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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">ijcs</journal-id>
      <journal-title-group>
        <journal-title>International Journal of Cardiovascular Sciences</journal-title>
        <abbrev-journal-title abbrev-type="publisher">Int. J. Cardiovasc. Sci.</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">2359-4802</issn>
      <issn pub-type="epub">2359-5647</issn>
      <publisher>
        <publisher-name>Sociedade Brasileira de Cardiologia</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v3">mpXSCC5Z4LDzxFqgms8B94k</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v2">S2359-56472017000100020</article-id>
      <article-id pub-id-type="doi">10.5935/2359-4802.20170019</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original Articles</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Effect Of Resistance Training On Myocardial Contractility In Vitro After Sleep Deprivation</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Giamp&#225;</surname>
            <given-names>Sara Quaglia de Campos</given-names>
          </name>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>M&#244;nico-Neto</surname>
            <given-names>Marcos</given-names>
          </name>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Souza</surname>
            <given-names>Helton de S&#225;</given-names>
          </name>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Mello</surname>
            <given-names>Marco T&#250;lio de</given-names>
          </name>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Tufik</surname>
            <given-names>Sergio</given-names>
          </name>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Portes</surname>
            <given-names>Leslie Andrews</given-names>
          </name>
          <xref ref-type="aff" rid="aff3">3</xref>
          <xref ref-type="aff" rid="aff4">4</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Serra</surname>
            <given-names>Andrey Jorge</given-names>
          </name>
          <xref ref-type="aff" rid="aff4">4</xref>
          <xref ref-type="aff" rid="aff5">5</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Tucci</surname>
            <given-names>Paulo Jos&#233; Ferreira</given-names>
          </name>
          <xref ref-type="aff" rid="aff4">4</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Antunes</surname>
            <given-names>Hanna Karen Moreira</given-names>
          </name>
          <xref ref-type="aff" rid="aff1">1</xref>
          <xref ref-type="aff" rid="aff6">6</xref>
          <xref ref-type="corresp" rid="c1"/>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <label>1</label>
        <institution content-type="orgname">Universidade Federal de S&#227;o Paulo</institution>
        <institution content-type="orgdiv1">Programa de P&#243;s-Gradua&#231;&#227;o Interdisciplinar em Ci&#234;ncias da Sa&#250;de</institution>
        <addr-line>
          <named-content content-type="city">S&#227;o Paulo</named-content>
          <named-content content-type="state">SP</named-content>
        </addr-line>
        <country country="BR">Brazil</country>
        <institution content-type="original">Programa de P&#243;s-Gradua&#231;&#227;o Interdisciplinar em Ci&#234;ncias da Sa&#250;de, Universidade Federal de S&#227;o Paulo, S&#227;o Paulo, SP &#8211; Brazil</institution>
        <institution content-type="normalized">Universidade Federal de S&#227;o Paulo</institution>
      </aff>
      <aff id="aff2">
        <label>2</label>
        <institution content-type="orgname">Universidade Federal de S&#227;o Paulo</institution>
        <institution content-type="orgdiv1">Departamento de Psicobiologia</institution>
        <addr-line>
          <named-content content-type="city">S&#227;o Paulo</named-content>
          <named-content content-type="state">SP</named-content>
        </addr-line>
        <country country="BR">Brazil</country>
        <institution content-type="original">Departamento de Psicobiologia, Universidade Federal de S&#227;o Paulo, S&#227;o Paulo, SP &#8211; Brazil</institution>
        <institution content-type="normalized">Universidade Federal de S&#227;o Paulo</institution>
      </aff>
      <aff id="aff3">
        <label>3</label>
        <institution content-type="orgname">Centro Universit&#225;rio Adventista de S&#227;o Paulo</institution>
        <institution content-type="orgdiv1">Programa de Mestrado em Promo&#231;&#227;o da Sa&#250;de</institution>
        <addr-line>
          <named-content content-type="city">S&#227;o Paulo</named-content>
          <named-content content-type="state">SP</named-content>
        </addr-line>
        <country country="BR">Brazil</country>
        <institution content-type="original">Programa de Mestrado em Promo&#231;&#227;o da Sa&#250;de, Centro Universit&#225;rio Adventista de S&#227;o Paulo, S&#227;o Paulo, SP &#8211; Brazil</institution>
        <institution content-type="normalized">Centro Universit&#225;rio Adventista de S&#227;o Paulo</institution>
      </aff>
      <aff id="aff4">
        <label>4</label>
        <institution content-type="orgname">Universidade Federal de S&#227;o Paulo</institution>
        <institution content-type="orgdiv1">Departamento de Medicina</institution>
        <addr-line>
          <named-content content-type="city">S&#227;o Paulo</named-content>
          <named-content content-type="state">SP</named-content>
        </addr-line>
        <country country="BR">Brazil</country>
        <institution content-type="original">Departamento de Medicina, Universidade Federal de S&#227;o Paulo, S&#227;o Paulo, SP &#8211; Brazil</institution>
        <institution content-type="normalized">Universidade Federal de S&#227;o Paulo</institution>
      </aff>
      <aff id="aff5">
        <label>5</label>
        <institution content-type="orgname">Universidade Nove de Julho</institution>
        <institution content-type="orgdiv1">Programa de P&#243;s-Gradua&#231;&#227;o em Ci&#234;ncias da Reabilita&#231;&#227;o</institution>
        <addr-line>
          <named-content content-type="city">S&#227;o Paulo</named-content>
          <named-content content-type="state">SP</named-content>
        </addr-line>
        <country country="BR">Brazil</country>
        <institution content-type="original">Programa de P&#243;s-Gradua&#231;&#227;o em Ci&#234;ncias da Reabilita&#231;&#227;o, Universidade Nove de Julho, S&#227;o Paulo, SP &#8211; Brazil</institution>
        <institution content-type="normalized">Universidade Nove de Julho</institution>
      </aff>
      <aff id="aff6">
        <label>6</label>
        <institution content-type="orgname">Universidade Federal de S&#227;o Paulo</institution>
        <institution content-type="orgdiv1">Departamento de Bioci&#234;ncias</institution>
        <addr-line>
          <named-content content-type="city">Santos</named-content>
          <named-content content-type="state">SP</named-content>
        </addr-line>
        <country country="BR">Brazil</country>
        <institution content-type="original">Departamento de Bioci&#234;ncias, Universidade Federal de S&#227;o Paulo, Santos, S&#227;o Paulo, SP - Brazil</institution>
        <institution content-type="normalized">Universidade Federal de S&#227;o Paulo</institution>
      </aff>
      <author-notes>
        <corresp id="c1"><bold>Mailing Address: Profa. Dra. Hanna Karen Moreira Antunes</bold>. Universidade Federal de S&#227;o Paulo - Campus Baixada Santista. Departamento de Bioci&#234;ncias Rua Silva Jardim, 136, T&#233;rreo. Postal Code: 11015-020, Vila Mathias, Santos, S&#227;o Paulo, Brazil. E-mail: <email>hanna.karen@unifesp.br</email>
				</corresp>
        <fn fn-type="con">
          <p>
            <bold>Author contributions</bold>
          </p>
          <p>Conception and design of the research: M&#244;nico-Neto M, Antunes HKM. Acquisition of data: Giamp&#225; SQC, M&#244;nico-Neto M, Souza HS, Portes LA, Serra AJ, Antunes HKM. Analysis and interpretation of the data: Giamp&#225; SQC, M&#244;nico-Neto M, Portes LA, Serra AJ, Tucci PJF, Antunes HKM. Statistical analysis: Giamp&#225; SQC. Obtaining financing: Mello MT, Tufik S, Tucci PJF, Antunes HKM. Writing of the manuscript: Giamp&#225; SQC, M&#244;nico-Neto M, Portes LA, Antunes HKM. Critical revision of the manuscript for intellectual content: M&#244;nico-Neto M, Souza HS, Mello MT, Tufik S, Portes LA, Serra AJ, Tucci PJF, Antunes HKM.</p>
        </fn>
        <fn fn-type="conflict">
          <p>
            <bold>Potential Conflict of Interest</bold>
          </p>
          <p>No potential conflict of interest relevant to this article was reported.</p>
        </fn>
      </author-notes>
      <pub-date pub-type="epub-ppub">
        <season>Jan-Feb</season>
        <year>2017</year>
      </pub-date>
      <volume>30</volume>
      <issue>1</issue>
      <fpage>20</fpage>
      <lpage>31</lpage>
      <history>
        <date date-type="received">
          <day>11</day>
          <month>01</month>
          <year>2016</year>
        </date>
        <date date-type="rev-recd">
          <day>04</day>
          <month>10</month>
          <year>2016</year>
        </date>
        <date date-type="accepted">
          <day>07</day>
          <month>12</month>
          <year>2016</year>
        </date>
      </history>
      <permissions>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/" xml:lang="en">
          <license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
        </license>
      </permissions>
      <abstract>
        <title>Abstract</title>
        <sec>
          <title>Background:</title>
          <p>Resistance training promotes cardiovascular health benefits that may affected by sleep deprivation.</p>
        </sec>
        <sec>
          <title>Objective:</title>
          <p>To evaluate the effect of high-intensity resistance training on myocardial contractility in rats subsequently subjected to paradoxical sleep deprivation.</p>
        </sec>
        <sec>
          <title>Methods:</title>
          <p>Forty male Wistar rats were distributed into control group (CTRL), resistance training (REST), 96-hour paradoxical sleep deprivation (PSD96) and resistance training followed by 96-hour paradoxical sleep deprivation (REST/PSD96). The animals underwent high-intensity resistance training for 8 weeks, 5x/week. Twenty-four hours after the last training session, the PSD96 and REST/PSD96 groups were submitted to paradoxical sleep deprivation, which was followed by the in vitro study of isolated papillary muscle contractile mechanics.</p>
        </sec>
        <sec>
          <title>Results:</title>
          <p>In comparison with the CTRL group, a lower papillary muscle length and increased cross sectional area were found in PSD96 and RETS/PSD96, which were associated with decreased temporal parameters of contraction force and relaxation. Decreased resting tension and slowing of relaxation time were found in the PSD96 group only. This effect was attenuated by previous resistance training.</p>
        </sec>
        <sec>
          <title>Conclusion:</title>
          <p>Resistance training partially prevented contractile changes induced by PSD, minimizing the slowing in relaxation time. Thus, high-intensity exercise seems to not fully protect the cardiac tissue from PSD-induced effects.</p>
        </sec>
      </abstract>
      <kwd-group xml:lang="en">
        <title>Keywords:</title>
        <kwd>Resistance Training</kwd>
        <kwd>Sleep Deprivation</kwd>
        <kwd>Cardiovascular Diseases</kwd>
        <kwd>Myocardial Contraction</kwd>
        <kwd>Rats</kwd>
        <kwd>Animal Experimentation</kwd>
