Experimental Gerontology 98 (2017) 1–7

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Experimental Gerontology
journal homepage: www.elsevier.com/locate/expgero

Effects of concurrent and aerobic exercises on postexercise hypotension in MARK

elderly hypertensive men
Rodrigo Ferraria,b,⁎, Daniel Umpierrea,b,c, Guilherme Vogelb, Paulo J.C. Vieirab,
Lucas P. Santosa,b, Renato Bandeira de Melloa, Hirofumi Tanakad, Sandra C. Fuchsa,c
a
Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
b
Exercise Pathophysiology Research Laboratory, Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
c
National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
d
Cardiovascular Aging Research Laboratory, The University of Texas at Austin, Austin, TX, USA

A R T I C L E I N F O A B S T R A C T

Editor: Christiaan Leeuwenburgh Despite the fact that simultaneous performance of resistance and aerobic exercises (i.e., concurrent exercise) has
Keywords: become a standard exercise prescription for the elderly, no information is available on its effects on post-exercise
Ambulatory blood pressure monitoring hypotension (PEH) in elderly men with hypertension.
Physical activity Purpose: To compare the effects of different types of exercise on PEH in elderly men with hypertension.
Hypertension Methods: Twenty elderly men with essential hypertension participated in three crossover interventions, in
Concurrent training random order, and on separate days: a non-exercise control session at seated rest, aerobic exercise performed for
45 min, and 45 min of concurrent resistance and aerobic exercise consisted of 4 sets of 8 repetitions at 70% 1RM
of resistance exercise followed by aerobic exercise on treadmill. After each session, blood pressure (BP) was
measured continuously for 1 h in the laboratory and for 24 h under ambulatory conditions.
Results: During the first hour in laboratory, diastolic BP was lower after aerobic (−5 mm Hg) and concurrent
exercise (−6 mm Hg) in comparison with Control. Day-time diastolic BP was significantly lower after aerobic
exercise (−7 mm Hg) when compared to the control. No significant differences were found among the three
experimental sessions for night-time and 24-hour diastolic BP, as well as day-time, night-time and 24-hour
systolic BP.
Conclusion: Concurrent exercise produced acute PEH similar to aerobic exercise but such effect did not last as
long as aerobic exercise in elderly patients with essential hypertension.

1. Introduction young healthy populations.

Hypertension is a major risk factor for developing cardiovascular
disease, and over two thirds of elderly population suffer from hy-
pertension in most industrialized countries worldwide (Chow et al.,
2013; Pescatello et al., 2015; Picon et al., 2013). Regular exercise is an
effective non-pharmacological therapy to reduce arterial blood pressure
(BP) in elderly individuals with hypertension (Brandao Rondon et al.,
2002; Cornelissen and Smart, 2013; Moraes et al., 2012; Sillanpaa et al.,
2009). Chronic reductions in BP with regular exercise appear to stem
from the summation of acute blood pressure decreases that occur fol-
lowing single bouts of exercise (called post-exercise hypotension – PEH)
(Kenney and Seals, 1993) (Halliwill et al., 2013). PEH resulting from a
single session has been investigated using different exercise protocols
(Keese et al., 2011) and in several populations (Brandao Rondon et al.,
2002; Eicher et al., 2010; Keese et al., 2011), but predominantly in
In a few previous studies carried out in elderly individuals with
hypertension, significant decreases in systolic and diastolic blood
pressure were observed after 45 min of aerobic exercise performed at
low to moderate intensities (i.e., 50% VO2max) (Brandao Rondon et al.,
2002) and high intensities (i.e., above 70%VO2max) (Taylor-Tolbert
et al., 2000). Additionally, different volumes of resistance exercise (e.g.,
1 and 3 sets) reduced blood pressure during 90 min after exercise with
more pronounced effects observed in the exercise session with higher
volume (Brito Ade et al., 2014). In recent years, it has been recognized
that concurrent training (i.e., a combination of resistance and aerobic
exercises) is the most effective strategy to improve both neuromuscular
and cardiovascular outcomes in elderly individuals (Cadore et al.,
2014). However, very few studies have compared the effects of aerobic,
resistance and concurrent exercise sessions on PEH and all of them used
young healthy participants (Keese et al., 2011; Teixeira et al., 2011).

