Submitted by Cláudio Spínola Najas (cnajas@gmail.com) on 2018-04-06T20:30:16Z No. of bitstreams: 1 TESE Nova corrigida 2018.pdf: 1836496 bytes, checksum: 5754878942303c31e60421d7ee692e04 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-04-06T20:47:06Z (GMT) No. of bitstreams: 1 najas_cs_dr_bot.pdf: 1836496 bytes, checksum: 5754878942303c31e60421d7ee692e04 (MD5) / Made available in DSpace on 2018-04-06T20:47:06Z (GMT). No. of bitstreams: 1 najas_cs_dr_bot.pdf: 1836496 bytes, checksum: 5754878942303c31e60421d7ee692e04 (MD5) Previous issue date: 2017-08-28 / O infarto agudo do miocárdio (IAM) é responsável por grande número de hospitalizações e óbitos em todo o mundo. Nos últimos anos, outro fator que vem ganhando destaque na literatura como preditor de má evolução após o IAM é a remodelação ventricular. Na fase aguda do infarto, há desintegração do colágeno interfibrilar. A perda desse tecido de sustentação torna a região mais propensa à distensão e, consequentemente, mais susceptível às deformações, denominada de expansão do infarto. Na fase crônica estudos revelam que a reversão da dilatação, por outro lado, pode ocorrer entre 30 e 60% dos pacientes estando associada à melhora na evolução. Diversos estudos têm demonstrado que medicamentos ou procedimentos que modificam a remodelação ventricular, prevenindo ou retardando a dilatação cardíaca, estão associadas à melhor evolução dos pacientes como a remodelação cardíaca reversa. Outro fator importante é a força de preensão palmar no IAM, diversos estudos mostram que a força do músculo esquelético, se altera em associação com eventos cardíacos, já a composição corporal demonstra que em indivíduos portadores de maior peso magro, tem significativamente maior força que os indivíduos portadores de menor peso magro. No entanto os resultados demonstram a correlação entre peso magro e percentual de gordura pode indicar uma melhor ou pior condição para realizar o esforço isométrico de preensão manual. Objetivo: Avaliar a força da musculatura esquelética e a composição corporal como preditoras de remodelação ventricular, remodelação reversa e disfunção ventricular após o infarto agudo do miocárdio de parede anterior. Metodologia: A análise da força muscular esquelética foi obtida pela técnica de Handgrip, feita por meio de aparelho específico, Hand Dinamometer T-18. Todas as medidas realizadas na mão não dominante, com o paciente sentado, e o cotovelo apoiado na cama. Foi utilizado o método de impedância bioelétrica para a avaliação da composição corporal, principalmente quanto ao volume e percentual de água. Para a remodelação cardíaca, foi realizado o ecocardiograma para avaliar a parede anterior do ventrículo esquerdo. Todas as análises foram realizadas entre o 3º e 5º dia após o infarto. A estatística foi analisada por meio do teste do χ2, o teste t de Student, o teste de Mann-Whitney, considerando nível de significância adotado de 5% para todos os testes. Resultados: Em relação a força muscular e composição corporal, não foram detectadas diferenças significativas entre os grupos avaliados para remodelação cardíaca e disfunção com fração de ejeção ˂ 50% (p ˃ 0,05). Resultados semelhantes foram observados na remodelação cardíaca reversa que também não foram encontradas diferenças significativas para os parâmetros de força muscular e composição corporal (p ˃ 0,05). Para as análises de regressão multivariada, o percentual de massa magra mostrou-se como preditora para a remodelação cardíaca reversa quando ajustado por sexo, idade e enzimas CK-MB ( OR= 0,876; p= 0,019 ), assim como o percentual de gordura ajustados para as mesmas variáveis ( OR= 1,145; p= 0,027 ). / Abstract: Acute myocardial infarction (AMI) is responsible for large numbers of hospitalizations and deaths worldwide. In recent years, another factor that has been gaining prominence in the literature as a predictor of poor evolution after AMI is ventricular remodeling. In the acute phase of infarction, there is disintegration of the interfibrillar collagen. The loss of this supporting tissue makes the region more prone to distention and, consequently, more susceptible to deformation, termed infarct expansion. On the other hand, in the chronic phase, studies reveal that the reversal of dilation can occur in between 30 and 60% of patients, being associated with improvement in evolution. Several studies have shown that medications or procedures that modify ventricular remodeling, preventing or delaying cardiac dilatation, such as reverse cardiac remodeling, are associated with better evolution of patients. Another important factor in AMI is the palmar grip strength; several studies show that skeletal muscle strength changes in association with cardiac events, whereas body composition demonstrates that individuals with higher lean weight present significantly greater strength than individuals with lower lean weight. However, results demonstrate that the correlation between lean weight and fat percentage may indicate a better or worse condition to perform the isometric handgrip effort. Objective: To evaluate skeletal muscle strength and body composition as predictors of ventricular remodeling, reverse remodeling, and ventricular dysfunction after acute myocardial infarction of the anterior wall. Methodology: Analysis of skeletal muscle strength was obtained through the Handgrip technique, carried out by means of a specific device, the Hand Dinamometer T-18. All measurements were taken on the non-dominant hand, with the patient seated, and the elbow resting on the bed. The bioelectrical impedance method was used to evaluate body composition, principally regarding the volume and percentage of water. For cardiac remodeling, an echocardiogram was performed to evaluate the left ventricular anterior wall. All analyzes were performed between the 3rd and 5th day after the infarction. The statistics were analyzed using the χ2 test, the Student t test, and the Mann-Whitney test, considering a significance level of 5% for all tests. Results: Regarding muscle strength and body composition, no significant differences were detected between the evaluated groups for cardiac remodeling or dysfunction, with ejection fraction ˂ 50% (p ˃ 0.05). Similar results were observed in the reverse cardiac remodeling, also with no significant differences found for the parameters muscle strength and body composition (p ˃ 0.05). For the multivariate regression analyzes, the percentage of lean mass was shown to be a predictor for reverse cardiac remodeling when adjusted by sex, age, and CK-MB enzymes (OR = 0.876, p = 0.019), as well as the percentage of fat adjusted for the same variables (OR = 1.145, p = 0.027).

