Adiponectin Concentration and Chronic Stroke Individuals, Associations with Body Composition, Physical Activity Levels and Lipid Profile: A Cross-Sectional Explorative Study.

OBJECTIVE: Higher adiponectin concentration has been associated with the presence of sarcopenia in individuals with cardiovascular diseases. Post-stroke individuals presented higher adiponectin concentrations than non-stroke ones. However, no previous study has investigated the association between the adiponectin concentration and skeletal muscle mass in post-stroke individuals. On the other hand, higher adiponectin concentration has been associated with a more favorable lipid profile and the physical activity level might regulate adiponectin concentration. These associations have not been studied in this population. Thus, the main objective of this study was to determine whether the adiponectin concentration is associated with: (1) body composition; (2) lipid profile; and (3) physical activity level in chronic post-stroke individuals. MATERIALS AND METHODS: This study was a correlational, cross-sectional exploratory study. Data on body composition and lipid profile were collected using a bioelectrical impedance analyzer (InBody® 720) and an automated method analyzer (CELL-DYN Ruby), respectively. The physical activity level was measured by the StepWatch® Activity Monitor and the serum adiponectin concentration was analyzed using an enzyme-linked immunosorbent assay kit. Correlation analyses were made using Spearman's rank correlation coefficient (rs). RESULTS: Twenty-one post-stroke participants took part in the study. The adiponectin concentration was associated with the following: skeletal muscle mass (rs = -0.78), skeletal muscle mass index (rs = -0.75) and high-density lipoprotein (rs = 0.43). CONCLUSIONS: A greater adiponectin concentration is associated with a lower skeletal muscle mass and a higher high-density lipoprotein level in chronic post-stroke individuals, but not with physical activity levels.

Interrater and Intrarater Reliability and Minimum Detectable Change of Ultrasound for Active Myofascial Trigger Points in Upper Trapezius Muscle in Individuals With Shoulder Pain.

OBJECTIVE: We sought to investigate the interrater and intrarater reliability of ultrasound and the minimum detectable change (MDC) for the trigger points (TrPs) active in the upper trapezius (UT) muscle in individuals with shoulder pain. METHODS: Forty individuals with shoulder pain were investigated for the presence of active TrPs in the UT muscle by means of ultrasound for the parameters of gray scale, muscle thickness of UT muscle at rest, and contraction and area of TrPs. The intrarater reliability was performed on 2 days, and interrater reliability on the same day. For the gray scale, the reliability was evaluated using the kappa coefficient (κ), while the other parameters were measured by the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and MDC. RESULTS: For the gray scale, the intrarater agreement was almost perfect (κ = 1.00) and the interrater agreement was substantial (κ = 0.75). The intrarater and interrater reliability were excellent for most of the parameters, except for the area of TrPs (intrarater: ICC = 0.71, substantial; interrater: ICC = 0.52, substantial). The MDC for intrarater reliability varied between 0.04 and 0.05 (SEM% between 2.4% and 38.87%), and that for interrater reliability ranged from 0.05 to 0.07 (SEM% between 3.18% and 55.10%), with a higher value for area. CONCLUSION: Parameters such as gray scale, resting muscle thickness, and muscle contraction of the UT muscle, obtained through ultrasound, showed excellent intrarater and interrater reliability with low SEM%. The intrarater and interrater reliability for the area deserves a caveat regarding their use.

The Effectiveness of Ischemic Compression Technique on Pain and Function in Individuals With Shoulder Pain: A Systematic Review.

OBJECTIVE: To systematically review current literature to determine the effectiveness of the ischemic compression (IC) technique on pain and function in individuals with shoulder pain. METHODS: This review was conducted according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration for Systematic Reviews; a search was performed in the electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence Database, and Web of Science. Randomized clinical trials and quasi-randomized clinical trials were included, and the methodological quality was evaluated through the Physiotherapy Evidence Database scale. RESULTS: The search found 572 studies; of these, 71 were selected by title and, subsequently, 29 were selected through abstract analyses. After critical analyses, 5 studies were included. The methodological quality ranged from 4 (reasonable) to 9 (excellent) points. Pain was assessed by all studies using the visual analog scale, Global Perceived Effect scale, Numerical Rating Scale, pressure pain threshold, or Perceived Amelioration Numerical Scale. Function was evaluated by 3 studies through the Shoulder Pain and Disability Index; Neck Disability Index; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment; and Disabilities of the Arm, Shoulder, and Hand questionnaires. The studies showed that the IC technique produces immediate and short-term positive effects for pain, and positive short-term effects for shoulder function in individuals with shoulder pain. CONCLUSION: The IC technique seems to be beneficial for pain and shoulder function. However, caution is needed when considering this evidence owing to the limited quality of some studies, the few articles found, and the lack of standardization of the application parameters of the technique to facilitate its reproducibility.