⁎
Corresponding author at: Centro de Pesquisa Clínica, 21301, LaFiEx, Rua Ramiro Barcelos 2350, Porto Alegre, RS, Brazil.
E-mail address: rod.ferrari84@gmail.com (R. Ferrari).

http://dx.doi.org/10.1016/j.exger.2017.08.012
Received 13 January 2017; Received in revised form 20 July 2017; Accepted 8 August 2017
Available online 10 August 2017
0531-5565/ © 2017 Elsevier Inc. All rights reserved.
R. Ferrari et al.
Keese et al. (2011) performed a study in young men, who did 60 min of
aerobic, resistance or concurrent exercise and found that exercise ses-
sions using concurrent exercise are as effective as aerobic exercise only
to promote PEH. It is unknown if a single session of concurrent exercise
would reduce BP in elderly individuals with hypertension (Cornelissen
and Smart, 2013) and whether the effects on PEH may be greater than
traditional aerobic exercise. In addition, it remains uncertain how long
a single session of concurrent exercise exerts PEH effects measured by
ambulatory blood pressure monitoring among elderly hypertensive in-
dividuals.
Therefore, the main aim of the present study was to compare the
effects of two types of exercise sessions (i.e., concurrent and aerobic
exercise) on postexercise blood pressure among hypertensive elderly
men. Based on results of previous studies that compared aerobic and
concurrent exercises in young participants (Keese et al., 2011), the
working hypothesis was that both concurrent and aerobic exercise
sessions would produce PEH responses with similar magnitude when
compared to the control session.
2. Material and methods
2.1. Participants
The study sample consisted of 20 men aged 60 to 70 years, with
previous physician diagnosis of hypertension. None of the participants
had engaged in regular exercise programs in the last three months. They
were informed about the study procedures and signed a consent form.
The study protocol was conducted according to the Declaration of
Helsinki and was approved by the Institutional Review Board (GPPG
protocol number: 130484) and registered on clinicaltrials.gov (NCT
02415582). The exclusion criteria included tobacco smoking, physical
limitation to perform resistance or endurance exercises, BMI ≥30 kg/
m2, and hypertensive individuals with systolic BP > 60 mm Hg or
diastolic BP > 110 mm Hg.
2.2. Study design and procedures
A randomized crossover trial was performed in order to evaluate the
effects of different exercises on BP (Fig. 1). Participants performed three
experimental sessions in a random order: (i) a non-exercise control
session of seated rest and two exercise bouts, (ii) an aerobic exercise
session; and (iii) a concurrent resistance and aerobic exercise session.
The randomization sequence was generated by computer
(randomization.org), with 1:1:1 allocation using random block sizes of
six, by an independent investigator, and the order of the sessions and
the sequence was concealed to the research team. The participant's
order was accessed only at the first day of experimental sessions. A
washout period of 7 days was implemented among the sessions. Parti-
cipants and investigators were blinded regarding the order of exercise
sessions and the sequence of randomization.
During the “run-in period”, which was necessary to assure the BP
measurement stability prior to the start of the actual protocol, each
participant performed a cardiopulmonary exercise testing and a mus-
cular strength testing in two separated days. The results of these max-
imal exercise tests were used to determine the exercise intensity. The
muscular strength was assessed using the one repetition maximum test
(1RM) on the bilateral elbow flexors, bench press, bilateral knee flexors,
and bilateral knee extensors. Briefly, participants warmed up for 5 min
on a cycle ergometer, performed light and brief stretching for all major
muscle groups, and practiced specific movements with 1 set of 15 re-
petitions with light load in each exercise evaluated (30–40% of the
estimated 1RM test load). Each subject's maximal load (i.e., 1RM) was
determined with no more than five attempts with a five-minute re-
covery period between sets. In order to determine maximal oxygen
consumption (VO2max) and maximal heart rate (HRmax), an incremental
