Bruno Gualano

• PhD
• Professor (Associate) at University of São Paulo

Creatine monohydrate supplementation (CrM) is a safe and effective intervention for improving certain aspects of sport, exercise performance, and health across the lifespan. Despite its evidence-based pedigree, several questions and misconceptions about CrM remain. To initially address some of these concerns, our group published a narrative review...

Background : Active commuting benefits both individual and planetary health. Estimating commuting behavior is desirable, although very challenging in large and regionally relevant nations like Brazil. Methods : This review (CRD42023431054) included observational studies that estimated prevalence of active commuting in Brazil for adults (≥18 y). We...

Purpose: This study assessed the impact of a 12-week, home-based exercise training (HBET) program on health-related quality of life (HRQOL, primary outcome), cardiovascular and metabolic parameters in pediatric COVID-19 patients. Methods: In this single-center, randomized controlled trial conducted in Sao Paulo (Brazil) from October 2020 to January...

Rheumatoid arthritis (RA) is characterized by deteriorated vascular health and increased cardiovascular risk. Physical activity (PA) is recommended for cardiovascular management in RA, but evidence on the associations between objectively-measured PA and vascular health markers in RA is limited. In this cross-sectional study, eighty-two post-menopau...

Introduction DNA hypomethylation in patients with systemic lupus erythematosus (SLE) has been recently documented in the literature. Low levels of DNA methylation have been observed globally and in genes associated with immune and inflammatory pathways in SLE’s CD4+T lymphocytes. Given that certain micronutrients can either donate methyl groups wit...

The social restriction imposed by the COVID-19 pandemic challenged traditional qualitative research methods (e.g., face-to-face interviews or in situ participant and non-participant observations), requiring researchers to adapt classic qualitative practices to this new scenario. In this article, we proposed a reflection on how online communications...

Purpose We investigated the effects of a 4-month intervention targeting sedentary behavior on sedentary time and physical activity level, clinical parameters, cardiometabolic risk factors, inflammatory markers, and health-related quality of life in post-menopausal women with rheumatoid arthritis. Methods This was a 4-month, parallel-group, randomi...

The literature suggests that obesity mirrors some aspects of aging, but little is known whether body weight can contribute to one’s self-perception of aging. We aimed to qualitatively understand the self-perception of aging of adult and older adult women who underwent bariatric surgery, both at the present time and at the time of the procedure. We...

We qualitatively evaluated the perceptions and experiences during the COVID-19 pandemic regarding overall health, lifestyle and well-being of Brazilian women who underwent a bariatric surgery. We conducted individual, semi-structured interviews with thirty women, and data were analyzed identifying significance units collected through the interviews...

Objective To investigate the effect of a single oral dose of 200,000 IU of vitamin D3 on antiphospholipid antibodies in hospitalized patients with moderate to severe COVID-19. Methods This is a post-hoc, exploratory analysis from a double-blind, placebo-controlled, randomized clinical trial performed in two centers in Sao Paulo, Brazil. Hospitaliz...

Background Systemic lupus erythematosus is an autoimmune condition characterized by immune dysregulation, exacerbated systemic inflammation, and tissue damage. Glucocorticoid (GC) pulse therapy is a pharmacological strategy used to manage high activity phases. Although clinically effective, it can lead to adverse effects, including compromised musc...

Background Although nutrition and exercise both influence bone metabolism, little is currently known about their interaction, or whether nutritional intervention can modulate the bone biomarker response to acute exercise. Improved understanding of the relationships between nutrition, exercise and bone metabolism may have substantial potential to in...

Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune and multisystemic rheumatic disease. Patients with SLE have decreased functional and aerobic capacity, as well as increased prevalence of Cardiovascular Diseases (CVD), which are the primary causes of morbimortality in this condition. Dietary intake and physical activity are well-known mod...

Importance Major concerns regarding individuals who adhere to a vegan diet are whether they meet protein and essential amino acid recommendations and how reliant they are on ultraprocessed foods. Objectives To investigate whether individuals who adhere to a vegan diet meet protein and essential amino acid recommendations and, as secondary objectiv...

Background The acute exercise-mediated changes in metabolic, immunomodulatory, and gut hormones are blunted by excessive adiposity. We investigated whether bariatric surgery restore the acute responses to exercise on glucose metabolism, gut hormones, and inflammatory markers in women with severe obesity. Methods Thirteen women eligible for bariatr...

Fatty acids are precursors of inflammatory oxylipins. In the context of COVID-19, an excessive production of pro-inflammatory cytokines is associated with disease severity. The objective was to investigate whether the baseline omega 3/omega 6 fatty acids ratio and the oxylipins were associated with inflammation and oxidative stress in unvaccinated...