      </kwd-group>
      <funding-group>
        <award-group>
          <funding-source>FAPESP</funding-source>
          <award-id>2013/00152-5</award-id>
        </award-group>
        <award-group>
          <funding-source>FAPESP</funding-source>
          <award-id>2011/15962-7</award-id>
        </award-group>
        <funding-statement>This study was funded by FAPESP (2013/00152-5, 2011/15962-7)</funding-statement>
      </funding-group>
    </article-meta>
  </front>
  <body>
    <sec sec-type="intro">
      <title>Introduction</title>
      <p>Sleep duration is one of the determining factors of cardiovascular health. Studies have demonstrated that a shorter time allocated to sleep is closely associated with increased prevalence and incidence of cardiovascular diseases, such as hypertension.<xref ref-type="bibr" rid="B1">1</xref> Among the possible mechanisms, an increased sympathetic activity and catabolism is evidenced by increased levels of catecholamine and cortisol/corticosterone<xref ref-type="bibr" rid="B2">2</xref><sup>-</sup><xref ref-type="bibr" rid="B6">6</xref> which leads to molecular and morphological changes<sup>7</sup>that may negatively affect cardiac tissue.</p>
      <p>In this scenario, resistance training stands out as a possible tool to minimize of even reverse the impact of sleep debt on cardiovascular health. In addition to reducing resting arterial pressure, left ventricular systolic pressure and heart rate,<xref ref-type="bibr" rid="B8">8</xref><sup>,</sup><xref ref-type="bibr" rid="B9">9</xref> resistance training can also increase papillary muscle isometric strength and its contractile performance.<xref ref-type="bibr" rid="B10">10</xref> Also, due to its effect on endocrine axes, resistance training can mitigate the catabolic effect of sleep deprivation.<xref ref-type="bibr" rid="B11">11</xref>
			</p>
      <p>Despite studies showing the impact of sleep debt on cardiovascular health,<xref ref-type="bibr" rid="B4">4</xref><sup>,</sup><xref ref-type="bibr" rid="B12">12</xref> little is known about its effects on cardiac contractile machinery and the role of resistance training as a preventive tool. Therefore, the aim of this study was to evaluate the effect of high-intensity resistance training on myocardial contractility in rats subsequently subjected to paradoxical sleep deprivation.</p>
    </sec>
    <sec sec-type="methods">
      <title>Methods</title>
      <p>Using a convenience sample, forty 3-month old male Wistar rats, weighing 300-350 g, obtained from the Center for the Development of Experimental Models in Medicine and Biology of Sao Paulo Federal University was used in the experiment. The animals were kept in polypropylene boxes in a temperature-controlled room (22 &#177; 1&#186;C), light/dark cycle (12:12h), and given water and food <italic>ad libitum</italic>.</p>
      <p>All procedures were performed according to the Guide for the Care and Use of Laboratory Animals - National Research Council, NIH Publication N&#186; 85-23 (revised 2011). The study protocol was approved by the Ethics Committee (#0764/10).</p>
      <p>The animals were distributed into four groups: control (CTRL, n = 10), resistance training (REST, n = 10), paradoxical sleep deprivation (PSD) for 96 hours (PSD96, n = 10), and resistance training followed by 96-hour PSD (REST/PSD96, n = 10). During the experiment, animals of the CTRL group were kept in the boxes and manipulated exclusively for laboratory routine practices.</p>
      <sec>
        <title>Resistance training</title>
        <p>Resistance training was performed for 8 weeks as described elsewhere.<xref ref-type="bibr" rid="B13">13</xref> A ladder (110cm high, 18 cm wide, 2 cm space between steps) was placed at an 80&#186; inclination, and a resting chamber (20x20x20 cm) was placed on the top of the ladder. The animals climbed the ladder carrying weights attached to the base of the tail, and the weights were gradually increased with exercise progression.</p>
        <p>Familiarization of the animals with the exercise apparatus was performed during three consecutive days by nine repetitions per day. After this period, the maximum load (ML) test was performed, which was repeated every week.</p>
        <p>Training sessions consisted of 4-8 sets of climbing, using progressive loads, interspaced with 60-second intervals. The animals had to perform 8 - 12 repetitions to go from the base to the top of the ladder. The load was progressively increased from 50% of maximum load in the first series, through 75%, 90% until 100% of maximum load in the fourth series. After that, resistance was increased in increments of 30 g per attempt until failure.<xref ref-type="bibr" rid="B13">13</xref> Training was performed in the afternoon, 5 times a week, from Monday to Friday. Monday session was replaced by the maximum load test. In order to prevent overtraining caused by the high intensity of exercise, a prophylactic rest was adopted at weeks 6, 7 and 8; in these weeks, the animals trained on Monday, Tuesday, Thursday and Friday. Forty-eight hours after the last training session, the CTRL and REST animals were euthanized and the PSD96 and REST/PSD96 groups underwent the PSD protocol.</p>
      </sec>
      <sec>
        <title>Paradoxical sleep deprivation</title>
        <p>PSD was conducted for 96 hours by the modified multiple platform method,<xref ref-type="bibr" rid="B14">14</xref> which totally promotes the total suppression of paradoxical sleep and the decrease in slow wave sleep by 37%.<xref ref-type="bibr" rid="B15">15</xref> Five socially stable animals were placed inside a stainless steel tank (123 cm length x 44 cm height x 44 cm width) on round platforms 10 cm distant from each other. The tank was filled with room temperature water until 1cm below the platform surfaces, so that the animals could walk from one platform to another one. When paradoxical sleep was achieved, the animals woke up as they touched the water due to muscle atonia accompanying this sleep stage. During the protocol, the room was maintained at optimal conditions,i.e., 22&#177;1&#186;C, light-dark cycle (12h) and water and chow <italic>ad libitum</italic>. The CTRL group was kept in the same room to experience the same conditions.</p>
      </sec>
      <sec>
        <title>Isolated cardiac muscle mechanics</title>
        <p>Immediately after the PSD protocol for PSD96 and REST/PSD96 groups, or 48 hours after the last resistance training sessions for the REST group, or after a corresponding period for the CTRL group, <italic>in vitro</italic> preparations were made of papillary muscle isolated from the left ventricle.</p>
        <p>Rats were anesthetized with urethane (Urethanechloride, 0,3 ml/100 g, <italic>i.p.</italic>, Sigma-Aldrich, St. Louis, Mo, USA), and the heart was rapidly removed and placed in Krebs-Henseleit solution previously bubbled with oxygen 100% at 30&#186;C. Papillary muscle was dissected from the left ventricle and its tendinous and parietal ends were attached to a strength transducer by stainless steel rings. The papillary muscle was then suspended vertically in a glass chamber containing Krebs-Henseleit (mM) solution (132 NaCl, 4.69 KCl, 1.5 CaCl, 1.16 MgSO<sub>4</sub>, 1.18 KH<sub>2</sub>PO<sub>4</sub>, 5.50 glucose and 20 HEPES), buffered at pH 7.4.<xref ref-type="bibr" rid="B16">16</xref> The ring attached to the lower end of muscle was connected to the hook fixed to the glass chamber, and the upper ring was connected to an isometric force transducer (model FT03E, Grass Instrument, Quincy, MA) via a stainless steel wire. The force transducer was attached to a micromanipulator for muscle length adjustments. The papillary muscle was electrically stimulated by two parallel platinum electrodes using square wave pulses of 5ms of duration, frequency of 0.2Hz,<xref ref-type="bibr" rid="B16">16</xref><sup>,</sup><xref ref-type="bibr" rid="B17">17</xref> and voltage approximately 20% higher than the minimum required to induce a maximal muscle response. After 60 minutes of stabilization of the preparation in isotonic condition and low preload (0.4g), the muscle was loaded to contract isometrically and then stretched until the peak of the length-tension curve was reached (L<sub>max</sub>: diastolic length of the muscle associated with maximal isometric tension). The tests were performed in L<sub>max</sub>, and isometric tension was assessed by force normalized for muscle fiber cross-sectional area (CSA) (g. mm<sup>-2</sup>). Muscle CSA was calculated from molecular weight and length of the fibers, based on the assumption that the muscle was a uniform cylinder of specific gravity 1.04.</p>
        <p>The following outcome measures were assessed for contraction function: developed tension (DT/ g.mm<sup>-2</sup>), resting tension (RT g.mm<sup>-2</sup>), temporal variation of contractile force (+dT/dt; g.mm<sup>-2</sup>.s<sup>-1</sup>), temporal variation of relaxation force (-dT/dt; g.mm<sup>-2</sup>.s<sup>-1</sup>), time to DT peak (TTP; ms) and time to a 50% decrease in maximum DT (RT50% ms). Mechanical behavior of papillary muscles was assessed (1) at baseline; (2) for length-tension relationship (variation of muscle length as a function of 92%-100% L<sub>max</sub>); (3) for post-rest potentiation (after 10, 20, 30, 60 and 120 seconds of rest); and (4) for contractile response to calcium (Ca<sup>+2</sup>) (increase in Ca<sup>+2</sup> concentration from 1.5mM to 2.5mM in the bathing solution).</p>
      </sec>
      <sec>
        <title>Statistical analysis</title>
        <p>Statistical analysis was performed using the Statistica&#174; software (Stat Soft, Inc, version 12.0). Measures of central tendency were calculated for descriptive analysis of data. Data normality was examined by the Shapiro Wilk test. Data with parametric distribution were analyzed by one-way or two-way ANOVA with Duncan post-hoc test, and after Z-score transformation, non-parametric data were analyzed by ANOVA. In the analyses of length-tension relationship and post-rest potentiation, linear regression was used for comparisons between slopes and between areas under the curves, respectively. Values in each group (slope and area under the curve) were analyzed by ANOVA. Statistical significance was set at &#945; = 0.05.</p>
      </sec>
    </sec>
    <sec sec-type="results">
      <title>Results</title>
      <sec>
        <title>Biometric parameters of papillary muscle</title>
        <p>No difference in papillary muscle mass was found between the groups (F<sub>(3,23)</sub> = 0.16005, p &gt; 0.05). There was a significant decrease in L<sub>max</sub> in the PSD96 (p = 0.03) and REST/PSD96 (p = 0.002) groups as compared with CTRL, and L<sub>max</sub> was significantly different between REST/PSD96 and PSD96 (p = 0.005), (F<sub>(3,21)</sub> = 6.0487, p &lt; 0.01). In addition, CSA significantly increased in the REST (p = 0.02), PSD96 (p = 0.02) and REST/PSD96 (p = 0.01) groups compared with CTRL (F<sub>(3,19)</sub> = 3.1706, p &lt; 0.05) (<xref ref-type="table" rid="t1">Table 1</xref>).</p>
        <table-wrap id="t1">
          <label>Table 1</label>
          <caption>
            <title>Effect of resistance training and paradoxical sleep deprivation on biometrical parameters of papillary muscle</title>
          </caption>
          <table frame="hsides" rules="groups">
            <colgroup>
              <col width="20%"/>
              <col width="20%"/>
              <col width="20%"/>
              <col width="20%"/>
              <col width="20%"/>
            </colgroup>
            <thead>
              <tr>
                <th align="left" style="background-color:#B2B2B2">Variables</th>