walking exercise test was performed on a treadmill. The protocol
2
Experimental Gerontology 98 (2017) 1–7
consisted of an initial velocity of 3.5 km/h with 1% inclination for the
first 2 min. Thereafter, velocity and grade were incremented by
0.4–0.6 km/h and 0.5–1.0% inclination, respectively, every 1 min until
the participants reached their volitional exhaustion. The expired gas
was analyzed using a metabolic cart (Oxycon Delta, VIASYS, Healthcare
GmbH, Jaeger, Germany). Blood pressure, ECG and heart rate were
continuously monitored and recorded throughout the test. The incre-
mental exercise test was conducted under the direct supervision by a
licensed physician.
2.3. Experimental protocols
Participants performed three experimental sessions in a random
order: an aerobic exercise session (AE), a concurrent resistance and
aerobic exercise session (RAE), and a time control session without any
exercise. They were instructed to avoid coffee and other stimulant
substances during the meal prior to each experimental session. In ad-
dition, each participant was advised to have breakfast at least 2 h be-
fore each session and did not drink water during the experimental
sessions. Moreover, they were instructed to avoid physical exercise and
to keep usual dietary intake throughout the study. Participants who
were taking antihypertensive medications were requested to maintain
their current treatment throughout the course of the investigation.
All experimental sessions started 9:00 AM (at the same time of day
to account for potential diurnal variation in BP) and lasted approxi-
mately 2 h. At the beginning of each session, the participants rested in
the seated position for 20 min and underwent standardized BP mea-
surements in the dominant arm, in triplicate, using a calibrated oscil-
lometric automatic device (Dinamap 1846 SX/P; Critikon, FL, USA).
The first BP measurement was excluded, and the average of the last 2
measurements was used for analyses. During the first hour after each
intervention, BP was measured in the laboratory every 5 min at seated
position using the same device (Dinamap 1846 SX/P; Critikon, FL,
USA). Afterwards, participants underwent the 24-hour ambulatory
blood pressure monitoring (90,207; Spacelabs, WA, USA) programmed
to take BP measurements every 15 min during day-time (11:00 AM to
10:00 PM) and every 20 min during night-time (10:00 PM to 06:00 AM)
(O'Brien et al., 2013). The average of ambulatory BP reading was cal-
culated per hour and for the day-time and night-time periods previously
established. Both the automatic BP device and ambulatory BP mon-
itoring were chosen in order to eliminate the investigator bias.
The aerobic exercise was performed on a treadmill for 45 min at the
exercise intensity corresponding to 65–70% VO2max, monitored through
Reserve Heart Rate or Borg rating of perceived exertion equivalent (i.e.,
Borg scale 11–13)(Binder et al., 2008), for patients receiving beta-
blockers. Heart rate was monitored throughout the exercise session in
order to assure that the intensity of exercise was maintained. The
concurrent resistance and aerobic exercise consisted of 20 min of re-
sistance exercises followed by 25 min of aerobic exercise at 65–70%
VO2max. The resistance exercise was 4 sets of 8 repetitions per set,
performed at 70% 1RM in the following sequence; bench press, bilateral
knee extensors, bilateral elbow flexors, and bilateral knee flexors. An
active interval of 2 min was allowed between sets in each exercise (i.e.,
exercises were grouped in block of two, and within each block the sets
of the second exercise were performed during the rest of the first). Each
contraction (concentric and eccentric) lasted 1.5 s and was controlled
by an electronic metronome. In the control session, the participants
rested in the seated position for 45 min without any physical exercise.
All Participants were instructed to maintain similar activities on the
day before the exercise sessions and during the 24-hour ABPM, after the
experimental sessions.
2.4. Statistical analyses
The sample size was calculated using a previous study with a similar
study design (Keese et al., 2011). In order to provide 80% power to
R. Ferrari et al. Experimental Gerontology 98 (2017) 1–7

