LAIS GALVANI DE BARROS CRUZ

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina

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  • article 66 Citação(ões) na Scopus
    Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: A randomized controlled trial (HEx trial)
    (2014) GUIMARAES, Guilherme Veiga; CRUZ, Lais Galvani de Barros; FERNANDES-SILVA, Miguel Morita; DOREA, Egidio Lima; BOCCHI, Edimar Alcides
    Background: Regular exercise is an effective intervention to decrease blood pressure (BP) in hypertension, but no data are available concerning the effects of heatedwater-based exercise (HEx). This study examines the effects of HEx on BP in resistant hypertensive patients. Methods: This is a parallel, randomized controlled trial. 125 nonconsecutive sedentary patients with resistant hypertension from a hypertension outpatient clinic in a university hospital were screened; 32 patients fulfilled the study requirements. The training was performed for 60-minute sessions in a heated pool (32 C), three times a week for 12 weeks. The HEx protocol consisted of callisthenic exercises and walking inside the pool. The control group was asked to maintain habitual activities. The main outcome measure was change in mean 24-hour ambulatory BP (ABPM). Results: 32 patients (HEx n = 16; control n = 16) were randomized; none were lost to follow-up. Office BPs decreased significantly after heated water exercise (36/12 mm Hg). HEx decreased 24-hour systolic (from 137 +/- 23 to 120 +/- 12 mm Hg, p = 0.001) and diastolic BPs (from 81 +/- 13 to 72 +/- 10 mm Hg, p = 0.009); daytime systolic (from 141 +/- 24 to 120 +/- 13 mm Hg, p < 0.0001) and diastolic BPs (from 84 +/- 14 to 73 +/- 11 mm Hg, p = 0.003); and nighttime systolic (from 129 +/- 22 to 114 +/- 12 mm Hg, p = 0.006) and diastolic BPs (from 74 +/- 11 to 66 +/- 10 mm Hg, p < 0.0001). The control group after 12 weeks significantly increased in 24-hour systolic and diastolic BPs, and daytime and nighttime diastolic BPs. Conclusion: HEx reduced office BPs and 24-hour ABPM levels in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients.
  • conferenceObject
    Heated Water-based Exercise Training Reduces 24-hour Ambulatory Blood Pressure Levels In Resistant Hypertensive Patients: A Randomized Controlled Trial (HEx Trial)
    (2014) CRUZ, Lais G.; BOCCHI, Edimar Alcides; FERNANDES-SILVA, Miguel Morita; DOREA, Egidio Lima; GUIMARAES, Guilherme Veiga
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    Neurohormonal response to Heated water-based Exercise training in treatment of resistant hypertension: results from the HEx Trial
    (2014) GUIMARAES, G. V.; CRUZ, L. G. B.; FERNANDES-SILVA, M. M.; DOREA, E. L.; BOCCHI, E. A.
  • article 29 Citação(ões) na Scopus
    Inflammatory biomarkers and effect of exercise on functional capacity in patients with heart failure: Insights from a randomized clinical trial
    (2017) FERNANDES-SILVA, Miguel M.; GUIMARAES, Guilherme V.; RIGAUD, Vagner O. C.; LOFRANO-ALVES, Marco S.; CASTRO, Rafael E.; CRUZ, Lais G. de Barros; BOCCHI, Edimar A.; BACAL, Fernando
    Background: In patients with heart failure, inflammation has been associated with worse functional capacity, but it is uncertain whether it could affect their response to exercise training. We evaluated whether inflammatory biomarkers are related to differential effect of exercise on the peak oxygen uptake (VO2) among patients with heart failure. Design: Open, parallel group, randomized controlled trial. Methods: Patients with heart failure and ejection fraction 0.4 were randomized into exercise training or control for 12 weeks. Patients were classified according to: 1) inflammatory biomarkers blood levels, defined as low' if both interleukin-6 and tumor necrosis factor-alpha blood levels were below median, and high' otherwise; and 2) galectin-3 blood levels, which also reflect pro-fibrotic processes. Results: Forty-four participants (507 years old, 55% men, 25% ischemic) were allocated to exercise training (n=28) or control (n=16). Exercise significantly improved peak VO2 among participants with low' inflammatory biomarkers (3.5 +/- 0.9 vs. -0.7 +/- 1.1ml/kg per min, p=0.006), as compared with control, but not among those with high' inflammatory biomarkers (0.4 +/- 0.6 vs. -0.2 +/- 0.7ml/kg per min, p=0.54, p for interaction=0.009). Similarly, exercise improved peak VO2 among participants with below median (2.4 +/- 0.8 vs. -0.3 +/- 0.9ml/kg per min, p=0.032), but not among those with above median galectin-3 blood levels (0.3 +/- 0.7 vs. -0.7 +/- 1.0ml/kg per min, p=0.41, p for interaction=0.053). Conclusion: In patients with heart failure, levels of biomarkers that reflect pro-inflammatory and pro-fibrotic processes were associated with differential effect of exercise on functional capacity. Further studies should evaluate whether exercise training can improve clinical outcomes in patients with heart failure and low levels of these biomarkers.