                <th align="center" style="background-color:#B2B2B2">CTRL</th>
                <th align="center" style="background-color:#B2B2B2">REST</th>
                <th align="center" style="background-color:#B2B2B2">PSD96</th>
                <th align="center" style="background-color:#B2B2B2">REST/PSD96</th>
              </tr>
            </thead>
            <tbody>
              <tr>
                <td align="left">Papillary muscle mass (mg)</td>
                <td align="center">5.96 &#177; 2.02</td>
                <td align="center">5.98 &#177; 1.43</td>
                <td align="center">6.35 &#177; 0.89</td>
                <td align="center">5.77 &#177; 1.64</td>
              </tr>
              <tr>
                <td align="left">L<sub>max</sub> (mm)</td>
                <td align="center">5.86 &#177; 0.84</td>
                <td align="center">5.71 &#177; 0.73</td>
                <td align="center">4.91 &#177; 0.64<xref ref-type="table-fn" rid="TFN2">*</xref>
								</td>
                <td align="center">4.40 &#177; 0.60<xref ref-type="table-fn" rid="TFN2">*</xref><sup>.<xref ref-type="table-fn" rid="TFN3">&#8224;</xref></sup></td>
              </tr>
              <tr>
                <td align="left">CSA (mm<sup>2</sup>)</td>
                <td align="center">1.00 &#177; 0.27</td>
                <td align="center">1.30 &#177; 0.19<xref ref-type="table-fn" rid="TFN2">*</xref>
								</td>
                <td align="center">1.29 &#177; 0.12<xref ref-type="table-fn" rid="TFN2">*</xref>
								</td>
                <td align="center">1.35 &#177; 0.21<xref ref-type="table-fn" rid="TFN2">*</xref>
								</td>
              </tr>
            </tbody>
          </table>
          <table-wrap-foot>
            <fn id="TFN1">
              <p>Data in mean &#177; standard deviation; Lmax - maximum papillary muscle length; CTRL: control group; REST: resistance training group; PSD96: paradoxical sleep deprivation for 96 hours ; REST/PSD96: resistance training followed by 96-hour paradoxical sleep deprivation; CSA: cross-sectional area;</p>
            </fn>
            <fn id="TFN2">
              <label>*</label>
              <p>different from CTRL;</p>
            </fn>
            <fn id="TFN3">
              <label>&#8224;</label>
              <p>different from REST group</p>
            </fn>
          </table-wrap-foot>
        </table-wrap>
      </sec>
      <sec>
        <title>Contractile mechanics of papillary muscle under isometric contraction (baseline)</title>
        <p>There was a significant decrease in DT in the REST/ PSD96 group as compared with the CTRL group (F<sub>(3,23)</sub> = 33049, p = 0.009). RT was lower in PSD96 than in REST (F<sub>(3,22)</sub> = 3.6623, p=0.01). A significant decrease in +dT/dt was observed in the PSD96 (0.006) and REST/ PSD96 groups as compared with CTRL (F<sub>(3,20)</sub> = 8.0313, p &lt; 0.05), whereas -dT/dt significantly decreased in PSD96 (F<sub>(3,26)</sub> = 2.7244, p = 0.01) (<xref ref-type="fig" rid="f1">Figure 1</xref>).</p>
        <p>
          <fig id="f1">
            <label>Figure 1</label>
            <caption>
              <title>Effect of resistance training and paradoxical sleep deprivation on contractile mechanics of the papillary muscle under isometric contraction. Oneway ANOVA with Duncan post-hoc test. Data expressed in mean &#177; standard error, with significance set at p = 0.05. DT: maximum developed tension; RT: isometric resting tension; +dT/dt: temporal variation of contraction force; -dT/dt: temporal variation of relaxation force; TTP: time to developed tension peak; RT50%: time required for maximum developed tension to decrease by 50%; CTRL: control group; REST: resistance training group; PSD96: paradoxical sleep deprivation for 96 hours; REST/PSD96: resistance training followed by 96-hour paradoxical sleep deprivation. *significantly different from CTRL; &#8224; different from REST group; &#8225; different from all groups</title>
            </caption>
            <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf01.jpg"/></fig>
        </p>
        <p>Similar behavior of time parameters of cardiac contraction was observed between the groups (F<sub>(3,23)</sub> = 0.00, p &gt; 0.05). However, with respect to RT50%, a prolongation of muscle relaxation was observed in PSD96 as compared with the other groups (F<sub>(3,26)</sub> = 3.9344, p &lt; 0.05).</p>
      </sec>
      <sec>
        <title>Contractile mechanics of papillary muscle in length-tension relationship</title>
        <p>Slopes of DT were significantly lower in the REST (p = 0.02), PSD96 (p = 0.03) and REST/PSD96 (p = 0.0001) groups than in CTRL group, and in the REST/PSD96 when compared with the REST (0.03) and PSD96 (p = 0.02) groups (F<sub>(3, 24)</sub> = 7.0880, p &lt; 0.01). In addition, a reduction in RT was observed in PSD96 as compared with REST (F<sub>(3,23)</sub> = 2.5483, p &lt; 0.05) (<xref ref-type="fig" rid="f2">Figure 2</xref>).</p>
        <p>
          <fig id="f2">
            <label>Figure 2</label>
            <caption>
              <title>Effect of resistance training and paradoxical sleep deprivation on papillary muscle contractile parameters in terms of length-tension relationship. One&#8209;way ANOVA with Duncan post-hoc test. Data expressed in mean &#177; standard error, with significance set at p = 0.05. DT: maximum developed tension; RT: isometric resting tension; +dT/dt: temporal variation of contraction force; -dT/dt: temporal variation of relaxation force; CTRL: control group; REST: resistance training group; PSD96: paradoxical sleep deprivation for 96 hours; REST/PSD96: resistance training followed by 96-hour paradoxical sleep deprivation. *significantly different from CTRL; &#8224;different from REST group; &#8225; different from all groups</title>
            </caption>
            <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf02.jpg"/></fig>
        </p>
        <p>Slopes of +dT/dt in PSD96 and REST/PSD96 were significantly lower than in CTRL (p &lt; 0.01) and REST (p &lt; 0.05), and significantly higher in PSD96 than in REST/PSD96 (p = 0.01), (F<sub>(3,21)</sub> = 15.741, p &lt; 0.01). No difference in -dT/dt slopes was found between the groups (F<sub>(3,20)</sub> = 2.4210, p &gt; 0.05).</p>
        <p>Also, TTP was not different between the groups. The PSD96 group had higher RT50% for all stretching percentages tested as compared with the other groups (F<sub>(3,25)</sub> = 5.1010, p &lt; 0.05) (<xref ref-type="fig" rid="f3">Figure 3</xref>).</p>
        <p>
          <fig id="f3">
            <label>Figure 3</label>
            <caption>
              <title>Effect of resistance training and paradoxical sleep deprivation on papillary muscle temporal parameters in terms of length-tension relationship. Two&#8209;way ANOVA with Duncan post-hoc test. Data expressed in mean &#177; standard error, with significance set at p = 0.05. TTP: time to developed tension peak; RT50%: time required for maximum developed tension to decrease by 50%; CTRL: control group; REST: resistance training group; PSD96: paradoxical sleep deprivation for 96 hours; REST/PSD96: resistance training followed by 96-hour paradoxical sleep deprivation; Lmax: maximum papillary muscle length. &#8225; different from all groups in each stretching percentage tested</title>
            </caption>
            <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf03.jpg"/></fig>
        </p>
      </sec>
      <sec>
        <title>Contractile mechanics of papillary muscle in post-rest potentiation</title>
        <p>There was a decrease in DT in REST/PSD96 compared with CTRL (p = 0.01), (F<sub>(3,22)</sub> = 2.2722, p &lt; 0.05). RT decreased in PSD96 compared with CTRL (p=0.02) and REST (p = 0.03), (F<sub>(3,21)</sub> = 2.9579, p &lt; 0.05), similarly to -dT/dt (F<sub>(3,23)</sub> = 4.3408, p &lt; 0.05). In addition, +dT/dt was lower in PSD96 (p = 0.02) and REST/PSD96 (p = 0.002) than in CTRL, and significantly different between RST/PSD96 and REST (p = 0.01) (F<sub>(3,23)</sub> = 4.6147, p &lt; 0.05) (<xref ref-type="fig" rid="f4">Figure 4</xref>).</p>
        <p>
          <fig id="f4">
            <label>Figure 4</label>
            <caption>
              <title>Effect of resistance training and paradoxical sleep deprivation on papillary muscle contractile parameters in terms of post-rest potentiation. One&#8209;way ANOVA with Duncan post-hoc test. Data expressed in mean &#177; standard error, with significance set at p = 0.05. DT: maximum developed tension; RT: isometric resting tension; +dT/dt: temporal variation of contraction force; -dT/dt: temporal variation of relaxation force; TTP: time to developed tension peak; CTRL: control group; REST: resistance training group; PSD96: paradoxical sleep deprivation for 96 hours; REST/PSD96: resistance training followed by 96-hour paradoxical sleep deprivation; *different from CTRL; &#8224; different from the REST group</title>
            </caption>
            <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf04.jpg"/></fig>
        </p>
        <p>No difference in time parameters was observed between the groups (F<sub>(12,96)</sub> = 0.7959, p &lt; 0,05), except for RT50% at 60s in comparison with other rest times - 10 (p = 0.00004), 20 (p = 0.001), 30 (p = 0.004) and 120 seconds (p = 0.0006), (F<sub>(4,88)</sub> = 3.8313, p &lt; 0.05) in REST/PSD96 (<xref ref-type="fig" rid="f5">Figure 5</xref>).</p>
        <p>
          <fig id="f5">
            <label>Figure 5</label>
            <caption>
              <title>Effect of resistance training and paradoxical sleep deprivation on papillary muscle temporal parameters in terms of post-rest potentiation. Two&#8209;way ANOVA with Duncan post-hoc test. Data expressed in mean &#177; standard error, with significance set at p = 0.05. TTP: time to developed tension peak; RT50%: time required for maximum developed tension to decrease by 50%; CTRL: control group; REST: resistance training group; PSD96: paradoxical sleep deprivation for 96 hours; REST/PSD96: resistance training followed by 96-hour paradoxical sleep deprivation; *different from CTRL; &#8224; different from the REST group; &#8225;different from all other rest periods within the same group</title>
            </caption>
            <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf05.jpg"/></fig>
        </p>
      </sec>
      <sec>
        <title>Contractile mechanics of papillary muscle in response to extracellular calcium</title>
        <p>There was an increase in DT in the REST group (F<sub>(1,18)</sub> = 5.1523, p = 0.02), and hence greater response to calcium-induced inotropy. RT was lower at Ca<sup>2+</sup> 2,5 mM as compared with Ca<sup>2+</sup> 1.5 mM levels in CTRL (p = 0.001) and REST/PSD96 (p = 0.04) (F<sub>(1,18)</sub> = 14,0730, p &lt; 0,01), and lower at both Ca<sup>2+</sup> 1.5 mM (p=0.009) and 2.5 mM (p = 0.02) in the PSD96 group than in CTRL group (F<sub>(3,18)</sub> = 3.2331, p &lt; 0.05) (<xref ref-type="fig" rid="f6">Figure 6</xref>).</p>
        <p>
          <fig id="f6">
            <label>Figure 6</label>
            <caption>
              <title>Effect of resistance training and paradoxical sleep deprivation on papillary muscle contractile mechanics in response to extracellular Ca<sup>2+</sup>. Two&#8209;way ANOVA with Duncan post-hoc test. Data expressed in mean &#177; standard error, with significance set at p = 0.05. DT: maximum isometric developed tension; RT: isometric resting tension; +dT/dt: temporal variation of contraction force; -dT/dt: temporal variation of relaxation force; TTP: time to developed tension peak; RT50%: time required for maximum developed tension to decrease by 50%; CTRL: control group; REST: resistance training group; PSD96: paradoxical sleep deprivation for 96 hours; REST/PSD96: resistance training followed by 96-hour paradoxical sleep deprivation; *different from CTRL at same Ca<sup>2+</sup> concentration; &#8224; different from the REST group at same Ca<sup>2+</sup> concentration; &#8225;different from Ca<sup>2+</sup> at 1.5 mM within the same group; &#167; different from all groups at same Ca<sup>2+</sup> concentration</title>