Fig. 1. Study flow diagram.

ABPM = ambulatory blood pressure monitoring.

detect a difference of 3 mmHg between two exercise sessions, a total Table 1

sample size of 20 individuals was needed. Trial results were analyzed Selected characteristics of the participants.
using intention-to-treat approach. Results were reported as mean
Variables n = 20
( ± SD) for normally distributed data, which were checked using the
Shapiro-Wilk test. Statistical comparisons throughout the interventions Age, year 65.3 ± 3.3
were performed using two-way ANOVA for repeated measures, with Height, m 1.70 ± 0.10
Body mass, kg 81.0 ± 7.8
sessions (control, aerobic exercise, and concurrent exercise) and time
Body mass index, kg·m− 2 28 ± 2
(pre, post 1 h, total awake, total asleep and 24 h after exercise) as main VO2max, ml·kg− 1·min− 1 32.6 ± 4.6
factors. Post-hoc comparisons were done by Bonferroni test. In order to Maximal heart rate, bpm 145 ± 23
maintain an equal sample size in each experimental session, we im- 1 RM bench press, kg 45 ± 9
puted the 24-hour ABPM values using the average for the control ses- 1 RM arm curl, kg 27 ± 4
1 RM knee extension, kg 109 ± 20
sion. In addition, we calculated the deltas from the difference between
1 RM knee flexion, kg 51 ± 8
each BP measurement and the corresponding baseline at the same Systolic blood pressure, mm Hg 120 ± 13
session. The differences refer to the mean decrease or increase during Diastolic blood pressure, mm Hg 71 ± 10
each hour. Statistical significance was accepted at P < 0.05, and a Anti-hypertensive medications (n)
trend toward significance was detected for P-values ranging from 0.05 No medication 1
β-Blockers 2
to 0.10. The SPSS statistical software package (version 22.0, IBM, New CCB 1
York, NY) was used to analyze the data. Diuretics 1
ACE inhibitor or ARA 4
Combination therapy 11
3. Results
Data are mean ± SD or absolute frequency. VO2max = maximal oxygen con-
As illustrated in Fig. 1, a total of 22 participants were initially en- sumption 1RM = one repetition maximum CCB = calcium channel blockers
rolled in the trial. Two withdrew from the study before the first session ACE = angiotensin-converting-enzyme ARA = angiotensin II receptor antagonist
of exercise, and one participant did not complete the ABPM assessment
during the control session. Table 1 shows that participants were elderly, after AE and RAE in comparison with control at 20 min of recovery
overweight, and had good cardiorespiratory fitness and muscular (P < 0.05), while mean BP was lower after AE and RAE in comparison
strength levels. One participant was not taking blood pressure lowering with control from 10 to 50 min of recovery (P < 0.05). Comparing
drugs, but most of them were taking one (40%) or two (45%) medi- average BP in the first hour after each experimental session with the
cations and 10% were using three anti-hypertensive agents. corresponding pre value, systolic BP tended to decrease after the AE
Resting BP was within the normal range, well-controlled with use of session from 10 to 50 min of recovery and after the RAE session from 10
BP lowering medications (Table 1). Fig. 2 describes the average systolic, to 40 min (P < 0.05), whereas no significant change was found after
diastolic, and mean BP responses within 1 h after the experimental the control session. Diastolic BP decreased after the RAE session from
sessions, observed under the laboratory setting. Significant interactions 10 to 40 min of recovery and at 10 min after the AE session, while it
were found for diastolic BP (P = 0.02) and mean BP (P = 0.006). Be- increased at 10, 40, 50 and 60 min after the control session (P < 0.05).
sides, a trend toward significance was observed for the interaction of Thus, mean BP decreased after the RAE session from 10 to 30 min of
exercise sessions on systolic BP (P = 0.067). Diastolic BP was lower

3
R. Ferrari et al.
recovery and after the AE session at 10 min of recovery, while it in-
creased from 40 to 60 min after the control session (P < 0.05).
Day-time diastolic BP was significantly lower after the aerobic ex-
ercise session (− 7 mm Hg; 95% CI: −11 to − 3 mm Hg; P < 0.001)
when compared with concurrent and control sessions. There was no
significant difference in day-time diastolic BP between the control
session and the concurrent session. No significant differences were
found among the three experimental sessions for night-time and 24-
hour diastolic BP, as well as day-time, night-time and 24-hour systolic
and mean BP (Fig. 3 and Table 2).
4
Experimental Gerontology 98 (2017) 1–7
Fig. 2. Changes in systolic, diastolic, and mean blood
pressure within the sedentary control, aerobic ex-
ercise, and concurrent (resistance + aerobic) exercise
sessions from pre-exercise to post-exercise within the
first hour. P value represents interaction between ex-
perimental sessions ∗ time; * different from pre in each
session; $ aerobic exercise different from control ses-
sion; & concurrent exercise different from control
session; # aerobic and concurrent exercise different
from control session; (*) trend for significance from
pre in each session.
4. Discussion
To the best of our knowledge, this is the first study to evaluate BP
responses after concurrent resistance and aerobic exercises in elderly
men with essential hypertension. We found that the concurrent exercise
reduced BP in the first hour after the exercise session and that the re-
duction was similar to the aerobic exercise alone. However, sustained
reductions in diastolic blood pressure observed in the aerobic exercise
session were not replicated after the concurrent exercise. These results
suggest that an acute bout of concurrent exercise would produce PEH
similar to aerobic exercise, but such effect may not last as long as
aerobic exercise in elderly patients with essential hypertension. Our
finding highlights the use of aerobic exercise as gold standard exercise
R. Ferrari et al. Experimental Gerontology 98 (2017) 1–7