Fatty infiltration in the thigh muscles in knee osteoarthritis: a systematic review and meta-analysis.

Knee osteoarthritis is a chronic degenerative joint disease, influenced by inflammatory, mechanical and metabolic processes. Current literature shows that thigh muscles of people with knee osteoarthritis can have increased infiltration of fat, both between and within the muscles (inter- and intramuscular fat). The fatty infiltration in the thigh in this population is correlated to systemic inflammation, poor physical function, and muscle impairment and leads to metabolic impairments and muscle disfunction. The objective of this study is to systematically review the literature comparing the amount of fatty infiltration between people with knee osteoarthritis and healthy controls. A literature search on the databases MEDLINE, Embase, CINAHL SPORTDiscuss, Web of Science and Scopus from insertion to December 2018, resulted in 1035 articles, from which 7 met inclusion/exclusion criteria and were included in the review. All included studies analyzed the difference in intermuscular fat and only one study analyzed intramuscular fat. A meta-analysis (random effects model) transforming data into standardized mean difference was performed for intermuscular fat (six studies). The meta-analysis showed a standardized mean difference of 0.39 (95% confidence interval from 0.25 to 0.53), showing that people with knee osteoarthritis have more intermuscular fat than healthy controls. The single study analyzing intramuscular fat shows that people with knee osteoarthritis have more intramuscular fat fraction than healthy controls. People with knee osteoarthritis have more fatty infiltration around the thigh than people with no knee osteoarthritis. That conclusion is stronger for intermuscular fat than intramuscular fat, based on the quality and number of studies analyzed.

Influence of a periodized circuit training protocol on intermuscular adipose tissue of patients with knee osteoarthritis: protocol for a randomized controlled trial.

BACKGROUND: The objective of this study is to analyze the influence of a 14-week periodized circuit training protocol on patients with knee osteoarthritis (OA), in randomized intervention groups, on thigh intermuscular adipose tissue (interMAT), body composition, systemic inflammation, cartilage degradation, and its repercussion on pain, functional performance and quality of life. METHODS: This study presents a protocol for a randomized controlled trial. Sixty selected participants diagnosed with knee OA grades II and III, 40-65 years old and BMI < 30 kg/m2, will be randomly divided into three groups:periodized circuit training, strength training, and educational protocol. The circuit training and strength training protocols consist of 14-week training protocols conducted 3 times a week. The circuit training group will perform selected exercises previously stratified as light, moderate, and intense, arranged progressively in a circuit model, the strength group will perform regular strength exercises, and the educational protocol group will participate in a 14-week protocol with lectures twice a month about healthy lifestyles. Baseline and follow-up evaluations will be conducted for thigh interMAT (computed tomography), body composition (DXA), inflammation (IL-1ß, IL-6, IL-10, TNF-α, leptin, and adiponectin), and joint degradation biomarkers (uCTX-II and sCOMP), performance-based tests (30s Chair Stand Test, 40 m Fast-paced Walk Test and Stair Climb Test), quadriceps and hamstring maximal isometric voluntary contraction (MIVC), and questionnaires (WOMAC and pain catastrophizing scale). Repeated measures ANOVA will be used to compare differences between groups (circuit training X strength training X educational protocol) at the different times of assessment (baseline x follow-up or baseline x during protocol x follow-up) for each of the dependent variables. When significant main effects were found, the pots hoc Bonferroni test will be used to identify statistical differences. A significance level of 5% (p < 0.05) will be adopted. DISCUSSION: This will be the first randomized controlled trial to assess the effects of a circuit training protocol on patients with knee OA on thigh intermuscular adipose tissue (interMAT). Given the prevalence and impact of OA and the widespread availability of this intervention, assessing the efficacy of a low-cost, non-pharmacological, and non-invasive treatment for knee OA patients has the potential for immediate and high clinical impact. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02761590 , registered in May 4, 2016.

Effects of inspiratory muscle training in professional women football players: a randomized sham-controlled trial.