            </caption>
            <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf06.jpg"/></fig>
        </p>
        <p>Regarding +dT/dt, this variable was higher at Ca<sup>2+</sup> 2.5 mM than Ca<sup>2+</sup> 1.5 mM (p = 0.03) in the REST/PSD96 group, however, at both concentrations (Ca<sup>2+</sup>1.5 mM, p = 0.01 and Ca<sup>2+</sup> 2.5mM, p=0.03), +dT/dt was lower in this group as compared with CTRL (F<sub>(1,18)</sub> = 9.354531, p &lt; 0.01). Similarly, reduced-dT/dt was observed at Ca<sup>2+</sup>1.5 mM and Ca<sup>2+</sup> 2.5 mM in the PSD96 group as compared with CTRL (p = 0.03) and REST (p = 0.02), (F<sub>(3,20)</sub> = 3.6516, p &lt; 0.05).</p>
        <p>TTP increased at Ca<sup>2+</sup> 2.5mM in PSD96 as compared with CTRL (p = 0.003), REST (p = 0.02) and REST/PSD96 (p = 0.01) (F<sub>(3,19)</sub> = 5.538, p &lt; 0.05). No difference in RT50% was found between the groups (F<sub>(3,19)</sub> = 0.69, p &lt; 0.05).</p>
      </sec>
    </sec>
    <sec sec-type="discussion">
      <title>Discussion</title>
      <p>Our results demonstrated the deleterious effect of PSD on myocardial contractility and the role of resistance training on partially attenuating such effect. Resistance training and PSD cause myocardial hypertrophy associated with reduced L<sub>max</sub>. This may be due to an increase in cardiac collagen content<xref ref-type="bibr" rid="B18">18</xref> and reduced papillary muscle elongation resulting from an increase in corticosterone levels induced by PSD.<xref ref-type="bibr" rid="B5">5</xref><sup>,</sup><xref ref-type="bibr" rid="B19">19</xref>
			</p>
      <p>Baseline measures indicated depression of myocardial function in the groups subjected to PSD. Interestingly, these data are similar to those reported in previously infarcted<xref ref-type="bibr" rid="B20">20</xref> or nephrectomized rats,<xref ref-type="bibr" rid="B21">21</xref> strongly suggesting a marked effect of PSD on contractile and temporal parameters of papillary muscle in just 4 days.</p>
      <p>Temporal parameter of cardiac relaxation was increased in PSD96, possibly due to cardiac muscle myosin composition<xref ref-type="bibr" rid="B22">22</xref> and calcium transient duration,<xref ref-type="bibr" rid="B23">23</xref> both influenced by calcium signaling dysfunction.<xref ref-type="bibr" rid="B24">24</xref> On the other hand, resistance training prevented the slowing down of relaxation time of papillary muscle, although it was not effective in preventing DT decrease.</p>
      <p>The decrease in DT in the REST/PSD96 group may be explained by the high intensity of the resistance training. Nevertheless, although it promotes beneficial changes, high-intensity resistance training combined with PSD resulted in papillary muscle contractile function depression. No difference in DT between CTRL and REST was observed, suggesting preservation of contractile function of papillary muscle. In contrast, resistance training at pre-determined loads (60-70% of 1RM) has been shown to improve myosin ATPase activity and papillary muscle contractility.<xref ref-type="bibr" rid="B8">8</xref> Regarding aerobic training, previous studies have shown higher DT in trained animals than in controls.<xref ref-type="bibr" rid="B16">16</xref><sup>,</sup><xref ref-type="bibr" rid="B25">25</xref>
			</p>
      <p>Analysis of contractile response of papillary muscles to stretching allowed the assessment of the Frank-Starling relationship. All groups, except the CTRL group, showed a depressed contractile response, suggesting a failure or exhaustion of the Frank-Starling mechanism in the myocardium. When +dT/dt was evaluated, a failure in this mechanism was detected in the PSD96 group only. Contractile response to stretching is generally related to the increase in the number of actin-related myosin heads associated with actin. Elongation of a muscle promotes the sliding and linkage between thick and thin filaments, and consequent binding of Ca<sup>2+</sup>to troponin. Therefore, it is plausible to say that the distance between the filaments is a determining factor for cardiac muscle physiological behavior.<xref ref-type="bibr" rid="B26">26</xref><sup>,</sup><xref ref-type="bibr" rid="B27">27</xref>
			</p>
      <p>The decrease in RT corroborates the lower contractile response in the PSD96 group in relation to the Frank-Starling mechanism, indicating stiffness and reduced contractility and relaxation capacity, as observed in infarcted animals.<xref ref-type="bibr" rid="B20">20</xref> The lower the RT, the higher the muscle distension capacity, which is associated with increased collagen type III: collagen type I ratio.<xref ref-type="bibr" rid="B28">28</xref> Another hypothesis is an impaired muscle oxygenation.<xref ref-type="bibr" rid="B29">29</xref><sup>-</sup><xref ref-type="bibr" rid="B31">31</xref> Besides, similarly to baseline analysis, there was an increase in the relaxation time in the PSD96.</p>
      <p>In our study, there was no increase in contractile parameters in the REST group. However, data on the literature have shown that regular exercise has an impact on length-tension relationship of left ventricular cardiomyocytes, thereby increasing contraction force.<xref ref-type="bibr" rid="B29">29</xref><sup>-</sup><xref ref-type="bibr" rid="B31">31</xref> On the other hand, length-DT relationship was decreased in animals subjected to aerobic exercise, suggesting no effect of this type of exercise on attenuating this parameter.<xref ref-type="bibr" rid="B25">25</xref>
			</p>
      <p>Post-rest potentiation of electrical stimulations allows to indirectly determine the balance between the processes of Ca<sup>+2</sup> reuptake, storage and release, controlled by sarcoplasmic reticulum, and intracellular Ca<sup>+2</sup> release through the sarcolemma. A pause in electrical stimulation potentiates contraction, due to Ca<sup>+2</sup> accumulation in sarcoplasmic reticulum during such pause, increased Ca<sup>2+</sup>released by sarcoplasmic reticulum, and reduced Na<sup>+</sup>/Ca<sup>+2</sup> exchange activity in removing Ca<sup>+2</sup> from the cells.<xref ref-type="bibr" rid="B32">32</xref><sup>,</sup><xref ref-type="bibr" rid="B33">33</xref> In infarcted rats, post-rest potentiation was decreased in papillary muscle.<xref ref-type="bibr" rid="B20">20</xref><sup>,</sup><xref ref-type="bibr" rid="B25">25</xref> These processes could be evidenced in our study when temporal variations of contraction (+dT/dt) and relaxation force (-dT/dt) were assessed in the PSD96 group, suggesting a possible kinetic dysfunction of Ca<sup>2+</sup> associated with increased Na<sup>+</sup>/Ca<sup>+2</sup> exchanger activity.</p>
      <p>Therefore, our findings suggest that PSD can affect cardiac function, and such effect is not prevented by high-intensity resistance training, since a +dT/dt depression was found in animals subjected to the exercise. It is possible that protocols of moderate- or low-intensity resistance training or even aerobic exercise would be more effective in improving contractile function of papillary muscle. Experimental data have shown an increased post-rest potentiation in infarcted rats submitted to aerobic training, which highlights the preventive role of this type of exercise.</p>
      <p>Finally, we evaluated the contractile response of papillary muscle to increasing concentrations of Ca<sup>2+</sup> in bathing solution. This approach aims to evaluate whether there is an improvement in contraction-relaxation behavior in response to increasing availability of Ca<sup>2+</sup>.<xref ref-type="bibr" rid="B34">34</xref> Our results have shown that, in response to increasing Ca<sup>2+</sup> concentrations, DT increased in the REST group and both RT and -dT/dt decreased in PSD96. The variable +dT/dt decreased in the REST/PSD96 group and temporal variation of cardiac contraction increased in the PSD96 group, suggesting an increase in the time to systole.</p>
      <p>Altogether, these results suggest that both contractile and temporal response was negatively affected by PSD. In response to Ca<sup>2+</sup>, regardless of the ion concentration, there was an impaired response of papillary muscle of animals submitted to PSD. These findings are in accordance with those reported in infarcted animals.<xref ref-type="bibr" rid="B35">35</xref>
			</p>
    </sec>
    <sec sec-type="conclusions">
      <title>Conclusion</title>
      <p>High-intensity resistance training was effective in improving temporal but not contractile parameters. Less intense exercise protocols may be more effective for myocardial protection, represented by the papillary muscle.</p>
      <sec>
        <title>Study limitations</title>
        <p>The present study aimed to investigate the effects of sleep deprivation on myocardial contractility in the absence of associated comorbidities, which may represent confounding factors in clinical trials. For this reason, caution is needed in extrapolating these results to the clinical setting.</p>
      </sec>
    </sec>
  </body>
  <back>
    <fn-group>
      <fn fn-type="financial-disclosure">
        <p>
          <bold>Sources of Funding</bold>
        </p>
        <p>This study was funded by FAPESP (2013/00152-5, 2011/15962-7).</p>
      </fn>
      <fn fn-type="other">
        <p>
          <bold>Study Association</bold>
        </p>
        <p>This article is part of the thesis of master submitted by Sara Quaglia de Campos Giamp&#225;, from Universidade Federal de S&#227;o Paulo.</p>
      </fn>
    </fn-group>
    <ack>
      <title>Acknowledgements</title>
      <p>The authors acknowledgement CAPES-Reuni, FAPESP (# 2013 / 00152-5; # 2011 / 15962-7) and the Laboratory of Cardiovascular Physiology of UNIFESP.</p>
    </ack>
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  </back>
  <sub-article article-type="translation" id="s1" xml:lang="pt">
    <front-stub>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Artigos Originais</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Efeito do Treinamento Resistido na Contratilidade Mioc&#225;rdica <italic>In Vitro</italic> ap&#243;s a Priva&#231;&#227;o de Sono</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Giamp&#225;</surname>
            <given-names>Sara Quaglia de Campos</given-names>
          </name>
          <xref ref-type="aff" rid="aff7">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>M&#244;nico-Neto</surname>
            <given-names>Marcos</given-names>
          </name>
          <xref ref-type="aff" rid="aff8">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Souza</surname>
            <given-names>Helton de S&#225;</given-names>
          </name>
          <xref ref-type="aff" rid="aff8">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Mello</surname>
            <given-names>Marco T&#250;lio de</given-names>
          </name>
          <xref ref-type="aff" rid="aff8">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Tufik</surname>
            <given-names>Sergio</given-names>
          </name>
          <xref ref-type="aff" rid="aff8">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Portes</surname>
            <given-names>Leslie Andrews</given-names>
          </name>
          <xref ref-type="aff" rid="aff9">3</xref>