Fig. 3. Changes in systolic (Δ SBP), diastolic (Δ DBP), and mean

(Δ MBP) ambulatory blood pressure with the sedentary control,
aerobic exercise, and concurrent (resistance + aerobic) exercise
sessions.
*Aerobic exercise different from concurrent exercise and control
sessions.

5
R. Ferrari et al. Experimental Gerontology 98 (2017) 1–7

Table 2 issue are warranted.

Ambulatory blood pressure monitoring after the interventions. In contrast to our working hypothesis and in agreement with a
previous study (Terblanche and Millen, 2012), concurrent exercise did
Intervention Blood pressure
not reduce systolic or diastolic ambulatory blood pressure. One session
24-h systolic AE 124.9 ± 8.2 of high-intensity resistance exercise is known to decrease maximal
RAE 127.1 ± 9.4 strength and power over 72 h after the exercise session (Ide et al.,
C 126.1 ± 9.8
2011). It is possible that the residual fatigue resulting from high-in-
Day-time systolic AE 129.0 ± 7.8
RAE 131.3 ± 9.5 tensity resistance exercise elevates the cardiovascular stress during
C 132.1 ± 9.3 daily activities of the participants, impairing the potential PEH of
Night-time systolic AE 117.3 ± 9.3 continuous aerobic exercise when performed simultaneously with re-
RAE 120.3 ± 11.6 sistance exercise. Alternatively, because a significant reduction in sys-
C 116.3 ± 12.7
tolic ambulatory BP monitoring was not observed even in aerobic ex-
24-h diastolic AE 73.6 ± 7.7
RAE 75.5 ± 8.5 ercise session, the lack of change could be due to the lower systolic BP
C 74.6 ± 8.9 at the pre-intervention, which was explained by the well-controlled
Day-time diastolic AE 74.1 ± 7.7⁎ hypertension through the use of anti-hypertensive medications. The
RAE 79.6 ± 7.7
magnitude of the BP reduction after exercise sessions is directly related
C 79.7 ± 8.6
Night-time diastolic AE 67.7 ± 9.3 to the pre intervention BP of participants (Melo et al., 2006; Pescatello
RAE 69.4 ± 10.1 and Kulikowich, 2001; Queiroz et al., 2015), and the absence of dif-
C 67.3 ± 10.3 ferences among the exercises session found in our study may be at-
tributed to this effect.
Data are mean ± SD. Blood pressure (mm Hg); AE, aerobic exercise; RAE, concurrent
The present study provides evidence on blood pressure reduction
(resistance + aerobic) exercise; C, control session;
⁎
AE different from RAE and C (P < 0.001).
after a single session of concurrent resistance and aerobic exercises in
elderly patients with essential hypertension on optimal anti-
to reduce BP. hypertensive treatment. However, in accordance with the hypertension
The present study combined the closely-supervised blood pressure evidence syntheses (Cornelissen and Smart, 2013; Pescatello et al.,
monitoring session in the laboratory setting for 1 h after exercise and 2015) only aerobic exercise session performed alone demonstrates
the ambulatory-monitored blood pressure session conducted at home sustained reductions (12 h) in diastolic blood pressure. Since the com-
thereafter. In the first hour of the post-exercise, when compared to bination of resistance and aerobic exercises is the most effective
control session, diastolic and mean BP decreased after both exercise strategy to improve functional independence in the elderly population
sessions, systolic BP had a tendency to decrease after both aerobic and (Cadore et al., 2014), future studies investigating additional concurrent
concurrent exercise, and the magnitude of hypotension was similar training strategies are encouraged in order to increase the observed
between exercise modes. These results observed in elderly patients with effects and possibly reveal underlying PEH mechanisms of this inter-
hypertension are consistent with previous studies using young healthy vention in hypertensives.
participants (Brandao Rondon et al., 2002; Eicher et al., 2010; Keese Some limitations of the present study should be taken into account
et al., 2011). However, unlike previous studies using a similar design in in order to properly interpret the results. Our present sample consisted
young healthy participants (Brandao Rondon et al., 2002; Eicher et al., of men only, therefore limiting the generalization of our findings to the