This study was conducted to determine the effects of inspiratory muscle training (IMT) on respiratory and peripheral muscles oxygenation during a maximal exercise tolerance test and on repeated-sprint ability (RSA) performance in professional women football players. Eighteen athletes were randomly assigned to one of the following groups: SHAM (n = 8) or IMT (n = 10). After a maximal incremental exercise test, all participants performed (on a different day) a time-to-exhaustion (Tlim) test. Peripheral and respiratory muscles oxygenation by near-infrared spectroscopy, breath-by-breath ventilatory and metabolic variables, and blood lactate concentration were measured. The RSA test was performed on a grass field. After a 6 week intervention, all athletes were reevaluated. Both groups showed increases in inspiratory muscles strength, exercise tolerance and RSA performance, however only the IMT group presented lower deoxyhemoglobin and total hemoglobin blood concentrations on intercostal muscles concomitantly to an increased oxyhemoglobin and total hemoglobin blood concentrations on vastus lateralis muscle during Tlim. In conclusion, these results may indicate the potential role of IMT to attenuate inspiratory muscles metaboreflex and consequently improve oxygen and blood supply to limb muscles during high-intensity exercise, with a potential impact on inspiratory muscle strength, exercise tolerance and sprints performance in professional women football players.

Low-level laser therapy prevents degenerative morphological changes in an experimental model of anterior cruciate ligament transection in rats.

The aim of this study was to analyze the effects of low-level laser therapy (LLLT) on the prevention of cartilage damage after the anterior cruciate ligament transection (ACLT) in knees of rats. Thirty male rats (Wistar) were distributed into three groups (n = 10 each): injured control group (CG); injured laser-treated group at 10 J/cm(2) (L10), and injured laser-treated group at 50 J/cm(2) (L50). Laser treatment started immediately after the surgery and it was performed for 15 sessions. An 808 nm laser, at 10 and 50 J/cm(2), was used. To evaluate the effects of LLLT, the qualitative and semi-quantitative histological, morphometric, and immunohistochemistry analysis were performed. Initial signs of tissue degradation were observed in CG. Interestingly, laser-treated animals presented a better tissue organization, especially at the fluence of 10 J/cm(2). Furthermore, laser phototherapy was able of modulating some of the aspects related to the degenerative process, such as the prevention of proteoglycans loss and the increase in cartilage area. However, LLLT was not able of modulating chondrocytes proliferation and the immunoexpression of markers related to inflammatory process (IL-1 and MMP-13). This study showed that 808 nm laser, at both fluences, prevented features related to the articular degenerative process in the knees of rats after ACLT.

Muscle stretching after immobilization applied at alternate days preserves components of articular cartilage.

We compared the response of articular cartilage subjected to muscle stretching at different frequencies after joint immobilization. Wistar rats with immobilized left hind limbs were classified into the following groups: immobilization, immobilization followed by muscle stretching applied daily (group IS7) or three times a week (IS3), muscle stretching applied daily (S7) or three times a week (S3), and a control group (C) that underwent no intervention. We then evaluated the cartilage for cellularity, loss of proteoglycans, collagen density, and immunostaining of fibronectin and chondroitin 4-sulfate. Group IS7 showed a significant increase in cellularity and significant loss of proteoglycan compared with the control. In addition, IS7 group had less proteoglycan than IS3. Thin collagen fibrils were significantly reduced in IS7 rats, compared with IS3 and C. There was a significant decrease in the amount of thick fibrils in all groups compared with the control. Groups IS7 and IS3 showed significantly more intense fibronectin immunostaining than the other groups. Our results show that if applied daily after immobilization, muscle stretching is harmful to articular cartilage. However, when applied on alternate days, muscle stretching preserves the components of articular cartilage. We suggest that the latter frequency is more suitable for treatment.

Ischemic compression associated with joint mobilization does not promote additional clinical effects in individuals with rotator cuff related shoulder pain: A randomized clinical trial.

