Chagas heart disease is associated with decreased physical activity levels: A cross-sectional analysis.

Background: Studies evaluating physical activity (PA) levels in individuals with Chagas disease (CD) are still scarce. The present study aimed to evaluate PA levels in CD individuals and examine their association with Chagas heart disease (ChHD). Methods: We included patients with CD regularly followed in a reference center for treatment of infectious diseases. PA levels were assessed using the short version of the International Physical Activity Questionnaire (IPAQ). ChHD was determined following the Brazilian Consensus on Chagas Disease. The association between ChHD and levels of PA (total, walking, moderate, and vigorous) as a continuous variable was fitted using generalized linear models. Logistic regression models were fitted to evaluate the association between ChHD and meeting WHO's PA recommendations. Results: Among the 361 participants included in the analysis (60.7 ± 10.7 years; 56.2 % women), 58.1 % (n = 210) complied with the WHO's PA recommendations. After adjustments for potential confounders, regression analyses revealed that ChHD without heart failure was significantly associated with reduced vigorous PA (Exp ß 0.32 95 % CI 0.10 to 0.98). ChHD with heart failure had significantly lower levels of total (Exp ß 0.61 95 % CI 0.44 to 0.84) and moderate (Exp ß 0.59 95 % CI 0.39 to 0.89) PA. ChHD with heart failure had a lower odd of meeting the PA recommendation in comparison to those with no cardiac involvement (OR 0.48 95 % CI 0.24 to 0.97). Conclusions: We found low levels of PA among individuals with CD. Presence of ChHD (mainly with HF) was associated with decreased levels of PA.

Sleep duration and quality during the COVID-19 pandemic and the association with physical activity and screen time among Brazilian college students.

BACKGROUND: As a result of social isolation during the COVID-19 pandemic, changes in sleep patterns have been observed in many countries, as well as changes in physical activity and screen time. The objective was to investigate sleep duration and quality during the COVID-19 pandemic and its association with physical activity and screen time. METHODS: Cross-sectional study with students from a University in Rio de Janeiro who answered an online questionnaire between August 2020 and March 2021. Physical activity was assessed using IPAQ-SF. Sleep was investigated based on questions about duration and sleep quality change, and screen time through self-reported questions. Multinomial logistic regression was performed to assess the association between physical activity and screen time with sleep duration and quality. Secondary analyses investigated the influence of the isolation time on this association. The confounding factors used were diagnosis of COVID-19, time of isolation, anxiety, depression, skin color, and gender. RESULTS: A total of 771 college students with a mean age of 24.5 years (±8.6) answered the questionnaire. About 75% reported more than 8 h of screen time per day and 49.8% were physically inactive. Regarding sleep, 54.9% had worsening sleep, while 40.6% had inadequate sleep duration during the pandemic. Physical activity was associated with improved sleep quality (Odds ratio (OR) 1.72; confidence interval (95% CI) 1.05-2.97). Also, physically active students who spent more than 14 weeks in social isolation demonstrated improved sleep quality (OR 1.99; 95% CI 1.02-3.78) compared to physically inactive individuals. No association was observed for sleep duration. No association was observed between screen time and sleep quality, or sleep duration. CONCLUSION: During the COVID-19 pandemic, there was considerable worsening of sleep quality, and physical activity was positively associated with improved sleep quality.

Association of non-chronic low back pain with physical function, endurance, fatigability, and quality of life in middle- and older-aged adults: Findings from Baltimore Longitudinal Study of Aging.

