ABC | Volume 115, Nº2, August 2020

Short Editorial Pacagnelli et al. Intermittent diet and exercise in heart Arq Bras Cardiol. 2020; 115(2):194-196 like PE. It can modulate the function of cardiac fibroblasts, extracellular matrix turnover, and paracrine induction of cardiomyocyte hypertrophy. 11 Therefore, future studies are needed to confirm the role of p38 MAPK in cardiac remodeling induced by PE and an influence of intermittent diet. Myocardial remodeling is regulated through a combination of responses from cardiomyocytes, other cell types, and various mechanosensitive pathways, which can modify the genetic expression and protein synthesis, which cause the functional modifications in the cells. 12 Mechanosensitive stimuli like PE affect cardiomyocytes and fibroblasts leading to alterations in genetic expression and cellular remodeling. Studies have shown the importance of integrins, angiotensin II, calcium, and transforming growth factor beta (TGF- β ) regulating the mitogen-activated protein kinase (MAPK) pathway with fibroblasts activation and increased cardiac fibrosis. 12,13 The effects of caloric restriction on cardiac remodeling have been extensively investigated in animal models with cardiac alterations. It has been demonstrated an improvement in cardiac dysfunction and chronotropic reserves, and regarding molecular aspects, an improvement in sympathetic cardiac innervation and levels of β -adrenergic receptors in rats with myocardial infarction-induced heart failure submitted to intermittent diet. 14 Another study showed that fasting/refeeding cycles resulted in beneficial cardiac effects and reduced myocardial damage due to the caloric restriction in spontaneously hypertensive rats, contributing to reduced cardiovascular risks and morphological damage. In addition, fasting/ refeeding cycles led to slight improvements in the transit of Ca 2+ and the beta-adrenergic system. 15 Although the study de Basilio et al. 1 did not aim to investigate the effects of isolated PE or combined with caloric restriction diet on Ca 2+ transport markers, it shows possibilities for future researches on molecular adaptations related to cardiac remodeling induced by PE. 1 We emphasize the importance of testing the findings of this study in other populations associated with health and disease, including groups with overweight, obese, and diabetic subjects such conditions are related to changes in glycemic metabolism. In conclusion, it is worth highlighting that the article, 1 demonstrates valuable information concerning the effects of isolated PE and the combination of PE with an intermittent diet on morphological and metabolic aspects involved in cardiac remodeling, such contributes to the understanding and enhancement of prevention programs and cardiac rehabilitation. Acknowledgements The authors would like to thank Eric Schloeffel for English editing. 1. Basilio PG, Oliveira APC, Castro ACF, Carvalho MB, Zagatto AM, Martinez PF, et al. Intermittent Fasting Attenuates Exercise Training-Induced Cardiac Remodeling. Arq Bras Cardiol. 2020; 115(2):184-193. 2. World Health Organization. (WHO). Available online: https://www.who . int/cardiovascular_diseases/en/ (accessed on 1 February 2019). 3. Malinowski B, Zalewska K,W ę sierska A, SokołowskaMM, SochaM, Liczner G, et al. Intermittent fasting in cardiovascular disorders—an overview. Nutrients . 2019;11(3):673. 4. Gomes MJ, Pagan LU, Okoshi MP. Non-pharmacological treatment of cardiovascular disease | importance of physical exercise. Arq Bras Cardiol. 2019;113(1):9 ‐ 10. 5. Wilson RA, Deasy W, Stathis CG, Hayes A, Cooke MB. Intermittent fasting with or without exercise prevents weight gain and improves lipids in diet- induced obese mice. Nutrients. 2018;10(3):346. 6. Moraes RCM, Portari GV, Ferraz ASM, da Silva TEO, Marocolo M. Effects of intermittent fasting and chronic swimming exercise on body composition and lipid metabolism. Appl Physiol Nutr Metab . 2017;42(12):1341 ‐ 46. 7. Bhutani S, Klempel MC, Kroeger CM, Trepanowski JF, Varady KA. Alternate day fasting and endurance exercise combine to reduce body weight and favorably alterplasmalipidsinobesehumans. Obesity (SilverSpring).2013;21(7):1370 ‐ 79. 8. Gotthardt JD, Verpeut JL, Yeomans BL, Yang JA, Yasrebi A, Roepke TA, et al. Intermittent fasting promotes fat loss with lean mass retention, increased hypothalamic norepinephrine content, and increased neuropeptide y gene expression in diet-induced obese male mice. Endocrinology . 2016;157(2):679–91. 9. Evans PL, McMillin SL, Weyrauch LA, &Witczak CA. Regulation of skeletal muscle glucose transport and glucose metabolism by exercise training. Nutrients . 2019; 11(10):2432. 10. Nicklas BJ, Brinkley TE, Houston DK, et al. Effects of caloric restriction on cardiorespiratory fitness, fatigue, and disability responses to aerobic exercise in older adults with obesity: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2019;74(7):1084 ‐ 90. 11. Wang, Y. Mitogen-activated protein kinases in heart development and diseases. Circulation . 2007;116(12):1413–23. 12. Saucerman JJ, Tan PM, Buchholz KS, McCulloch AD, & Omens JH. Mechanical regulation of gene expression in cardiac myocytes and fibroblasts. Nature Reviews Cardiology . 2019;16(6):361-78. 13. 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