Is functional training an efficient approach to improve body composition in older people? A systematic review

Introduction: Increases in fat mass and reductions in lean mass are associated with the frailty and mortality of older people. In this context, Functional Training (FT) is an option to increase lean mass and reduce fat mass in older people. Thus, this systematic review aims to investigate the effects of FT on body fat and lean mass in older people.Methods: We included randomized controlled clinical trials, with at least one intervention group that employed FT, with the age of participants ≥60 years; and participants physically independent and healthy. We performed the systematic investigation in Pubmed MEDLINE, Scopus, Web of Science, Cochrane Library, and Google Scholar. We extracted the information and used the PEDro Scale to assess the methodological quality of each study.Results: Our research found 3,056 references with five appropriate studies. Of the five studies, three presented reductions in fat mass, all of them with interventions between three and 6 months, different training dose parameters, and 100% of the sample was composed of women. On the other hand, two studies with interventions between 10 and 12 weeks presented conflicting results.Conclusion: Despite the limited literature about lean mass, it appears that long-term FT interventions may reduce fat mass in older women.Clinical Trial Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399257, identifier CRD4202339925

Balance between the two kinin receptors in the progression of experimental focal and segmental glomerulosclerosis in mice

Focal and segmental glomerulosclerosis (FSGS) is one of the most important renal diseases related to end-stage renal failure. Bradykinin has been implicated in the pathogenesis of renal inflammation, whereas the role of its receptor 2 (B2RBK; also known as BDKRB2) in FSGS has not been studied. FSGS was induced in wild-type and B2RBK-knockout mice by a single intravenous injection of Adriamycin (ADM). in order to further modulate the kinin receptors, the animals were also treated with the B2RBK antagonist HOE-140 and the B1RBK antagonist DALBK. Here, we show that the blockage of B2RBK with HOE-140 protects mice from the development of FSGS, including podocyte foot process effacement and the re-establishment of slit-diaphragm-related proteins. However, B2RBK-knockout mice were not protected from FSGS. These opposite results were due to B1RBK expression. B1RBK was upregulated after the injection of ADM and this upregulation was exacerbated in B2RBK-knockout animals. Furthermore, treatment with HOE-140 downregulated the B1RBK receptor. the blockage of B1RBK in B2RBK-knockout animals promoted FSGS regression, with a less-inflammatory phenotype. These results indicate a deleterious role of both kinin receptors in an FSGS model and suggest a possible cross-talk between them in the progression of disease.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Clin & Expt Immunol Lab, Div Nephrol, BR-04023900 São Paulo, BrazilUniv São Paulo, Inst Biomed Sci 4, Dept Immunol, Lab Transplantat Immunobiol, BR-05508000 São Paulo, BrazilUniversidade Federal de São Paulo, Translat Med Div, Clin & Expt Immunol Lab, BR-04039002 São Paulo, BrazilInst Butantan, Lab Cellular Biol, BR-05503900 São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Biophys, BR-04023062 São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Microbiol Immunol & Parasitol, BR-04023062 São Paulo, BrazilINSERM, Unite Mixte Rech 699, F-75870 Paris, FranceAlbert Einstein Hosp, Inst Israelita Ensino & Pesquisa Albert Einst, Renal Transplantat Unit, BR-05521000 São Paulo, BrazilUniversidade Federal de São Paulo, Clin & Expt Immunol Lab, Div Nephrol, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Translat Med Div, Clin & Expt Immunol Lab, BR-04039002 São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Biophys, BR-04023062 São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Microbiol Immunol & Parasitol, BR-04023062 São Paulo, BrazilFAPESP: 2012/05605-5FAPESP: 07/07139-3FAPESP: 12/02270-2CNPq: 140739/2008-4Web of Scienc

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Effects of functional training on body composition of older people