Low back pain (LBP) is an important condition associated with high healthcare burden. However, the relationship of this condition with physical function (PF) and health-related quality of life (HRQoL) remains unclear. This is a cross-sectional study that aims to investigate the association between presence and intensity of non-chronic LBP with PF and HRQoL in middle-and older-aged adults. Participants answered questions about presence and intensity of LBP in the previous year, self-reported their PF and HRQoL (SF-12), and underwent objective measures of PF ([ExSPPB] including usual gait speed, narrow walk, chair stands, and standing balance), endurance performance ([EP] long-distance corridor walk) and fatigability. Generalized linear models and logistic regression models were performed. A total of 1500 participants (52.5% women, 70.3% white) aged 69.0 (SD 13.1) years were included. Of those, 642 (42.8%) reported LBP and the mean pain intensity was 4.1 (SD 2.2). After adjustments for potential confounders, presence of LBP was associated with lower self-reported PF (OR 1.73, 95% CI 1.27 to 2.37), lower physical component of HRQoL (ß -0.03, 95% CI -0.04 to -0.02) and poorer chair stand performance (ß -0.05, 95% CI -0.09 to -0.008). Higher intensity of LBP was associated with lower physical component of HRQoL (ß -0.01, 95% CI -0.02 to -0.007), poorer ExSPPB performance (ß -0.01, 95% CI -0.02 to -0.004), slower usual gait speed (ß -0.01, 95% CI -0.02 to -0.004), lower total standing balance time (ß -0.01, 95% CI -0.02 to -0.001) and higher fatigability (OR 1.13, 95% CI 1.01 to 1.25). The presence of non-chronic LBP was more consistently associated with lower self-reported PF, while higher intensity non-chronic LBP was associated with poorer objectively measured PF and fatigability. Collectively, this evidence suggests that although presence of pain may affect perception of function, greater pain intensity appears more strongly associated with unfavorable functional performance in mid-to-late life.

Functional capacity and rehabilitation strategies in Covid-19 patients: current knowledge and challenges.

Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.

Functional capacity and rehabilitation strategies in Covid-19 patients: current knowledge and challenges

Abstract Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.

Impactos da dor lombar em adultos de meia idade e idosos - Resultados do Baltimore Longitudinal Study of Aging / Impacts of low back pain in middle and older-aged adults - findings from Baltimore Longitudinal Study of Aging

A dor lombar (DL) é uma preocupação global e urgente de saúde pública pela alta prevalência, repercussões econômicas e sobre outros aspectos da saúde. O objetivo desta tese é produzir dois manuscritos: (1) associação entre presença e intensidade de DL com função física (FF) e qualidade de vida relacionada à saúde (QVRS); (2) associação entre presença e intensidade da DL prévia e no momento com atividade física diária (AF), comportamento sedentário, fragmentação da atividade e alcance das recomendações AF em adultos de meia-idade e idosos. Esta é uma análise transversal com voluntários do Baltimore Longitudinal Study of Aging acima de 40 anos que responderam sobre presença e intensidade da DL no ano anterior Participantes do primeiro manuscrito autorrelataram FF e QVRS (SF-12) e realizaram testes objetivos de FF ([Short Physical Performance Battery Expanded - ExSPPB] incluindo velocidade usual da marcha, Narrow walk, levantar da cadeira, equilíbrio de pé), de endurance (long distance corridor walk) e fatigabilidade. Voluntários do segundo manuscrito usaram acelerômetro Actiheart na semana seguinte à entrevista. Modelos lineares generalizados e de regressão logística foram gerados brutos e ajustados. No manuscrito 1, participaram 1.500 voluntários (52,5% mulheres, 70,3% brancos) com idade média de 69,0 (+13,1). A frequência de DL foi de 42,8%, com intensidade média de 4,1 (+2,2). Após ajustes, presença de DL foi associada à FF autorrelatada (OR 1,73, IC 95% 1,27 a 2,37), domínio físico da QVRS (ß -0,03, IC 95% -0,04 a -0,02) e pior desempenho do levantar da cadeira (ß -0,05, IC 95% -0,09 a -0,008). Maior intensidade de DL foi associada com menor QVRS ­ domínio físico (ß -0,01, IC 95% -0,02 a -0,007), pior desempenho no ExSPPB (ß -0,01, IC 95% -0,02 a -0,004), menor velocidade usual da marcha (ß -0,01, IC 95% -0,02 a -0,004), menor tempo de equilíbrio em pé (ß -0,01, IC 95% -0,02 a -0,001) e alta fatigabilidade (OR 1,13, IC 95% 1,01 a 1,25). No manuscrito 2, participaram 662 voluntários (50,8% mulheres, 68,1% brancos) com idade média de 68,0 (+11,4) anos. A frequência de DL prévia foi de 36,3%, com intensidade média de 3,5 (+2,0), e DL no momento foi de 5,7%, com intensidade média de 4,1 (+2,3). Indivíduos com DL no momento apresentaram menores níveis de AF total (ß -0,18, IC 95% -0,34 a -0,02), vigorosa (ß -0,29, IC 95% -0,56 a -0,007) e menor chance de alcançar as recomendações de AF (OR 0,20, 95% CI 0,05 a 0,92) independente da intensidade da dor. DL prévia não foi associada com os desfechos de AF. Concluímos que a presença de DL foi mais consistentemente associada com FF autorrelatada, enquanto maiores intensidades de DL foram associadas a FF medida objetivamente e alta fatigabilidade. Independentemente da intensidade, a presença de DL no momento parece interferir negativamente nos níveis de AF, dificultando o alcance das recomendações do guia de AF. A diminuição da AF total parece ser impulsionada pela diminuição da vigorosa, sem impacto sobre leve e moderada, comportamento sedentário e fracionamento das atividades.

