Helena Santa-Clara

• Technical University of Lisbon

Background Arterial stiffness and cardiac autonomic function are crucial indicators of cardiovascular health. Acute exercise and age impact these parameters, but research often focuses on specific exercise activities, lacking ecological validity. Methods We examined the acute effects of commercially available group fitness classes (indoor cycling,...

The post-exercise hypotension response is controversial among patients with coronary artery disease (CAD). Factors behind this disparity may include post-exercise differential effects on central and brachial blood pressure (BP), exercise intensity and inter-individual variability. Thus, we investigate group and individual central and brachial BP re...

Background Vascular cognitive impairment is frequent, in mild (mVCI) or severe forms (vascular dementia). Objective To do a randomized controlled-trial to evaluate the impact of physical activity on cognition (primary outcome), neurocognitive measures, quality of life, functional status, and physical function (secondary outcomes), in patients with...

Background: We compared the effects of home- vs gym-based delivery modes of two 8-week supervised multicomponent intensity training regimes on cardiorespiratory fitness and arterial stiffness in 17 adults with intellectual and developmental disability during the COVID-19 pandemic. Methods: Participants were assigned to sprint interval training or c...

Purpose We examined heart rate variability (HRV) and baroreflex sensitivity (BRS) disease- and age-related response at 10-and 60-min after an acute high-intensity interval (HIIE) and moderate continuous exercise (MICE) in older adults with and without type 2 diabetes mellitus (T2DM) and healthy young adults. Methods Twelve older male adults with (...

Flow-mediated slowing (FMS) is a non-invasive measure of endothelial function measured through reactive hyperemia-induced changes in pulse wave velocity (PWV). FMS is suggested to mitigate known pitfalls of flow-mediated dilation (FMD) including suboptimal repeatability and high-operator dependency. However, the few single-rater studies that examin...

Brachial vascular function after acute aerobic exercise in older adults with and without type 2 diabetes Purpose: The acute exercise model provides clinical insights regarding vascular dysfunction in adults with type 2 Diabetes Mellitus (T2DM), as it uncovers abnormalities not normally present at rest. However, whether vascular responses to acute e...

We examined the effects of adding a Kettlebell Swing training program (KB) to the regular skill-training protocol (REGULAR) on cardiorespiratory fitness, cardiorespiratory/metabolic demand, and recovery to a simulated competition of female artistic gymnastics. Nine gymnasts (13±2 years) had their REGULAR complemented with a 4-week kettlebell traini...

Cardiovascular events are the leading cause of on-duty deaths among firefighters. Screening firefighters for risk of sudden cardiac event is a critical element of a comprehensive medical program. Although intense physical exertion has been shown to trigger sudden cardiac events in the general population, it is unclear how hemodynamic responses foll...

Resistance training has been shown to acutely increase arterial stiffness (AS), while endurance training appears to decrease AS. However, the findings are from studies in apparently healthy subjects and have limited applicability to patients at low and high cardiovascular risk, for whom combined exercise is recommended. We compared the time course...

Arterial stiffness (AS) is associated with coronary artery disease (CAD). Acute endurance training decreases AS, whereas acute resistance training increases it. However, these results are from studies in apparently healthy adults, and there is no information on the effects of such after load AS in elderly patients with CAD. We aimed to investigate...

We compared central and peripheral arterial stiffness response patterns between persons with and without intellectual and developmental disabilities (IDD) of different age groups at rest and following a cardiopulmonary exercise test (CPET). Fifteen young adults with and without IDD, and 15 middle-aged adults without IDD performed a CPET. Central an...

Pulse wave velocity (PWV) deceleration to reactive hyperemia–flow-mediated slowing (FMS)–has been suggested as an alternative method to flow-mediated dilation (FMD) to evaluate brachial artery endothelial function. FMS is suggested to address major caveats of the FMD procedure including its suboptimal repeatability and high-operator dependency. How...

We compared response patterns of cardiovagal modulation through indices of heart-rate variability (HRV) and baroreflex sensitivity (BRS) at 10 and 60 min following an acute bout of high-intensity interval exercise (HIIE) and moderate-intensity continuous exercise (MICE) in active young and older adults. Twelve young (aged 20-40 years) and older (ag...