          <xref ref-type="aff" rid="aff10">4</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Serra</surname>
            <given-names>Andrey Jorge</given-names>
          </name>
          <xref ref-type="aff" rid="aff10">4</xref>
          <xref ref-type="aff" rid="aff11">5</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Tucci</surname>
            <given-names>Paulo Jos&#233; Ferreira</given-names>
          </name>
          <xref ref-type="aff" rid="aff10">4</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Antunes</surname>
            <given-names>Hanna Karen Moreira</given-names>
          </name>
          <xref ref-type="aff" rid="aff7">1</xref>
          <xref ref-type="aff" rid="aff12">6</xref>
          <xref ref-type="corresp" rid="c2"/>
        </contrib>
      </contrib-group>
      <aff id="aff7">
        <label>1</label>
        <institution content-type="original">Programa de P&#243;s-Gradua&#231;&#227;o Interdisciplinar em Ci&#234;ncias da Sa&#250;de, Universidade Federal de S&#227;o Paulo, S&#227;o Paulo, SP &#8211; Brazil</institution>
      </aff>
      <aff id="aff8">
        <label>2</label>
        <institution content-type="original">Departamento de Psicobiologia, Universidade Federal de S&#227;o Paulo, S&#227;o Paulo, SP &#8211; Brazil</institution>
      </aff>
      <aff id="aff9">
        <label>3</label>
        <institution content-type="original">Programa de Mestrado em Promo&#231;&#227;o da Sa&#250;de, Centro Universit&#225;rio Adventista de S&#227;o Paulo, S&#227;o Paulo, SP &#8211; Brazil</institution>
      </aff>
      <aff id="aff10">
        <label>4</label>
        <institution content-type="original">Departamento de Medicina, Universidade Federal de S&#227;o Paulo, S&#227;o Paulo, SP &#8211; Brazil</institution>
      </aff>
      <aff id="aff11">
        <label>5</label>
        <institution content-type="original">Programa de P&#243;s-Gradua&#231;&#227;o em Ci&#234;ncias da Reabilita&#231;&#227;o, Universidade Nove de Julho, S&#227;o Paulo, SP &#8211; Brazil</institution>
      </aff>
      <aff id="aff12">
        <label>6</label>
        <institution content-type="original">Departamento de Bioci&#234;ncias, Universidade Federal de S&#227;o Paulo, Santos, S&#227;o Paulo, SP - Brasil</institution>
      </aff>
      <author-notes>
        <corresp id="c2"><bold>Correspond&#234;ncia: Profa. Dra. Hanna Karen Moreira Antunes</bold>. Universidade Federal de S&#227;o Paulo - Campus Baixada Santista. Departamento de Bioci&#234;ncias Rua Silva Jardim, 136, T&#233;rreo. CEP: 11015-020, Vila Mathias, Santos, S&#227;o Paulo - Brasil. E-mail: <email>hanna.karen@unifesp.br</email>
				</corresp>
        <fn fn-type="con">
          <p>
            <bold>Contribui&#231;&#227;o dos autores</bold>
          </p>
          <p>Concep&#231;&#227;o e desenho da pesquisa: M&#244;nico-Neto M, Antunes HKM. Obten&#231;&#227;o de dados: Giamp&#225; SQC, M&#244;nico-Neto M, Souza HS, Portes LA, Serra AJ, Antunes HKM. An&#225;lise e interpreta&#231;&#227;o dos dados: Giamp&#225; SQC, M&#244;nico-Neto M, Portes LA, Serra AJ, Tucci PJF, Antunes HKM. An&#225;lise estat&#237;stica: Giamp&#225; SQC. Obten&#231;&#227;o de financiamento: Mello MT, Tufik S, Tucci PJF, Antunes HKM. Reda&#231;&#227;o do manuscrito: Giamp&#225; SQC, M&#244;nico-Neto M, Portes LA, Antunes HKM. Revis&#227;o cr&#237;tica do manuscrito quanto ao conte&#250;do intelectual importante: M&#244;nico-Neto M, Souza HS, Mello MT, Tufik S, Portes LA, Serra AJ, Tucci PJF, Antunes HKM.</p>
        </fn>
        <fn fn-type="conflict">
          <p>
            <bold>Potencial Conflito de Interesse</bold>
          </p>
          <p>Declaro n&#227;o haver conflito de interesses pertinentes.</p>
        </fn>
      </author-notes>
      <abstract>
        <title>Resumo</title>
        <sec>
          <title>Fundamento:</title>
          <p>O treinamento resistido promove benef&#237;cios &#224; sa&#250;de cardiovascular, a qual &#233; influenciada pela priva&#231;&#227;o de sono.</p>
        </sec>
        <sec>
          <title>Objetivo:</title>
          <p>Investigar o efeito pr&#233;vio do treinamento resistido de alta intensidade sobre a contratilidade mioc&#225;rdica de ratos privados de sono paradoxal.</p>
        </sec>
        <sec>
          <title>M&#233;todos:</title>
          <p>Quarenta ratos machos Wistar foram distribu&#237;dos nos grupos controle (CTRL), treinamento resistido (TRES), priva&#231;&#227;o de sono paradoxal por 96 horas (PSP96) e treinamento resistido seguido de priva&#231;&#227;o de sono paradoxal por 96 horas (TRES/PSP96). O treinamento resistido foi de alta intensidade, por 8 semanas, 5x/semana. Vinte e quatro horas ap&#243;s a &#250;ltima sess&#227;o de treinamento, os grupos PSP96 e TRES/PSP96 foram submetidos ao protocolo de priva&#231;&#227;o de sono paradoxal e em seguida foi realizado o estudo <italic>in vitro</italic> da mec&#226;nica contr&#225;til do m&#250;sculo papilar isolado.</p>
        </sec>
        <sec>
          <title>Resultados:</title>
          <p>Em compara&#231;&#227;o ao CTRL, os grupos PSP96 e TRES/PSP96 apresentaram menor comprimento do m&#250;sculo papilar e aumento da &#225;rea de sec&#231;&#227;o transversa. Associado a essas altera&#231;&#245;es, verificou-se a diminui&#231;&#227;o das derivadas temporais da for&#231;a na contra&#231;&#227;o e relaxamento em todas as condi&#231;&#245;es avaliadas. Somente o grupo PSP96 apresentou redu&#231;&#227;o da tens&#227;o de repouso e lentid&#227;o no tempo de relaxamento, sendo este &#250;ltimo atenuado pelo treinamento resistido pr&#233;vio.</p>
        </sec>
        <sec>
          <title>Conclus&#227;o:</title>
          <p>O treinamento resistido pr&#233;vio &#224; PSP foi parcialmente protetor contra as altera&#231;&#245;es contr&#225;teis do m&#250;sculo papilar, minimizando a lentid&#227;o no tempo de relaxamento. Assim, o car&#225;ter de alta intensidade do protocolo adotado parece n&#227;o proteger plenamente o tecido card&#237;aco frente a PSP.</p>
        </sec>
      </abstract>
      <kwd-group xml:lang="pt">
        <title>Palavras-chave:</title>
        <kwd>Treinamento de Resist&#234;ncia</kwd>
        <kwd>Priva&#231;&#227;o do Sono</kwd>
        <kwd>Doen&#231;as Cardiovasculares</kwd>
        <kwd>Contra&#231;&#227;o Mioc&#225;rdica</kwd>
        <kwd>Ratos</kwd>
        <kwd>Experimenta&#231;&#227;o Animal</kwd>
      </kwd-group>
      <funding-group>
        <award-group>
          <funding-source>FAPESP</funding-source>
          <award-id>2013/00152-5</award-id>
        </award-group>
        <award-group>
          <funding-source>FAPESP</funding-source>
          <award-id>2011/15962-7</award-id>
        </award-group>
        <funding-statement>O presente estudo foi financiado por FAPESP (2013/00152-5, 2011/15962-7)</funding-statement>
      </funding-group>
    </front-stub>
    <body>
      <sec sec-type="intro">
        <title>Introdu&#231;&#227;o</title>
        <p>A dura&#231;&#227;o do tempo de sono &#233; um dos fatores determinantes da sa&#250;de cardiovascular. Estudos demonstram que um menor tempo alocado para o sono est&#225; intimamente associado ao aumento da preval&#234;ncia e incid&#234;ncia de doen&#231;as cardiovasculares como, por exemplo, a hipertens&#227;o.<xref ref-type="bibr" rid="B1">1</xref> Dentre os poss&#237;veis mecanismos, destaca-se a eleva&#231;&#227;o da atividade simp&#225;tica e do catabolismo, evidenciada pelo aumento dos n&#237;veis de catecolaminas e cortisol/corticosterona,<xref ref-type="bibr" rid="B2">2</xref><sup>-</sup><xref ref-type="bibr" rid="B6">6</xref> culminando em altera&#231;&#245;es moleculares e morfol&#243;gicas,<xref ref-type="bibr" rid="B7">7</xref> podendo, assim, prejudicar o tecido card&#237;aco.</p>
        <p>Diante desse cen&#225;rio, o treinamento resistido destaca-se como uma poss&#237;vel ferramenta para minimizar ou at&#233; mesmo reverter o impacto do d&#233;bito de sono sobre a sa&#250;de cardiovascular. Al&#233;m de induzir a redu&#231;&#227;o da press&#227;o arterial de repouso, da press&#227;o sist&#243;lica do ventr&#237;culo esquerdo e da frequ&#234;ncia card&#237;aca,<xref ref-type="bibr" rid="B8">8</xref><sup>,</sup><xref ref-type="bibr" rid="B9">9</xref> o treinamento resistido tamb&#233;m &#233; capaz de promover o aumento da for&#231;a isom&#233;trica do m&#250;sculo papilar, e consequentemente melhorar sua performance contr&#225;til.<xref ref-type="bibr" rid="B10">10</xref> Ainda, por influenciar os diversos eixos end&#243;crinos, pode proporcionar uma involu&#231;&#227;o do quadro catab&#243;lico instalado pela priva&#231;&#227;o de sono.<xref ref-type="bibr" rid="B11">11</xref>
				</p>
        <p>Embora existam estudos destacando o impacto do d&#233;bito de sono sobre a sa&#250;de cardiovascular,<xref ref-type="bibr" rid="B4">4</xref><sup>,</sup><xref ref-type="bibr" rid="B12">12</xref> pouco se sabe sobre os seus efeitos sobre a maquinaria contr&#225;til card&#237;aca, e o papel do treinamento resistido como ferramenta preventiva. Assim, o objetivo do estudo foi avaliar o efeito pr&#233;vio do treinamento resistido de alta intensidade sobre a contratilidade mioc&#225;rdica de ratos privados de sono paradoxal.</p>
      </sec>
      <sec sec-type="methods">
        <title>M&#233;todos</title>
        <p>Usando uma amostragem por conveni&#234;ncia, foram utilizados 40 ratos machos Wistar com 3 meses de idade, pesando 300-350g, provenientes da col&#244;nia do Centro de Desenvolvimento de Modelos Experimentais para Medicina e Biologia (CEDEME) da Universidade Federal de S&#227;o Paulo. Os animais foram mantidos em caixas de polipropileno, em uma sala com temperatura controlada (22 &#177; 1&#186;C), ciclo claro/escuro (12:12h), e com &#225;gua e ra&#231;&#227;o <italic>ad libitum</italic>.</p>
        <p>Os procedimentos foram realizados de acordo com o <italic>Guide for the Care and Use of Laboratory Animals - National Research Council, NIH Publication N&#186; 85-23 (revised 2011</italic>). O protocolo foi aprovado pelo Comit&#234; de &#201;tica da Universidade Federal de S&#227;o Paulo/Hospital S&#227;o Paulo (#0764/10).</p>
        <p>Os animais foram distribu&#237;dos em 4 grupos: controle (CTRL, n = 10), treinamento resistido (TRES, n = 10), priva&#231;&#227;o de sono paradoxal (PSP) por 96 horas (PSP96, n = 10), e treinamento resistido seguido de PSP por 96 horas (TRES/PSP96, n = 10). Durante todo o per&#237;odo do experimento os animais do grupo CTRL permaneceram em suas caixas moradias e n&#227;o sofreram manipula&#231;&#245;es al&#233;m da rotina usual do laborat&#243;rio.</p>
        <sec>
          <title>Treinamento Resistido</title>
          <p>O treinamento resistido foi realizado durante 8 semanas conforme descrito previamente.<xref ref-type="bibr" rid="B13">13</xref> Foi utilizado uma escada com dimens&#245;es de 110 cm de altura, 18 cm de largura, 80&#186; de inclina&#231;&#227;o e com espa&#231;amento de 2 cm entre os degraus. No topo da escada existia uma c&#226;mara de 20x20x20 cm que servia de abrigo durante o repouso entre as s&#233;ries do exerc&#237;cio. Os animais subiram a escada com um sistema de peso acoplado na base da cauda, o que permitia o incremento da carga com a progress&#227;o do exerc&#237;cio.</p>
          <p>A familiariza&#231;&#227;o do animal com o aparato foi constitu&#237;da de 9 tentativas por dia durante 3 dias consecutivos. Em seguida, foi realizado um teste para determina&#231;&#227;o da carga m&#225;xima<xref ref-type="bibr" rid="B13">13</xref> e, semanalmente, os animais foram submetidos &#224; reavalia&#231;&#227;o da carga m&#225;xima.</p>