Orientador: Leonardo Antonio Mamede Zornoff / Resumo: O infarto agudo do miocárdio (IAM) é responsável por grande número de hospitalizações e óbitos em todo o mundo. Nos últimos anos, outro fator que vem ganhando destaque na literatura como preditor de má evolução após o IAM é a remodelação ventricular. Na fase aguda do infarto, há desintegração do colágeno interfibrilar. A perda desse tecido de sustentação torna a região mais propensa à distensão e, consequentemente, mais susceptível às deformações, denominada de expansão do infarto. Na fase crônica estudos revelam que a reversão da dilatação, por outro lado, pode ocorrer entre 30 e 60% dos pacientes estando associada à melhora na evolução. Diversos estudos têm demonstrado que medicamentos ou procedimentos que modificam a remodelação ventricular, prevenindo ou retardando a dilatação cardíaca, estão associadas à melhor evolução dos pacientes como a remodelação cardíaca reversa. Outro fator importante é a força de preensão palmar no IAM, diversos estudos mostram que a força do músculo esquelético, se altera em associação com eventos cardíacos, já a composição corporal demonstra que em indivíduos portadores de maior peso magro, tem significativamente maior força que os indivíduos portadores de menor peso magro. No entanto os resultados demonstram a correlação entre peso magro e percentual de gordura pode indicar uma melhor ou pior condição para realizar o esforço isométrico de preensão manual. Objetivo: Avaliar a força da musculatura esquelética e a composição corporal como predit... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Abstract: Acute myocardial infarction (AMI) is responsible for large numbers of hospitalizations and deaths worldwide. In recent years, another factor that has been gaining prominence in the literature as a predictor of poor evolution after AMI is ventricular remodeling. In the acute phase of infarction, there is disintegration of the interfibrillar collagen. The loss of this supporting tissue makes the region more prone to distention and, consequently, more susceptible to deformation, termed infarct expansion. On the other hand, in the chronic phase, studies reveal that the reversal of dilation can occur in between 30 and 60% of patients, being associated with improvement in evolution. Several studies have shown that medications or procedures that modify ventricular remodeling, preventing or delaying cardiac dilatation, such as reverse cardiac remodeling, are associated with better evolution of patients. Another important factor in AMI is the palmar grip strength; several studies show that skeletal muscle strength changes in association with cardiac events, whereas body composition demonstrates that individuals with higher lean weight present significantly greater strength than individuals with lower lean weight. However, results demonstrate that the correlation between lean weight and fat percentage may indicate a better or worse condition to perform the isometric handgrip effort. Objective: To evaluate skeletal muscle strength and body composition as predictors of ventricu... (Complete abstract click electronic access below) / Doutor

