The effect of a multicomponent exercise protocol (VIVIFRAIL©) on inflammatory profile and physical performance of older adults with different frailty status: study protocol for a randomized controlled trial.

BACKGROUND: To investigate whether an exercise intervention using the VIVIFRAIL© protocol has benefits for inflammatory and functional parameters in different frailty status. METHODS/DESIGN: This is a randomized clinical trial in an outpatient geriatrics clinic including older adults ≥60 years. For each frailty state (frail, pre-frail and robust), forty-four volunteers will be randomly allocated to the control group (n = 22) and the intervention group (n = 22) for 12 weeks. In the control group, participants will have meetings of health education while those in the intervention group will be part of a multicomponent exercise program (VIVIFRAIL©) performed five times a week (two times supervised and 3 times of home-based exercises). The primary outcome is a change in the inflammatory profile (a reduction in inflammatory interleukins [IL-6, TNF- α, IL1beta, IL-17, IL-22, CXCL-8, and IL-27] or an increase in anti-inflammatory mediators [IL-10, IL1RA, IL-4]). Secondary outcomes are change in physical performance using the Short Physical Performance Battery, handgrip strength, fatigue, gait speed, dual-task gait speed, depressive symptoms, FRAIL-BR and SARC-F scores, and quality of life at the 12-week period of intervention and after 3 months of follow-up. DISCUSSION: We expect a reduction in inflammatory interleukins or an increase in anti-inflammatory mediators in those who performed the VIVIFRAIL© protocol. The results of the study will imply in a better knowledge about the effect of a low-cost intervention that could be easily replicated in outpatient care for the prevention and treatment of frailty, especially regarding the inflammatory and anti-inflammatory pathways involved in its pathophysiology. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (RBR-9n5jbw; 01/24/2020). Registred January 2020. http://www.ensaiosclinicos.gov.br/rg/RBR-9n5jbw/ .

What are the Benefits of Exercise for Alzheimer's Disease? A Systematic Review of the Past 10 Years.

To identify and characterize the scientific literature on the effects of exercise on Alzheimer's disease, research was conducted in the following databases: MEDLINE, CINAHL, Web of Science, and Scopus. These MeSH terms--"exercise", "motor activity", "physical fitness", "Alzheimer disease", and its synonyms in English--were used in the initial search to locate studies published between 2003 and 2013. After reading the 12 final articles in their entirety, two additional articles, found by a manual search, were included. Of these, 13 had beneficial results of exercise in Alzheimer's disease. Given the results discussed here, the exercise may be important for the improvement of functionality and performance of daily life activities, neuropsychiatric disturbances, cardiovascular and cardiorespiratory fitness, functional capacity components (flexibility, agility, balance, strength), and improvements in some cognitive components such as sustained attention, visual memory, and frontal cognitive function in patients with AD.

Health-related quality of life and related factors of military police officers.

PURPOSE: The present study aimed to determine the effect of demographic characteristics, occupation, anthropometric indices, and leisure-time physical activity levels on coronary risk and health-related quality of life among military police officers from the State of Santa Catarina, Brazil. METHODS: The sample included 165 military police officers who fulfilled the study's inclusion criteria. The International Physical Activity Questionnaire and the Short Form Health Survey were used, in addition to a spreadsheet of socio-demographic, occupational and anthropometric data. Statistical analyses were performed using descriptive analysis followed by Spearman Correlation and multiple linear regression analysis using the backward method. RESULTS: The waist-to-height ratio was identified as a risk factor low health-related quality of life. In addition, the conicity index, fat percentage, years of service in the military police, minutes of work per day and leisure-time physical activity levels were identified as risk factors for coronary disease among police officers. CONCLUSIONS: These findings suggest that the Military Police Department should adopt an institutional policy that allows police officers to practice regular physical activity in order to maintain and improve their physical fitness, health, job performance, and quality of life.

Validation of the Brazilian version of the apathy inventory.