OBJECTIVE: The objective of this study was to verify which are the additional effects of the ischemic compression (IC) technique associated with joint mobilization techniques on pain, morphological aspects of myofascial trigger points (MTrPs), function, and psychological aspects in individuals with rotator cuff-related shoulder pain (RCRSP). METHODS: Sixty individuals with RCRSP were randomly allocated intervention sessions the Mobilization Group (MG, n = 20), only joint mobilizations of the shoulder complex; intervention sessions Compression Group (CG, n = 20), with the same mobilizations associated with the IC over MTrPs; and Placebo Group (PG, n = 20), with the same mobilizations associated with placebo of IC. All interventions performed 2 per week, for 6-weeks. Pain was assessed by Visual Analogue Scale and function by the Disabilities of the Arm, Shoulder and Hand questionnaire. The kinesiophobia, pain catastrophizing, perception of improvement, mobility, pain threshold and area the MTrPs were also evaluated at baseline (week-0), after 6-weeks and after 10-weeks. RESULTS: There were no between-group difference in pain: CG-MG 0.8 (95% CI 0.4 to 1.2), CG-PG 0.5 (95% CI 0.0 to 0.9), MG-PG -0.3 (95% CI -0.8 to 0.1) after 6-weeks and CG-MG 0.1 (95% CI -0.2 to 0.5), CG-PG -0.7 (95% CI -0.9 to -0,4), MG-PG -0,8 (95% CI -1.07 to 0.5) at 10-weeks. Similar effects were observed on function, characteristics of MTrPs and psychological aspects. CONCLUSION: The IC technique on the MTrPs of the upper trapezius muscle associated with joint mobilization techniques has no additional effect on pain in individuals with RCRSP. TRIAL REGISTRATION: RBR-44v8y7.

Face-to-face and telerehabilitation delivery of circuit training have similar benefits and acceptability in patients with knee osteoarthritis: a randomised trial.

QUESTION: Is periodised circuit training delivered via a telerehabilitation model of care as effective as the same training applied face-to-face for improving pain intensity, physical function, muscle strength, pain catastrophising, body composition, intermuscular adipose tissue and muscle architecture in people with knee osteoarthritis (OA)? DESIGN: Randomised controlled, non-inferiority trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: One hundred adults aged ≥ 40 years with knee OA and pain for ≥ 3 months, with current pain ≥ 40 mm on a 100-mm visual analogue scale (VAS). INTERVENTION: The experimental group received 14 weeks of circuit training delivered via telerehabilitation using video recordings, followed by periodic phone calls in order to motivate and instruct participants. The control group received the same circuit training program in a face-to-face format. OUTCOME MEASURES: The primary outcomes were pain VAS and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale, measured at 14 weeks. Secondary outcomes included objective physical function, strength, pain catastrophising and morphological measures (muscle architecture and thigh and body composition). Outcomes were measured at 14 and 26 weeks. RESULTS: Periodised circuit training delivered via telerehabilitation had equivalent effects to face-to-face delivery for pain intensity, physical function, muscle strength, pain catastrophising, thigh composition, intermuscular adipose tissue and muscle architecture. Whole body composition did not change appreciably in either group. Adherence to the training was excellent and participants in each group reported good perceptions of their randomised intervention. CONCLUSION: A periodised circuit training protocol can be delivered to people with knee OA in their own homes, using available technology while maintaining high levels of acceptability. More importantly, telerehabilitation appears to cause non-inferior physical and functional outcomes to face-to-face rehabilitation programs. TRIAL REGISTRATION: RBR-662hn2.

Older Adults With Alzheimer's Disease Have Lower Bone Mineral Density Compared to Older Adults Without Dementia: A Systematic Review With Meta-analysis of Observational Studies.

BACKGROUND AND PURPOSE: The literature has associated bone mineral density (BMD) and Alzheimer's disease (AD). The aim of the present systematic review was to investigate BMD in older adults with AD compared with older adults with no dementia. METHODS: Searches were performed in the MEDLINE, EMBASE, CINAHL, and Web of Science databases from inception to May 2022. Observational studies that compared BMD in the populations of interest were included. Methodical quality (risk of bias) was appraised using the Newcastle-Ottawa Scale. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Standardized mean differences (SMD) were calculated for meta-analyses. RESULTS AND DISCUSSION: Five studies were included, involving a total of 1772 older adults (373 with AD and 1399 with no dementia). A first meta-analysis compared 207 older adults with AD and 1243 with no dementia for BMD in the femoral neck. The results showed lower BMD in the AD groups (SMD =-1.52; 95% CI, -2.61 to -0.42; P = .007, low quality of evidence). A second meta-analysis considering different sites of the body (whole body, trunk, femur, and lumbar spine) also showed lower BMD in older adults with AD compared with the group with no dementia (SMD =-0.98; 95% CI, -1.91 to -0.05; P = .04, low quality of evidence). Newcastle-Ottawa Scale scores ranged from 7 to 9, indicating low risk of bias. CONCLUSIONS: Bone mineral density is lower in older adults with AD than in older adults with no dementia, especially in the femoral neck. These results suggest that older adults with AD may be at greater risk of developing osteopenia and osteoporosis. Current clinical practice guidelines should be amended for screening frequency and methodology for this particular cohort. Further studies are needed to confirm whether older people with AD have lower BMD in other sites of the body.