Master of Science / Department of Kinesiology / Thomas J. Barstow / Dietary nitrate supplementation via beetroot juice (BR) has been shown to have positive effects on mitochondrial and muscle efficiency during large muscle mass exercise in humans, and more recently on locomotory muscle blood flow [Q-dot] in rats. To date, an integrated measure of these effects has not been performed in humans. Therefore, we assessed the influence of BR on [Q-dot] and muscle oxygenation characteristics during moderate and severe intensity handgrip exercise. Seven healthy men (age: 25 ± 3 yrs; height: 179 ± 4 cm; weight: 82 ± 9 kg) completed four constant-power exercise tests randomly assigned to condition (BR or placebo (PL)) and intensity (moderate (40% peak) or severe (85% peak)). Resting mean arterial pressure was significantly lower after BR compared to PL (79.3 ± 5.8 vs 86.8 ± 6.7 mmHg; p < 0.01). All subjects were able to sustain 10 min of exercise at moderate intensity in both conditions. BR had no significant effect on exercise tolerance during severe (342 ± 83 vs 382 ± 138 s, p = 0.382). Brachial artery [Q-dot] was not significantly different after BR at rest or any time during exercise in either intensity. Deoxygenated-[hemoglobin + myoglobin] was elevated at min 2 & 3 for moderate (p < 0.05) and throughout severe exercise (p = 0.03) after BR. The estimated metabolic cost ([V-dot]O₂) was not significantly different during either intensity after BR. These findings support the notion that an acute dose of BR may be valuable to reduce blood pressure in young adults, but revealed that it does not augment [Q-dot] or [V-dot]O₂ during small muscle mass handgrip exercise.

Doctor of Philosophy / Department of Kinesiology / Carl Ade / During exercise, muscle blood flow (Q ̇m) increases to match metabolic demand of the active skeletal muscle. In order for this matching to take place, ‘competition’ between local vasodilating metabolites and sympathetically mediated vasoconstriction, termed “functional sympatholysis,” must take place. A key feature of functional sympatholysis is that it is driven largely by metabolic rate (i.e., a higher work rates lead to greater sympatholysis), but may also be largely dependent on nitric oxide bioavailability and oxidative stress in certain disease states (e.g., hypertension). Thus, evaluation of these factors may provide valuable insight into the vascular control mechanisms during exercise in both health and disease. Therefore, the purpose of this dissertation was to 1) determine the role metabolic rate and blood flow on mediating functional sympatholysis, 2) determine the role of nitric oxide bioavailability on functional sympatholysis with high salt intake, a risk factor for primary hypertension, and 3) determine the effect of increases in nitric oxide bioavailability on functional sympatholysis in primary hypertension patients. In the first investigation (Chapter 1), we increased the relaxation phase of the contraction-relaxation cycle to increase active skeletal muscle blood flow (Q ̇m) and see if this would impact vasoconstriction of the active skeletal muscle. We showed that a decreased relaxation time led to greater functional sympatholysis. Interestingly, despite a lower metabolic rate (15% and 20% MVC), we showed that there was no difference in vasoconstriction between the increased relaxation times. These results may show that increases in Q ̇m play a role in functional sympatholysis when mechanical compression is minimized. In the second investigation (Chapter 2), we sought to determine if high dietary sodium (HS) intake would impact functional sympatholysis. We showed that HS intake (15g/day for 7 days) did not impact functional sympatholysis during exercise. Importantly, we show a significant increase in mean arterial pressure (i.e., pressor response) during handgrip exercise. These findings show the deleterious changes in blood pressure, but further work is needed to pinpoint specific mechanisms causing the responses. In the final investigation (Chapter 3), we used an acute nitrate rich (NR) supplement to improve NO bioavailability in hypertensive post-menopausal women (PMW), and observe the impact on functional sympatholysis. We provide novel evidence that functional sympatholysis is improved (~50%) with a NR supplement. The finding that a NR supplement can attenuate vasoconstriction in hypertensive PMW sheds light on the complexities of hypertension, functional sympatholysis and NO bioavailability. The current results indicate that the ‘competition’ between vasodilating metabolites and sympathetically mediated vasoconstriction can be independently modified in health and disease. In individuals with impairment to local vasodilation (e.g., hypertension), the ability to increase functional sympatholysis and muscle blood flow may lead to improvements in cardiovascular health. Taken together, the present results suggest that modifying duty cycle, sodium intake, and NO bioavailability are important factors to be considered with regard to overall cardiovascular health.

