CELSO RICARDO FERNANDES DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - Docente
LIM/20 - Laboratório de Terapêutica Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/20 - Laboratório de Terapêutica Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina - Líder
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- Exercise effects in adults with asthma(2022) MCLOUGHLIN, R. F.; URROZ, P. D.; MCDONALD, V. M.; CARVALHO, C. R. F.; MCDONALD, V. M.Asthma is a common chronic disease, affecting over 339 million people worldwide. People with asthma present with episodes of symptoms such as shortness of breath, wheezing, coughing, and chest tightness, which can be triggered by a variety of factors. However not all asthma is the same. The severity, frequency, duration, and symptoms vary, making asthma a complex heterogeneous disease, with many triggers of symptoms. Exercise is one such trigger that induces asthma symptoms, however, despite this exercise remains important for people with asthma and can usually be performed safely in this population. Indeed, people with asthma are recommended to engage in regular physical activity. Despite this, low levels of physical activity are still being reported in those living with asthma, particularly in those with severe disease. This unnecessary avoidance of physical activity and exercise results in negative health consequences including poorer respiratory functioning, increased disease severity, and healthcare use, decreased physical and mental health, and decreased quality of life. This chapter discusses the available evidence in relation to the benefits of regular exercise training in asthma. Several physiological and psychological benefits are reported including improved asthma control, fewer asthma symptoms and exacerbations, reduced medication and healthcare use including reduced emergency department visits, improved health status, and decreased symptoms of anxiety and depression. Although there is a paucity of evidence regarding the mechanisms responsible for the beneficial effects of exercise training in asthma, a number of mechanisms have been proposed which will also be explored. Finally, based on the currently available evidence clinical practice recommendations for exercise prescribers are provided using the FITT (frequency, intensity, time, and type) principles for exercise prescription, as well important safety considerations that should be taken into account. However, more research is required to determine optimal exercise prescription principles within the asthma population. © 2022 Elsevier Inc. All rights reserved.
- Fat mass to fat-free mass ratio and its associations with clinical characteristics in asthma(2022) RUGILA, Diery Fernandes; OLIVEIRA, Joice Mara; MACHADO, Felipe Vilaca Cavallari; CORREIA, Natielly Soares; PUZZI, Vitoria Cavalheiro; PASSOS, Natalia Febrini Piassi; FREITAS, Patricia Duarte; PITTA, Fabio; CARVALHO, Celso Ricardo Fernandes; FURLANETTO, Karina CoutoBackground: Fat mass to fat-free mass ratio (FM/FFM) assesses the combined effect of the balance between fat mass and fat-free mass. Aims: to evaluate the associations beetween FM/FFM and clinical outcomes in asthma and to compare clinical characteristics between individuals with higher and lower FM/FFM. Methods: 128 participants with asthma underwent anthropometric, spirometry and bioelectrical impedance assessments. Physical activity in daily life (PADL) was assessed by the Actigraph for 7 days. Daily dose of inhaled medication, steps of pharmacological treatment, Asthma Control Questionnaire, Asthma Quality of Life Questionnaire and Hospital Anxiety and Depression Scale were also assessed. Participants were classified into two groups according to the 50th percentile of reference values for FM/FFM. Results: Individuals with higher FM/FFM (n=75) used higher daily doses of inhaled corticosteroids, had worse lung function and fewer steps/day when compared to those with lower FM/FFM (n=53) (P <= 0.021). Associations were found between absolute values of FM/FFM with lung function (FEV1 and FVC [liters]): R-2=0.207 and 0.364;P<0.0001), and between the categories of lower or higher FM/FFM with steps of medication treatment (Cramer's V=0.218;P=0.016) and level of PADL (Cramer's V=0.236;P=0.009). The highest FM/FFM was a determining factor of physical inactivity (OR: 3.21;95%CI:1.17-8.78) and highest steps of pharmacological treatment (OR: 8.89;95%CI:1.23-64.08). Conclusion: Higher FM/FFM is significantly associated with worse clinical characteristics in individuals with asthma, such as higher doses of inhaled corticosteroids, worse lung function and fewer steps/day. Moreover, higher FM/FFM is a determining factor of physical inactivity and the highest steps of pharmacological treatment for asthma.
