Effect of Physical Exercise Training in Patients With Chagas Heart Disease (from the PEACH STUDY)

Mendes, Fernanda de Souza Nogueira Sardinha; Mediano, Mauro Felippe Felix; Souza, Fernando Cesar de Castro e; Silva, Paula Simplício da; Carneiro, Fernanda Martins; Holanda, Marcelo Teixeira de; Saraiva, Roberto Magalhães; Xavier, Sérgio Salles; Brasil, Pedro Emmanuel Alvarenga Americano do; Sousa, Andréa Silvestre de

doi:10.1016/j.amjcard.2020.01.035

Cited by 25 publications

(11 citation statements)

References 28 publications

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“…After 3 months of follow-up, patients who performed physical exercise improved their functional capacity, clinical symptoms and health-related quality of life when compared with those who only received usual care. These results were confirmed by later studies performed by our group that showed that a CR program with physical exercises can bring benefits for different health parameters in patients with CCC, including improvement of cardiorespiratory capacity, microcirculatory function and health-related quality of life, with stabilisation of inflammatory markers [12,25,26].…”

Section: Discussionsupporting

confidence: 64%

“…The detailed methodological description of the PEACH study can be found elsewhere [17]. The study demonstrated an important positive effect of physical exercise on improvement of peak functional capacity, through evaluation of peak oxygen consumption (VO 2peak ) [12]. All 30 patients included in the PEACH study were included in this cost-effectiveness secondary analysis.…”

Section: Health Economic Analysis Study Designmentioning

confidence: 99%

“…Exercise-based cardiovascular rehabilitation (CR) is a low-cost strategy that has been widely advocated for secondary prevention in individuals with different cardiovascular diseases, aiming to reestablish functional capacity, improve health-related quality of life and reduce hospitalisation and mortality [7][8][9]. In CCC, CR programs seem to improve functional capacity, health-related quality of life and cardiac function in patients with a varied degree of cardiac commitments in comparison to usual care including pharmacological treatment and nutritional counselling [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of an exercise‐based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study

Simões

Mendes

Avellar

et al. 2022

Tropical Med Int Health

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Objectives: The present study aimed to perform a cost-effectiveness analysis of an exercise-based cardiovascular rehabilitation (CR) program in patients with chronic Chagas cardiomyopathy (CCC). Methods: Cost-effectiveness analysis alongside a randomised clinical trial evaluating the effects of a 6-month exercise-based CR program. The intervention group underwent 3 weekly exercise sessions. The variation of peak oxygen consumption (VO 2peak ) was used as a measurement of clinical outcome. Cost information from all healthcare expenses (examinations, healthcare visits, medication and hospitalisation) were obtained from the medical records in Brazilian reais (R$) and transformed into dollars using the purchasing power parity ($PPP). The longitudinal costs variation was evaluated through linear mixed models, represented by β coefficient, adjusted for the baseline values of the dependent variable. The cost-effectiveness evaluation was determined through an incremental cost-effectiveness ratio using the HEABS package (Stata 15.0). Results: The intervention group presented higher costs with healthcare visits (β = +3317.3; p < 0.001), hospitalisation (β = +2810.4; p = 0.02) and total cost (β = +6407.9; p < 0.001) after 3 months of follow-up. Costs related to healthcare visits (β = +2455.8; p < 0.001) and total cost (β = +4711.4; p < 0.001) remained higher in the intervention group after 6 months. The CR program showed an incremental cost-effectiveness ratio (ICER) of $PPP 1874.3 for each increase of 1.0 ml kg À1 min À1 of VO 2peak . Conclusions: The CR program can be considered a cost-effective alternative and should be included as an intervention strategy in the care of patients with CCC.