BACKGROUND: Apathy is a frequent neuropsychiatric condition in neurodegenerative disorders, depression, and often in mild cognitive impairment. The Apathy Inventory (AI) is a reliable instrument for improving the accuracy of the apathy diagnosis. The aim was to establish the validity of the Apathy Inventory for the Brazilian community. METHODS: We established the concurrent validity, internal consistency, inter-rater reliability, and the sensitivity and specificity of AI for the Brazilian community in a cohort of 175 individuals with Alzheimer's disease, Parkinson's disease, depression, mild cognitive impairment, and healthy controls. The three dimensions of the AI (emotional blunting, lack of initiative, and lack of interest) were compared with the Apathy domain of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C) in an independent scheme. RESULTS: The analyses demonstrated high correlation coefficients in AI's individual dimensions and in AI-total score (F = 0.965). Concerning the NPI-C/Apathy domain, intra-class correlation coefficients were also high (F = 0.977). Concurrent validity was high according to both raters on AI dimensions × NPI-C/Apathy domain and regarding total score (rater 1: rho = 0.956 vs. rater 2: rho = 0.970). The internal consistency of the AI was also high concerning the AI's individual dimensions and total score (rater 1: 0.945 vs. rater 2: 0.958). CONCLUSION: We observed high internal consistency, high concurrent validity, and inter-rater reliability of the Apathy Inventory. In addition, we found that its sensitivity and specificity were high. We suggest that the Brazilian version of the Apathy Inventory would be an appropriate instrument to identify the apathy syndrome in Brazilian patients.

Effects of square-stepping exercise on cognitive functions of older people.

AIM: Cognitive functions can decline with age, and interventions focusing on stimulating them may have positive results. Previous studies have shown that square-stepping exercise (SSE) has a good influence on balance, but this exercise also seems to promote cognitive stimulation. Therefore, the purpose of the present study was to analyse the effect of 16 weeks of SSE on cognitive functions in non-demented community-dwelling older people. METHODS: This was a longitudinal, non-randomized study. Forty-one older adults (60 years and older) were recruited, and 21 participated in the SSE group (practised only SSE sequences) and 20 were in the control group (continued with their activities of daily living). Both groups were evaluated using the Mini-Mental State Examination, the Digit Span test, the Toulouse-Pierón Attention Test and the Modified Card Sorting Test. RESULTS: The SSE group showed a significant improvement in global cognitive status, concentrated attention and mental flexibility after 16 weeks of the SSE intervention. CONCLUSION: Evidence shows that SSE is a physical activity that positively influences cognitive functions in non-demented older people.

Case report: A case of neuro-Behçet's syndrome presenting as brain stem mass lesions.

Neuro-Behçet's syndrome, a severe and rare manifestation of Behçet's disease (BD), can be misdiagnosed due to its challenging clinical presentation. This article presents the case of a 20-year-old cis-gender male with intermittent fever, bilateral uveitis, and neurological symptoms who was found to have multiple brain stem mass lesions on brain imaging. A careful medical history elicited recurrent painful oral and genital ulcerations which were important in making the correct diagnosis. As there are no validated criteria or definite set of tests available to confirm neuro-Behçet's disease, the diagnosis is often established by exclusion after ruling out other potential etiologies. In our case, after an extensive negative workup for infectious, neuro-degenerative and malignant etiologies combined with the patient's medical history, a diagnosis of Behçet's disease with neurological involvement (neuro-Behçet's syndrome) was made. High doses of steroids were given, and the patient had a favorable outcome. Repeated magnetic resonance imaging of the brain 2 years later showed no new brain lesions. Neuro-Behçet's disease should be included as a differential diagnosis of unexplained brain stem lesions in the right clinical context. In these situations, providers should obtain medical histories related to genital and oral ulcers and eye problems as these may help to narrow down the diagnosis. The clinical presentation and challenges of this uncommon presentation of BD including a brief literature review of neuro-Behçet's disease with brain stem mass lesions are discussed in this case study.

Implementation of an integrated infectious disease and substance use disorder team for injection drug use-associated infections: a qualitative study.

