A influência do treinamento físico em biomarcadores de inflamação e de função endotelial em indivíduos com hipertensão arterial pulmonar idiopática

Abstract

Background: Physical training has been recommended for idiopathic pulmonary arterial hypertension (IPAH) because of the beneficial effects on exercise tolerance, improvement of dyspnea and quality of life. In addition to the known benefits to the cardiopulmonary and musculoskeletal systems, it may also promote adaptations such as attenuation of the inflammatory process and endothelial dysfunction in addition to increased bioavailability of nitric oxide (NO), while the chronic effect of physical training on biomarkers of inflammation in humans with HAPI had not yet been investigated. Methods: Uncontrolled clinical trial. Fifteen individuals with IPAH (11 women; mean age: 42.8 ± 14.6 years) participated in the protocol that consisted of analysis of the serum levels of IL-6, IL-10, IL-13, IL- 23, VEGF, nitrite (NO2), nitrate (NO3) and nitrite / nitrate (NOx) and they underwent to cardiopulmonary exercise test (CPET) and 6-minute walk test (6MWT) before and after the combined training (8 weeks; 2x/week). Results: After the training, there was a decrease in IL-6, IL-13, IL-17, and an increase in IL-10, VEGF, NO2, NO3 and NOx. About the physical capacity data, there was an increase of the VO2 (14.8 ± 5.4 vs 18.9 ± 6.8) and the maximum workload (64 ± 40 vs 79 ± 41) of the CPET and increased distance walked of the 6MWT (455 ± 81 vs 499 ± 83). We observed that patients with higher IL-6 levels had lower values of VO2 (r = -0.71, p = 0.03) and maximal workload of CPET (r = -0.7, p = 0.004), and patients with higher IL-6 and NO2 levels had higher values of VO2 (r = 0.54, p = 0.03 \ r = 0.97, p = 0.0, respectively) and maximal workload of CPET (r = 0.62, p = 0.013, r = 0.82, p = 0.001 respectively). Conclusions: Combined physical training was able to increase functional capacity and seems to contribute positively to attenuation of the inflammatory process and endothelial dysfunction, demonstrating that physical training entails beneficial endothelial adaptations in individuals with IPAH. These results reinforce the importance of physical exercise as a non-drug treatment in individuals with IPAH.