The evolving prevalence of anabolic androgenic steroids (AAS) abuse among nonathletes is alarming because of the known harm to an individual’s health. Among the adverse effects of AAS abuse, male infertility and sexual dysfunction have been often reported in the literature, but little is known regarding its actual prevalence, possible underpinning...

Carbohydrate (CHO) supplementation during endurance exercise can improve performance. However, it is unclear whether low glycemic index (GI) CHO leads to differential ergogenic and metabolic effects compared with a standard high GI CHO. This study investigated the ergogenic and metabolic effects of CHO supplementation with distinct GIs, namely, (a)...

Background: The pathoetiology of systemic lupus erythematosus (SLE) involves a multifactorial interaction consisting of various genetic, epigenetic and environmental factors. Considering epigenetic characteristics, notable alterations in DNA methylation, particularly hypomethylation in immune-related pathways, such as T cell receptor have been obse...

Post-acute Sequelae of SARS-CoV-2 infection (PASC) often leads to exertional intolerance and reduced exercise capacity, particularly in individuals previously admitted to an intensive care unit (ICU). However, the impact of invasive mechanical ventilation (IMV) on PASC-associated cardiorespiratory abnormalities during exercise remains poorly unders...

A systematic review with meta-analysis was completed to study the effects of dietary inorganic nitrate (NO3−) oral ingestion from vegetables and salts on blood pressure responses during and following exercise. Background NO3− is a hypotensive agent with the potential to reduce blood pressure peaks during exercise and amplify exercise-induced hypot...

Objective: The aim of the present study was to investigate the effects of a lifestyle intervention on cardiometabolic risk factors in patients with systemic lupus erythematosus with a high cardiovascular risk profile. Methods: This trial was conducted in Sao Paulo, Brazil between August 2020 and March 2023. The patients were randomly assigned to...

The magnitude of muscle hypertrophy in response to resistance training (RT) is highly variable between individuals (response heterogeneity). Manipulations in RT variables may modulate RT-related response heterogeneity; yet, this remains to be determined. Using a within-subject unilateral design, we aimed to investigate the effects of RT volume mani...

Introduction In prolonged physical activities, water replacement and muscle glycogen content are limiting factors in marathon runners. Carbohydrate-loading (CHO) in the days prior to endurance competition is a commonly employed method to optimise muscle glycogen stores and optimise exercise performance. Since each gram of muscle glycogen binds ∼2.7...

Introduction In prolonged physical activities, water replacement and muscle glycogen content are limiting factors in marathon runners. Carbohydrate-loading (CHO) in the days prior to endurance competition is a commonly employed method to optimise muscle glycogen stores and optimise exercise performance. Since each gram of muscle glycogen binds ∼2.7...

Aim Events of context marked by an increased capacity for some sort of change, such as living a healthier lifestyle, are known as “teachable moments” (TM) and commonly occur during or after a significant health event. In this context, the COVID-19 pandemic may constitute a potential TM for lifestyle change. Thus, this study aimed to investigate whe...

Importance: Major concerns regarding vegan dieters are whether they meet protein and essential amino acids (EAA) recommendations, and how reliant they are on ultra-processed foods (UPF). Objectives: To investigate whether vegan dieters meet protein and EAA recommendations. As secondary objectives, to determine UPF intake and potential predictors of...

Introduction: In prolonged physical activities, water replacement and muscle glycogen content are limiting factors in marathon runners. Carbohydrate-loading (CHO) in the days prior to endurance competition is a commonly employed method to optimise muscle glycogen stores and optimise exercise performance. Since each gram of muscle glycogen binds ~2....

Introdução: Em atividades físicas prolongadas a reposição hídrica e o conteúdo de glicogênio muscular são fatores limitantes em corredores de maratonas. O carregamento de carboidrato (CHO) nos dias anteriores à competição de resistência é um método comumente empregado para otimizar os estoques de glicogênio muscular e o desempenho no exercício. Uma...

Background The increase in blood pressure (BP) levels in the postmenopausal period can be partly explained by the decrease in nitric oxide synthases (NOS). Objective To investigate the acute and one-week effects of beetroot juice nitrate-rich (BRJ-NO3−rich) ingestion on cardiovascular and autonomic performance in response to submaximal aerobic exe...

Most studies on bariatric surgery identify personal factors such as “non-compliance” to lifestyle changes as the cause of weight gain and subsequent inability to lose weight. Prior qualitative studies suggest that weight loss patients have complicated relationships with both self and weight, with significant emotional and psychological implications...