BACKGROUND: Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment intervention for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. We conducted a qualitative study to identify patient- and clinician-level perceived implementation barriers and facilitators to the SIRI team intervention. METHODS: Participants were patients with history of SIRIs (n = 7) and healthcare clinicians (n = 8) at one implementing hospital (Jackson Memorial Hospital). Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed, double coded, and categorized by study team members using CFIR constructs. RESULTS: Implementation barriers to the SIRI team intervention identified by participants included: (1) complexity of the SIRI team intervention; (2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; (3) clinician-level stigma and lack of knowledge around addiction and medications for opioid use disorder (OUD); and (4) concerns about underinvestment in the intervention. Implementation facilitators of the intervention included: (1) a non-judgmental, harm reduction-oriented approach; (2) the team's advocacy for PWID as a means of institutional culture change; (3) provision of close post-hospital follow-up that is often inaccessible for PWID; (4) strong communication with patients and their hospital physicians; and (5) addressing diverse needs such as housing, insurance, and psychological wellbeing. CONCLUSION: Integration of infectious disease and SUD treatment is a promising approach to managing patients with SIRIs. Implementation success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction across multilevel (inner and outer) implementation contexts.

Integrated Infectious Disease and Substance Use Disorder Care for the Treatment of Injection Drug Use-Associated Infections: A Prospective Cohort Study With Historical Control.

Background: To address the infectious disease (ID) and substance use disorder (SUD) syndemic, we developed an integrated ID/SUD clinical team rooted in harm reduction at a county hospital in Miami, Florida. The Severe Injection-Related Infection (SIRI) team treats people who inject drugs (PWID) and provides medical care, SUD treatment, and patient navigation during hospitalization and after hospital discharge. We assessed the impact of the SIRI team on ID and SUD treatment and healthcare utilization outcomes. Methods: We prospectively collected data on patients seen by the SIRI team. A diagnostic code algorithm confirmed by chart review was used to identify a historical control group of patients with SIRI hospitalizations in the year preceding implementation of the SIRI team. The primary outcome was death or readmission within 90 days post-hospital discharge. Secondary outcomes included initiation of medications for opioid use disorder (MOUD) and antibiotic course completion. Results: There were 129 patients included in the study: 59 in the SIRI team intervention and 70 in the pre-SIRI team control group. SIRI team patients had a 45% risk reduction (aRR, 0.55 [95% confidence interval CI, .32-.95]; 24% vs 44%) of being readmitted in 90 days or dying compared to pre-SIRI historical controls. SIRI team patients were more likely to initiate MOUD in the hospital (93% vs 33%, P < .01), complete antibiotic treatment (90% vs 60%, P < .01), and less likely to have patient-directed discharge (17% vs 37%, P = .02). Conclusions: An integrated ID/SUD team was associated with improvements in healthcare utilization, MOUD initiation, and antibiotic completion for PWID with infections.

Severe monkeypox with superimposed bacterial infection in an immunocompetent patient: A case report.

Monkeypox, a member of the Orthopoxvirus genu, has been the center of global attention since it has been declared a public health emergency by the World Health Organization. Typically, it is a self-limiting disease; however, it can occasionally have severe presentations in patients with underlying conditions, such as HIV, malignancy, and transplantation. In this article, we will present a case of an immunocompetent patient with a severe presentation of monkeypox. The patient presented with facial pustules with superimposed bacterial infection; furthermore, he had painful vesicles in oral and nasal mucosa and the penis. Dermatologic conditions such as atopic dermatitis has been associated with severe monkeypox. While our patient does not have a history of atopic dermatitis, he does report contact dermatitis as well as a history of skin infections. Researchers have hypothesized that disruption of the skin barrier allows for proliferation of the monkeypox virus; therefore, it is important to take a thorough history of the patient's skin conditions. Lastly, we described the use of Tecovirimat in our patient. Although it is impossible to demonstrate the efficacy of this medication without a randomized clinical trial, our patient seemed to have a faster improvement of the lesions after initiating this antiviral.

Physical exercise is effective for neuropsychiatric symptoms in Alzheimer's disease: a systematic review.