Low back pain (LBP) is a global and urgent public health concern due to its high prevalence, economic repercussions and other health aspects. The aim of this thesis is to produce two manuscripts: (1) association of presence and intensity of LBP in the previous year and physical function (PF) and health-related quality of life (HRQoL); (2) association between the presence and intensity of previous and current LBP and daily physical activity (PA), sedentary behavior, activity fragmentation and meeting PA guidelines in middle- and older- aged adults. This is a cross-sectional analysis with volunteers from the Baltimore Longitudinal Study of Aging, over 40 years old, who answered questions about presence and intensity of LBP in the previous year. For the first manuscript, participants self-reported PF and HRQoL (SF-12) and performed objective PF tests ([Short Physical Performance Battery Expanded - ExSPPB] including usual gait speed, Narrow walk, chair stands, standing balance), endurance performance (long distance corridor walk) and fatigability. For the second manuscript, volunteers wore Actiheart accelerometers for thr subsequent week. Generalized linear models and logistic regression models were generated crude and adjusted. In manuscript 1, 1,500 volunteers participated (52.5% women, 70.3% white) aged 69.0 (+13.1). 642 (42.8%) reported LBP with mean intensity of 4.1 (+2.2). After adjustments, presence of LBP was associated with self-reported PF (OR 1.73, 95% CI 1.27 to 2.37), physical domain of HRQOL (ß -0.03, 95% CI -0.04 to -0 .02) and poorer chair stand performance (ß -0.05, 95% CI -0.09 to -0.008). Higher LBP intensity was associated with lower HRQoL ­ physical domain (ß -0.01, 95% CI -0.02 to -0.007), poorer ExSPPB performance (ß -0.01, 95% CI -0.02 to -0.004), slower usual gait speed (ß -0.01, 95% CI -0.02 to -0.004), lower total standing balance time (ß -0.01, 95% CI -0.02 to - 0.001) and higher fatigability (OR 1.13, 95% CI 1.01 to 1.25). In manuscript 2, 662 volunteers (50.8% women, 68.1% white) aged 68.0 (+11.4) Years were included. 240 (36.3%) reported previous LBP (<12 weeks) with mean pain intensity of 3.5(+2.0), and 38 (5.7%) current LBP with mean pain intensity of 4.1 (+2 .3). Participants reporting current LBP had lower levels of objectively measured total (ß -0.18, 95% CI -0.34 to -0.02) and vigorous PA (ß -0.29, 95% CI -0.56 to -0.007) and lower odds to meet PA guidelines (OR 0.20, 95% CI 0.05 to 0.92) regardless of pain intensity. Previous LBP was not associated with PA outcomes. We conclude that presence of LBP was more consistently associated with self-reported PF, whereas higher LBP intensity were associated with objectively measured PF and high fatigability. Regardless of intensity, presence of current LBP seems to negatively interfere in PA levels, making difficult to meet PA guidelines recommendation. The decrease in total PA levels seem to be driven by a decrease in vigorous PA, with no impact on light and moderate PA, sedentary behavior and activity fragmentation.