- Age-associated phenotypic imbalance in TCD4 and TCD8 cell subsets: comparison between healthy aged, smokers, COPD patients and young adults(2022) FERNANDES, Juliana Ruiz; PINTO, Thalyta Nery Carvalho; ARRUDA, Lia Barbara; SILVA, Cibele Cristine Berto Marques da; CARVALHO, Celso Ricardo Fernandes de; PINTO, Regina Maria Carvalho; DUARTE, Alberto Jose da Silva; BENARD, GilBackground COPD is associated with an abnormal lung immune response that leads to tissue damage and remodeling of the lung, but also to systemic effects that compromise immune responses. Cigarette smoking also impacts on innate and adaptative immune responses, exerting dual, pro- and anti-inflammatory effects. Previously, we showed that COPD patients presented accelerated telomere shortening and decreased telomerase activity, while, paradoxically, cigarette-smokers exhibited preserved telomerase activity and slower rate of telomere shortening. Results Here, we evaluated the naive, CM, EM and T-EMRA subsets of TCD4 and TCD8 cells according to the expression of CCR7/CD45RA. We compared age-matched COPD patients, cigarette-smokers without clinical-laboratory evidence of pulmonary compromise, and healthy individuals. They were additionally compared with a group of young adults. For each subset we analysed the expression of markers associated with late differentiation, senescence and exhaustion (CD27/CD28/CD57/KLRG1/PD1). We show that COPD patients presented a drastically reduced naive cells pool, and, paradoxically, increased fractions of naive cells expressing late differentiation, senescence or exhaustion markers, likely impacting on their immunocompetence. Pronounced phenotypic alterations were also evidenced in their three memory T-cell subsets compared with the other aged and young groups, suggesting an also dysfunctional memory pool. Surprisingly, our smokers showed a profile closer to the Healthy aged than COPD patients. They exhibited the usual age-associated shift of naive to EM TCD4 and TCD8 cells, but not to CM or T-EMRA T-cells. Nonetheless, their naive T-cells phenotypes were in general similar to those of the Youngs and Healthy aged, suggesting a rather phenotypically preserved subset, while the memory T-cells exhibited increased proportions of cells with the late-differentiation or senescence/exhaustion markers as in the Healthy aged. Conclusion Our study extends previous findings by showing that COPD patients have cells expressing a full range of late differentiated, senescent or exhausted phenotypes encompassing all TCD4 and TCD8 subsets, consistent with a premature immunosenescence phenotype. Surprisingly, the smokers group's results suggest that moderate to heavy chronic cigarette smoking did not accelerate the pace of immunosenescence as compared with the Healthy aged.
- Postural balance in COPD with obstructive sleep apnea: a cross-sectional study(2022) CENSO, C. Maschio de; PASSINI, V. Vieira; VERRI, B. Aparecida Teodoro Alcantara; CARVALHO-PINTO, R. Maria De; STELMACH, R.; LORENZI-FILHO, G.; XAVIER, R. Fagundes; CARVALHO, C. Ricardo Fernandes
- Effect of exercise training on Treg cell response in severe COPD individuals: a randomized and controlled trial(2022) ITO, J. T.; OLIVEIRA, L. M.; V, L. Alves; XAVIER, R. F.; SATO, M. N.; CARVALHO, C. R. F.; TIBERIO, I. F. L. C.; LOPES, F. D. T. Q. S.
- Constant-Load Exercise Versus High-Intensity Interval Training on Aerobic Fitness in Moderate-to-Severe Asthma: A Randomized Controlled Trial(2022) SILVA, Ronaldo Aparecido da; STELMACH, Rafael; OLIVEIRA, Luanda Mara da Silva; SATO, Maria Notomi; CUKIER, Alberto; CARVALHO, Celso Ricardo FernandesBACKGROUND: The effects of high-intensity interval training (HIIT) on dyspnea and aerobic fitness in adults with asthma are poorly understood. OBJECTIVE: To compare constant-load exercise (CLE) versus HIIT for improvements in dyspnea symptoms and clinical control in adults with moderate-to-severe asthma. METHODS: Participants were randomized into 2 groups: CLE (n = 27; started with 70% of maximal watts [Wmax] obtained during cardiopulmonary exercise testing [CPET]) and HIIT (n = 28; started with 80% and increased until 140% Wmax). Exercise training lasted 12 weeks (twice/week, 40 minutes/ session on a cycle ergometer), and the intensity was based on CPET. Clinical asthma control (Asthma Control Questionnaire), aerobic fitness (the peak of oxygen uptake), health-related quality of life (Asthma Quality of Life Questionnaire), physical activity levels (PAL; accelerometer), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale questionnaire), and dyspnea were evaluated before and after the intervention. Systemic and airway inflammation were also assessed. Two-way analysis of variance and chi(2) tests were used for comparisons. Sixteen participants dropped out during the interventions and returned for the final evaluations. RESULTS: The CLE and HIIT groups showed similar improvements in aerobic fitness. The HIIT group had lower dyspnea and fatigue perception scores and higher PAL than the CLE group (P < .05) and clinical improvements in the psychosocial distress. In addition, only the HIIT group achieved a minimal clinically important difference in asthma symptoms. There was no change in the systemic and airway inflammation (P > .05). CONCLUSION: Both interventions promoted similar improvements in aerobic fitness; however, HIIT induced a greater reduction in dyspnea and fatigue perception. Similar responses were observed for other variables. (C) 2022 American Academy of Allergy, Asthma & Immunology