          <p>As sess&#245;es de treinamento foram constitu&#237;das de 4 a 8 s&#233;ries de escalada, com cargas progressivamente maiores e intervalo de 60 segundos entre as s&#233;ries. O comprimento do aparato de treinamento exigia que os animais executassem de 8 a 12 movimentos (repeti&#231;&#245;es) para se deslocarem do in&#237;cio ao topo da escada. Na primeira s&#233;rie, a sobrecarga imposta ao animal foi equivalente a 50% da carga m&#225;xima. Em seguida, a sobrecarga foi incrementada para 75%, 90% e quarta s&#233;rie com 100% da carga m&#225;xima; para as subidas subsequentes foram adicionados 30g em cada tentativa at&#233; a falha.<xref ref-type="bibr" rid="B13">13</xref> O treinamento foi realizado 5 vezes por semana, de segunda a sexta-feira, no per&#237;odo da tarde. A sess&#227;o da segunda-feira foi substitu&#237;da pelo teste de carga m&#225;xima. A fim de evitar o <italic>overtraining</italic>, devido &#224; alta intensidade do protocolo, foi adotado o descanso profil&#225;tico &#224;s quartas-feiras nas semanas 6, 7 e 8. Durante essas semanas, os animais treinaram segunda-feira, ter&#231;a-feira, quinta-feira e sexta-feira. Quarenta e oito horas ap&#243;s a &#250;ltima sess&#227;o de treinamento os animais dos grupos CTRL e TRES foram eutanasiados e os grupos PSP96 e TRES/PSP96 foram submetidos ao protocolo de PSP.</p>
        </sec>
        <sec>
          <title>Priva&#231;&#227;o de Sono Paradoxal</title>
          <p>A PSP foi aplicada por 96 horas cont&#237;nuas pelo m&#233;todo das plataformas m&#250;ltiplas modificado,<xref ref-type="bibr" rid="B14">14</xref> capaz de suprimir totalmente o sono paradoxal e reduzir em 37% o sono de ondas lentas.<xref ref-type="bibr" rid="B15">15</xref> Foram alocados 5 animais socialmente est&#225;veis sobre plataformas circulares distantes 10 cm umas das outras em um tanque de a&#231;o inox (123 cm de comprimento x 44 cm de largura x 44 cm de altura). O tanque foi cheio de &#225;gua em temperatura ambiente at&#233; 1cm abaixo da superf&#237;cie das plataformas, permitindo que os animais se deslocassem de uma plataforma para outra e, ao atingirem o sono paradoxal, tocavam na &#225;gua devido &#224; atonia muscular que acompanha essa fase do sono, sendo ent&#227;o acordados. No decorrer do protocolo, o ambiente foi mantido em condi&#231;&#245;es adequadas de temperatura (22 &#177; 1&#176;C), ciclo claro-escuro (12h) e a &#225;gua e ra&#231;&#227;o foram ofertadas <italic>ad libitum.</italic> O grupo CTRL permaneceu na mesma sala, para que experimentassem as mesmas condi&#231;&#245;es ambientais.</p>
        </sec>
        <sec>
          <title>Mec&#226;nica Muscular Card&#237;aca Isolada</title>
          <p>Imediatamente ap&#243;s o protocolo de PSP para os grupos PSP96 e TRES/PSP96, ou 48 horas ap&#243;s a &#250;ltima sess&#227;o de treinamento resistido para os animais do grupo TRES ou ap&#243;s per&#237;odo equivalente para o grupo CTRL, foram feitas prepara&#231;&#245;es <italic>in vitro</italic> do m&#250;sculo papilar isolado do ventr&#237;culo esquerdo.</p>
          <p>Os animais foram anestesiados com Uretana (Urethanechloride, 0,3 ml/100 g, <italic>i.p.</italic>, Sigma-Aldrich, St. Louis, Mo, EUA), o cora&#231;&#227;o foi rapidamente removido e colocado em solu&#231;&#227;o de Krebs-Henseleit, previamente oxigenada com 100% de oxig&#234;nio e aquecida a 30&#186;C. O m&#250;sculo papilar foi dissecado do ventr&#237;culo esquerdo, e suas extremidades tend&#237;nea e parietal foram presas por an&#233;is de a&#231;o inoxid&#225;vel ao transdutor de for&#231;a. Posteriormente, o m&#250;sculo papilar foi suspenso verticalmente na cuba de vidro, contendo a solu&#231;&#227;o de Krebs-Henseleit (mM), composta por: 132 NaCl; 4,69 KCl; 1,5 CaCl; 1,16 MgSO<sub>4</sub>; 1,18 KH<sub>2</sub>PO<sub>4</sub>; 5,50 glicose e 20 HEPES, tamponado a pH 7,4.<xref ref-type="bibr" rid="B16">16</xref> O anel da extremidade inferior do m&#250;sculo foi conectado ao gancho fixo na cuba de vidro, e o anel superior foi ligado, via um fio de a&#231;o inoxid&#225;vel, ao transdutor de for&#231;a isom&#233;trica (model FT03E, Grass Instrument, Quincy, MA). O transdutor de for&#231;a estava conectado ao micromanipulador que permitia o ajuste de comprimento do m&#250;sculo. Paralelamente ao m&#250;sculo papilar, estavam dois eletrodos de platina acoplados ao estimulador el&#233;trico, que liberavam est&#237;mulos em onda quadrada de 5ms de dura&#231;&#227;o, em frequ&#234;ncia de 0,2Hz,<xref ref-type="bibr" rid="B16">16</xref><sup>,</sup><xref ref-type="bibr" rid="B17">17</xref> e voltagem aproximadamente 20% maior que o m&#237;nimo necess&#225;rio para provocar resposta mec&#226;nica m&#225;xima do m&#250;sculo. Ap&#243;s 60 minutos em condi&#231;&#227;o isot&#244;nica com pr&#233;-carga baixa (0,4 g) para estabiliza&#231;&#227;o da prepara&#231;&#227;o, o m&#250;sculo foi carregado para contrair isometricamente por 15 minutos e, em seguida, estirado at&#233; atingir o &#225;pice da curva comprimento-tens&#227;o desenvolvida (L<sub>m&#225;x:</sub> comprimento diast&#243;lico do m&#250;sculo associado com tens&#227;o isom&#233;trica desenvolvida m&#225;xima). Os testes foram realizados em L<sub>m&#225;x</sub> e a tens&#227;o isom&#233;trica foi avaliada pela for&#231;a normalizada para a &#225;rea da sec&#231;&#227;o transversa (AST) do m&#250;sculo (g.mm<sup>-2</sup>). A AST do m&#250;sculo papilar foi calculada pela raz&#227;o entre a sua massa (mg) e seu comprimento em repouso, verificado em L<sub>m&#225;x</sub> (mm), assumindo uniformidade cil&#237;ndrica e uma gravidade espec&#237;fica de 1,04.</p>
          <p>Os par&#226;metros de fun&#231;&#227;o contr&#225;til analisados foram: tens&#227;o desenvolvida (TD; g.mm<sup>-2</sup>), tens&#227;o de repouso (TR; g.mm<sup>-2</sup>), varia&#231;&#227;o temporal da for&#231;a na contra&#231;&#227;o (+dT/dt; g.mm<sup>-2</sup>.s<sup>-1</sup>), varia&#231;&#227;o temporal da for&#231;a no relaxamento (-dT/dt; g.mm<sup>-2</sup>.s<sup>-1</sup>), tempo para atingir o pico da tens&#227;o desenvolvida (TPT; ms) e tempo para tens&#227;o desenvolvida decrescer 50% de seu valor m&#225;ximo, como par&#226;metro temporal de capacidade de relaxamento (TR50%; ms). O comportamento mec&#226;nico dos m&#250;sculos papilares foi avaliado nas seguintes condi&#231;&#245;es: 1) Basal; 2) Rela&#231;&#227;o Comprimento-Tens&#227;o (varia&#231;&#227;o do comprimento muscular de 92% a 100% do L<sub>m&#225;x</sub>); 3) Potencia&#231;&#227;o P&#243;s-Pausa (utilizando 10, 20, 30, 60 e 120 segundos de pausa); e 4) Resposta contr&#225;til ao c&#225;lcio (Ca<sup>2+</sup>) (aumento da concentra&#231;&#227;o de Ca<sup>2+</sup> de 1,5 mM para 2,5 mM na solu&#231;&#227;o nutridora).</p>
        </sec>
        <sec>
          <title>An&#225;lise Estat&#237;stica</title>
          <p>As an&#225;lises foram realizadas com aux&#237;lio do programa Statistica&#174; (Stat Soft, Inc, vers&#227;o 12.0). Para a an&#225;lise descritiva dos dados, calcularam-se as medidas de tend&#234;ncia central. A normalidade dos dados foi verificada pelo teste de Shapiro Wilk. Os dados com distribui&#231;&#227;o param&#233;trica foram analisados pela an&#225;lise de vari&#226;ncia (ANOVA) <italic>one-way</italic> ou <italic>two-way</italic>, com teste <italic>post hoc</italic> de Duncan, enquanto os dados n&#227;o param&#233;tricos foram padronizados com Z-score e posteriormente avaliados pela ANOVA. Nas manobras/condi&#231;&#245;es experimentais de rela&#231;&#227;o comprimento-tens&#227;o e potencia&#231;&#227;o p&#243;s-pausa, foi realizada a regress&#227;o linear para compara&#231;&#227;o entre os <italic>slopes</italic> e a &#225;rea abaixo da curva, respectivamente. Posteriormente, os valores relativos aos <italic>slopes</italic> e a &#225;rea abaixo da curva de cada grupo foram analisados pela ANOVA, conforme descrito acima. A signific&#226;ncia estat&#237;stica adotada foi de &#945; = 0,05.</p>
        </sec>
      </sec>
      <sec sec-type="results">
        <title>Resultados</title>
        <sec>
          <title>Par&#226;metros Biom&#233;tricos do M&#250;sculo Papilar</title>
          <p>N&#227;o houve diferen&#231;a da massa do m&#250;sculo papilar entre os grupos (F<sub>(3,23</sub> = 0,16005, p &gt; 0,05). Para L<italic><sub>m&#225;x</sub></italic>, houve redu&#231;&#227;o nos grupos PSP96 (p = 0,03) e TRES/PSP96 (p = 0,002) quando comparados ao grupo CTRL, sendo o grupo TRES/PSP96 diferente do grupo TRES (p = 0,005), (F<sub>(3,21)</sub> = 6,0487, p &lt; 0,01). Quanto &#224; AST, verificou-se aumento nos grupos TRES (p = 0,02), PSP96 (p = 0,02) e TRES/PSP96 (p=0,01) comparado ao grupo CTRL (F<sub>(3,19)</sub> = 3,1706, p &lt; 0,05) (<xref ref-type="table" rid="t2">Tabela 1</xref>).</p>
          <table-wrap id="t2">
            <label>Tabela 1</label>
            <caption>
              <title>Efeito do treinamento resistido e da priva&#231;&#227;o de sono paradoxal sobre os par&#226;metros biom&#233;tricos do m&#250;sculo papilar</title>
            </caption>
            <table frame="hsides" rules="groups">
              <colgroup>
                <col width="20%"/>
                <col width="20%"/>
                <col width="20%"/>
                <col width="20%"/>
                <col width="20%"/>
              </colgroup>
              <thead>
                <tr>
                  <th align="left" style="background-color:#B2B2B2">Vari&#225;veis</th>
                  <th align="center" style="background-color:#B2B2B2">CTRL</th>
                  <th align="center" style="background-color:#B2B2B2">TRES</th>
                  <th align="center" style="background-color:#B2B2B2">PSP96</th>
                  <th align="center" style="background-color:#B2B2B2">TRES/PSP96</th>
                </tr>
              </thead>
              <tbody>
                <tr>
                  <td align="left">Massa do m&#250;sculo papilar (mg)</td>
                  <td align="center">5,96 &#177; 2,02</td>
                  <td align="center">5,98 &#177; 1,43</td>
                  <td align="center">6,35 &#177; 0,89</td>
                  <td align="center">5,77 &#177; 1,64</td>
                </tr>
                <tr>
                  <td align="left">L<sub>m&#225;x</sub> (mm)</td>
                  <td align="center">5,86 &#177; 0,84</td>
                  <td align="center">5,71 &#177; 0,73</td>
                  <td align="center">4,91 &#177; 0,64<xref ref-type="table-fn" rid="TFN5">*</xref>
									</td>
                  <td align="center">4,40 &#177; 0,60<xref ref-type="table-fn" rid="TFN5">*</xref><sup>, <xref ref-type="table-fn" rid="TFN6">&#8224;</xref></sup></td>
                </tr>
                <tr>
                  <td align="left">AST (mm<sup>2</sup>)</td>
                  <td align="center">1,00 &#177; 0,27</td>
                  <td align="center">1,30 &#177; 0,19<xref ref-type="table-fn" rid="TFN5">*</xref>
									</td>
                  <td align="center">1,29 &#177; 0,12<xref ref-type="table-fn" rid="TFN5">*</xref>
									</td>
                  <td align="center">1,35 &#177; 0,21<xref ref-type="table-fn" rid="TFN5">*</xref>
									</td>
                </tr>
              </tbody>
            </table>
            <table-wrap-foot>
              <fn id="TFN4">
                <p>Dados apresentados em m&#233;dia &#177; desvio-padr&#227;o. Lm&#225;x: comprimento m&#225;ximo do m&#250;sculo papilar; AST: &#225;rea de sec&#231;&#227;o transversa.</p>
              </fn>
              <fn id="TFN5">
                <label>*</label>
                <p>diferente do grupo CTRL;</p>
              </fn>
              <fn id="TFN6">
                <label>&#8224;</label>
                <p>diferente do grupo TRES.</p>
              </fn>