Adults with Down-Syndrome seem to be protected from early aging-associated increases in arterial stiffness and to present blunted responses to maximal aerobic exercise in comparison to age-matched controls, possibly underlying diminished vascular reserve. However, whether these arterial stiffness responses apply to adults with intellectual and deve...

Background The World Health Organization (WHO) recommends a minimum of 150 minutes of moderate physical activity per week. Adherence to these recommendations is difficult to assess. Objective We aimed to evaluate the validity of self-reported physical activity in mild vascular cognitive impairment (mVCI) and whether physical activity was associate...

Objectives. To examine the acute effect of a maximal aerobic exercise effort on aortic, peripheral arterial stiffness and cardiovagal modulation of trained and untrained patients with coronary artery disease (CAD). Design. Cross-sectional study. Methods. Eighteen untrained patients with CAD, 18 trained patients with CAD, and 18 apparently healthy t...

Introduction The daily life of Chronic obstructive pulmonary disease (COPD) patients is characterised not only by chronic respiratory symptoms but also by exercise intolerance due to their breathlessness. Proper diagnosis and management of this disease consequently includes evaluation of exercise tolerance [1], frequently associated with a reduced...

We compared the impact of a one-year periodized exercise training versus a non-periodized exercise training on health-related physical fitness (HRPF) including body composition, cardiorespiratory and muscular fitness in patients with coronary artery disease (CAD). Fifty CAD patients (60.4 ± 9.9 years) were randomized to either a periodized training...

risk stratification in heart failure patients

Objective: To estimate total energy expenditure and intensity of a low impact BodyattackTM session using combined heart rate and movement sensing technology. Method: Participants were 10 (8 males) normal-weight adults (33 ± 3 years-old). Maximal oxygen capacity and heart rate were determined by the performance on a treadmill maximal exercise test u...

Aims To determine the effects of high-intensity interval training (HIIT) following cardiac resynchronization therapy (CRT) implantation in patients with chronic heart failure (CHF), on noninvasive estimates of systolic ventricular function, exercise performance, severity of symptoms and quality of life. Methods Cardiopulmonary exercise testing, re...

Objectives: Evaluate the effects of a 6-month High Intensity Interval Training (HIIT) program on (1) functional capacity and health-related quality of life, (2) multiple blood biomarkers, (3) echocardiographic parameters, and (4) exercise performance, in patients in cardiac resynchronization therapy (CRT) stratified by the presence of atrial fibril...

Previous studies have reported that slower VO2 kinetics typically observed in healthy older individuals can be prevented by long-term endurance training interventions. However, the chronic adaptations on the VO2 kinetics and muscle deoxygenation ([HHb]) kinetics response in trained older adults with coronary artery disease (CAD) remains unknown. Pu...

Background Benefits from cardiac rehabilitation (CR) programs are evidence-based and widely recognized. Less than 50% of people who participate in hospital-based CR programs maintain an exercise regime for as long as six months after completion. Little is known about interventions making the patients continue to exercise after the hospital-based fo...

Introduction: Chronic obstructive pulmonary disease (COPD) is associated with pronounced exercise intolerance resulting in an impaired health-related quality of life [1 Jones PW. Activity Limitation and Quality of life In COPD. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2007;4(3):273–278. doi:10.1080/15412550701480265[Taylor & Francis...

Background Cognitive impairment and cerebrovascular pathology are both frequent with ageing. Cognitive impairment due to vascular pathology of the brain, termed vascular cognitive impairment (VCI), is one of the most frequent causes of cognitive impairment in elderly subjects. Thus far, VCI has no specific pharmacological treatment. Recent observat...

Purpose: To examine the acute effect of maximal exercise effort on pulse wave velocity (PWV) and heart rate variability (HRV) in patients with CAD with a range of functional capacity levels, and the association between these parameters 1,2,3. Methods: Thirty-six patients with CAD (62 ± 10 y) ranging in very-poor (5.22 ± 0.83METs; n = 18; VPFIT-CAD)...

Introduction: Arterial stiffness is associated with coronary artery disease (CAD). Acute aerobic exercise decreases arterial stiffness, while acute resistance exercise increases arterial stiffness. There is little information on the effect of such exercise on arterial stiffness in older patients with CAD. Purpose: We examined arterial stiffness, be...

