BRUNO GUALANO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Erratic control of breathing during exercise in patients with systemic lupus erythematosus: a pilot-study(2011) PRADO, D. M. L. do; GUALANO, B.; MIOSSI, R.; LIMA, F. R.; ROSCHEL, H.; BORBA, E.; BONFA, E.; PINTO, A. L. de SaPurpose: The aim of this study was to provide a comprehensive evaluation of the pattern and timing of breathing during incremental exercise in a sample of women living with systemic lupus erythematosus (SLE). Methods: In this cross-sectional study, 20 women with SLE without pulmonary involvement were compared with 20 gender-, body mass index- (BMI), and age-matched healthy individuals. By using a cardiopulmonary incremental exercise test, the following parameters were assessed: tidal volume (VT); breathing frequency (BF); total respiratory time (TOT); inspiratory time (TI); expiratory time (TE); inspiratory time to total time (TI/TOT); mean inspiratory flow (VT/TI); ventilatory equivalent for carbon dioxide (VE/VCO(2)) and end-tidal carbon dioxide pressure (PETCO(2)). Results: BF and BF/VT were significantly higher in patients with SLE versus controls, whereas VT, TE, TI and TOT were significantly lower in the former group (p < 0.05). Additionally, patients with SLE presented higher VE/VCO(2) and lower PETCO(2) than controls (p < 0.05), suggesting a ventilatory inefficiency. Conclusion: We reported compelling evidence of abnormal pattern and timing of breathing during incremental exercise in SLE. Considering that an erratic control of breathing may play an important role in exercise intolerance and fatigue, respiratory exercises emerge as a potential treatment for these symptoms in patients with SLE. Lupus (2011) 20, 1535-1540.
- Abnormal chronotropic reserve and heart rate recovery in patients with SLE: a case-control study(2011) PRADO, D. M. Leite do; GUALANO, B.; MIOSSI, R.; SA-PINTO, A. L.; LIMA, F. R.; ROSCHEL, H.; BORBA, E. F.; BONFA, E.Abnormal heart-rate (HR) response during or after a graded exercise test has been recognized as a strong and an independent predictor of all-cause mortality in healthy and diseased subjects. The purpose of the present study was to evaluate the HR response during exercise in women with systemic lupus erythematosus (SLE). In this case-control study, 22 women with SLE (age 29.5 perpendicular to 1.1 years) were compared with 20 gender-, BMI-, and age-matched healthy subjects (age 26.5 +/- 1.4 years). A treadmill cardiorespiratory test was performed and HR response during exercise was evaluated by the chronotropic reserve (CR). HR recovery (Delta HRR) was defined as the difference between HR at peak exercise and at both first (Delta HRR1) and second (Delta HRR2) minutes after exercising. SLE patients presented lower peak VO(2) when compared with healthy subjects (27.6 perpendicular to 0.9 vs. 36.7 perpendicular to 1.1 ml/kg/min, p = 0.001, respectively). Additionally, SLE patients demonstrated lower CR (71.8 +/- 2.4 vs. 98.2 +/- 2.6%, p = 0.001), Delta HRR1 (22.1 +/- 2.5 vs. 32.4 +/- 2.2%, p = 0.004) and Delta HRR2 (39.1 +/- 2.9 vs. 50.8 +/- 2.5%, p = 0.001) than their healthy peers. In conclusion, SLE patients presented abnormal HR response to exercise, characterized by chronotropic incompetence and delayed Delta HRR. Lupus (2011) 20, 717-720.
- Effect of creatine supplementation on measured glomerular filtration rate in postmenopausal women(2011) NEVES JR., Manoel; GUALANO, Bruno; ROSCHEL, Hamilton; LIMA, Fernanda Rodrigues; SA-PINTO, Ana Lucia de; SEGURO, Antonio Carlos; SHIMIZU, Maria Heloisa; SAPIENZA, Marcelo Tatit; FULLER, Ricardo; LANCHA JR., Antonio Herbert; BONFA, EloisaWe aimed to investigate whether creatine supplementation affects the measured glomerular filtration rate in postmenopausal women (age, 58 +/- 3 years). Subjects were randomly assigned to receive either creatine (20 g(.)day(-1) for 1 week and 5 g(.)day(-1) thereafter) or a placebo. Kidney function was assessed at baseline and after 12 weeks. [Cr-51] EDTA clearance remained unchanged (CR-PRE: 86.16 +/- 14.36 mL(.)min(-1) per 1.73 m(2), POST: 87.25 +/- 17.60 mL(.)min(-1) per 1.73 m(2); PL-PRE: 85.15 +/- 8.54 mL(.)min(-1) per 1.73 m(2), POST: 87.18 +/- 9.64 mL(.)min(-1) per 1.73 m(2); p = 0.81). Thus, we concluded that creatine supplementation does not affect glomerular filtration rate in postmenopausal women.
