease patients: role of the muscle metaboreflex. J Neurophysiol 2018; 120:1516-1524. [DOI: 10.1152/jn.00308.2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients with Parkinson’s disease (PD) exhibit attenuated cardiovascular responses to exercise. The underlying mechanisms that are potentially contributing to these impairments are not fully understood. Therefore, we sought to test the hypothesis that patients with PD exhibit blunted cardiovascular responses to isolated muscle metaboreflex activation following exercise. For this, mean blood pressure, cardiac output, and total peripheral resistance were measured using finger photoplethysmography and the Modelflow method in 11 patients with PD [66 ± 2 yr; Hoehn and Yahr score: 2 ± 1 a.u.; time since diagnosis: 7 ± 1 yr; means ± SD) and 9 age-matched controls (66 ± 3 yr). Measurements were obtained at rest, during isometric handgrip exercise performed at 40% maximal voluntary contraction, and during postexercise ischemia. Also, a cold pressor test was assessed to confirm that blunted cardiovascular responses were specific to exercise and not representative of generalized sympathetic responsiveness. Changes in mean blood pressure were attenuated in patients with PD during handgrip (PD: ∆25 ± 2 mmHg vs. controls: ∆31 ± 3 mmHg; P < 0.05), and these group differences remained during postexercise ischemia (∆17 ± 1 mmHg vs. ∆26 ± 1 mmHg, respectively; P < 0.01). Additionally, changes in total peripheral resistance were attenuated during exercise and postexercise ischemia, indicating blunted reflex vasoconstriction in patients with PD. Responses to cold pressor test did not differ between groups, suggesting no group differences in generalized sympathetic responsiveness. Our results support the concept that attenuated cardiovascular responses to exercise observed in patients with PD are, at least in part, explained by an altered skeletal muscle metaboreflex. NEW & NOTEWORTHY Patients with Parkinson’s disease (PD) presented blunted cardiovascular responses to exercise. We showed that cardiovascular response evoked by the metabolic component of the exercise pressor reflex is blunted in patients with PD. Furthermore, patients with PD presented similar pressor response during the cold pressor test compared with age-matched controls. Altogether, our results support the hypothesis that attenuated cardiovascular responses to exercise observed in patients with PD are mediate by an altered skeletal muscle metaboreflex.
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Affiliation(s)
- Jeann L. Sabino-Carvalho
- NeuroVASQ-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
| | - André L. Teixeira
- NeuroVASQ-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Milena Samora
- NeuroVASQ-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Maurício Daher
- NeuroVASQ-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Lauro C. Vianna
- NeuroVASQ-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
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16
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Vianna LC, Fernandes IA, Barbosa TC, Teixeira AL, Nóbrega ACL. Capsaicin-based analgesic balm attenuates the skeletal muscle metaboreflex in healthy humans. J Appl Physiol (1985) 2018; 125:362-368. [PMID: 29698108 DOI: 10.1152/japplphysiol.00038.2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The exercise pressor reflex (EPR) is comprised of group III and IV skeletal muscle afferents and is one of the principal mediators of the cardiovascular response to exercise. In animals, capsaicin-based analgesic balm (CAP) attenuates the pressor response to muscle contraction, indicating the transient receptor potential vanilloid 1 (TRPv1) receptor (localized on the group IV afferent neuron) as an important mediator of the EPR. However, whether these findings can be extrapolated to humans remains unknown. Here, we tested the hypothesis that CAP would attenuate blood pressure (BP) and muscle sympathetic nerve activity (MSNA) responses to isolated muscle metaboreflex activation in healthy men. MSNA (microneurography) and beat-to-beat heart hate (HR, by electrocardiography), and BP (finger photoplethysmography) were continuously measured in eight healthy males (23 ± 5 yr) at rest, during isometric handgrip exercise, and during postexercise ischemia (PEI). Trials were performed before and 30 and 60 min after the topical application of CAP (0.1%, CAPZASIN-HP) over the volar forearm of the subject's exercising arm. Isometric exercise evoked increases in mean BP (∆32 ± 4 mmHg) and MSNA (∆26 ± 5 bursts/min; ∆19 ± 5 bursts/100 heart beats). The increases in BP during handgrip were not affected by CAP, but the increase in MSNA was lower after 60 min of CAP application. During PEI, the increases in BP and MSNA were all significantly less than those before CAP (all P < 0.05). In conclusion, CAP attenuated BP and sympathetic responses evoked by PEI in humans. These data provide evidence that transient receptor potential vanilloid 1 receptors potentially contribute to the EPR in humans, via its metabolic component. NEW & NOTEWORTHY We found that topical application of capsaicin-based analgesic balm attenuates arterial blood pressure and muscle sympathetic nerve activity during isolated muscle metaboreflex activation following isometric handgrip exercise in healthy humans. These findings suggest that the transient receptor potential vanilloid 1 may contribute to the exercise pressor reflex in humans via its metabolic component.