- Impact of prone positioning on patients with COVID-19 and ARDS on invasive mechanical ventilation: a multicenter cohort study(2022) CUNHA, Marieta C. A.; SCHARDONG, Jociane; RIGHI, Natiele Camponogara; LUNARDI, Adriana Claudia; SANT'ANNA, Guadalupe Nery de; ISENSEE, Larissa Padrao; XAVIER, Rafaella Fagundes; BRAMBATTI, Kaciane Roberta; POMPEU, Jose Eduardo; FRANCIO, Fabiano; FARIA, Luiza Martins; CARDOSO, Rozana Astolfi; SILVA, Antonio Marcos Vargas da; DORNELES, Camila de Christo; WERLE, Roberta Weber; FERREIRA, Juliana Carvalho; PLENTZ, Rodrigo Della Mea; CARVALHO, Celso R. F.Objective: To identify factors that lead to a positive oxygenation response and predictive factors of mortality after prone positioning. Methods: This was a retrospective, multicenter, cohort study involving seven hospitals in Brazil. Inclusion criteria were being > 18 years of age with a suspected or confirmed diagnosis of COVID-19, being on invasive mechanical ventilation, having a PaO2/FIO2 ratio < 150 mmHg, and being submitted to prone positioning. After the first prone positioning session, a 20 mmHg improvement in the PaO2/FIO2 ratio was defined as a positive response. Results: The study involved 574 patients, 412 (72%) of whom responded positively to the first prone positioning session. Multiple logistic regression showed that responders had lower Simplified Acute Physiology Score III (SAPS III)/SOFA scores and lower D-dimer levels (p = 0.01; p = 0.04; and p = 0.04, respectively). It was suggested that initial SAPS III and initial PaO2/FIO2 were predictors of oxygenation response. The mortality rate was 69.3%. Increased risk of mortality was associated with age (OR = 1.04 [95 CI: 1.01-1.06]), time to first prone positioning session (OR = 1.18 [95 CI: 1.06-1.31]), number of sessions (OR = 1.31 [95% CI: 1.00-1.72]), proportion of pulmonary impairment (OR = 1.55 [95% CI: 1.02-2.35]), and immunosuppression (OR = 3.83 [95% CI: 1.35-10.86]). Conclusions: Our results show that most patients in our sample had a positive oxygenation response after the first prone positioning session. However, the mortality rate was high, probably due to the health status and the number of comorbidities of the patients, as well as the severity of their disease. Our results also suggest that SAPS III and the initial PaO2 /FIO2 predict the oxygenation response; in addition, age, time to first prone positioning, number of sessions, pulmonary impairment, and immunosuppression can predict mortality.
- An online behavior change intervention to promote physical activity in adults with asthma: study protocol for a multicenter randomized controlled trial(2022) OLIVEIRA, Joice Mara de; KARLOH, Manuela; MATIAS, Thiago Sousa; BARBOSA, Graziele Besen; FREITAS, Patricia Duarte; CARVALHO, Celso R. F.; FURLANETTO, Karina CoutoBackground: Behavior change interventions have been the focus of recent studies, and the COVID-19 pandemic highlighted the importance of online interventions. However, no previous studies have investigated behavior change techniques to improve physical activity in adults with asthma through online intervention. Methods: This double-blind clinical trial will investigate the effectiveness of an online behavior change intervention in increasing physical activity and reducing sedentary behavior in adults with asthma, as well as in improving other clinical outcomes in short and medium terms. Patients with clinically stable moderate to severe asthma, who are physically inactive and do not have cardiovascular and/or osteoneuromuscular impairments will be randomized into control or intervention groups (23 in each). Both groups will carry out an online educational program (1 h). Additionally, the intervention group will receive weekly individual online sessions for 12 weeks of motivation-based behavior change intervention to promote an increase in physical activity and reduce sedentary behavior based on both self-determination theory and transtheoretical model. The intervention group will also receive an activity monitor with specific strategies related to it. Both groups will be reassessed immediately after the intervention and 6 months after that. The primary outcomes are physical activity and sedentary behavior, which will be objectively assessed by a triaxial accelerometer (Actigraph wGT3X-BT). Secondary outcomes are Asthma Control Questionnaire, Incremental Step Test, Sit-To-Stand, Timed Up-and-Go, 4-Metre Gait Speed, Asthma Quality of Life Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Actiwatch 2, and the Hospital Anxiety and Depression Scale. Discussion: The intervention is unprecedented and was carefully developed to joint most characteristics and techniques of both behavioral strategies (transtheoretical model and self-determination theory). Therefore, this intervention has the potential to improve physical activity levels and asthma management and reduce sedentary behavior. As a consequence, this novel intervention will improve global health in this population and support its use in clinical practice. The intervention will be carried out online with direct weekly contact with the therapist. Consequently, it has low implementation costs, might improve patient's attendance, and has the potential to be largely offered elsewhere.
- Behavior change to increase physical activity reduces sleep disturbances in asthma: A randomized controlled trial(2022) FREITAS, P.; PASSOS, N. F.; CUKIER, A.; CARVALHO-PINTO, R.; CARVALHO, C. R. Fernandes de
conferenceObject Physical Function Trajectories in of Critically Ill Patients by COVID-19 and Risk Factors: From ICU to Hospital Discharge(2022) FU, C.; LUNARDI, A. C.; PESO, C. N.; POMPEO, J. E.; CARVALHO, C. R. F.; SCHMITT, A. C. B.; SILVA, E. C. G.; TANAKA, C.; SCHUJMANN, D. S.