BACKGROUND: Neuropsychiatric symptoms are disorders frequently seen in Alzheimer's disease. These symptoms contribute to reduction of brain reserve capacity and, in addition, they present unfavorable implications, such as: poor prognosis for the disease, increased functional decline, increased burden on the caregiver and institutionalization. This scenario makes neuropsychiatric symptoms one of the biggest problems in Alzheimer's disease, and gives rise to a need for treatments focused on improving these symptoms. Sow progress in drug trials has led to interest in exploring non-pharmacological measures for improving the neuropsychiatric symptoms of Alzheimer's disease, such as physical exercise. OBJECTIVE: To ascertain the effect of exercise on the neuropsychiatric symptoms of Alzheimer's disease and its implications. METHODS: This was a systematic review of effective longitudinal research, conducted by searching for articles in the PubMed, Web of Science, CINAHL and Scopus electronic databases, from 2009 to 2019. Studies in which the sample consisted of elderly people aged 65 years old or over with a diagnosis of Alzheimer's disease were included. Initially 334 articles were identified. After exclusions, 21 articles remained to be read in full. From these, five articles fitted the eligibility criteria, and a further two articles were added through manual searches in the references of the articles found. RESULTS: Out of the seven articles analyzed in this review, five studies revealed that physical exercise had a positive effect on the neuropsychiatric symptoms of Alzheimer's disease. CONCLUSION: This systematic review indicated that physical exercise is a favorable non-pharmacological means for attenuating the neuropsychiatric symptoms of elderly people with Alzheimer's disease, with special attention to aerobic exercises.

Physical exercise is effective for neuropsychiatric symptoms in Alzheimer's disease: a systematic review / Exercício físico é efetivo para sintomas neuropsiquiátricos na doença de Alzheimer: uma revisão sistemática

ABSTRACT Background: Neuropsychiatric symptoms are disorders frequently seen in Alzheimer's disease. These symptoms contribute to reduction of brain reserve capacity and, in addition, they present unfavorable implications, such as: poor prognosis for the disease, increased functional decline, increased burden on the caregiver and institutionalization. This scenario makes neuropsychiatric symptoms one of the biggest problems in Alzheimer's disease, and gives rise to a need for treatments focused on improving these symptoms. Sow progress in drug trials has led to interest in exploring non-pharmacological measures for improving the neuropsychiatric symptoms of Alzheimer's disease, such as physical exercise. Objective: To ascertain the effect of exercise on the neuropsychiatric symptoms of Alzheimer's disease and its implications. Methods: This was a systematic review of effective longitudinal research, conducted by searching for articles in the PubMed, Web of Science, CINAHL and Scopus electronic databases, from 2009 to 2019. Studies in which the sample consisted of elderly people aged 65 years old or over with a diagnosis of Alzheimer's disease were included. Initially 334 articles were identified. After exclusions, 21 articles remained to be read in full. From these, five articles fitted the eligibility criteria, and a further two articles were added through manual searches in the references of the articles found. Results: Out of the seven articles analyzed in this review, five studies revealed that physical exercise had a positive effect on the neuropsychiatric symptoms of Alzheimer's disease. Conclusion: This systematic review indicated that physical exercise is a favorable non-pharmacological means for attenuating the neuropsychiatric symptoms of elderly people with Alzheimer's disease, with special attention to aerobic exercises.

RESUMO Introdução: Sintomas neuropsiquiátricos são desordens frequentemente observadas na Doença de Alzheimer, os quais contribuem para a diminuição da capacidade de reserva cerebral e ocasiona implicações ruins, como mau prognóstico da doença, aumento do declínio funcional, aumento da sobrecarga do cuidador e institucionalização. Esse cenário faz com que os sintomas neuropsiquiátricos se tornem um dos maiores problemas da Doença de Alzheimer, incitando, assim, o interesse em explorar medidas não-farmacológicas nos sintomas neuropsiquiátricos na Doença de Alzheimer, como o exercício físico. Objetivo: Verificar o efeito do exercício físico em sintomas neuropsiquiátricos da Doença de Alzheimer e suas implicações. Métodos: Trata-se de uma revisão sistemática com pesquisas longitudinais efetivadas por meio da busca de artigos nas bases de dados eletrônicas: PubMed, Web of Science, CINAHL e Scopus, de 2009 a 2019. Foram incluídos estudos cuja amostra foi constituída por idosos com diagnóstico de Doença de Alzheimer com idade igual ou acima de 65 anos. Inicialmente, foram identificados 334 artigos; após as exclusões, restaram 21 artigos para leitura na íntegra. Destes, cinco artigos se enquadraram nos critérios de elegibilidade, assim como dois artigos adicionados por meio de busca manual nas referências dos artigos encontrados. Resultados: Dos sete artigos analisados na presente revisão, cinco estudos revelaram um efeito positivo do exercício físico em sintomas neuropsiquiátricos na Doença de Alzheimer. Conclusão: Esta revisão sistemática indica que o exercício físico é um meio não-farmacológico favorável à atenuação dos sintomas neuropsiquiátricos de idosos com Doença de Alzheimer, com especial atenção na modalidade aeróbia.