- Creatine in Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial(2011) GUALANO, Bruno; PAINNELI, Vitor De Salles; ROSCHEL, Hamilton; ARTIOLI, Guilherme Giannini; NEVES JR., Manoel; PINTO, Ana Lucia De Sa; SILVA, Maria Elizabeth Rossi Da; CUNHA, Maria Rosaria; OTADUY, Maria Concepcion Garcia; LEITE, Claudia Da Costa; FERREIRA, Julio Cesar; PEREIRA, Rosa Maria; BRUM, Patricia Chakur; BONFA, Eloisa; LANCHA JR., Antonio HerbertGUALANO, B., V. DE. SALLES PAINNELI, H. ROSCHEL, G. G. ARTIOLI, M. NEVES JR, A. L. DE SA PINTO, M. E. DA SILVA, M. R. CUNHA, M. C. G. OTADUY, C. DA COSTA LEITE, J. C. FERREIRA, R. M. PEREIRA, P. C. BRUM, E. BONFA, and A. H. LANCHA JR. Creatine in Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial. Med. Sci. Sports Exerc., Vol. 43, No. 5, pp. 770-778, 2011. Creatine supplementation improves glucose tolerance in healthy subjects. Purposes: The aim was to investigate whether creatine supplementation has a beneficial effect on glycemic control of type 2 diabetic patients undergoing exercise training. Methods: A 12-wk randomized, double-blind, placebo-controlled trial was performed. The patients were allocated to receive either creatine (CR) (5 g.d(-1)) or placebo (PL) and were enrolled in an exercise training program. The primary outcome was glycosylated hemoglobin (Hb(A1c)). Secondary outcomes included the area under the curve of glucose, insulin, and C-peptide and insulin sensitivity indexes. Physical capacity, lipid profile, and GLUT-4 protein expression and translocation were also assessed. Results: Twenty-five subjects were analyzed (CR: n = 13; PL: n = 12). Hb(A1c) was significantly reduced in the creatine group when compared with the placebo group (CR: PRE = 7.4 +/- 0.7, POST = 6.4 +/- 0.4; PL: PRE = 7.5 +/- 0.6, POST = 7.6 +/- 0.7; P = 0.004; difference = -1.1%, 95% confidence interval = -1.9% to -0.4%). The delta area under the curve of glucose concentration was significantly lower in the CR group than in the PL group (CR = -7790 +/- 4600, PL = 2008 +/- 7614; P = 0.05). The CR group also presented decreased glycemia at times 0, 30, and 60 min during a meal tolerance test and increased GLUT-4 translocation. Insulin and C-peptide concentrations, surrogates of insulin sensitivity, physical capacity, lipid profile, and adverse effects were comparable between the groups. Conclusions: Creatine supplementation combined with an exercise program improves glycemic control in type 2 diabetic patients. The underlying mechanism seems to be related to an increase in GLUT-4 recruitment to the sarcolemma.
- Exercise in a Child with Systemic Lupus Erythematosus and Antiphospholipid Syndrome(2011) PRADO, Danilo M.; GUALANO, Bruno; PINTO, Ana Lucia S.; SALLUM, Adriana M.; PERONDI, Maria B.; ROSCHEL, Hamilton; SILVA, Clovis ArturPRADO, D. M., B. GUALANO, A. L. S. PINTO, A. M. SALLUM, M. B. PERONDI, H. ROSCHEL, and C. A. SILVA. Exercise in a Child with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Med. Sci. Sports Exerc., Vol. 43, No. 12, pp. 2221-2223, 2011. Exercise training has emerged as a potential therapeutic strategy to counteract the decline in physical function and aerobic capacity in pediatric rheumatic disease. Purpose: We report for the first time on the effects of exercise training in juvenile systemic lupus erythematosus (JSLE) and antiphospholipid syndrome (APS). Methods: A 15-yr-old boy with JSLE and APS treated with warfarin, azathioprine, and prednisone underwent a 12-wk aerobic exercise training program to improve his physical capacity and functioning. Before and after the 12-wk exercise program, the patient was submitted to incremental cardiopulmonary tests to determine (V) over dotO(2peak), peak and submaximal exercise intensity, and time to exhaustion. In addition, a 6-min square-wave test was performed for assessing metabolic parameters. Functioning was assessed by using the visual analog scale. Laboratory parameters of inflammation were also assessed at baseline and 48 h after the last training session. Results: All the cardiopulmonary parameters (e. g., (V) over dotO(2max) = +36.0%, time to exhaustion = +67.8%, peak exercise intensity = +16.7%) and the metabolic cost of movement (e. g., energy expenditure = -28.3% to -33.3%, (V) over dotO(2) = -29.3% to -33.4%) were improved. Both disease activity and cumulative damage scores did not change after the intervention, and no evidence of exercise-induced exacerbation of inflammation was observed. Visual analog scale scores were also improved according to the patients' evaluation (before intervention = 8 vs after intervention = 10), parents' evaluation (before intervention = 8 vs after intervention = 10), and physicians' evaluation (before intervention = 6 vs after intervention = 9). Conclusions: This is the first evidence that a 12-wk supervised aerobic training program can be safe and effective in improving aerobic conditioning and physical function in a patient with JSLE and APS. In light of these findings, the therapeutic effects of exercise training in pediatric rheumatic diseases merit further investigations.