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  • conferenceObject
    Heated Water-based Exercise Training Improves Physical Capacity In Resistant Hypertension Patients: A Randomized Controlled Trial (HEx Trial).
    (2014) GUIMARAES, Guilherme V.; CRUZ, Lais G. B.; FERNADES-SILVA, Miguel M.; DOREA, Egidio L.; BOCCHI, Edimar A.
  • article 16 Citação(ões) na Scopus
    Hypotensive Effect of Heated Water-Based Exercise Persists After 12-Week Cessation of Training in Patients With Resistant Hypertension
    (2018) GUIMARAES, Guilherme Veiga; FERNANDES-SILVA, Miguel Morita; DRAGER, Luciano Ferreira; CRUZ, Lais Galvani de Barros; CASTRO, Rafael Ertner; CIOLAC, Emmanuel Gomes; BOCCHI, Edimar Alcides
    Background: Heated water-based exercise (HEx) promotes a marked reduction of blood pressure (BP), but it is not entirely clear whether its effects on BP persist after cessation of HEx. Methods: We analyzed the effects of cessation of HEx on 24-hour ambulatory BP monitoring (ABPM) in patients with resistant hypertension (RH). Thirty-two patients (aged 53 +/- 6 years) with RH (4 to 6 antihypertensive drugs) were randomly assigned to HEx (n = 16) or control (n = 16) groups. Antihypertensive therapy remained unchanged during the protocol. The HEx group participated in 36 sessions (60 minutes) in a heated pool (32 degrees C [89.6 degrees F]) for 12 weeks (training), followed by 12 weeks of cessation of training. The control group was evaluated during the same period and instructed to maintain their habitual activities. Results: HEx and control groups had similar BP levels at baseline. HEx training reduced the 24-hour systolic (-19.5 +/- 4.6 vs 3.0 +/- 0.7 mm Hg, P = 0.001) and diastolic BP (-11.1 +/- 2.4 vs 2.06 +/- 0.9 mm Hg, P = 0.001) at week 12, compared with the control group. After 12 weeks of training cessation (week 24), 24-hour BP remained significantly lower in the HEx group than in the control group (-9.6 +/- 3.8 vs 6.3 +/- 3.5 mm Hg, P = 0.01 and -7.5 +/- 2.2 vs 2.2 +/- 1.0 mm Hg, P = 0.009, for systolic and diastolic BP, respectively), although these differences were attenuated. Conclusions: BP remained lower after cessation of 12-week training among patients with RH who underwent HEx compared with the controls. The carryover effects of HEx on BP may help to overcome the challenging problem of exercise compliance in long-term follow-up.
  • article 26 Citação(ões) na Scopus
    Neurohumoral and Endothelial Responses to Heated Water-Based Exercise in Resistant Hypertensive Patients
    (2017) CRUZ, Lais Galvani de Barros; BOCCHI, Edimar Alcides; GRASSI, Guido; GUIMARAES, Guilherme Veiga
    Background: The neurohumoral and endothelial responses to the blood pressure (BP) lowering effects of heated water- based exercise (HEx) in resistant hypertension (HT) patients remain undefined. Methods and Results: We investigated these in 44 true resistant HT patients (age 53.3 +/- 0.9 years, mean +/- SEM). They were randomized and allocated to 2 groups, 28 to a HEx training protocol, which consisted of callisthenic exercises and walking in a heated pool for 1 h, three times weekly for 12 weeks and 16 patients to a control group maintaining their habitual activities. Measurements made before and after 12 weeks of HEx included clinic and 24-h BP, plasma levels of nitric oxide, endothelin- 1, aldosterone, renin, norepinephrine and epinephrine, as well as peak V. O2, and endothelial function (reactive hyperemia). After 12 weeks of HEx patients showed a significant decrease in clinic and 24- h systolic and diastolic BPs. Concomitantly, nitric oxide increased significantly (from 25 +/- 8 to 75 +/- 24 mu mol/ L, P < 0.01), while endothelin-1 (from 41 +/- 5 to 26 +/- 3 pg/ mL), renin (from 35 +/- 4 to 3.4 +/- 1 ng/mL/h), and norepinephrine (from 720 +/- 54 to 306 +/- 35 pg/ mL) decreased significantly (P < 0.01). Plasma aldosterone also tended to decrease, although not significantly (from 101 +/- 9 to 76 +/- 4 pg/ mL, P=NS). Peak VO2 increased significantly after HEx (P < 0.01), while endothelial function was unchanged. No significant change was detected in the control group. Conclusions: The BP-lowering effects of HEx in resistant HT patients were accompanied by a significant reduction in the marked neurohumoral activation characterizing this clinical condition.
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    INTERLEUKIN-6 AND GALECTIN-3 ARE LOWER IN PATIENTS WITH HEART FAILURE WHO DO NOT RESPONSE TO EXERCISE TRAINING
    (2015) SILVA, Miguel Morita Fernandes da; GUIMARAES, Guilherme; LOFRANO-ALVES, Marco; CASTRO, Rafael; CRUZ, Lais; BOCCHI, Edimar; BACAL, Fernando