[Estimators of internal consistency in health research: the use of the alpha coefficient]. / Estimadores de consistencia interna en las investigaciones en salud: el uso del coeficiente alfa.

Academic production has increased in the area of health, increasingly demanding high quality in publications of great impact. One of the ways to consider quality is through methods that increase the consistency of data analysis, such as reliability which, depending on the type of data, can be evaluated by different coefficients, especially the alpha coefficient. Based on this, the present review systematically gathers scientific articles produced in the last five years, which in a methodological manner gave the α coefficient psychometric use as an estimator of internal consistency and reliability in the processes of construction, adaptation and validation of instruments. The identification of the studies was conducted systematically in the databases BioMed Central Journals, Web of Science, Wiley Online Library, Medline, SciELO, Scopus, Journals@Ovid, BMJ and Springer, using inclusion and exclusion criteria. Data analyses were performed by means of triangulation, content analysis and descriptive analysis. It was found that most studies were conducted in Iran (f=3), Spain (f=2) and Brazil (f=2). These studies aimed to test the psychometric properties of instruments, with eight studies using the α coefficient to assess reliability and nine for assessing internal consistency. All studies were classified as methodological research when their objectives were analyzed. In addition, four studies were also classified as correlational and one as descriptive-correlational. It can be concluded that though the α coefficient is widely used as one of the main parameters for assessing internal consistency of questionnaires in health sciences, its use as an estimator of trust of the methodology used and internal consistency has some critiques that should be considered.

Just-in-time learning is effective in helping first responders manage weapons of mass destruction events.

BACKGROUND: Chemical, biologic, radiologic, nuclear, and explosive (CBRNE) incidents require specialized training. The low frequency of these events leads to significant skill decay among first responders. To address skill decay and lack of experience with these high-impact events, educational modules were developed for mobile devices to provide just-in-time training to first responders en route to a CBRNE event. This study assessed the efficacy and usability of the mobile training. METHODS: Ninety first responders were randomized to a control or an intervention group. All participants completed a pretest to measure knowledge of CBRNE topics. The intervention group then viewed personal protective equipment and weapons of mass destruction field management videos as an overview. Both groups were briefed on a disaster scenario (chemical nerve agent, radiologic, or explosives) requiring them to triage, assess, and manage a patient. Intervention group participants watched a mobile training video corresponding to the scenario. The control group did not receive prescenario video training. Observers rated participant performance in each scenario. After completing the scenarios, all participants answered a cognitive posttest. Those in the intervention group also answered a questionnaire on their impressions of the training. RESULTS: The intervention group outperformed the control group in the explosives and chemical nerve agent scenarios; the differences were statistically significant (explosives, mean of 26.32 for intervention and 22.85 for control, p < 0.01; nerve agent, mean of 23.14 for intervention and 16.61 for control, p < 0.01). There was no statistically significant difference between the groups in the radiologic scenario (mean, 12.7 for intervention and 11.8 for control; p = 0.51). The change in pretest to posttest cognitive scores was significantly higher in the intervention group than in the control group (t = 3.28, p < 0.05). CONCLUSION: Mobile just-in-time training improved first-responder knowledge of CBRNE events and is an effective tool in helping first responders manage simulated explosive and chemical agent scenarios. LEVEL OF EVIDENCE: Therapeutic/care management study, level II.

Anthropometric indicators of obesity in policemen: a systematic review of observational studies.