Background: DNA methylation patterns are directly associated with diverse metabolic disorders. The status of methyl-donor micronutrients has been associated with DNA methylation levels, and altered ingestion of folate, choline, betaine, B vitamins and methionine may impact genes both globally and at the level of promoter regions. Despite this, the...

Purpose: This study aimed to describe cardiopulmonary fitness and endothelial function 6 months after hospital diagnosis in a sample mainly comprising immunocompromised patients with confirmed SARS-Cov-2 infection vs. controls. Methods: Youth (n=30; 14; 60% females) with confirmed SARS-CoV-2 seen in a tertiary hospital of Sao Paulo, Brazil, were ma...

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterized by increased risk of cardiovascular disease and hypertension (HT). A single session of aerobic exercise may reduce blood pressure (BP) in different clinical groups; however, little is known about the acute effects of exercise on BP in RA patients. This is a randomized con...

Systemic lupus erythematosus (SLE) patients report worse health-related quality of life (HRQL), fatigue, anxiety, depression, and sleep quality, when compared to the general population and other chronic diseases. Furthermore, cardiometabolic diseases are highly prevalent in SLE and are also associated with these parameters. Thus, it is plausible to...

Prior studies suggest that one anticipated benefit of bariatric surgery is the achievement of a thinner body, one that is less subject to perceived negative judgment and condemnation by others. However, additional analyses also indicate that stigma may persist even with significant post-surgery weight loss. To investigate the stigma-related percept...

We aimed to investigate associations between sleep quality with selected quantitative and qualitative parameters of health in older individuals with obesity. Cross-sectional assessment (n = 95 men/women; ≥ 65 years; BMI ≥ 30 kg/m²) of sleep quality, body composition, handgrip strength, quality-of-life, anxiety/depression. Mean PSQI score was 6.3. P...

Importance: It remains controversial whether adhering to a vegan diet may be associated with a higher prevalence of disordered eating. Also, main food choice motives and their association with disordered eating in this population are still unknown. Objective: To determine the association between disordered eating attitudes and food choice motive...

É bem estabelecido na literatura médica que a prática de atividade física (AF) é benéfica a saúde, sendo capaz de prevenir e tratar doenças crônicas além de promover saúde e qualidade de vida. No entanto, a prevalência de inatividade física na população vem aumentando nos últimos anos, especialmente se considerado o contexto da pandemia de Covid-19...

There is a paucity of studies assessing multidisciplinary interventions focused on tackling physical inactivity/sedentary behavior and poor dietary habits in SLE. The Living well with Lupus (LWWL) is a randomized controlled trial to investigate whether a six-month lifestyle change intervention will improve cardiometabolic risk factors (primary outc...

Objectives To prospectively assess health-related quality of life (HRQoL), global functionality, and disability in primary caregivers of surviving children and adolescents after COVID-19. Methods A longitudinal observational study was carried out on primary caregivers of surviving pediatric post-COVID-19 patients (n = 51) and subjects without COVI...

Sedentary behaviors (SB) are characterized by a low energy expenditure while in a sitting or reclining posture. Evidence relevant to understanding the physiology of SB can be derived from studies employing several experimental models: bed rest, immobilization, reduced step count, and reducing/interrupting prolonged SB. We examine the relevant physi...

Aim: To investigate the association between physical activity and immunogenicity among SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases prior to and following a 2-dose schedule of CoronaVac (Sinovac inactivated vaccine). Methods: This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial co...

Bone mass and quality declines with age, and can culminate in osteoporosis and increased fracture risk. This investigation modelled associations between bone and physical, dietary, and metabolic factors in a group of 200 pre-frail/frail older adults using factor analysis and structural equation modelling (SEM). Exploratory (EFA) and confirmatory fa...

Objective: To assess the potential therapeutic role of exercise on health-related quality of life, assessed by the Pediatric Outcomes Data Collection Instrument (PODCI), coronary flow reserve (CFR), cardiac function, cardiorespiratory fitness, and inflammatory and cardiac blood markers in multisystemic inflammatory syndrome in children (MIS-C) pat...

The COVID-19 pandemic impacts on eating habits among adolescents may be more relevant in pediatric patients with immunocompromised chronic diseases. This case-control study conducted between June and October 2020 aimed to: (i) describe dietary patterns of adolescents with chronic conditions compared to healthy controls and (ii) determine associatio...