Is Health-related Quality of Life Decreased in Adolescents With Back Pain?

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To evaluate the association between back pain and health-related quality of life (HRQoL) among adolescents. SUMMARY OF BACKGROUND DATA: The prevalence of back pain has been increasing not only in the adult population but also among children and adolescents. The better knowledge about the association between back pain and health-related quality of life could facilitate the implementation of new intervention strategies on prevention and treatment of back pain. METHODS: A sample of 350 students from the fifth to ninth grades of one public school in Niterói, Rio de Janeiro, Brazil. Anthropometric measures and information regarding sociodemographic, lifestyle, frequency and intensity of neck (NP), thoracic (TP), and low back pain in the previous month were collected using a personal digital assistant. HRQoL was assessed by KIDSCREEN-27. Multiple linear regression analyses were performed to investigate the association between back pain and HRQoL by sex. RESULTS: The mean age of participants was 12.7 (±1.6) years. Frequency of NP, TP, and low back pain was 34.3, 27.1, and 13.1%, respectively. The mean intensity of pain was 2.3 (±0.2) for neck, 2.0 (±0.2) for thoracic, and 1.3 (±0.1) for low back pain. The presence of two/three painful sites was reported by 21.7% of the adolescents. The frequency and severity of neck pain were inversely associated with global HRQoL in both the sexes. There is a strong inverse association between the number of painful sites and global HRQoL and domains. CONCLUSION: The presence and intensity of cervical pain and the number of painful regions were associated with lower HRQoL in adolescents, which is worrying due to the important relationship between back pain in the adolescence and in the adulthood. LEVEL OF EVIDENCE: 3.

Dor nas costas e percepção da qualidade de vida relacionada à saúde em adolescentes / Back pain and health-related quality of life among adolescents

A dor musculoesquelética constitui um importante problema de saúde pública na sociedade moderna, não só em adultos, mas também em crianças e adolescentes, sendo as dores cervical e lombar importantes causas de incapacidade nesta população. A alta prevalência de dor nas costas neste grupo etário é um ponto de preocupação devido à importante relação entre dor nas costas na adolescência e na idade adulta. Doenças crônicas geram impactos na qualidade de vida e, embora os estudos em adultos tenham crescido em todo o mundo, a avaliação do bem-estar subjetivo em crianças e adolescentes ainda é escassa. Pouco se sabe sobre o estado geral de saúde de crianças e adolescentes com dor nas costas, e a maioria dos estudos realizados até agora procurou avaliar a prevalência e os fatores de risco associados à dor nas costas. O presente estudo tem como objetivo avaliar a associação entre dor lombar e qualidade de vida relacionada à saúde (QVRS) entre adolescentes. Trata-se de um estudo transversal com uma amostra de 350 alunos do 5º ao 9º ano de uma escola pública de Niterói, Rio de Janeiro. Foram realizadas medidas antropométricas e as informações sociodemográficas, de estilo de vida, frequência e intensidade das dores cervical, torácica e lombar no mês anterior além da QVRS (avaliada por meio do instrumento KIDSCREEN-27) foram autorreferidas. Foram realizadas análises de regressão linear múltipla para investigar a associação entre dor lombar e QVRS, estratificada por sexo. A idade média dos escolares foi de 12,7 (+1,6) anos. A frequência de dor cervical, torácica e lombar foi de 34,3%, 27,1% e 13,1%, respectivamente. A presença de duas ou três regiões dolorosas na coluna foi relatada por 21,7% dos adolescentes. A frequência e a intensidade da dor cervical se mostraram inversamente associadas com a QVRS global em ambos os sexos. Há uma forte associação inversa entre o número de regiões dolorosas na coluna com a QVRS e seus domínios. Os adolescentes sem dor apresentaram maiores escores de QVRS reforçando a ideia de que esta população necessita de maior atenção, uma vez que existe uma importante relação entre a qualidade de vida na adolescência e na vida adulta