The aim of this paper was to summarize scientific literature on obesity in policemen through a systematic review of observational studies. For this purpose the following electronic databases were selected: Medline by Pubmed, CINAHL, and Scopus; and a manual search of the referenced studies concerning this topic was performed. There were no restrictions with respect to the year or language of the publication. Twenty-three studies were identified and 9 articles, considered as potentially relevant, were included. The labor time, shift and career progression promoted changes in body composition. Most of the policemen taking part in the studies included in this paper were overweight (BMI: 25.2-29.3), obese (body fat ≥ 25%), had increased waist (90.4-102 cm) and abdominal perimeters (18.9-90.5 cm), and had a higher risk of chronic disease, which is associated with depression and stress development. Interventional studies are needed for the purpose of proposing preventive and rehabilitation programs, which would result in providing physical and mental well-being, improvement of life quality and, especially, prevention of obesity related to police work.

Effects of resistance training on the performance of activities of daily living in patients with Alzheimer's disease.

AIM: The objective of this study was to investigate the effects of resistance training in activities of daily living performance in Alzheimer's disease (AD) patients. METHODS: An exploratory and longitudinal study, lasting for 16 weeks, with the participation of 34 patients divided equally in: the training group (TG), who participated in a resistance training protocol (three sets of 20 repetitions in five exercises); and the social gathering group (SGG), who participated in a social interaction protocol (i.e. group dynamics, writing and reading activities). RESULTS: We observed significant differences between the groups in moving around the house, climbing stairs, standing up from the floor and putting on socks tests. CONCLUSION: This study showed that resistance training improves agility, lower limb strength, balance and flexibility in AD patients, while SGG protocol is important to improve the agility.

Apathy, cognitive function and motor function in Alzheimer's disease.

The aims of this study were to characterize the presence of apathy in patients with AD, determine the relationship between apathy, motor function and cognitive function, and to verify differences among patients stratified by level of apathy in relation to cognitive and motor abilities. METHODS: A cross-sectional study was conducted of 37 patients with AD. The following tests were used: MoCA, the Frontal Assessment Battery, Verbal Fluency, Clock Drawing Test, Andreotti & Okuma Battery Tests, Sit and Reach, Resistance of Upper Limbs - AAHPERD Battery Test, Sit and Lift Chair and the Apathy domain of the Neuropsychiatric Inventory. After verifying the normality of the data distribution, comparisons were made using Student's t-test and the U Mann Whitney test; relationships were also assessed using Pearson's and Spearman's correlation coefficients. All analyses were considered to be statistically significant at a p-value of 0.05. RESULTS: 46% of participants in this study showed mild symptoms of apathy. Significant and weak associations were found (p=0.04) between apathy and the attention domain on the MoCA and between apathy and the Walk Test. Analysis of differences in cognitive and motor functions according to participants' level of apathy revealed no significant differences for any of the variables. CONCLUSION: Apathy was reflected in attention and the Walk Test, suggesting these variables may be related to cognitive and functional decline in AD patients.

Os objetivos deste estudo compreendem: caracterizar a presença de apatia em pacientes com doença de Alzheimer (DA); verificar se há relação entre apatia, funções cognitivas e funcionalidade motora dos mesmos e analisar se há diferenças entre os pacientes, separados por nível de apatia, em relação às suas funções cognitivas e funcionalidade motora. MÉTODOS: Trata-se de um estudo com delineamento transversal. Ao todo 37 pacientes com DA compuseram a amostra. Foram utilizados os seguintes testes: Mini-Exame de Estado Mental, Montreal Cognitive Assessment (MoCA), Bateria de Avaliação Frontal, Teste de Fluência Verbal Semântica, Teste do Desenho do Relógio, Bateria de Testes de Andreotti & Okuma, Teste de Sentar e Alcançar, Resistência de Membros Superiores da AAHPERD, Teste Sentar-se e Levantar-se da Cadeira e o domínio Apatia do Inventário Neuropsiquiátrico. Após verificar a distribuição dos dados as comparações seguiram através dos testes t student e U Mann Whitney e as relações, através das correlações de Pearson e Spearman. Todas as análises admitiram nível de significância de 5%. RESULTADOS: 46% dos participantes deste estudo apresentam sintomatologia para apatia em nível leve. Foram verificadas relações significativas e fracas (p=0,04) entre apatia e o domínio atenção do MoCA e entre apatia e o Teste de Caminhar. Ao verificar a diferença nas funções cognitivas e funcionalidade motora segundo o nível de apatia dos participantes não foram encontradas diferenças significativas para nenhuma das variáveis analisadas. CONCLUSÃO: Apatia relaciona-se com a atenção e o Teste de Caminhar sugerindo que estas variáveis podem estar relacionadas com o declínio cognitivo e funcional dos pacientes com esta patologia.