Background Long-lasting effects of COVID-19 may include cardiovascular, respiratory, skeletal muscle, metabolic, psychological disorders and persistent symptoms that can impair health-related quality of life (HRQoL). We investigated the effects of a home-based exercise training (HBET) programme on HRQoL and health-related outcomes in survivors of s...

Despite some controversy, with recent reviews showing both positive 1 and inconclusive results, 2 face masks are a commonly used strategy to prevent infections during the COVID-19 pandemic. 3 However, concerns have been raised on whether its usage could affect breathing and cardiorespiratory health during physical effort. A study from our laborator...

Introduction Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms. Methods Participants’ assessment included medical history and physical examination, cardiac troponin T, resting e...

ABSTRACT Background: Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in clinical MBS settings have not been systematically determined. Objectives: To investigate: (1) who are the professionals implementin...

Background: Physical activity associates with improved immunogenicity following a 2-dose schedule of CoronaVac (Sinovac's inactivated SARS-CoV-2 vaccine) in patients with autoimmune rheumatic diseases (ARD). This study evaluates whether physical activity impacts vaccine-induced antibody responses to a booster dose in this population. Methods: Th...

Creatine has become one of the most popular dietary supplements among a wide range of healthy and clinical populations. However, its potential adverse effects on kidney health are still a matter of concern. This is a narrative review of the effects of creatine supplementation on kidney function. Despite a few case reports and animal studies suggest...

Objective To investigate if a cloth facemask could affect physiological and perceptual responses to exercise at distinct exercise intensities in healthy young individuals. Methods Nine participants (sex, female/male: 6/3; age: 13±1 years; VO2peak: 44.5±5.5 mL/kg/min) underwent a progressive square-wave test at four intensities: (1) 80% of ventilat...

Background: Social distancing measures designed to contain the COVID-19 pandemic can restrict physical activity, a particular concern for high-risk patient groups. We assessed rheumatoid arthritis patients' physical activity and sedentary behavior level, pain, fatigue, and health-related quality of life prior to and during the social distancing me...

Background There is no evidence of the use of beetroot juice with a previously recommended dose of nitrate (NO3) (> 300 mg) on the cardiovascular performance during and recovery following exercise in postmenopausal women with systemic arterial hypertension (SAH). Methods We will investigate the effects of beetroot juice rich in NO3 acutely (800 mg...

Exercise training and bariatric surgery have been shown to independently modulate DNA methylation profile in clusters of genes related to metabolic and inflammatory pathways. This study aimed to investigate the effects of a 6-month exercise training program on DNA methylation profile in women who underwent bariatric surgery. In this exploratory, qu...

Objective: To assess factors associated with emotional changes and Hyperactivity/Inattention (HI) motivated by COVID-19 quarantine in adolescents with immunocompromising diseases. Methods: A cross-sectional study included 343 adolescents with immunocompromising diseases and 108 healthy adolescents. Online questionnaires were answered including s...

The aim of this study was to determine whether Post-acute Sequelae of SARS-CoV-2 Infection (PASC) are associated with physical inactivity in COVID-19 survivors. This is a cohort study of COVID-19 survivors discharged from a tertiary hospital in Sao Paulo, Brazil. Patients admitted as inpatients due to laboratory-confirmed COVID-19 between March and...

Objective: This study aimed to assess physical and mental health, and health-related quality of life (HRQL) parameters in adolescents with physical disabilities enrolled in a sports nongovernmental organization (NGO) versus adolescents without disabilities during coronavirus disease 2019 (COVID-19) pandemic. Methods: This cross-sectional study i...

Background Obesity is a disease that may involve disrupted connectivity of brain networks. Bariatric surgery is an effective treatment for obesity, and the positive effects on obesity-related conditions may be enhanced by exercise. Herein, we aimed to investigate the possible synergistic effects of Roux-en-Y Gastric Bypass (RYGB) and exercise train...

Purpose: Investigate whether a cloth facemask could affect physiological and perceptual responses to exercise at distinct exercise intensities in untrained individuals. Methods: Healthy participants (n = 35; 17 men, age 30 [4] y, and 18 women, age 28 [5] y) underwent a progressive square wave test at 4 intensities: (1) 80% of ventilatory anaerob...

Background The observation that 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography/magnetic resonance imaging ([18F]F-FDG-PET/MRI) revealed high-grade arterial wall FDG uptake, without arterial wall thickening with contrast-enhancement, in a considerable number of c-TA patients in our previous study, encouraged us to compare patients with...

Objective We examined the impact of loss of skeletal muscle mass in post-acute sequelae of SARS-CoV-2 (PASC) infection, hospital readmission rate, self-perception of health, and health care costs in a cohort of COVID-19 survivors. Design Prospective observational study. Setting and Participants Tertiary Clinical Hospital. Eighty COVID-19 survivor...