- EFFICACY AND SAFETY OF CONCURRENT TRAINING IN SYSTEMIC SCLEROSIS(2011) PINTO, Ana L. S.; OLIVEIRA, Natalia C.; GUALANO, Bruno; CHRISTMANN, Romy B.; PAINELLI, Vitor S.; ARTIOLI, Guilherme G.; PRADO, Danilo M. L.; LIMA, Fernanda R.Pinto, ALS, Oliveira, NC, Gualano, B, Christmann, RB, Painelli, VS, Artioli, GG, Prado, DML, and Lima, FR. Efficacy and safety of concurrent training in systemic sclerosis. J Strength Cond Res 25(5): 1423-1428, 2011-The optimal training model for patients with systemic sclerosis (SSc) is unknown. In this study, we aimed to investigate the effects of a 12-week combined resistance and aerobic training program (concurrent training) in SSc patients. Eleven patients with no evidence of pulmonary involvement were recruited for the exercise program. Lower and upper limb dynamic strengths (assessed by 1 repetition maximum [1RM] of a leg press and bench press, respectively), isometric strength (assessed by back pull and handgrip tests), balance and mobility (assessed by the timed up-and-go test), muscle function (assessed by the timed-stands test), Rodnan score, digital ulcers, Rayland's phenomenon, and blood markers of muscle inflammation (creatine kinase and aldolase) were assessed at baseline and after the 12-week program. Exercise training significantly enhanced the 1RM leg press (41%) and 1RM bench press (13%) values and back pull (24%) and handgrip strength (11%). Muscle function was also improved (15%), but balance and mobility were not significantly changed. The time-to-exhaustion was increased (46.5%, p = 0.0004), the heart rate at rest condition was significantly reduced, and the workload and time of exercise at ventilatory thresholds and peak of exercise were increased. However, maximal and submaximal (V)over dotO(2) were unaltered (p > 0.05). The Rodnan score was unchanged, and muscle enzymes remained within normal levels. No change was observed in digital ulcers and Raynaud's phenomenon. This is the first study to demonstrate that a 12-week concurrent training program is safe and substantially improves muscle strength, function, and aerobic capacity in SSc patients.
- Creatine supplementation does not impair kidney function in type 2 diabetic patients: a randomized, double-blind, placebo-controlled, clinical trial(2011) GUALANO, Bruno; PAINELLI, Vitor de Salles; ROSCHEL, Hamilton; LUGARESI, Rebeca; DOREA, Egidio; ARTIOLI, Guilherme Giannini; LIMA, Fernanda Rodrigues; SILVA, Maria Elizabeth Rossi da; CUNHA, Maria Rosaria; SEGURO, Antonio Carlos; SHIMIZU, Maria Heloisa; OTADUY, Maria Concepcion Garcia; SAPIENZA, Marcelo Tatit; LEITE, Claudia da Costa; BONFA, Eloisa; LANCHA JUNIOR, Antonio HerbertCreatine supplementation may have a therapeutic role in diabetes, but it is uncertain whether this supplement is safe for kidney function. The aim of this study was to investigate the effects of creatine supplementation on kidney function in type 2 diabetic patients. A randomized, double-blind, placebo-controlled trial was performed. The patients were randomly allocated to receive either creatine or placebo for 12 weeks. All the patients underwent exercise training throughout the trial. Subjects were assessed at baseline and after the intervention. Blood samples and 24-h urine samples were obtained for kidney function assessments. Additionally, (51)Cr-EDTA clearance was performed. To ensure the compliance with creatine intake, we also assessed muscle phosphorylcreatine content. The creatine group presented higher muscle phosphorylcreatine content when compared to placebo group (CR Pre 44 +/- A 10, Post 70 +/- A 18 mmol/kg/wt; PL Pre 52 +/- A 13, Post 46 +/- A 13 mmol/kg/wt; p = 0.03; estimated difference between means 23.6; 95% confidence interval 1.42-45.8). No significant differences were observed for (51)Cr-EDTA clearance (CR Pre 90.4 +/- A 16.9, Post 96.1 +/- A 15.0 mL/min/1.73 m(2); PL Pre 97.9 +/- A 21.6, Post 96.4 +/- A 26.8 mL/min/1.73 m(2); p = 0.58; estimated difference between means -0.3; 95% confidence interval -24.9 to 24.2). Creatinine clearance, serum and urinary urea, electrolytes, proteinuria, and albuminuria were unchanged. CR supplementation does not affect kidney function in type 2 diabetic patients, opening a window of opportunities to explore its promising therapeutic role in this population. ClinicalTrials.gov registration number: NCT00992043.