Aerobic and Resistance Training Attenuate Differently Knee Joint Damage Caused by a High-Fat-High-Sucrose Diet in a Rat Model.

OBJECTIVE: Obesity and associated low-level local systemic inflammation have been linked to an increased rate of developing knee osteoarthritis (OA). Aerobic exercise has been shown to protect the knee from obesity-induced joint damage. The aims of this study were to determine (1) if resistance training provides beneficial metabolic effects similar to those previously observed with aerobic training in rats consuming a high-fat/high-sucrose (HFS) diet and (2) if these metabolic effects mitigate knee OA in a diet-induced obesity model in rats. DESIGN: Twelve-week-old Sprague-Dawley rats were randomized into 4 groups: (1) a group fed an HFS diet subjected to aerobic exercise (HFS+Aer), (2) a group fed an HFS diet subjected to resistance exercise (HFS+Res), (3) a group fed an HFS diet with no exercise (HFS+Sed), and (4) a chow-fed sedentary control group (Chow+Sed). HFS+Sed animals were heavier and had greater body fat, higher levels of triglycerides and total cholesterol, and more joint damage than Chow+Sed animals. RESULTS: The HFS+Res group had higher body mass and body fat than Chow+Sed animals and higher OA scores than animals from the HFS+Aer group. Severe bone lesions were observed in the HFS+Sed and Chow+Sed animals at age 24 weeks, but not in the HFS+Res and HFS+Aer group animals. CONCLOSION: In summary, aerobic training provided better protection against knee joint OA than resistance training in this rat model of HFS-diet-induced obesity. Exposing rats to exercise, either aerobic or resistance training, had a protective effect against the severe bone lesions observed in the nonexercised rats.

Effects of telehealth on functional capacity, mental health and quality of life among older people with dementia: LAPESI telehealth protocol for a randomized controlled trial.

BACKGROUND: Telehealth can be an alternative action at a distance that can help as a form of motor intervention, alleviating the deleterious effects arising from social distancing on functional capacity, mental health and quality of life among older people with dementia during the COVID-19 pandemic. PURPOSE: We aim to analyze the effects of a telehealth program on functional capacity, mental health and quality of life among older people with dementia and their caregivers. METHODS: seventy-eight individuals with mild and moderate dementia and their caregivers will answer an anamnesis and be evaluated through Clinical Dementia Assessment Score. They will also be evaluated by blinded examiners in terms of functional capacity (Activities of Daily Living Questionnaire and World Health Organization Disability Assessment Schedule 2.0), mental health (Mini-Mental State Examination, Clock Drawing Test, Verbal Fluency test and the Neuropsychiatric Inventor) and quality of life (Quality of Life in Alzheimer's Disease scale). Afterward, the volunteers will be randomized into the telehealth training group and the control group. The TR will perform systematic physical and cognitive exercises in 50-min sessions three times a week with professional monitoring, while the CG will receive non-systematized guidance, both for 12 weeks. Participants will be evaluated at baseline, immediately after the three-month interventions and with a 12-week follow- up. DISCUSSION: Technological approaches such as telehealth can be a viable alternative in home care service during times of pandemic. We expect that older people with dementia and their caregivers have high adherence to the telehealth program and improve their functional capacity, mental health and quality of life of older people with dementia. Telehealth is an alternative that can contribute to public policies and the development of effective intervention strategies that neutralize adverse outcomes. It can also be presented as an alternative to home care services, which could reduce demands for health resources.

Analysis of the deep digital flexor tendon in rats submitted to stretching after immobilization.