            </table-wrap-foot>
          </table-wrap>
        </sec>
        <sec>
          <title>Mec&#226;nica Contr&#225;til do M&#250;sculo Papilar sob Contra&#231;&#227;o Isom&#233;trica (Basal)</title>
          <p>Observou-se diminui&#231;&#227;o da TD no grupo TRES/PSP96 quando comparado ao CTRL (F<sub>(3,23)</sub> = 3,3049; p = 0,009), e menor TR no grupo PSP96 quando comparado ao TRES (F<sub>(3,22)</sub> = 3,6623; p = 0,01). Em rela&#231;&#227;o &#224; +dT/dt, os grupos PSP96 (p = 0,006) e TRES/PSP96 (p = 0,001) apresentaram redu&#231;&#227;o quando comparados ao grupo CTRL (F<sub>(3,20)</sub>=8,0313, p &lt; 0,05). Esse comportamento foi semelhante ao encontrado na avalia&#231;&#227;o da vari&#225;vel -dT/dt, mas somente para o grupo PSP96 (F<sub>(3,26)</sub> = 2,7244, p = 0,01) (<xref ref-type="fig" rid="f7">Figura 1</xref>).</p>
          <p>
            <fig id="f7">
              <label>Figura 1</label>
              <caption>
                <title>Efeito do treinamento resistido e da priva&#231;&#227;o de sono paradoxal sobre a mec&#226;nica contr&#225;til do m&#250;sculo papilar sob contra&#231;&#227;o isom&#233;trica. ANOVA one&#8209;way com post hoc de Duncan Test. Dados apresentados em m&#233;dia &#177; erro-padr&#227;o, com resultados significativos para p = 0,05. TD: tens&#227;o isom&#233;trica desenvolvida m&#225;xima; TR: tens&#227;o isom&#233;trica de repouso; (+dT/dt): varia&#231;&#227;o temporal da for&#231;a na contra&#231;&#227;o; (-dT/dt): varia&#231;&#227;o temporal da for&#231;a no relaxamento; TPT: tempo para atingir o pico da tens&#227;o desenvolvida; TR50% - tempo decorrido para a tens&#227;o desenvolvida decrescer 50% de seu valor m&#225;ximo; CTRL: grupo controle; TRES: treinamento resistido; PSP96: priva&#231;&#227;o de sono paradoxal por 96 horas; TRES/PSP96: treinamento resistido seguido de priva&#231;&#227;o de sono paradoxal por 96 horas. * diferente do grupo CTRL; &#8224; diferente do grupo TRES; &#8225; diferente de todos os grupos</title>
              </caption>
              <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf01-pt.jpg"/></fig>
          </p>
          <p>Quanto aos par&#226;metros temporais, observamos um comportamento similar entre os grupos em rela&#231;&#227;o &#224; contra&#231;&#227;o card&#237;aca (F<sub>(3,23)</sub> = 0,00, p &gt; 0,05). J&#225; em rela&#231;&#227;o ao par&#226;metro referente ao TR50%, evidenciamos prolongamento do relaxamento no grupo PSP96, comparado a todos os grupos (F<sub>(3,26)</sub> = 3,9344, p &lt; 0,05).</p>
        </sec>
        <sec>
          <title>Mec&#226;nica Contr&#225;til do M&#250;sculo Papilar na Rela&#231;&#227;o Comprimento-Tens&#227;o</title>
          <p>Os grupos TRES (p = 0,02), PSP96 (p = 0,03) e TRES/PSP96 (p = 0,0001) apresentaram menores <italic>slopes</italic> da vari&#225;vel TD quando comparados ao grupo CTRL, sendo o grupo TRES/PSP96 tamb&#233;m estatisticamente inferior aos grupos TRES (p = 0,03) e PSP96 (p = 0,02), (F<sub>(3, 24)</sub> = 7,0880, p &lt; 0,01). J&#225; em rela&#231;&#227;o a TR, houve redu&#231;&#227;o no grupo PSP96 em compara&#231;&#227;o ao grupo TRES (p = 0,03), (F<sub>(3,23)</sub> = 2,5483, p &lt; 0,05) (<xref ref-type="fig" rid="f8">Figura 2</xref>).</p>
          <p>
            <fig id="f8">
              <label>Figura 2</label>
              <caption>
                <title>Efeito do treinamento resistido e da priva&#231;&#227;o de sono paradoxal sobre os par&#226;metros contr&#225;teis do m&#250;sculo papilar na rela&#231;&#227;o comprimentotens&#227;o. ANOVA one-way com post hoc de Duncan Test. Dados apresentados em m&#233;dia &#177; erro-padr&#227;o, com resultados significativos para p = 0,05. TD: tens&#227;o desenvolvida; TR: tens&#227;o de repouso; (+dT/dt): varia&#231;&#227;o temporal da for&#231;a na contra&#231;&#227;o; (-dT/dt): varia&#231;&#227;o temporal da for&#231;a no relaxamento; CTRL: grupo controle; TRES: treinamento resistido; PSP96: priva&#231;&#227;o de sono paradoxal por 96 horas; TRES/PSP96: treinamento resistido seguido de priva&#231;&#227;o de sono paradoxal por 96 horas.* diferente do grupo CTRL; &#8224; diferente do grupo TRES; &#8225; diferente de todos os grupos.</title>
              </caption>
              <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf02-pt.jpg"/></fig>
          </p>
          <p>Na avalia&#231;&#227;o da +dT/dt, os grupos PSP96 e TRES/PSP96 apresentaram <italic>slopes</italic> inferiores aos grupos CTRL (p &lt; 0,01) e TRES (p &lt; 0,05), sendo o grupo PSP96 superior ao grupo TRES/PSP96 (p = 0,01), (F<sub>(3,21)</sub> = 15,741, p &lt; 0,01). N&#227;o houve diferen&#231;as entre os <italic>slopes</italic> da -dT/dT dos grupos estudados (F<sub>(3,20)</sub> = 2,4210, p &gt; 0,05).</p>
          <p>Para o TPT, n&#227;o houve diferen&#231;as entre os grupos (p &gt; 0,05). Quanto ao TR50%, o grupo PSP96 apresentou valores superiores desta vari&#225;vel em todas as porcentagens de estiramento avaliada, quando comparado aos demais grupos (F<sub>(3,25)</sub> = 5,1010, p &lt; 0,05) (<xref ref-type="fig" rid="f9">Figura 3</xref>).</p>
          <p>
            <fig id="f9">
              <label>Figura 3</label>
              <caption>
                <title>Efeito do treinamento resistido e da priva&#231;&#227;o de sono paradoxal sobre os par&#226;metros temporais do m&#250;sculo papilar na rela&#231;&#227;o comprimento-tens&#227;o. ANOVA two-way com post hoc de Duncan Test. Dados apresentados em m&#233;dia &#177; erro-padr&#227;o, com resultados significativos para p = 0,05. TPT: tempo para atingir o pico da tens&#227;o desenvolvida; TR50%: tempo decorrido para a tens&#227;o desenvolvida decrescer 50% de seu valor m&#225;ximo; Lm&#225;x: comprimento m&#225;ximo do m&#250;sculo papilar CTRL: grupo controle; TRES: treinamento resistido; PSP96: priva&#231;&#227;o de sono paradoxal por 96 horas; TRES/PSP96: treinamento resistido seguido de priva&#231;&#227;o de sono paradoxal por 96 horas. &#8225; diferente de todos os grupos, em cada porcentagem de estiramento avaliada</title>
              </caption>
              <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf03-pt.jpg"/></fig>
          </p>
        </sec>
        <sec>
          <title>Mec&#226;nica Contr&#225;til do M&#250;sculo Papilar na Potencia&#231;&#227;o P&#243;s-Pausa</title>
          <p>Houve redu&#231;&#227;o da TD no grupo TRES/PSP96 quando comparado ao grupo CTRL (p = 0,01), (F<sub>(3,22)</sub> = 2,2722, p &lt; 0,05). A TR reduziu no grupo PSP96 comparado aos grupos CTRL (p = 0,02) e TRES (p = 0,03), (F<sub>(3,21)</sub> = 2,9579, p &lt; 0,05), comportamento similar ao observado quando avaliado a vari&#225;vel -dT/dt (F<sub>(3,23)</sub> = 4,3408, p &lt; 0,05). A +dT/dt foi inferior nos grupos PSP96 (p = 0,02) e TRES/PSP96 (p = 0,002) comparado ao grupo CTRL, sendo o grupo TRES/PSP96 diferente do grupo TRES (p = 0,01), (F<sub>(3,23)</sub> = 4,6147, p &lt; 0,05) (<xref ref-type="fig" rid="f10">Figura 4</xref>).</p>
          <p>
            <fig id="f10">
              <label>Figura 4</label>
              <caption>
                <title>Efeito do treinamento resistido e da priva&#231;&#227;o de sono paradoxal sobre os par&#226;metros contr&#225;teis do m&#250;sculo papilar na potencia&#231;&#227;o p&#243;s-pausa. ANOVA one&#8209;way com post hoc de Duncan Test. Dados apresentados em m&#233;dia &#177; erro-padr&#227;o, com resultados significativos para p = 0,05. TD: tens&#227;o desenvolvida; TR: tens&#227;o de repouso; (+dT/dt): varia&#231;&#227;o temporal da for&#231;a na contra&#231;&#227;o; (-dT/dt): varia&#231;&#227;o temporal da for&#231;a no relaxamento; CTRL: grupo controle; TRES: treinamento resistido; PSP96: priva&#231;&#227;o de sono paradoxal por 96 horas; TRES/PSP96: treinamento resistido seguido de priva&#231;&#227;o de sono paradoxal por 96 horas. * diferente do grupo CTRL; &#8224; diferente do grupo TRES.</title>
              </caption>
              <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf04-pt.jpg"/></fig>
          </p>
          <p>N&#227;o foram observadas diferen&#231;as nos par&#226;metros temporais entre os grupos (F<sub>(12,96)</sub> = 0,7959, p &gt; 0,05), exceto o aumento da TR50% no momento 60s em rela&#231;&#227;o a todos os momentos de pausa, 10 (p = 0,00004), 20 (p = 0,001), 30 (p = 0,004) e 120 segundos (p = 0,0006), (F<sub>(4,88)</sub> = 3,8313, p &lt; 0,05) no grupo TRES/PSP96 (<xref ref-type="fig" rid="f11">Figura 5</xref>).</p>
          <p>
            <fig id="f11">
              <label>Figura 5</label>
              <caption>
                <title>Efeito do treinamento resistido e da priva&#231;&#227;o de sono paradoxal sobre os par&#226;metros temporais do m&#250;sculo papilar na potencia&#231;&#227;o p&#243;s-pausa. ANOVA Two-way com post hoc de Duncan Test. Dados apresentados em m&#233;dia &#177; erro-padr&#227;o, com resultados significativos para p = 0,05. TPT: tempo para atingir o pico da tens&#227;o desenvolvida; TR50%: tempo decorrido para a tens&#227;o desenvolvida decrescer 50% de seu valor m&#225;ximo; CTRL: grupo controle; TRES: treinamento resistido; PSP96: priva&#231;&#227;o de sono paradoxal por 96 horas; TRES/PSP96: treinamento resistido seguido de priva&#231;&#227;o de sono paradoxal por 96 horas * diferente do grupo CTRL; &#8224; diferente do grupo TRES; &#8225; diferente de todos os momentos de pausa, no mesmo grupo</title>
              </caption>
              <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf05-pt.jpg"/></fig>
          </p>
        </sec>
        <sec>
          <title>Mec&#226;nica Contr&#225;til do M&#250;sculo Papilar em Resposta ao C&#225;lcio Extracelular</title>
          <p>Observou-se aumento da vari&#225;vel TD no grupo TRES (F<sub>(1,18)</sub> = 5,1523, p = 0,02), logo, maior resposta &#224; manobra inotr&#243;pica despertada pelo c&#225;lcio. A TR foi menor &#224; concentra&#231;&#227;o de Ca<sup>2+</sup> 2,5 mM em compara&#231;&#227;o &#224; concentra&#231;&#227;o de 1,5 mM (F<sub>(1,18)</sub> = 14,0730, p &lt; 0,01) nos grupos CTRL (p = 0,001) e TRES/PSP96 (p = 0,04), e inferior no grupo PSP96 em ambas as concentra&#231;&#245;es de Ca<sup>2+</sup>, 1,5 mM (p = 0,009) e 2,5 mM (p = 0,02), (F<sub>(3,18)</sub> = 3,2331, p &lt; 0,05) em compara&#231;&#227;o ao grupo CTRL (<xref ref-type="fig" rid="f12">Figura 6</xref>).</p>
          <p>
            <fig id="f12">
              <label>Figura 6</label>
              <caption>
                <title>Efeito do treinamento resistido e da priva&#231;&#227;o de sono paradoxal sobre a mec&#226;nica contr&#225;til do m&#250;sculo papilar em resposta ao aumento da concentra&#231;&#227;o de Ca<sup>2+</sup> extracelular. ANOVA two-way com post hoc de Duncan Test. Dados apresentados em m&#233;dia &#177; erro-padr&#227;o, com resultados significativos para p = 0,05. TD: tens&#227;o desenvolvida; TR: tens&#227;o de repouso; (+dT/dt): varia&#231;&#227;o temporal da for&#231;a na contra&#231;&#227;o; (-dT/dt): varia&#231;&#227;o temporal da for&#231;a no relaxamento; TPT: tempo para atingir o pico da tens&#227;o desenvolvida; TR50%: tempo decorrido para a tens&#227;o desenvolvida decrescer 50% de seu valor m&#225;ximo. * diferente do grupo CTRL, na mesma concentra&#231;&#227;o de Ca<sup>2+</sup>; &#8224; diferente do grupo TRES, na mesma concentra&#231;&#227;o Ca<sup>2+</sup>; &#8225; diferente da concentra&#231;&#227;o de Ca<sup>2+</sup> 1,5 mM, no mesmo grupo; &#167; diferente de todos os grupos, na mesma concentra&#231;&#227;o de Ca<sup>2+</sup>.</title>
              </caption>
              <graphic xlink:href="2359-5647-ijcs-30-01-0020-70019-gf06-pt.jpg"/></fig>
          </p>