- Cardiac autonomic impairment and chronotropic incompetence in fibromyalgia(2011) RIBEIRO, Roberta Potenza da Cunha; ROSCHEL, Hamilton; ARTIOLI, Guilherme Gianini; DASSOUKI, Thalita; PERANDINI, Luiz Augusto; CALICH, Ana Luisa; PINTO, Ana Lucia de Sa; LIMA, Fernanda Rodrigues; BONFA, Elosa; GUALANO, BrunoIntroduction: We aimed to gather knowledge on the cardiac autonomic modulation in patients with fibromyalgia (FM) in response to exercise and to investigate whether this population suffers from chronotropic incompetence (CI). Methods: Fourteen women with FM (age: 46 +/- 3 years; body mass index (BMI): 26.6 +/- 1.4 kg/m(2)) and 14 gender-, BMI- (25.4 +/- 1.3 kg/m(2)), and age-matched (age: 41 +/- 4 years) healthy individuals (CTRL) took part in this cross-sectional study. A treadmill cardiorespiratory test was performed and heart-rate (HR) response during exercise was evaluated by the chronotropic reserve. HR recovery (deltaHRR) was defined as the difference between HR at peak exercise and at both first (deltaHRR1) and second (deltaHRR2) minutes after the exercise test. Results: FM patients presented lower maximal oxygen consumption (VO2 max) when compared with healthy subjects (22 +/- 1 versus CTRL: 32 +/- 2 mL/kg/minute, respectively; P < 0.001). Additionally, FM patients presented lower chronotropic reserve (72.5 +/- 5 versus CTRL: 106.1 +/- 6, P < 0.001), deltaHRR1 (24.5 +/- 3 versus CTRL: 32.6 +/- 2, P = 0.059) and deltaHRR2 (34.3 +/- 4 versus CTRL: 50.8 +/- 3, P = 0.002) than their healthy peers. The prevalence of CI was 57.1% among patients with FM. Conclusions: Patients with FM who undertook a graded exercise test may present CI and delayed HR recovery, both being indicative of cardiac autonomic impairment and higher risk of cardiovascular events and mortality.
- Strength capacity in young patients who are receiving maintenance therapy for acute lymphoblastic leukemia: a case-control study(2011) MURATT, Mavi Diehl; PERONDI, Maria Beatriz; GREVE, Julia Maria D'Andrea; ROSCHEL, Hamilton; PINTO, Ana Lucia de Sa; GUALANO, Bruno
article 21 Citação(ões) na Scopus Therapeutic effects of exercise training in patients with pediatric rheumatic diseases(2011) GUALANO, Bruno; PINTO, Ana Lucia de Sa; PERONDI, Maria Beatriz; ROSCHEL, Hamilton; SALLUM, Adriana Maluf Elias; HAYASHI, Ana Paula Tanaka; SOLIS, Marina Yazigi; SILVA, Clovis ArturOver the past decades, the role of exercise training in rheumatic diseases has been largely explored. Currently, physical activity is well known to benefit patients with osteoporosis, osteoarthritis, systemic lupus erythematosus, systemic sclerosis, idiopathic inflammatory myopathy, fibromyalgia and rheumatoid arthritis. Therefore, exercise training has been considered a valuable tool for treating rheumatic patients. The therapeutic effects of exercise training have also been investigated in pediatric rheumatic diseases. Collectively, studies have revealed the therapeutic potential of exercise in juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, juvenile dermatomyositis, juvenile fibromyalgia and other causes of chronic pain. The aim of this review is to familiarize the pediatric rheumatologist with the exercise science field; discuss the potential benefits of exercise training in pediatric rheumatic diseases, emphasize both research and clinical perspectives of this promising field; and propose practical models of pre-participation examinations and contraindications to exercise.