Current knowledge indicates that nonthermal muscle metaboreflex activity plays a critical role in the modulation of skin vasodilation and sweating. However, the mechanisms of control have primarily been studied during isometric handgrip exercise in which muscle metaboreceptor activation is induced by a brief post-exercise ischemia of the upper limb. While the reflex increase in mean arterial pressure associated with this period of ischemia is consistent with the activation of muscle metaboreceptors, the change in baroreflex activity may in itself modulate the response. Thus, we sought to understand how these nonthermal stimuli interact in modulating the control of skin perfusion and sweating under conditions of elevated hyperthermia. Furthermore, we examined the mechanisms responsible for the maintenance of arterial blood pressure under varying levels of heat stress during isometric handgrip exercise. Our study findings indicate that the parallel activation of muscle metaboreceptors and baroreceptors during post-exercise ischemia causes divergent influences on the control of skin blood flow and sweating; and these nonthermal stimuli are dependent on the level of hyperthermia. Moreover, we report that heat stress reduces the increase in arterial blood pressure during isometric handgrip exercise and this attenuation is attributed to a blunted increase in peripheral resistance, since cardiac output increased to similar levels for all heat stress conditions. These results provide important insight and understanding into the role of muscle metabo- and baroreflex activity on the control of skin blood flow and sweating; along with further knowledge into the cardiovascular mechanisms responsible for the regulation of arterial blood pressure during hyperthermia.

Current knowledge indicates that nonthermal muscle metaboreflex activity plays a critical role in the modulation of skin vasodilation and sweating. However, the mechanisms of control have primarily been studied during isometric handgrip exercise in which muscle metaboreceptor activation is induced by a brief post-exercise ischemia of the upper limb. While the reflex increase in mean arterial pressure associated with this period of ischemia is consistent with the activation of muscle metaboreceptors, the change in baroreflex activity may in itself modulate the response. Thus, we sought to understand how these nonthermal stimuli interact in modulating the control of skin perfusion and sweating under conditions of elevated hyperthermia. Furthermore, we examined the mechanisms responsible for the maintenance of arterial blood pressure under varying levels of heat stress during isometric handgrip exercise. Our study findings indicate that the parallel activation of muscle metaboreceptors and baroreceptors during post-exercise ischemia causes divergent influences on the control of skin blood flow and sweating; and these nonthermal stimuli are dependent on the level of hyperthermia. Moreover, we report that heat stress reduces the increase in arterial blood pressure during isometric handgrip exercise and this attenuation is attributed to a blunted increase in peripheral resistance, since cardiac output increased to similar levels for all heat stress conditions. These results provide important insight and understanding into the role of muscle metabo- and baroreflex activity on the control of skin blood flow and sweating; along with further knowledge into the cardiovascular mechanisms responsible for the regulation of arterial blood pressure during hyperthermia.

The vascular endothelium is a single layer of cells that lines the interior surface of our blood vessels. The endothelium plays a key role in vasoprotection and vasoregulation and its proper function is therefore essential to the maintenance of vascular health. The endothelial cells respond to the frictional force (shear stress (SS)) that occurs with an increase in blood flow. As a response, vasoactive substances are released, causing the artery to dilate, this is termed flow-mediated dilation (FMD). Endothelial cell function can be assessed by measuring the vasodilatory response to an increase in SS. Currently however, our ability to interpret the results of FMD assessment in order to make accurate judgements regarding arterial health is hindered by an incomplete understanding of the “dose-response” relationship between SS and FMD. The dose-response relationship is characterized by 1) the SS stimulus required to elicit an FMD response (threshold), 2) the magnitude of dilation for a given increase in SS (the slope of the SS-FMD relationship), and 3) the point at which further increases in SS no longer elicit dilation (the ceiling). The primary purpose of the current study was to characterize the magnitude and day-to-day variability of the parameters described above. N=20 males (mean 22-years). Brachial artery diameter (BAD) and blood velocity (BV) were assessed with echo and Doppler ultrasound. SS was estimated as shear rate (SR=BV/BAD). Subjects performed 2 incremental handgrip exercise trials on two separate visits (V1 and V2). CV=co-efficient of variation. The SS-FMD relationship was characterized by a shallow slope followed by an inflection point (threshold (T1)) and a steeper slope (pre vs. post T1 slope p=0.002). There was no difference between V1 vs. V2 in the SR-FMD slope or threshold (p>0.05), but there was considerable within-subject variability in the SR-FMD parameters: pre-T1 slope CV = 47.0 ± 33.1%; post-T1 slope CV = 55.3 ± 40.7%; T1 CV = 25.6 ± 6.3%. In conclusion, %FMD did not plateau with increasing SR, therefore no ceiling was identified. The inflection in slope may indicate the involvement of different or additional vasodilator mechanisms post-threshold. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2011-09-15 20:17:11.582