Introduction: There is a lack of consensus on the definition of response to cardiac resynchronization therapy (CRT), and it is not clear which response criteria have most influence on cardiac event-free survival. Objectives: To assess the predictive value of various response criteria in patients undergoing CRT and the agreement between them. Me...

Introduction There is a lack of consensus on the definition of response to cardiac resynchronization therapy (CRT), and it is not clear which response criteria have most influence on cardiac event-free survival. Objectives To assess the predictive value of various response criteria in patients undergoing CRT and the agreement between them. Method...

Background: Supervised (SE) and home-based exercise (HBE) training regimes are effective on reconditioning patients with familial amyloidotic polyneuropathy (FAP) after liver transplantation, but research of the long-term retention of the benefits attained in patients with FAP has not yet been conducted. Purpose: In this 5-year follow-up study,...

Background: Cardiac autonomic dysfunction as assessed by 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy is associated with poor prognosis in heart failure (HF) patients. Although cardiac resynchronization therapy (CRT) has emerged as an effective therapy in improving outcomes on HF patients, its effect on cardiac sympathetic nervous functio...

Cardiac rehabilitation (CR) is a multidisciplinary process for patients recovering after an acute cardiac event or with chronic cardiovascular disease that reduces mortality and morbidity and improves quality of life. It is considered a cost-effective intervention and is expressly indicated in the guidelines of the major medical societies.In Portug...

Background: During a maintenance cardiac rehabilitation program several transition factors (travel, vacation or even rehabilitation program discharge) may often interfere with the systematic planning of a supervised exercise (SE) regime, leading to a disruption in physical activity patterns by either decreasing physical fitness, frequency or even c...

Cardiac rehabilitation (CR) is a multidisciplinary process for patients recovering after an acute cardiac event or with chronic cardiovascular disease that reduces mortality and morbidity and improves quality of life. It is considered a cost-effective intervention and is expressly indicated in the guidelines of the major medical societies. In Portu...

Background: Heart failure (HF) is associated with cardiac autonomic denervation (AD), which can be non-invasively assessed by 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy and has prognostic implications. We aimed to study the relationship between myocardial contractility assessed by global longitudinal strain (GLS) and AD assessed by 123I...

Increasing energy expenditure (EE) in cardiac patients remains a challenge. Exercise approaches in cardiac rehabilitation/secondary prevention programs (CR/SP) have consistently resulted in minimal weight loss, due in part to the low exercise-related EE. The purpose of this study was to measure the EE among patients participating in a routine exerc...

Introduction: The benefits of cardiac resynchronization therapy (CRT) documented in heart failure (HF) may be influenced by atrial fibrillation (AF). We aimed to compare CRT response in patients in AF and in sinus rhythm (SR). Methods: We prospectively studied 101 HF patients treated by CRT. Rates of clinical, echocardiographic and functional re...

Introduction The benefits of cardiac resynchronization therapy (CRT) documented in heart failure (HF) may be influenced by atrial fibrillation (AF). We aimed to compare CRT response in patients in AF and in sinus rhythm (SR). Methods We prospectively studied 101 HF patients treated by CRT. Rates of clinical, echocardiographic and functional respon...

Purpose: We examined whether exposure to high PP in adolescence predicts carotid artery intima-media thickness (IMT) and stiffness indices at young adulthood. Methods: Seventy-nine participants had their brachial systolic (SBP) and diastolic blood (DBP) pressures taken at the age of 15–16 years and later at young adulthood (29–31 years). Carotid IM...

Introduction Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. Aims To identify baseline characteristics that might influence echocardiogr...

Introduction: Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. Aims: To identify baseline characteristics that might influence echocard...

Background: Waist-to-height ratio (WHtR) has been reported as a preferable risk related body fat (BF) marker, although no standardised waist circumference measurement protocol (WCmp) has been proposed. The present study aimed to investigate whether the use of a different WCmp affects the strength of relationship between WHtR and both whole and cen...

Central accumulation and distribution of body fat (BF) is an important cardiometabolic risk factor. Waist-to-hip ratio (WHR), commonly elevated in non-alcoholic fatty liver disease (NAFLD) patients, has been endorsed as a risk related marker of central BF content and distribution, but no standardized waist circumference measurement protocol (WCmp)...