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Affiliation(s)
- Lauro C Vianna
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília , Brasilia, Federal District , Brazil
| | - Igor A Fernandes
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília , Brasilia, Federal District , Brazil.,Department of Physiology and Pharmacology, Fluminense Federal University , Niterói, Rio de Janeiro , Brazil
| | - Thales C Barbosa
- Department of Kinesiology, University of Texas at Arlington , Arlington, Texas
| | - André L Teixeira
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília , Brasilia, Federal District , Brazil
| | - Antonio C L Nóbrega
- Department of Physiology and Pharmacology, Fluminense Federal University , Niterói, Rio de Janeiro , Brazil
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17
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Silva TM, Aranda LC, Paula-Ribeiro M, Oliveira DM, Medeiros WM, Vianna LC, Nery LE, Silva BM. Hyperadditive ventilatory response arising from interaction between the carotid chemoreflex and the muscle mechanoreflex in healthy humans. J Appl Physiol (1985) 2018; 125:215-225. [PMID: 29565769 DOI: 10.1152/japplphysiol.00009.2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Physical exercise potentiates the carotid chemoreflex control of ventilation (VE). Hyperadditive neural interactions may partially mediate the potentiation. However, some neural interactions remain incompletely explored. As the potentiation occurs even during low-intensity exercise, we tested the hypothesis that the carotid chemoreflex and the muscle mechanoreflex could interact in a hyperadditive fashion. Fourteen young healthy subjects inhaled randomly, in separate visits, 12% O2 to stimulate the carotid chemoreflex and 21% O2 as control. A rebreathing circuit maintained isocapnia. During gases administration, subjects either remained at rest (i.e., normoxic and hypoxic rest) or the muscle mechanoreflex was stimulated via passive knee movement (i.e., normoxic and hypoxic movement). Surface muscle electrical activity did not increase during the passive movement, confirming the absence of active contractions. Hypoxic rest and normoxic movement similarly increased VE [change (mean ± SE) = 1.24 ± 0.72 vs. 0.73 ± 0.43 l/min, respectively; P = 0.46], but hypoxic rest only increased tidal volume (Vt), and normoxic movement only increased breathing frequency (BF). Hypoxic movement induced greater VE and mean inspiratory flow (Vt/Ti) increase than the sum of hypoxic rest and normoxic movement isolated responses (VE change: hypoxic movement = 3.72 ± 0.81 l/min vs. sum = 1.96 ± 0.83 l/min, P = 0.01; Vt/Ti change: hypoxic movement = 0.13 ± 0.03 l/s vs. sum = 0.06 ± 0.03 l/s, P = 0.02). Moreover, hypoxic movement increased both Vt and BF. Collectively, the results indicate that the carotid chemoreflex and the muscle mechanoreflex interacted, mediating a hyperadditive ventilatory response in healthy humans. NEW & NOTEWORTHY The main finding of this study was that concomitant carotid chemoreflex and muscle mechanoreflex stimulation provoked greater ventilation increase than the sum of ventilation increase induced by stimulation of each reflex in isolation, which, consequently, supports that the carotid chemoreflex and the muscle mechanoreflex interacted, mediating a hyperadditive ventilatory response in healthy humans.
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Affiliation(s)
- Talita M Silva
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo , Brazil.,Postgraduate Program in Pulmonary Medicine, Department of Medicine, Federal University of São Paulo , Brazil.,Division of Exercise Physiology, Department of Physiology, Federal University of São Paulo , Brazil
| | - Liliane C Aranda
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo , Brazil.,Postgraduate Program in Pulmonary Medicine, Department of Medicine, Federal University of São Paulo , Brazil.,Division of Exercise Physiology, Department of Physiology, Federal University of São Paulo , Brazil
| | - Marcelle Paula-Ribeiro
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo , Brazil.,Division of Exercise Physiology, Department of Physiology, Federal University of São Paulo , Brazil.,Postgraduate Program in Translational Medicine, Department of Medicine, Federal University of São Paulo , Brazil
| | - Diogo M Oliveira
- Division of Exercise Physiology, Department of Physiology, Federal University of São Paulo , Brazil.,Postgraduate Program in Translational Medicine, Department of Medicine, Federal University of São Paulo , Brazil
| | - Wladimir M Medeiros
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo , Brazil.,Postgraduate Program in Pulmonary Medicine, Department of Medicine, Federal University of São Paulo , Brazil
| | - Lauro C Vianna
- Faculty of Physical Education, University of Brasilia, Federal District, Brazil
| | - Luiz E Nery
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo , Brazil.,Postgraduate Program in Pulmonary Medicine, Department of Medicine, Federal University of São Paulo , Brazil
| | - Bruno M Silva
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo , Brazil.,Postgraduate Program in Pulmonary Medicine, Department of Medicine, Federal University of São Paulo , Brazil.,Division of Exercise Physiology, Department of Physiology, Federal University of São Paulo , Brazil.,Postgraduate Program in Translational Medicine, Department of Medicine, Federal University of São Paulo , Brazil
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