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Section: Discussionsupporting

confidence: 64%

Section: Health Economic Analysis Study Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of an exercise‐based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study

Simões

Mendes

Avellar

et al. 2022

Tropical Med Int Health

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“…Eles demonstraram que o grupo que realizou exercícios aumentou o consumo de oxigênio de pico durante o exercício e a ventilação máxima por minuto, melhorando a capacidade funcional desses pacientes. 32 Entretanto, apesar de demonstrar que o TEF tem efeitos benéficos para pacientes com DC, é difícil analisar os efeitos desse tipo de treinamento no nível do tecido, celular e molecular, considerando que esses estudos foram realizados em seres humanos, para quem seriam necessárias biópsias. Portanto, para investigar os possíveis mecanismos associados a esses efeitos benéficos do TEF na DC, alguns estudos foram realizados em modelos experimentais de DC in vivo.…”

Section: Doença De Chagas E Treinamento Com Exercício Físico: Mirnas Como Possíveis Moduladoresunclassified

Treinamento com Exercício Físico e Doença de Chagas: Função Potencial dos MicroRNAs

Improta-Caria

Júnior

2021

Arquivos Brasileiros De Cardiologia

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“…In experimental models of CCC, physical exercises improve morphological and morphometric parameters in heart tissue (42,43). In patients with CCC, physical exercises ameliorate cutaneous microvascular function, hemodynamics, ECHO, and clinical parameters (33,34,(44)(45)(46). Very little is known about the physiopathology of CIF.…”

Section: Introductionmentioning

confidence: 99%

Physical Exercise Promotes a Reduction in Cardiac Fibrosis in the Chronic Indeterminate Form of Experimental Chagas Disease

et al. 2021

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Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is a neglected tropical disease and a health problem in Latin America. Etiological treatment has limited effectiveness in chronic CD; thus, new therapeutic strategies are required. The practice of physical exercises has been widely advocated to improve the quality of life of CD patients. The most frequent clinical CD manifestation is the chronic indeterminate form (CIF), and the effect of physical exercises on disease progression remains unknown. Here, in a CIF model, we aimed to evaluate the effect of physical exercises on cardiac histological, parasitological, mitochondrial, and oxidative metabolism, electro and echocardiographic profiles, and immunological features. To establish a CIF model, BALB/c and C57BL/6 mice were infected with 100 and 500 trypomastigotes of the Y T. cruzi strain. At 120 days postinfection (dpi), all mouse groups showed normal PR and corrected QT intervals and QRS complexes. Compared to BALB/c mice, C57BL/6 mice showed a lower parasitemia peak, mortality rate, and less intense myocarditis. Thus, C57BL/6 mice infected with 500 parasites were used for subsequent analyses. At 120 dpi, a decrease in cardiac mitochondrial oxygen consumption and an increase in reactive oxygen species (ROS) were detected. When we increased the number of analyzed mice, a reduced heart rate and slightly prolonged corrected QT intervals were detected, at 120 and 150 dpi, which were then normalized at 180 dpi, thus characterizing the CIF. Y-infected mice were subjected to an exercise program on a treadmill for 4 weeks (from 150 to 180 dpi), five times per week in a 30–60-min daily training session. At 180 dpi, no alterations were detected in cardiac mitochondrial and oxidative metabolism, which were not affected by physical exercises, although ROS production increased. At 120 and 180 dpi, comparing infected and non-infected mice, no differences were observed in the levels of plasma cytokines, indicating that a crucial biomarker of the systemic inflammatory profile was absent and not affected by exercise. Compared with sedentary mice, trained Y-infected mice showed similar parasite loads and inflammatory cells but reduced cardiac fibrosis. Therefore, our data show that physical exercises promote beneficial changes that may prevent CD progression.

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Effect of Physical Exercise Training in Patients With Chagas Heart Disease (from the PEACH STUDY)

Cited by 25 publications

References 28 publications

Cost‐effectiveness of an exercise‐based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study

Cost‐effectiveness of an exercise‐based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study

Treinamento com Exercício Físico e Doença de Chagas: Função Potencial dos MicroRNAs

Physical Exercise Promotes a Reduction in Cardiac Fibrosis in the Chronic Indeterminate Form of Experimental Chagas Disease

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