ABC | Volume 110, Nº1, January 2018

Viewpoint Rêgo et al Heart Failure, Brain and Physical Activity Arq Bras Cardiol. 2018; 110(1):91-94 Figure 1 – Aerobic physical activity promotes an increase in the concentrations of VEGF and BDNF, which can improve cognitive processes, increase the parasympathetic tone, and decrease the sympathetic activation. This condition may decrease peripheral vascular resistance and lead to increased cerebral blood flow in the prefrontal cortex, positively interfering with cognitive ability. With increased cerebral blood flow in the prefrontal cortex, there may be an inhibition of the amygdala promoting a vagal increase and sympathetic decrease, feedback system. VEGF: vascular endothelial growth factor; BDNF: brain-derived neurotrophic factor Aerobic physical activity ↑ VEGF ↑ BDNF ↑ Parasympathetic ↓ Sympathetic ↑ Cognition ↑ PFC Perfusion ↓ Peripheral vascular resistance ↓ Amygdala 1. BocchiEA.HeartfailureinSouthAmerica.CurrCardiolRev.2013;9(2):147-56. PMID: 23597301. 2. Bocchi EA, Marcondes-Braga FG, Ayub Ferreira SM, Rohde LE, Oliveira WA, Almeida DR, et al; Sociedade Brasileira de Cardiologia. [III Brazilian guidelines on chronic heart failure]. Arq Bras Cardiol. 2009;93(1 Suppl.1):3-70. PMID: 20963312. 3. Vogels RL, Scheltens P, Schroeder-Tanka JM, Weinstein HC. Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail. 2007;9(5):440-9. doi: 10.1016/j.ejheart.2006.11.001. 4. Diamond A. Executive functions. Annu Rev Psychol. 2013;64:135-68. doi: 10.1146/annurev-psych-113011-143750. 5. Woo MA, Kumar R, Macey PM, Fonarow GC, Harper RM. Brain injury in autonomic, emotional, and cognitive regulatory areas in patients with heart failure. J Card Fail. 2009;15(3):214-23. doi: 10.1016/j. cardfail.2008.10.020. 6. Alagiakrishnan K, Mah D, Ahmed A, Ezekowitz J. Cognitive decline in heart failure.HeartFailRev.2016;21(6):661-73.doi:10.1007/s10741-016-9568-1. 7. Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, et al. Prospectivestudyofheartratevariabilityandmortality inchronicheartfailure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation. 1998;98(15):1510-6. PMID: 9769304. 8. Creager MA, Faxon DP, Cutler SS, Kohlmann O, Ryan TJ, Gavras H. Contribution of vasopressin to vasoconstriction in patients with congestive heart failure: comparison with the renin-angiotensin system and the sympathetic nervous system. J Am Coll Cardiol. 1986;7(4):758‑65. PMID: 3514728. References changes in the brain and ANS, is clear, implying greater efficiency in cognitive processes. Therefore, it is valid to emphasize once again the prescription of APA with a focus on cognition, with the justification of enhancing performance in the basic and instrumental activities of this population and explaining its practical benefits and its contribution to the possibility of greater well-being of the patients during the evolution of the clinical condition. Finally, in addition to combating sedentary lifestyle and improved heart muscle, APA prescription should be focused on cognitive benefit, with repercussion in the management of possible daily limitations, such as shopping, compromising understanding, communication and interpersonal relationships. This can be a way to increase the patient's adherence to this therapeutic component, aiding in his treatment and bringing more benefits and quality of life. Author contributions Conception and design of the research, Writing of the manuscript and Critical revision of the manuscript for intellectual content: Rêgo MLM, Cabral DAR, Fontes EB. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. 93