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- Relationship between heart rate variability and functional fitness in breast cancer survivors: a cross-sectional studyPublication . Martins, Alexandre; Brito, João; Oliveira, Rafael; Costa, Tiago; Ramalho, Fátima; Santos-Rocha, Rita; Pimenta, NunoBackground: Breast cancer is the most common malignancy among women worldwide. The treatments may also cause neuromuscular and skeletal disorders; therefore, the aim of this study was to verify the existence of a relationship between heart rate variability and different functional fitness parameters in women survivors of breast cancer. Methods: This cross-sectional study included 25 women survivors of breast cancer, with a mean SD age, height, and body mass of 50.8 8.8 years, 1.6 0.7 m, and 67.1 12.3 kg, respectively. Patients underwent measurements of heart rate variability with time and frequency domain analyses, as well as a “30 s chair-stand test”, “6 min walking test”, “timed up and go test”, and “ball throwing test”. Results: A multiple linear regression analysis showed that from the heart rate variability frequency domain, high frequency explained 21% (R2 = 0.21) of the “30 s chair-stand test” performance. Conclusion: The findings of this study highlight high frequency as a predictor of “30 s chair-stand test” performance, regardless of age and time after diagnosis, suggesting its usefulness as a clinical indicator of functionality in breast cancer survivors. This study presents a straightforward and non-invasive methodology predicting functional fitness in women breast cancer survivors potentially applicable to clinical practice.
- Waist-to-height ratio is independently related to whole and central body fat, regardless of the waist circumference measurement protocol, in non-alcoholic fatty liver disease patientsPublication . Pimenta, Nuno; Cortez-Pinto, Helena; Melo, Xavier; Silva-Nunes, José; Sardinha, Luís; Santa-Clara, HelenaBackground: Waist-to-height ratio (WHtR) has been reported as a prefer-able risk related body fat (BF) marker, although no standardised waistcircumference measurement protocol (WCmp) has been proposed. Thepresent study aimed to investigate whether the use of a different WCmpaffects the strength of relationship between WHtR and both whole andcentral BF in non-alcoholic fatty liver disease (NAFLD) patients.Methods: BF was assessed with dual energy X-ray absorptiometry (DXA) in28 NAFLD patients [19 males, mean (SD) 51 (13) years and nine females,47 (13) years]. All subjects also underwent anthropometric evaluationincluding height and waist circumference (WC) measurement using fourdifferent WCmp (WC1, minimal waist; WC2, iliac crest; WC3, mid-distancebetween iliac crest and lowest rib; WC4, at the umbilicus) and WHtR wascalculated using each WC measurements (WHtR1, WHtR2, WHtR3 andWHtR4, respectively). Partial correlations were conducted to assess the rela-tion of WHtR and DXA assessed BF.Results: All WHtR were particularly correlated with central BF, includingabdominal BF (r = 0.80, r = 0.84, r = 0.84 and r = 0.78, respectively, forWHtR1, WHtR2, WHtR3 and WHtR4) and central abdominal BF (r = 0.72,r = 0.77, r = 0.76 and r = 0.71, respectively, for WHtR1, WHtR2, WHtR3and WHtR4), after controlling for age, sex and body mass index. There wereno differences between the correlation coefficients obtained between allstudied WHtR and each whole and central BF variable.Conclusions: Waist-to-height ratio was found a suitable BF marker in thepresent sample of NAFLD patients and the strength of the relationshipbetween WHtR and both whole and central BF was not altered by usingdifferent WCmp in the present sample of NAFLD patients.
- Phase angle cutoff value as a marker of the health status and functional capacity in breast cancer survivorsPublication . Martins, Alexandre; Oliveira, Rafael; Brito, João; Costa, Tiago; Ramalho, Fatima; Pimenta, Nuno; Santos-Rocha, RAAccurate predictive tools are key factors for cancer care. Phase angle (PhA) has been proposed as a marker of cellular health, particularly of cell-membrane integrity. Cutoff values have been proposed, including for cancer survivors. This study aimed to assess the usefulness of the proposed PhA cutoff, as a marker of bioelectrical impedance analysis (BIA) assessed health-status, and functional capacity in breast cancer (BC) survivors. This cross-sectional study included 25 women (50.6 ± 8.6 yrs) survivors of BC, divided into two groups according to the PhA reference value of 5.6◦ (group 1 [G1]: PhA ≤ 5.6◦ [n=13]; group 2 [G2]: PhA > 5.6◦ [n=12]) (Gupta et al. 2008). BIA-assessed health status parameters included: extracellular water (ECW), intracellular water (ICW), total body water (TBW), PhA, body mass, fat-free mass, muscle mass, body cell mass (BCM). Four functional tests were performed: 30 s chair-stand test, timed up and go test, ball throw test and 6-minute walking test. Results showed G2 had lower ECW/ICW ratio (p=0.001; ES=1.2), ECW/BCM ratio (p=0.001; ES=3.2) and ECW/TBW ratio (p=0.001; ES=4.8). There was no difference in functional capacity between groups. The results of the present study show that patients with higher PhA values have a higher ICW values and preservation in the ECW/ICW ratio, suggesting it’s a better cell membrane quality and integrity. Relation of both PhA and cell membrane integrity with functional capacity warrants further research.