Current knowledge indicates that nonthermal muscle metaboreflex activity plays a critical role in the modulation of skin vasodilation and sweating. However, the mechanisms of control have primarily been studied during isometric handgrip exercise in which muscle metaboreceptor activation is induced by a brief post-exercise ischemia of the upper limb. While the reflex increase in mean arterial pressure associated with this period of ischemia is consistent with the activation of muscle metaboreceptors, the change in baroreflex activity may in itself modulate the response. Thus, we sought to understand how these nonthermal stimuli interact in modulating the control of skin perfusion and sweating under conditions of elevated hyperthermia. Furthermore, we examined the mechanisms responsible for the maintenance of arterial blood pressure under varying levels of heat stress during isometric handgrip exercise. Our study findings indicate that the parallel activation of muscle metaboreceptors and baroreceptors during post-exercise ischemia causes divergent influences on the control of skin blood flow and sweating; and these nonthermal stimuli are dependent on the level of hyperthermia. Moreover, we report that heat stress reduces the increase in arterial blood pressure during isometric handgrip exercise and this attenuation is attributed to a blunted increase in peripheral resistance, since cardiac output increased to similar levels for all heat stress conditions. These results provide important insight and understanding into the role of muscle metabo- and baroreflex activity on the control of skin blood flow and sweating; along with further knowledge into the cardiovascular mechanisms responsible for the regulation of arterial blood pressure during hyperthermia.

Current knowledge indicates that nonthermal muscle metaboreflex activity plays a critical role in the modulation of skin vasodilation and sweating. However, the mechanisms of control have primarily been studied during isometric handgrip exercise in which muscle metaboreceptor activation is induced by a brief post-exercise ischemia of the upper limb. While the reflex increase in mean arterial pressure associated with this period of ischemia is consistent with the activation of muscle metaboreceptors, the change in baroreflex activity may in itself modulate the response. Thus, we sought to understand how these nonthermal stimuli interact in modulating the control of skin perfusion and sweating under conditions of elevated hyperthermia. Furthermore, we examined the mechanisms responsible for the maintenance of arterial blood pressure under varying levels of heat stress during isometric handgrip exercise. Our study findings indicate that the parallel activation of muscle metaboreceptors and baroreceptors during post-exercise ischemia causes divergent influences on the control of skin blood flow and sweating; and these nonthermal stimuli are dependent on the level of hyperthermia. Moreover, we report that heat stress reduces the increase in arterial blood pressure during isometric handgrip exercise and this attenuation is attributed to a blunted increase in peripheral resistance, since cardiac output increased to similar levels for all heat stress conditions. These results provide important insight and understanding into the role of muscle metabo- and baroreflex activity on the control of skin blood flow and sweating; along with further knowledge into the cardiovascular mechanisms responsible for the regulation of arterial blood pressure during hyperthermia.

Bakgrund: ​Kvinnor är underrepresenterade i studier gällande sport och träning. En av anledningarna till det, skulle kunna vara att menstruationscykeln anses vara ett stort hinder till varför kvinnor inte har undersökts. De olika faserna i menstruationscykeln påverkar hormonnivåerna hos kvinnan, vilket också sägs kunna påverka styrkan. De två hormonerna som tros påverka styrkan är östrogen och progesteron. ​Syfte: ​Syftet med denna studie är att undersöka greppstyrkan under menstruationscykeln.​ Metod: ​Till studien rekryterades 13 kvinnor. Greppstyrkan hos kvinnorna har undersökts fem gånger under deras menstruationscykel och resultaten analyserades med hjälp av ett Factorial Repeated Measures ANOVA-test. ​Resultat​: Studien visar en signifikant skillnad i greppstyrka för den icke-dominanta handen mellan menstruationfas två (350 Newton) och menstruationsfas fem (322 Newton), p=0,016. Resterande mentruationsfaser, för dominant respektive icke dominant hand visar ej några signifikanta skillnader. ​Diskussion: ​Resultatet av studien visar att det finns tendenser till styrkeskillnader i respektive hand under menstruationscykeln. Men på grund det låga antalet deltagare i studien kunde dessa skillnader ej styrkas. Slutsats: ​Det finns en signifikant skillnad i greppstyrkan i den icke-dominanta handen under menstruationscykeln, men ingen signifikant skillnad i greppstyrkan i den dominanta handen. Ytterligare studier med en större studiepopulation behövs för att få en mer klar bild av hur menstruationscykeln påverkar greppstyrkan.