Musculoskeletal pain is an important public health problem in modern society, not only in adults, but also in children and adolescents, neck and low back pain are important causes of disability in this population. The high prevalence of back pain in this age group is a point of concern due to the important relationship between back pain in adolescence and adulthood. Chronic diseases have an impact on quality of life, and although studies on adults have grown worldwide, the evaluation of subjective well-being in children and adolescents is still scarce. Little is known about the general health status of children and adolescents with back pain, and most of the studies conducted so far have assed the prevalence and risk factors associated with back pain. The present study aims to evaluate the association between low back pain and health-related quality of life (HRQoL) among adolescents. This is a cross-sectional study with a sample of 350 students from the 5th to 9th grade of a public school in Niterói, Rio de Janeiro. Anthropometric measurements were performed and sociodemographic, lifestyle, frequency and severity information of neck, thoracic and low back pain in the previous month, besides HRQoL (evaluated using the KIDSCREEN-27 instrument) were self-reported. Multiple linear regression analyzes were performed to investigate the association between low back pain and HRQoL, stratified by sex. The mean age of schoolchildren was 12.7 (+1.6) years. The frequency of neck, thoracic and low back pain was 34.3%, 27.1% and 13.1%, respectively. The presence of two or three painful sites in the spine was reported by 21.7% of adolescents. The frequency and severity of neck pain were inversely associated with global HRQoL index in both sexes. There is a strong inverse association between the number of painful sites in the spine with the global HRQoL index and their domains. Adolescents without pain had higher HRQoL scores, reinforcing the idea that this population needs more attention, since there is an important relationship between quality of life in adolescence and in adult life

Evasão de um programa de tratamento multidisciplinar para mulheres com fibromialgia / Dropout of a multidisciplinary treatment program for women with fibromyalgia

Objetivo: Avaliar a evasão de um programa de tratamento multidisciplinar da fibromialgia (FM). Métodos: Estudo observacional realizado durante o período de abril de 2000 adezembro de 2005, incluindo 133 mulheres com FM, participantes de um programa de tratamento multidisciplinar. As que se afastaram do tratamento por período de duas semanas ou mais foram classificadas como inativas e contatadas por telefone para registro dos motivos de sua evasão, sendo estes divididos em quatro grupos: 1) Familiares; 2) Ocupações;3) Médicos; 4) Outros Motivos. Resultados: No momento da coleta de dados, 92 (69,4%) mulheres foram consideradas como inativas. Não houve diferença significativa entre a evasão de antes e de após seis meses de tratamento. Do total de mulheres inativas, 54 (40,8%) participantes evadiram por motivos médicos, 30 (22,6%) por outros motivos, 26 (19,4%) por motivos familiares e 23 (17,2%) por ocupação. Não foi observada diferença estatística entre os motivos de evasão de acordo com o tempo de permanência no programa (p > 0,05). Conclusão: Conclui-se que o programa multidisciplinar para mulheres com FM apresentou níveis elevados de evasão, sendo que metade destes ocorreu nos seis primeiros meses. Dentre os principais motivos relatados para o abandono, os motivos médicos foram mais observados.

Objective: To evaluate the dropout of a multidisciplinary treatment program in fibromyalgia (FM). Methods: An observational study conducted during the period of April 2000 to December 2005, including 133 women with fibromyalgia, participating in a multidisciplinary treatment program. Those who had left the treatment for two weeks or more were classified as inactive and contacted by telephone to record the reasons for their noncompliance, which were divided into four groups: 1) Family; 2) Occupations; 3) Medical; 4) Other Reasons. Results: When collecting data, 92 (69.4%) women were considered inactive. There was no significant difference between noncompliance before and after six months of treatment. Of the total number of inactive women, 54 (40.8%) participants left for medical reasons, 30 (22.6%) for other reasons, 26 (19.4%) for family reasons and 23 (17.2%) due to occupation. There was no statistical difference between the motives of dropout according to the length of stay in the program (p> 0.05). Conclusion: We conclude that the multidisciplinary program for women with fibromyalgia had high levels of noncompliance, half of them occurred in the first six months. Among the main reasons reported for dropout, the medical reasons were more frequent.