- Waist-to-Hip Ratio is Related to Body Fat Content and Distribution Regardless of the Waist Circumference Measurement Protocol, in Non-Alcoholic Fatty Liver Disease PatientsPublication . Pimenta, Nuno; Santa-Clara, Helena; Melo, Xavier; Cortez-Pinto, Helena; Silva Nunes, José António; Sardinha, LuisCentral accumulation and distribution of body fat (BF) is an important cardiometabolic risk factor. Waist-to-hip ratio (WHR), commonly elevated in non-alcoholic fatty liver disease (NAFLD) patients, has been endorsed as a risk related marker of central BF content and distribution, but no standardized waist circumference measurement protocol (WCmp) has been proposed. We aimed to investigate whether using different WCmp affects the strength of association between WHR and BF content and distribution in NAFLD patients. BF was assessed with Dual Energy X-ray Absorptiometry (DXA) in 28 NAFLD patients (19 males, 51 ± 13 yrs, and 9 females, 47 ± 13 yrs). Waist circumference (WC) was measured using four different WCmp (WC1: minimal waist; WC2: iliac crest; WC3: mid-distance between iliac crest and lowest rib; WC4: at the umbilicus) and WHR was calculated accordingly (WHR1, WHR2, WHR3 and WHR4, respectively). High WHR was found in up to 84.6% of subjects, depending on the WHR considered. With the exception of WHR1, all WHR correlated well with abdominal BF (r=0.47 for WHR1; r=0.59 for WHR2 and WHR3; r=0.58 for WHR4) and BF distribution (r=0.45 for WHR1; r=0.56 for WHR2 and WHR3; r=0.51 for WHR4), controlling for age, sex and body mass index (BMI). WHR2 and WHR3 diagnosed exactly the same prevalence of high WHR (76.9%). The present study confirms the strong relation between WHR and central BF, regardless of WCmp used, in NAFLD patients. WHR2 and WHR3 seemed preferable for use in clinical practice, interchangeably, for the diagnosis of high WHR in NAFLD patients.
- Effect of exercise on phase angle in cancer patients: a systematic reviewPublication . Martins, Alexandre; Oliveira, Rafael; Brito, João; Costa, Tiago; Silva, Júlia; Ramalho, Fátima; Santos-Rocha, RA; Pimenta, NunoINTRODUCTION: Body composition is one of the main variables of interest in clinical practice in cancer patients. Specific markers from bioelectrical impedance analysis, such as phase angle (PhA), have been assuming increasing relevance in this population. The aim of the present systematic review was to study and systematise the effect of exercise on PhA in cancer survivors, as compared to control conditions, namely usual care, with no exercise. The effect of exercise on PhA in the population of cancer survivors is not yet established. EVIDENCE ACQUISITIONː This systematic review was conducted on October 13, 2021, through PubMed, Web of Science, Wiley Online Library, Directory of Open Access Journals, Science Direct and JSTOR, following PRISMA guidelines and PICOS model that include: cancer survivors with ≥18 years; intervention of any exercise program for the target group; comparison between intervention group and control group that followed control conditions, namely usual care, with no exercise; outcome related to PhA; and studies of randomized control trials. EVIDENCE SYNTHESIS: We founded a total of 1244 publications, using selected keywords. Eight studies were included in this systematic review, after inclusion/exclusion criteria considered. Compared with the control conditions, exercise training programs seem associated with a positive effect on PhA, both in solid tumours and haematologic cancer types, but only when using resistance exercise alone. According to the best evidence synthesis criteria, we could not conclude the superiority of any exercise program analysed in the value of the PhA. CONCLUSIONS: There were several exercise details that may have potential to be beneficial for PhA in cancer patients, including an early start of the exercise intervention (during treatment and immediately after discharge from hospital), the use of resistance exercise or/and aerobic exercise, and mainly a long follow-up period (≥ 4 months) to verify the structural effects of exercise on the PhA. However, there were no effects on the PhA value immediately after the intervention, regardless of the type of protocol and the intervention time.