Effects of weight training on cognitive functions in elderly with Alzheimer's disease.

Deterioration in cognitive functions is characteristic in Alzheimer's disease (AD) and may be associated with decline in daily living activities with consequent reduced quality of life. OBJECTIVE: To analyze weight training effects on cognitive functions in elderly with AD. SUBJECTS: 34 elderly with AD were allocated into two groups: Training Group (TG) and Social Gathering Group (SGG). METHODS: Global cognitive status was determined using the Mini-Mental State Exam. Specific cognitive functions were measured using the Brief Cognitive Battery, Clock Drawing Test and Verbal Fluency Test. The protocols were performed three times a week, one hour per session. The weight training protocol consisted of three sets of 20 repetitions, with two minutes of rest between sets and exercises. The activities proposed for the SGG were not systematized and aimed at promoting social interaction among patients. The statistical analyses were performed with the U Mann Whitney and Wilcoxon tests for group comparisons. All analyses were considered statistically significant at a p-value of 0.05. RESULTS: There were no significant differences associated to the effects of the practice of weight training on cognition in AD patients. CONCLUSION: In this study, no improvement in cognitive functions was evident in elderly with AD who followed a low intensity resistance exercise protocol. Thus, future studies could evaluate the effect of more intense exercise programs.

A deterioração das funções cognitivas é característica na doença de Alzheimer (DA) e se relaciona com uma pior realização das atividades de vida diária levando a uma pior qualidade de vida. OBJETIVO: Analisar os efeitos de um programa de treinamento com pesos nas funções cognitivas de idosos com DA. SUJEITOS: 34 idosos com DA foram alocados em dois grupos: Grupo Treinamento (GT) e Grupo de Convívio Social (GCS). MÉTODOS: Para caracterização do perfil cognitivo global utilizou-se o Mini-Exame de Estado Mental. Para a mensuração das funções cognitivas foram utilizadas: Bateria Cognitiva Breve, Teste do Desenho do Relógio e teste de Fluência Verbal. Os protocolos oferecidos foram realizados três vezes na semana, durante uma hora. O protocolo de treinamento do GT consistiu em realizar três séries de 20 repetições para cada exercício, com dois minutos de intervalo entre séries e entre exercícios. As atividades propostas para o GCS não foram sistematizadas e tiveram por objetivo promover uma socialização dos pacientes. A análise estatística consistiu na utilização dos testes U Mann Whitney e Wilcoxon para comparação intra e entre grupos. Adotou-se nível de significância de 5% para todas as análises. RESULTADOS: Não foram evidenciadas diferenças significativas relacionadas aos efeitos da prática do treinamento com pesos na cognição de idosos com DA. CONCLUSÃO: Neste estudo não houve melhora nas funções cognitivas em idosos com DA que realizaram um protocolo de exercícios resistidos de intensidade leve. Assim, estudos futuros poderiam verificar o efeito de exercícios mais intensos.

Depressive symptoms and level of physical activity in patients with Alzheimer's disease.

AIM: The purpose of this study was to determine the presence of depressive symptoms in patients with Alzheimer's disease, to assess whether there was an association between physical activity level and depressive symptoms in this population, and to assess whether more active patients had lower rates of depressive symptoms when compared with less active patients. METHODS: The study included 37 patients with Alzheimer's disease and used the following instruments: the Geriatric Depression Scale, the Cornell Scale for Depression in Dementia and the Baecke Questionnaire Modified for the Elderly. The Shapiro-Wilk test was used to determine whether the data were normally distributed. The Spearman correlation test and the Mann-Whitney U-test was used. P-values less than 5% were considered statistically significant. RESULTS AND DISCUSSION: The prevalence of depressive symptoms in the sample was 35.13%. The Spearman correlation test verified the relationship between level of physical activity and depressive symptoms (rho = -0,4), and between the sports activities domain and depressive symptoms (rho = -0,4). Patients who were more active had lower depressive symptoms. CONCLUSIONS: The prevalence of depressive symptoms in the sample was 35.13%. Patients who were more active had lower rates of depressive symptoms.