The post-acute phase of COVID-19 is often marked by several persistent symptoms and exertional intolerance, which compromise survivors' exercise capacity. This was a cross-sectional study aiming to investigate the impact of COVID-19 on oxygen uptake (VO 2 ) kinetics and cardiopulmonary function in survivors of severe COVID-19 three to six months af...

Background: To investigate the effect of 200,000IU of vitamin D3 on hospital length of stay in patients with coronavirus disease 2019 (COVID-19). Methods: This RCT was conducted in two centers in Sao Paulo, Brazil. The primary outcome was hospital length of stay (HLOS). Results: Of 240 randomized patients, 237 were assessed in the primary outcome....

Aims Mitochondrial (mt) DNA replication is strongly associated with oxidative stress, a condition triggered by aging and hyperglycemia, both of which contribute to mitophagy disruption and inflammation. This observational exploratory study evaluated mtDNA-copy number (mtDNA-CN) and expression of genes involved in mitochondriogenesis (PPARGC1A, TFAM...

This prospective cohort study within an open‐label, single‐arm, phase 4 vaccination trial (clinicaltrials.gov #NCT04754698) aimed to investigate the association between physical activity and persistent anti‐SARS‐CoV‐2 antibodies 6 months after two‐dose schedule of CoronaVac in autoimmune rheumatic diseases (ARD) patients (n=748). Persistent immunog...

Background Circulating biomarkers are often used to investigate the bone response to an acute bout of exercise, but heterogeneity in factors such as study design, quality, selected biomarkers, and exercise and participant characteristics render it difficult to synthesize and evaluate available evidence. Objective The aim of this study was to quant...

Sarcopenia refers to the age-related reduction in strength, muscle mass and functionality which increases the risk for falls, injuries and fractures. Sarcopenia is associated with other age-related conditions such as osteoporosis, frailty and cachexia. Identifying treatments to overcome sarcopenia and associated conditions is important from a globa...

Objectives: To assess mental health and life conditions in adolescents with autoimmune rheumatic diseases (ARDs) and healthy controls quarantined during COVID-19 pandemic. Method: A cross-sectional study included 155 ARD adolescents and 105 healthy controls. Online survey included self-reported strengths and difficulties questionnaire (SDQ), and...

Objective To describe acute/postacute COVID-19 presentations in athletes. Design Systematic review and meta-analysis. Data sources The search was conducted in four databases (MEDLINE, EMBASE, SCOPUS, SPORTDiscus) and restricted to studies published from 2019 to 6 January 2022. Eligibility criteria for selecting studies Studies were required to (...

The aim of this study was to determine whether Post-acute Sequelae of SARS-CoV-2 Infection (PASC) are associated with physical inactivity in COVID-19 survivors. This is a cohort study of COVID-19 survivors discharged from a tertiary hospital in Sao Paulo, Brazil. Patients admitted as inpatients due to laboratory-confirmed COVID-19 between March and...

It is well-established that creatine supplementation augments the gains in muscle mass and performance during periods of resistance training. However, whether the timing of creatine ingestion influences these physical and physiological adaptations is unclear. Muscle contractions increase blood flow and possibly creatine transport kinetics which has...

Glucocorticoid (GC) therapy is a common treatment employed in rheumatic and autoimmune diseases due to its anti-inflammatory and immunosuppressive effects. However, GC therapy can also induce a number of adverse effects, including muscle and bone loss, hypertension, metabolic perturbations and increased visceral adiposity. We reviewed available evi...

Studies have suggested a potential role of endothelial dysfunction and atherosclerosis in the pathophysiology of COVID-19. Herein we tested whether brachial flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT) measured upon hospital admission are associated with acute in-hospital outcomes in hospitalized COVID-19 patients. A total...

Objective: To investigate if wearing a cloth facemask could affect physiological and perceptual responses to exercise at distinct exercise intensities in healthy young individuals. Methods: In a crossover design, 9 participants (sex, female/male: 6/3; age: 13±1 years; BMI: 18.4±2.1 kg/m2; sexual maturity rating, I/II/III/IV: 0/3/4/2; VO2peak: 44.5...

Background Although there are a considerable number of clinical studies on nitrate (NO3) rich beetroot juice (BRJ) and hypertension, it is difficult to indicate the real effects of NO3 from BRJ on the BP of hypertensive patients because there are still no estimates of the effects of NO3 derived from BRJ on the BP of hypertension patients. Objectiv...