Few studies have analyzed the effect of stretching after immobilization on the structural and biochemical properties of tendons. Here, the effect of stretching and immobilization on the proximal (p), intermediate (i), and distal (d) regions of the deep digital flexor tendon in rats was analyzed. The d region was subjected to compression and tension forces, the i region was subjected to compressive forces and the p region received tension forces. Rats were separated into five groups: GI--control for GII; GII--immobilized rats; GIII--control for GIV and GV groups; GIV--immobilized and stretched rats; and GV--immobilized rats which were allowed free cage activity. GII showed a higher molecular organization in the d and p regions as detected by measuring optical retardation, a lower concentration of hydroxyproline in the i region and a significant decrease in noncollagenous proteins found in the three regions of the tendon. Regarding the glycosaminoglycans, diminishing dermatan sulfate and the absence of chondroitin sulfate in the i region were observed in GII when compared to GI. However, in the same region of GIV, higher concentrations of chondroitin and dermatan sulfate were observed along with a strong metachromasy. An increase in hydroxyproline content in the i region and a higher molecular organization in the d and p regions were observed in GIV. Apparently, the active isoforms of metalloproteinase-2 also increased after stretching in all regions. These results suggest that stretching after immobilization contributed to the increase in molecular organization and to the synthesis of extracellular matrix components.

Progression of articular cartilage degeneration after application of muscle stretch.

The aim of study was to evaluate the progression of the ankle articular cartilage alterations after a post-immobilization muscle stretching. Twenty-nine Wistar rats were separated into five groups: C--control, S--stretched, SR--stretch recovery, IS--immobilized and stretched, and ISR--immobilized stretched recovery. The immobilization was maintained for 4 weeks and the left ankle was then stretched manually through a full dorsal flexion for 10 times for 60 s with a 30 s interval between each 60 s period, 7 days/week for 3 weeks. The recovery period was of 7 weeks. At the end of the experiment, the left ankles were removed, processed in paraffin, and stained in hematoxylin-eosin and safranin O. Two blinded observers evaluated the articular cartilage using the Mankin grading system (cellularity, chondrocyte cloning, and proteoglycan content) through light microscopy, and performed the morphometry (cellularity, total thickness, non-calcified thickness, and calcified thickness measures). Both the Mankin grading system and the morphometric analysis showed that the ISR group presented the most increased cellularity among the groups. The IS and SR groups showed the highest proteoglycan loss, and the ISR group showed the same content of proteoglycan observed in the C group. No significant differences were found in the chondrocyte cloning, the total cartilage thickness, the non-calcified cartilage thickness, and the calcified cartilage thickness among the groups. The results suggest that the cartilage can recover the proteoglycan loss caused by immobilization and stretching, probably because of the increased chondrocyte density. Therefore, the ankle articular cartilage responded as to repair the metabolic deficits.

Serratus anterior sEMG - sensor placement and test position for normalization purposes during maximal and submaximal exertions.

There is great variability regarding serratus anterior sEMG sensor placement and test positions during normalization procedures. We investigated between-trials reliability of serratus anterior sEMG, acquired at two sensor placements and four test positions, during maximal and submaximal isometric contractions. Twenty young healthy women participated. sEMG was captured at the 7th intercostal space and at the xiphoid process level, in the mid-axillary line, during maximal and submaximal isometric contractions, in four test positions. Intraclass Correlation Coefficient (ICC2,1), coefficient of variation and standard error of measurement were calculated. Interactions between sensor placements and test positions were investigated using a two-way repeated-measures ANOVA. All test conditions presented ICC2,1 > 0.8. There was no interaction between sensor placement and test position. Signal obtained from the sensor at 7th intercostal space was more stable between-trials and showed higher amplitude, during maximal and submaximal contractions, at seated positions with shoulder protracted at both 90° or 125° of flexion. We suggest to acquire serratus anterior sEMG at the 7th intercostal space and perform maximal or submaximal isometric contractions for signal normalization with shoulder protracted and flexed, at seated position.

Serum activity of matrix metalloproteinase-2 and -9 is increased in chronic post-stroke individuals: a cross-sectional exploratory study.