Effects of Nordic walking on Parkinson’s disease: a systematic review of randomized clinical trials / Efeitos da caminhada nórdica na doença de Parkinson: uma revisão sistemática de ensaios clínicos randomizados / Los beneficios de la caminata nórdica en la enfermedad de Parkinson: estudio clínico sistemático aleatorio

ABSTRACT Several exercise modalities improve the symptoms of Parkinson’s Disease (PD). Among the variety of physical exercises, Nordic walking has been used. The aim of this study was to summarize scientific literature on effects of Nordic walking on patients with PD by a systematic review of randomized clinical trials. The following electronic databases were selected: MEDLINE by Pubmed, Cochrane, PEDro, SCOPUS and Web of Science and articles identified by manual search, without restriction of date and language. The reviewers evaluated the articles and selected studies according to the eligibility criteria. The following data were extracted from the selected studies: publication identification, participants’ characteristics (sex, age, disease stage, duration of disease), experimental intervention characteristics, control group characteristics, duration, follow-up time, outcome measures and main results. Nordic walking programs with moderate and high intensities, with a minimum of 12 sessions of 60 minutes in a period from 6 to 24 weeks promoted positive effects on the severity, gait, balance, quality of life, functional capacity and motor function in patients with PD.

RESUMO Várias modalidades de exercício melhoram os sintomas da Doença de Parkinson. Dentre a variedade de exercícios físicos, a caminhada nórdica tem sido utilizada. O objetivo do estudo foi sintetizar a produção científica sobre os efeitos da caminhada nórdica na doença de Parkinson por meio de uma revisão sistemática de ensaios clínicos randomizados. Foram selecionadas as seguintes bases de dados eletrônicas: MEDLINE via Pubmed, Cochrane, PEDro, SCOPUS e Web of Science, e artigos identificados por meio de busca manual, sem restrição de data e idioma. Os revisores avaliaram os artigos completos e os estudos selecionados de acordo com os critérios de elegibilidade. Os dados extraídos foram: identificação da publicação, características dos participantes (sexo, idade, estágio da doença, duração da doença), características da intervenção experimental, características do grupo controle, duração, seguimento, desfechos avaliados e principais resultados. Um programa de caminhada nórdica, realizado com intensidades moderada e alta, com mínimo de 12 sessões de 60 minutos em um período de 6 a 24 semanas promove efeitos positivos na gravidade da doença, marcha, equilíbrio, qualidade de vida, aptidão funcional e função motora em pacientes com doença de Parkinson.

RESUMEN Hay varias modalidades de ejercicios físicos que mejoran los síntomas de la enfermedad de Parkinson. Entre las modalidades, se destaca la caminata nórdica. El propósito de este estudio es sintetizar la producción científica sobre los beneficios de la caminata nórdica en la enfermedad de Parkinson a través de una revisión sistemática de los estudios clínicos aleatorios. Se eligieron las bases de datos electrónicas MEDLINE por PubMed, Cochrane, PEDro, SCOPUS y Web of Science, de las cuales se identificaron textos a través de búsqueda manual, sin restricción de fecha e idioma. Los revisores evaluaron los textos completos y los elegidos según criterios. Se obtuvieron los datos: identificación de la publicación, características de los participantes (sexo, edad, etapa de la enfermedad, duración de la enfermedad), características de la intervención experimental, características del grupo control, duración, seguimiento, resultados evaluados y principales resultados. Un programa de caminata nórdica, realizado con intensidades moderada y alta, con el mínimo de 12 sesiones de 60 minutos en el periodo de 6 a 24 semanas les proporciona resultados positivos en la gravedad de la enfermedad, la marcha, el equilibrio, la calidad de vida, la aptitud funcional y la función motora de pacientes con esta enfermedad.