          <p>Na vari&#225;vel +dT/dt, observou-se que o grupo TRES/PSP96 foi superior no momento Ca<sup>2+</sup> 2,5 mM em rela&#231;&#227;o ao momento Ca<sup>2+</sup> 1,5 mM (p = 0,03), entretanto, em ambos os momentos, Ca<sup>2+</sup> 1,5 mM (p = 0,01) e Ca<sup>2+</sup> 2,5 mM (p = 0,03) este grupo apresentou valores reduzidos quando comparado ao CTRL (F<sub>(1,18)</sub> = 9,354531, p &lt; 0,01). Comportamento semelhante foi observado para a -dT/dt, com redu&#231;&#227;o no grupo PSP96 em ambas as concentra&#231;&#245;es de Ca<sup>2+</sup>, quando comparado aos grupos CTRL (p = 0,03) e TRES (p = 0,02), (F<sub>(3,20)</sub> = 3,6516, p &lt; 0,05).</p>
          <p>A TPT aumentou &#224; concentra&#231;&#227;o de Ca<sup>2+</sup> 2,5 mM no grupo PSP96 quando comparado aos grupos CTRL (p = 0,003), TRES (p = 0,02) e TRES/PSP96 (p = 0,01) (F<sub>(3,19)</sub> = 5,538, p &lt; 0,05). J&#225; quando observado a vari&#225;vel TR50%, n&#227;o se verificaram diferen&#231;as entre os grupos estudados (F<sub>(3,19)</sub> = 0,69, p &lt; 0,05).</p>
        </sec>
      </sec>
      <sec sec-type="discussion">
        <title>Discuss&#227;o</title>
        <p>Os resultados demonstram o efeito delet&#233;rio da PSP sobre a contratilidade mioc&#225;rdica e a efic&#225;cia parcial do treinamento resistido como estrat&#233;gia para atenuar as altera&#231;&#245;es observadas. O treinamento resistido e a PSP promovem hipertrofia do mioc&#225;rdio associado &#224; redu&#231;&#227;o de L<sub>m&#225;x</sub>, possivelmente pelo aumento do conte&#250;do de col&#225;geno card&#237;aco<xref ref-type="bibr" rid="B18">18</xref> e menor capacidade de estiramento do m&#250;sculo papilar consequente ao aumento de corticosterona induzido pela PSP.<xref ref-type="bibr" rid="B5">5</xref><sup>,</sup><xref ref-type="bibr" rid="B19">19</xref>
				</p>
        <p>As medidas basais forneceram um indicativo de depress&#227;o funcional mioc&#225;rdica nos grupos submetidos &#224; PSP. Interessantemente, os dados assemelham-se aos encontrados em ratos infartados<xref ref-type="bibr" rid="B20">20</xref> ou nefrectomizados,<xref ref-type="bibr" rid="B21">21</xref> nos permitindo destacar o car&#225;ter agressivo da PSP sobre os par&#226;metros contr&#225;teis e temporais do m&#250;sculo papilar em apenas 4 dias.</p>
        <p>O par&#226;metro temporal de relaxamento card&#237;aco foi aumentado no grupo PSP96, possivelmente pela composi&#231;&#227;o da miosina do m&#250;sculo card&#237;aco<xref ref-type="bibr" rid="B22">22</xref> e pela dura&#231;&#227;o do transiente de c&#225;lcio,<xref ref-type="bibr" rid="B23">23</xref> ambos influenciados pelo desequil&#237;brio na via do c&#225;lcio.<xref ref-type="bibr" rid="B24">24</xref> No entanto, o treinamento resistido foi capaz de prevenir a lentid&#227;o no tempo de relaxamento do m&#250;sculo papilar, embora n&#227;o tenha sido eficaz sobre o decr&#233;scimo na vari&#225;vel TD.</p>
        <p>A redu&#231;&#227;o da TD no grupo TRES/PSP96 pode ser justificada pela alta intensidade do treinamento resistido. Contudo, apesar de promover adapta&#231;&#245;es ben&#233;ficas, seu efeito somado &#224; PSP resultou em depress&#227;o da fun&#231;&#227;o contr&#225;til no m&#250;sculo papilar. N&#227;o houve diferen&#231;a da TD entre os grupos CTRL e TRES, indicando a manuten&#231;&#227;o da fun&#231;&#227;o contr&#225;til do m&#250;sculo papilar. Em contrapartida, previamente foi demonstrado que o treinamento resistido com cargas pr&#233;-definidas (60-70% de 1RM) &#233; capaz de melhorar a atividade da miosina ATPase e a contratilidade do m&#250;sculo papilar.<xref ref-type="bibr" rid="B8">8</xref> Quanto ao treinamento aer&#243;bio, estudos demonstram valores superiores da TD em animais treinados em rela&#231;&#227;o a animais controles.<xref ref-type="bibr" rid="B16">16</xref><sup>,</sup><xref ref-type="bibr" rid="B25">25</xref>
				</p>
        <p>A an&#225;lise da resposta contr&#225;til dos m&#250;sculos papilares ao estiramento permitiu avaliar a integridade da rela&#231;&#227;o de Frank-Starling. Todos os grupos, exceto o CTRL, tiveram resposta contr&#225;til deprimida, sugerindo preju&#237;zo ou exaust&#227;o no mecanismo de Frank-Starling no mioc&#225;rdio. Quando avaliada a +dT/dt, observamos um preju&#237;zo somente no grupo PSP96. A resposta contr&#225;til ao estiramento est&#225; geralmente relacionada ao aumento do n&#250;mero de cabe&#231;as de miosina associadas &#224; actina. O alongamento de um m&#250;sculo promove diminui&#231;&#227;o da dist&#226;ncia entre os filamentos grossos e finos, facilitando a liga&#231;&#227;o desses, e consequente liga&#231;&#227;o do Ca<sup>2+</sup> &#224; troponina. Assim, &#233; plaus&#237;vel afirmar que a dist&#226;ncia entre os filamentos &#233; um fator significativo para determina&#231;&#227;o do comportamento fisiol&#243;gico do m&#250;sculo card&#237;aco.<xref ref-type="bibr" rid="B26">26</xref><sup>,</sup><xref ref-type="bibr" rid="B27">27</xref>
				</p>
        <p>A diminui&#231;&#227;o da TR corrobora a piora da resposta contr&#225;til observada no grupo PSP96 frente ao mecanismo de Frank-Starling, indicando maior rigidez e comprometimento da contratilidade e do relaxamento como observado em animais infartados.<xref ref-type="bibr" rid="B20">20</xref> Quanto menor o valor da TR, maior a capacidade de distens&#227;o do m&#250;sculo papilar, que se associa ao aumento da taxa de col&#225;geno do tipo III sobre o col&#225;geno tipo I.<xref ref-type="bibr" rid="B28">28</xref> Outra poss&#237;vel hip&#243;tese &#233; a inadequada oxigena&#231;&#227;o muscular.<xref ref-type="bibr" rid="B29">29</xref><sup>-</sup><xref ref-type="bibr" rid="B31">31</xref> Associado a isso, e de maneira similar ao observado nas an&#225;lises basais, destaca-se o aumento do tempo de relaxamento no grupo PSP96.</p>
        <p>Quanto ao grupo TRES, n&#227;o observamos eleva&#231;&#227;o dos par&#226;metros contr&#225;teis. No entanto, a literatura demonstra que o exerc&#237;cio f&#237;sico regular tem impacto na rela&#231;&#227;o comprimento-tens&#227;o em cardiomi&#243;citos do ventr&#237;culo esquerdo, aumentando a for&#231;a de contra&#231;&#227;o.<xref ref-type="bibr" rid="B29">29</xref><sup>-</sup><xref ref-type="bibr" rid="B31">31</xref> Em contrapartida, foi verificado que a rela&#231;&#227;o comprimento-tens&#227;o desenvolvida foi deprimida em animais submetidos ao treinamento aer&#243;bio, sugerindo que esse tipo de exerc&#237;cio n&#227;o foi capaz de atenuar esse comportamento.<xref ref-type="bibr" rid="B25">25</xref>
				</p>
        <p>A potencia&#231;&#227;o ap&#243;s pausa de est&#237;mulos el&#233;tricos permite avaliar indiretamente o equil&#237;brio entre a capta&#231;&#227;o, armazenamento e libera&#231;&#227;o de Ca<sup>2+</sup> pelo ret&#237;culo sarcoplasm&#225;tico e a extrus&#227;o de Ca<sup>2+</sup> da c&#233;lula atrav&#233;s do sarcolema. A pausa de est&#237;mulos potencializa a contra&#231;&#227;o seguinte em consequ&#234;ncia do ac&#250;mulo de Ca<sup>2+</sup> no ret&#237;culo sarcoplasm&#225;tico durante a pausa; do aumento na libera&#231;&#227;o deste &#237;on pelo ret&#237;culo sarcoplasm&#225;tico e da reduzida participa&#231;&#227;o do trocador Na<sup>+</sup>/Ca<sup>2+</sup> em retirar o Ca<sup>2+</sup> do sarcolema.<xref ref-type="bibr" rid="B32">32</xref><sup>,</sup><xref ref-type="bibr" rid="B33">33</xref> Em ratos infartados, foi verificado a depress&#227;o da potencia&#231;&#227;o p&#243;s-pausa do m&#250;sculo papilar.<xref ref-type="bibr" rid="B20">20</xref><sup>,</sup><xref ref-type="bibr" rid="B25">25</xref> Essas caracter&#237;sticas foram evidenciadas em nosso estudo somente quando avaliada as varia&#231;&#245;es temporais da for&#231;a na contra&#231;&#227;o (+dT/dt) e relaxamento (-dT/dt) do grupo PSP96, sugerindo poss&#237;vel disfun&#231;&#227;o na cin&#233;tica de Ca<sup>2+</sup> associado ao aumento da atividade do trocador Na<sup>+</sup>/Ca<sup>2+</sup>.</p>
        <p>Assim, os dados sugerem que a PSP &#233; capaz de interferir na funcionalidade card&#237;aca, e que tais altera&#231;&#245;es n&#227;o foram atenuadas pelo treinamento resistido de alta intensidade, uma vez que os animais submetidos ao exerc&#237;cio apresentaram uma involu&#231;&#227;o da +dT/dt. Talvez, protocolos de intensidade moderada ou baixa, ou at&#233; mesmo o treinamento aer&#243;bio poderiam ser mais eficazes para a melhora da fun&#231;&#227;o contr&#225;til do m&#250;sculo papilar. Dados experimentais demonstraram uma potencia&#231;&#227;o p&#243;s-pausa aumentada em animais infartados submetidos ao treinamento f&#237;sico aer&#243;bio, destacando o car&#225;ter preventivo desse tipo de treinamento.<xref ref-type="bibr" rid="B25">25</xref>
				</p>
        <p>Por fim, avaliamos a resposta contr&#225;til do m&#250;sculo papilar ao aumento da concentra&#231;&#227;o de Ca<sup>2+</sup> na solu&#231;&#227;o nutridora. Essa manobra tem como objetivo averiguar se h&#225; melhora do comportamento contra&#231;&#227;o-relaxamento com o aumento da disponibilidade de Ca<sup>2+</sup>.<xref ref-type="bibr" rid="B34">34</xref> De acordo com nossos resultados, mediante o aumento nas concentra&#231;&#245;es de Ca<sup>2+</sup>, houve aumento da TD no grupo TRES e diminui&#231;&#227;o tanto da TR como da -dT/dt no grupo PSP96. J&#225; a +dT/dt melhorou no grupo TRES/PSP9696 mediante ao est&#237;mulo dado, enquanto a vari&#225;vel temporal de contra&#231;&#227;o card&#237;aca aumentou no grupo PSP96, sugerindo piora do tempo para ocorr&#234;ncia da s&#237;stole.</p>
        <p>Esse conjunto de resultados nos permite afirmar que a resposta contr&#225;til e temporal foi prejudicada com a PSP. Independente da concentra&#231;&#227;o de Ca<sup>2+</sup>, o m&#250;sculo papilar dos animais submetidos &#224; PSP n&#227;o responderam adequadamente. Essas respostas deprimidas v&#234;m ao encontro ao observado em animais infartados.<xref ref-type="bibr" rid="B35">35</xref>
				</p>
      </sec>
      <sec sec-type="conclusions">
        <title>Conclus&#227;o</title>
        <p>Diante do exposto, conclui-se que o treinamento resistido de alta intensidade foi eficaz na melhoria dos par&#226;metros temporais, embora n&#227;o tenham sido observados benef&#237;cios para as altera&#231;&#245;es contr&#225;teis. Sugere-se que protocolos de exerc&#237;cios f&#237;sicos menos intensos possam ser mais interessantes para a prote&#231;&#227;o plena do mioc&#225;rdio, representado pelo m&#250;sculo papilar.</p>
        <sec>
          <title>Limita&#231;&#245;es do Estudo</title>
          <p>O presente estudo teve como objetivo investigar os efeitos da priva&#231;&#227;o de sono na contratilidade mioc&#225;rdica, na aus&#234;ncia de comorbidades associadas, o que em estudos cl&#237;nicos poderia confundir os resultados. Dessa forma, &#233; preciso cautela para aplicar os resultados encontrados em investiga&#231;&#245;es cl&#237;nicas.</p>
        </sec>
      </sec>
    </body>
    <back>
      <fn-group>
        <fn fn-type="financial-disclosure">
          <p>
            <bold>Fontes de Financiamento</bold>
          </p>
          <p>O presente estudo foi financiado por FAPESP (2013/00152-5, 2011/15962-7).</p>
        </fn>
        <fn fn-type="other">
          <p>
            <bold>Vincula&#231;&#227;o Acad&#234;mica</bold>
          </p>
          <p>Este artigo &#233; parte de disserta&#231;&#227;o de Mestrado de Sara Quaglia de Campos Giamp&#225; pela Universidade Federal de S&#227;o Paulo.</p>
        </fn>
      </fn-group>
      <ack>
        <title>Agradecimentos</title>
        <p>Os autores agradecem &#224; CAPES-Reuni, FAPESP (#2013/00152-5; #2011/15962-7) e ao Laborat&#243;rio de Fisiologia Cardiovascular da UNIFESP.</p>
      </ack>
    </back>
  </sub-article>
</article>