- Finding the best waist circumference measurement protocol in patients with nonalcoholic fatty liver diseasePublication . Pimenta, Nuno; Santa-Clara, Helena; Melo, Xavier; Cortez-Pinto, Helena; Silva Nunes, José António; Sardinha, LuisBackground Central fat accumulation is important in Non-alcoholic Fatty Liver Disease (NAFLD) etiology. It is unknown weather any commonly used waist circumference (WC) measurement protocol (mp), as whole and central fat accumulation marker, is preferable for patients with NAFLD. The present study sought to find a preferable WC mp to be used in patients with NAFLD, based on three-fold criterion. Material and methods Body fat (BF) was assessed through Dual Energy X-ray Absorptiometry (DXA) in 28 patients with NAFLD (19 males, 51 + 13 yrs, and 9 females, 47 + 13 yrs). WC was measured using four different WC mp (WC1-narrowest torso, WC2- just above iliac crest, WC3- mid-distance between iliac crest and last rib and WC4- at the umbilicus). Results All WC measurements were highly correlated particularly with central BF depots, including trunk BF (r=0.78; r=0.82; r=0.82; r=0.84; respectively for WC1, WC2, WC3 and WC4) abdominal BF (r=0.78; r=0.78; r=0.80; r=0.72; respectively for WC1, WC2, WC3 and WC4) and central abdominal BF (r=0.76; r=0.77; r=0.78; r=0.68; respectively for WC1, WC2, WC3 and WC4), controlling for age, sex and body mass index. There were no differences between the correlation coefficients obtained between all studied WC measurements and each whole and central analyzed BF variable. Conclusion All studied WC mp seem suitable for use in patients with NAFLD, particularly as central BF clinical assessment tool, though not interchangeably. Hence biological and precision criteria alone did not sanction the superiority of any WC mp. Practical criteria may endorse WC measured at the iliac crest.
- The acute effect of maximal exercise on central and peripheral arterial stiffness indices and hemodynamics in children and adultsPublication . Melo, Xavier; Fernhall, Bo; Santos, Diana; Pinto, Rita; Pimenta, Nuno; Sardinha, Luis; Santa-Clara, HelenaThis study compared the effects of a bout of maximal running exercise on arterial stiffness in children and adults. Right carotid blood pressure and artery stiffness indices measured by pulse wave velocity (PWV), compliance and distensibility coefficients, stiffness index α and β (echo-tracking), contralateral carotid blood pressure, and upper and lower limb and central/aortic PWV (applanation tonometry) were taken at rest and 10 min after a bout of maximal treadmill running in 34 children (7.38 ± 0.38 years) and 45 young adults (25.22 ± 0.91 years) having similar aerobic potential. Two-by-two repeated measures analysis of variance and analysis of covariance were used to detect differences with exercise between groups. Carotid pulse pressure (PP; η(2) = 0.394) increased more in adults after exercise (p < 0.05). Compliance (η(2) = 0.385) decreased in particular in adults and in those with high changes in distending pressure, similarly to stiffness index α and β. Carotid PWV increased more in adults and was related to local changes in PP but not mean arterial pressure (MAP). Stiffness in the lower limbs decreased (η(2) = 0.115) but apparently only in those with small MAP changes (η(2) = 0.111). No significant exercise or group interaction effects were found when variables were adjusted to height. An acute bout of maximal exercise can alter arterial stiffness and hemodynamics in the carotid artery and within the active muscle beds. Arterial stiffness and hemodynamic response to metabolic demands during exercise in children simply reflect their smaller body size and may not indicate a particular physiological difference compared with adults.
- Analysing the Effects of Different Types of Exercise on Dyspnoea and Fatigue in Adults through COPD-Systematic Review and Meta-Analysis of Randomised Clinical TrialsPublication . Couto, Nuno; Cid, Luis; Alves, Susana; Brito, João; Pimenta, Nuno; Bento, TeresaBackground: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition, the main symptoms of which are dyspnoea and fatigue. Though exercise has been recommended for subjects with COPD, its benefits remain unclear. The aim of this study was to summarise, through a systematic review and meta-analysis, the available evidence on the effects of aerobic, resistance, stretching, and combined exercise on the main symptoms of COPD. Methods: Search was performed using the electronic databases PubMed and Web of Science. Randomised controlled trials (RCTs) with interventions based on aerobic, resistance and/or combined exercise published until July 2022 were identified. The effects were summarised based on standardised mean differences (95% confidence intervals) using random and fixed effect models. Results: Eight studies were selected, including a total of 375 subjects. The results obtained showed that resistance exercise, aerobic exercise and combined exercise seem to improve dyspnoea and fatigue symptoms in COPD subjects. Conclusions: In general, we can conclude that exercise-based interventions appear to improve the main COPD symptoms and may benefit quality of life in this population.