Body composition is a good health indicator for older people, related to autonomy and mortality. Specifically, during aging, two events stand out: the reduction of lean body mass and the increase of body fat. On the other hand, functional training (FT) has been highlighted in recent years in health promotion for older people, however, its effects on body composition are not well established yet. Thus, the objective of this dissertation was to analyze the effect of functional training on body composition variables in the elderly. For this, two distinct studies were conducted. First, we conducted a systematic review of the literature with the following guiding question: "What are the effects of functional training on lean mass and body fat in the older population?" establishing the acronym PICOT as P: Older people; I: Functional training; C: Other exercise interventions or no comparison; O: Lean mass and body fat; T: Randomized clinical trials. The search for studies was conducted in the Pubmed, Scopus, Web of Science, Cochrane Library, and Google Scholar databases, and the risk of bias was assessed using the PEDro scale. In a second step, a randomized controlled trial was conducted with a total duration of 16 weeks that had 96 participants randomized into three distinct groups: FT (n = 32, 63.9 ± 3.8 years; 28.67 ± 4.83 kg/m²); combined training (CT) (n = 32; 64.9 ± 4.0 years; 27.76 ± 4.36 kg/m²); and control group (CG) (n = 32; 67.5 ± 5.9 years; 28.52 ± 6.34 kg/m²). Body composition measurements were evaluated by bioimpedance and checked every four weeks, totaling five evaluations. Regarding the systematic review, of the 3956 studies identified in the literature, only five studies were included according to the eligibility criteria listed. Of these, only two studies had a low risk of bias. The studies that presented interventions lasting between 5 and 6 months promoted reduced body fat and increased lean mass, whereas interventions lasting between 10 and 12 weeks presented conflicting results. As for the clinical trial, it was verified an increase in lean mass in the eighth week of training (TF: Δ = +1,77%, TC: Δ = +1,54%), and in the twelfth week it was verified a reduction in the percentage of fat (TF: Δ = - 3,2%, TC: Δ = - 4,3%) and an increase in the appendicular lean mass (TF: Δ = +2,31% TC: Δ = +2,37%) of the older women. These changes in body composition lasted until the end of the intervention. In conclusion, the literature points out that interventions lasting between 5 and 6 months show positive adaptations in the body composition of the elderly; however, there are still few high-quality studies in the literature that can provide a higher level of evidence regarding the effects of FT on the body composition of this population. On the other hand, the FT seems to have similar effects to the CT on the adaptations promoted in the body composition of older women, increasing lean mass from the eighth week of training and decreasing body fat from the twelfth week of intervention.A composição corporal é um importante componente da saúde do idoso, estando relacionada à autonomia e mortalidade. Especificamente durante o envelhecimento, comumente dois eventos se destacam: a redução da massa magra e o aumento da gordura corporal. Por outro lado, o treinamento funcional (TF) tem se destacado nos últimos anos na promoção de saúde para idosos, contudo, seus efeitos em relação à composição corporal ainda não são bem estabelecidos. Sendo assim, o objetivo da presente dissertação foi analisar o efeito do TF sobre variáveis da composição corporal de idosos. Para isso, dois estudos distintos foram realizados. Primeiramente, uma revisão sistemática da literatura foi conduzida com a seguinte pergunta norteadora: "Quais os efeitos do treinamento funcional sobre a massa magra e gordura corporal da população idosa?", estabelecendo o acrônimo PICOT como: P: Idosos; I: Treinamento funcional; C: Outras intervenções de exercício ou sem comparação; O: Massa magra e gordura corporal; T: Ensaios clínicos aleatorizados. A busca de estudos foi realizada nas bases de dados Pubmed, Scopus, Web of Science, Cochrane Library e Google Scholar, e a qualidade metodológica foi avaliada por meio da escala PEDro. Em segundo momento, foi conduzido um ensaio clínico randomizado controlado, com duração total de 16 semanas que contou com 96 participantes aleatorizadas em três grupos distintos: TF (n = 32, 63,9 ± 3,8 anos; 28,67 ± 4,83 kg/m²); treinamento combinado (TC) (n = 32; 64,9 ± 4,0 anos; 27,76 ± 4,36 kg/m²); e grupo controle (CG) (n = 32; 67,5 ± 5,9 anos; 28,52 ± 6,34 kg/m²). As medidas de composição corporal foram avaliadas por bioimpedância e verificadas a cada quatro semanas, totalizando cinco avaliações. Em relação a revisão sistemática, dos 3.956 estudos identificados na literatura, apenas cinco estudos foram incluídos de acordo com os critérios de elegibilidade elencados. Desses, apenas dois estudos apresentaram alta qualidade metodológica. Os estudos que apresentaram intervenções com duração entre cinco e seis meses, promoveram redução da gordura corporal e aumento da massa magra, enquanto que intervenções com duração entre 10 e 12 semanas, apresentam resultados distintos entre si. Quanto ao ensaio clínico, foi verificado aumento na massa magra na oitava semana de treinamento (TF: Δ = +1,77%, TC: Δ = +1,54%), e na décima segunda semana foi verificada a redução no percentual de gordura (TF: Δ = - 3,2%, TC: Δ = - 4,3%) e aumento na massa magra apendicular das idosas (TF: Δ = +2,31% TC: Δ = +2,37%). Essas alterações em composição corporal perduraram até o final da intervenção. Em conclusão, a literatura aponta que intervenções com duração entre cinco e seis meses apresentam adaptações positivas na composição corporal de idosos, contudo, ainda há poucos estudos de alta qualidade na literatura que possam fornecer um maior nível de evidência quanto aos efeitos do TF na composição corporal dessa população. Por outro lado, o TF aparenta ter efeitos similares ao TC sobre as adaptações promovidas na composição corporal de idosas, aumentando a massa magra a partir da oitava semana de treinamento e diminuindo a gordura corporal a partir da décima segunda semana de intervenção.São Cristóvã

Bodyweight and Combined Training Reduce Chronic Low-Grade Inflammation and Improve Functional Fitness of Postmenopausal Women

Exercise is an important tool against the deleterious effects of aging. Among the possibilities of exercise, bodyweight training (BWT) has been highlighted in the last years as a safe option to improve the health of older people. We compared the effects of 24 weeks of BWT and combined training (CT) on low-grade systematic inflammation and functional fitness in postmenopausal women. For this, 40 women were allocated and submitted to CT (n = 20, 64.43 &plusmn; 3.13 years, 29.56 &plusmn; 4.80 kg/m&sup2;) and BWT (n = 20, 65.10 &plusmn; 4.86 years, 28.76 &plusmn; 4.26 kg/m&sup2;). We measured inflammation by the interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-&alpha; (TNF-&alpha;) assessments. For functional fitness, we used tests similar to activities of daily living. At the end of the 16 weeks, data from 24 women were analyzed, CT (n = 14) and BT (n = 10). Both groups reduced TNF-&alpha; and IL-6 levels, without differences in IL-10. Regarding functional fitness, both groups demonstrated improvements in all tests after 24 weeks, except for rise from prone position and the 400-meter walk test for CT. In summary, CT and BWT are effective in reducing the plasma concentration of pro-inflammatory cytokines and improving functional fitness in postmenopausal women