BACKGROUND: High concentrations of matrix metalloproteinase-2 (MMP-2) and -9 (MMP-9) are associated with inflammation early after stroke. In chronic stages, the elevation of some cytokines is related to the presence of co-morbid conditions in these individuals. In addition to this, some characteristics such as sensorimotor impairment, atrophy, and sedentary lifestyle predispose the system to an inflammatory response. OBJECTIVE: To quantify MMP-2 and -9 serum activity in chronic post-stroke individuals and correlate it with variables of physical activity level, body composition, functional and walking capacity, and with inflammatory biomarkers. Additionally, gelatinase activity was characterized according to motor impairment. METHODS: Fourteen patients with stroke onset >6 months and seven healthy individuals were enrolled in this study. The clinical assessment included: body composition, measure by bioelectrical impedance analyzer; Fugl-Meyer Motor Assessment Scale; six-minute and ten-meter walk tests, and physical activity level assessed by the StepWatch® Activity Monitor. Blood samples were collected from antecubital vein and serum MMP-2 and -9 activity was analyzed using gelatin Zymography, and the TNFα, IL-6, IL-1ß, IL-10 biomarkers using ELISA kits. RESULTS: Chronic post-stroke individuals presented an increased activity of MMP-2 and -9 compared to healthy individuals. Positive correlations with time and steps in low cadence and negative ones with medium cadence and peak activity index were observed. According to the motor impairment, the MMP-2 activity was increased in the mild-moderate group compared to the control group. CONCLUSION: Increased gelatinases in chronic post-stroke individuals could describe an inflammation process related to the limited capacity of walking in high intensities.

Effects of a periodized circuit training protocol delivered by telerehabilitation compared to face-to-face method for knee osteoarthritis: a protocol for a non-inferiority randomized controlled trial.

BACKGROUND: Regular exercise is an effective method for reducing pain and disability in patients with knee osteoarthritis (OA), as well as improving body composition. Thus, a combination of both resistance and aerobic training (circuit training) has shown to be promising for this population. However, access to physical therapy is limited by physical distance, social isolation, and/or treatment costs. Remote rehabilitation seems to be an effective way to minimize these barriers, but the benefits are dependent on the participants' adherence to the interventions provided at a distance. The objectives of this protocol are to compare the effects of a periodized circuit training applied via telerehabilitation with the same protocol applied in the face-to-face model for individuals with knee OA. METHODS: This study presents a single-blinded protocol for a non-inferiority randomized controlled trial. One hundred participants diagnosed with knee OA (grades II and III Kellgren and Lawrence system), aged 40 years or more, and BMI < 30 kg/m2 will be randomly divided into two groups: telerehabilitation (TR) and face-to-face (FtF) circuit training. The FtF group will perform a 14-week periodized circuit training protocol supervised by a physical therapist, 3 times a week. The TR group will perform the same exercise protocol at home, at least 3 times a week. In addition, the TR group will be able to follow the execution and orientations of the exercises by DVD, a website, and online file sharing tools, and they will receive periodic phone calls in order to motivate, clarify, and inform some aspects of knee OA. The primary outcomes are changes in self-reported pain intensity (visual analog scale (VAS)) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), with a primary end-point of 14 weeks and a secondary end-point of 26 weeks. Secondary outcomes include changes in other clinical outcomes, in morphological characteristics, adherence, acceptability, and treatment perspective. DISCUSSION: A circuit training through telerehabilitation may contribute to developing early intervention in the causative and potentiating factors of the knee OA, verifying the effects of a low-cost, non-pharmacological and non-invasive treatment. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-662hn2. Registered on 31 March 2019. Link: http://www.ensaiosclinicos.gov.br ; Universal Trial Number (UTN) of World Health Organization: U1111-1230-9517.

Reductions of cardiovascular and metabolic risk factors after a 14-week periodized training model in patients with knee osteoarthritis: a randomized controlled trial.