This study compared the effects of a bout of maximal running exercise on arterial stiffness in children and adults. Right carotid blood pressure and artery stiffness indices measured by pulse wave velocity (PWV), compliance and distensibility coefficients, stiffness index α and β (echo-tracking), contralateral carotid blood pressure, and upper and...

Background: Cardiac resynchronization therapy (CRT) improves prognosis, leading to reverse remodelling with a reduction in left ventricular (LV) size, improvement in the LV ejection fraction (LVEF) and systolic volume. However, 30– 40% of patients who underwent CRT are non-responders. The addition of aerobic training can maximize patient benefits f...

It is well known that not all patients submitted to cardiac resynchronization for heart failure (HF) positively respond to this therapy. On the other hand, exercise has been demonstrated to have additional benefits to cardiac resynchronization therapy (CRT). Lately, in small groups of patients, exercise modalities like high intensity interval train...

Background: Cardiac resynchronization therapy (CRT) is an established non pharmacological treatment for chronic heart failure (CHF) patients (P). CRT response can currently be evaluated by different clinical or echocardiographic criteria, with no strong evidence supporting the use of one criterion over the others. Recently, reductions in brain natr...

Introduction: Cardiac resynchronization therapy (CRT) has positively modified the prognosis of chronic heart failure (CHF), however, not all patients (P) respond. The big issue is to find out baseline characteristics as predictors of CRT response. Purpose: To identify patient’s baseline factors which might influence a positive echocardiographic re...

Central fatness might be a more sensitive predictor of atherosclerotic changes in children than are total body fat measures. However, it is unclear whether a total body fat measure coupled with an estimate of a more central pattern of fat accumulation predicts increased carotid intima-media-thickness (cIMT) better than either measure alone. The obj...

CARDIAC AUTONOMIC CONTROL INDEPENDENT ASSOCIATIONS WITH CARDIORESPIRATORY FITNESS AND RESTING METABOLIC RATE IN NAFLD PATIENTS Pimenta, N.1,2, Cortez-Pinto, H.3, Silva-Nunes, J.4, Sousa, P.5, Calé, R.5, Melo, X.1, Sardinha, L.B.1, Fernhall, B.6, Santa-Clara H.1 1: CIPER, FMH-UL (Lisbon, Portugal), 2: ESDRM-IPS (Rio Maior, Portugal), 3: Santa Maria...

Background: A growing body of evidence suggests that high intensity interval training (HIIT) leads to major benefits in cardiac remodeling parameters in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF). It is unknown, however, whether the beneficial effects of exercise training described in patients w...

Background: A growing body of evidence suggests that high intensity interval training (HIIT) leads to major benefits in cardiac remodelling parameters in patients with chronic heart failure (CHF). However, up to 30% of patients receiving cardiac resynchronization therapy (CRT) do not have a positive clinical or reverse remodelling response. CRT res...

Central fat accumulation is important in nonalcoholic fatty liver disease (NAFLD) etiology. It is unknown whether any commonly used waist circumference measurement protocol (WCmp), as a whole and central fat accumulation marker, is preferable for patients with NAFLD. The present study sought to find a preferable WCmp to be used in patients with NAF...

The aim of this cross-sectional study was to examine the influence of muscular strength on carotid intima-media thickness (cIMT) in children, controlling for the effect of cardiorespiratory fitness (CRF) and central adiposity and to examine if differences among muscular strength tertiles translate to physiological differences. We assessed cIMT of t...

It is unclear if cardiorespiratory fitness (CRF) can be used as a screening tool for premature changes in carotid intima-media thickness (cIMT) in paediatric populations. The purpose of this cross-sectional study was 3-fold: (i) to determine if CRF can be used to screen increased cIMT; (ii) to determine an optimal CRF cut-off to predict increased c...

BACKGROUND: Acute aerobic exercise increases arterial compliance in adults. However, the systemic effect of increases in compliance along the arterial tree after a single bout of aerobic exercise may differ with age. PURPOSE: The main purpose of this study was to compare the effects of a bout of maximal running exercise on arterial stiffness in ch...