2010; Keese et al., 2011), diastolic blood pressure was decreased after female population. There was no resistance exercise only session in the
concurrent exercise but had only a trend toward reduction after aerobic present study. Our participants performed a specific protocol of aerobic
exercise when compared to the corresponding pre value. It is possible exercise and a specific protocol of concurrent exercise that were ex-
that aging and/or hypertension (as well as the associated medication) clusively matched by total duration (45 min). A comparison among
may have affected the plasticity of the vasculature to respond to ex- other protocols might produce results completely different. Moreover,
ercise stimuli differently although differences in exercise protocol be- this study did not evaluate hemodynamic mechanisms responsible for
tween the studies cannot be overlooked. BP reductions in response to aerobic and concurrent exercise sessions,
Although the two primary mechanisms (i.e., peripheral vascular and future studies need to be conducted in order to better understand
resistance and cardiac output) underlying PEH were not evaluated in these mechanisms.
the present study, the prevalent theory is that PEH may be due to a The present study provides several important implications for the
decrease in stroke volume, leading to a reduction in cardiac output that exercise prescription targeted to the elderly population who have es-
was not compensated by an increase in systemic vascular resistance sential hypertension. First, although a combination of resistance and
(Brandao Rondon et al., 2002; Teixeira et al., 2011). Indeed a recent aerobic exercise acutely decreases blood pressure for 1 h, this effect
study suggested that cardiac output reduced in 75% of cases in elderly, does not appear to last long. Second, even for patients who have well-
whereas peripheral vascular resistance did not decrease in this popu- controlled BP, aerobic exercise performed alone is an effective strategy
lation (Brito et al., 2014). to reduce BP during the hours after the cessation of exercise.
Previous studies that assessed the effect of acute aerobic exercise on Considering that BP is directly related to vascular and overall mortality
ambulatory diastolic BP have found reductions in ~4 mm Hg and reduction of 5 mm Hg of BP is associated with a 40% lower risk of
(Pescatello et al., 1991; Taylor-Tolbert et al., 2000) or even no reduc- death (Lewington et al., 2002), our result for aerobic exercise has im-
tion (Guidry et al., 2006). In those studies, participants had higher portant clinical relevance to the elderly population. Future studies need
resting BP than those in the present study. Regression to the mean to investigate the chronic effects of concurrent resistance and aerobic
shows that a greater reduction in diastolic BP would be expected in exercise program on blood pressure and its associated mechanisms in
those with higher resting BP (Queiroz et al., 2015). However, in the elderly patients with hypertension.
present study, in accordance with current guidelines (Pescatello et al.,
2015) we found a reduction of ~7 mm Hg in day-time diastolic BP after 5. Conclusion
aerobic exercise even though the participants had resting BP within the
normotensive range. It will be interesting to speculate that the magni- In conclusion, the present study demonstrates that concurrent re-
tude of reductions would have been greater if the elderly patients with sistance and aerobic exercise produces significant reductions in both
essential hypertension had higher resting BP. Future studies on this diastolic and mean BP in the first hour following exercise in older pa-
tients with essential hypertension. However, the duration of the post-

6
R. Ferrari et al.
exercise hypotension did not last as long as aerobic exercise alone.
Conflict of interests
The authors declare no conflict of interest for the present manu-
script.
Funding
This study was funded, in part, by scholarships from Brazilian
Federal Agency for the Improvement of Higher Education (CAPES,
PNPD 2818/2011) and National Counsel of Technological and
Scientific Development (CNPq), and a grant from Hospital de Clínicas
de Porto Alegre (FIPE-HCPA: no 130484), RS, Brazil.
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