INTRODUCTION/OBJECTIVE: To evaluate the effects of a periodized circuit training (CT) compared with a conventional strength training (ST) and an educational protocol (EP) on body composition, metabolic parameters, muscle strength, pain, and physical performance in patients with knee osteoarthritis (KOA). METHOD: This study followed a randomized controlled trial design. A sample of sixty-one patients with KOA, 40-65 years old and BMI < 30 kg/m2, were randomly divided into three 14-week protocols: CT, ST, or EP. The CT performed whole body exercises organized in circuit, 3 times a week. The ST performed conventional resistance exercises also 3 times a week, and the EP joined in educational meetings twice a month. Body composition (dual-energy X-ray absorptiometry (DXA)); metabolic parameters (abdominal obesity, triglyceride, HDL, blood pressure and fasting glucose), knee maximal isometric voluntary contraction (MIVC) extension and flexion, performance-based tests (40-m walk test, 30-s chair test, and stair climb test), self-reported pain, stiffness, and physical function (WOMAC) and pain catastrophism were evaluated at baseline and follow-up. Repeated measures ANOVA were used to compare differences between groups (CTxSTxEP) at the different times of assessment (baseline × follow-up). When group-time interaction was found, a one-way ANOVA, followed by a Bonferroni post hoc test, was used to compare groups in each time point; while a paired t test was used to verify the time effect in each group. Additionally, the training effect was analyzed in terms of the percent change (Δ%). Effect size was calculated for post intervention (week 14) between groups. For all analyses a significance level of 5% was adopted (p < 0.05). RESULTS: The CT was the only protocol that presented significant lower body mass (p = 0.018; Δ% = - 1.4), fat mass (p = 0.017; Δ% = - 10.3), %fat mass (p < 0.001; Δ% = - 13.9), adipose indices (%fat trunk/%fat legs p = 0.031; Δ% = 7.8; fat mass/height2 p = 0.011; Δ% = - 15.1; trunk/limb fat mass p = 0.012; Δ% = - 8.2; visceral adipose tissue (VAT) volume (cm3) p = 0.039; Δ% = - 11.6; VAT area (cm2) p = 0.044; Δ% = - 12.2), blood pressure levels (SBP p = 0.042; Δ% = - 3.4 and DBP p = 0.001; Δ% = - 4.9), higher lean mass and HDL (p < 0.001; Δ% = 5.9) compared to baseline. CT and ST presented lower WOMAC pain, stiffness and physical function (p < 0.001; Δ% = - 64.0 for CT and p < 0.001; Δ% = 0.001; Δ% = - 46.4 for ST in WOMAC total score, pain catastrophizing (p < 0.001; Δ% = - 66.7 for CT and p < 0.001; Δ% = - 61.5 for ST) a higher functional performance (30 s chair test: p < 0.001; Δ% = 45.7 for CT and p < 0.001; Δ% = 26.9 for ST; 40 m walk test: p < 0.001; Δ% = 26.7 for CT and p < 0.001; Δ% = 12.5 for ST; stair climb test: p = 0.002; Δ% = - 33.9 for CT and p < 0.001; Δ% = - 18.8 for ST) and knee extension MIVC (p < 0.001; Δ% = 21.92 for CT and p < 0.001; Δ% = 30.25 for ST). CONCLUSION: A periodized CT model reduces visceral adipose tissue, SBP and DBP, and improves HDL, important cardiovascular and metabolic risk factors, in patients with KOA. Both trained groups (CT and ST) improve self-reported clinical symptoms, muscle strength, and physical performance in this sample. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov , NCT02761590 (registered on May 4, 2016). KEY POINTS: • A 14-week periodized circuit training reduces visceral adipose tissue, systolic and diastolic blood pressure, and improves HDL blood levels in patients with knee osteoarthritis. • Both periodized circuit training and conventional strength training improve clinical symptoms, functional performance and muscle strength in this sample.

Lower education is an associated factor with the combination of pain catastrophizing and kinesiophobia in patients with knee osteoarthritis?

OBJECTIVES: To analyze if socioeconomic characteristics as lower education and lower family income are associated factors with the combination of pain catastrophizing and kinesiophobia in patients with knee osteoarthritis (KOA). METHODS: This cross-sectional study included 140 participants aged 40 years or older with KOA grades II and III. Based on the Pain Catastrophizing Scale (PCS) and the Tampa Scale of Kinesiophobia (TSK), four groups were identified: non-catastrophic/non-kinesiophobic (NC/NK), non-catastrophic/non-kinesiophobic (NC/K), catastrophic/non-kinesiophobic (C/NK), and catastrophic/kinesiophobic (C/K). Pain intensity was measured using the visual analog scale (VAS). The 30-s chair stand test was performed to access physical function. Sociodemographic characteristics included age, sex, years of formal education (0 to 11 and > 11), and family income (up to 2 minimum wages and > 2). Multinomial regression analysis adjusted for age, radiographic severity, physical function, and pain intensity was used to determine the association between lower education and lower family income with the combination of pain catastrophizing and kinesiophobia. RESULTS: Only lower education was independently associated with the combination of pain catastrophizing and kinesiophobia (OR = 3.96 CI 95% 1.01-15.51). CONCLUSIONS: Lower education but not lower family income was an important associated factor with the combination of pain catastrophizing and kinesiophobia in individuals with knee osteoarthritis. Thus, physician and physical therapist must pay attention on this important socioeconomic characteristic while conducting the treatment, since specific strategies of approach could be necessary for those patients. Key points • Lower education is an important associated factor with the combination of pain catastrophizing and kinesiophobia in individuals with knee osteoarthritis. • Physician and physical therapist must pay attention on patients schooling while conducting the treatment.