1: CIPER, FMH-UL (Lisbon, Portugal), 2: FEFD-ULHT (Lisbon, Portugal), Introduction: Raw Power in Motion (RPM) is a cycling program well spread in the Fitness world. It´s implemented over 80 countries and it´s a fitness trend represent by 100.000 instructors. The purpose of this study was to analyze the effects of one RPM session. It´s a 50 minutes...

Introduction: The magnitude of excess post-exercise consumption (EPOC) after aerobic exercise clearly depends on both the duration and intensity of exercise and the conflicting results that surround EPOC may be resolved if differences in these parameters are considered. As the absence of a sustained EPOC after exercise seems to be a consistent find...

Background: It is unclear how sedentary behavior (SED), physical activity (PA), and cardiorespiratory fitness (CRF) influence vascular structure in children of varying body size. This study examined whether associations between SED, PA, and CRF with intima-media thickness (IMT) added to that of abdominal fatness and IMT. Differences in physiologic...

Introduction Body composition (BC), particularly central body fat (BF), is a major issue in Non-alcoholic Fatty Liver Disease (NAFLD). Decreased vagal activity, as assessed by heart rate recovery (HRR), is known to be a marker of imbalanced cardiac autonomic control and a risk factor for death. HRR was shown to be inversely associated with BF conte...

In the literature, concepts of “polyneuropathy”, “peripheral neuropathy” and “neuropathy”, are often mistakenly used as synonyms. Polyneuropathy is a specific term that refers to a relatively homogenous process that affects multiple peripheral nerves. Most of these tend to be distal symmetric polyneuropathies that first manifest in the distal porti...

Background/objectives: Heart rate recovery (HRR), a cardiac autonomic control marker, was shown to be related to body composition (BC), yet this was not tested in non-alcoholic fatty liver disease (NAFLD) patients. The aim of this study was to determine if, and to what extent, markers of BC and body fat (BF) distribution are related to cardiac aut...

Unlabelled: Early detection of impairment in vascular structure is an important clinical pursuit. However, it is unknown which measure of body composition best predicts vascular wall changes. We assess the differences in body composition among intima-media thickness (IMT) tertiles and determined which measures of body composition are associated wi...

Background: Cardiac heart failure patients may benefit from cardiac resynchronization, but around 30% do not respond. Several parameters have been studied to evaluate possible positive predictive factors. Aim: To evaluate if baseline 123 I-MIBG cardiac scintigraphy parameters can predict functional capacity modification after cardiac resynchronizat...

To analyze the body fat (BF) content and distribution modifications in coronary artery disease (CAD) patients in response to a 1-year combined aerobic and resistance exercise training (CET) program. We followed two groups of CAD male patients for 12 months. One group consisted of 17 subjects (57 ± 12 years) who engaged in a CET program (CET group)...

Background. Liver transplantation is nowadays the only effective answer to adjourn the outcome of functional limitations associated with familial amyloidotic polyneuropathy (FAP), a neurodegenerative disease characterized by sensory and motor polyneuropathies. Nevertheless, there is a detrimental impact associated with the after-surgery period on t...

Aim: Examine the influence of sedentary behaviour (SED), physical activity (PA), muscular strength (MS) and cardiorespiratory fitness (CRF) on subclinical atherosclerosis in 11-12 years-old children. Methods: We assessed intima-media thickness (IMT) of the common carotid artery in 366 children aged 11-12 years-old (191 girls). Measures included IMT...

Background: A better physical fitness may have survival advantages in adults. Aim: To analyze the relationship between cardiorespiratory fitness and cardiovascular risk factors among obese subjects aged 58 years and older. Material and methods: Cardiorespiratory fitness using the six-minute walk test, body composition by dual-energy x-ray abso...

Background: A better physical fitness may have survival advantages in adults. Aim: To analyze the relationship between cardiorespiratory fitness and cardiovascular risk factors among obese subjects aged 58 years and older. Material and Methods: Cardiorespiratory fitness using the six-minute walk test, body composition by dual-energy x-ray absorptio...

Background: A better physical fitness may have survival advantages in adults. Aim: To analyze the relationship between cardiorespiratory fitness and cardiovascular risk factors among obese subjects aged 58 years and older. Material and Methods: Cardiorespiratory fitness using the six-minute walk test, body composition by dual-energy x-ray absorptio...