Effects of combined exercise training with sleep education in older adults with obstructive sleep apnea: protocol for a randomized clinical trial.

Background: Obstructive sleep apnea (OSA) is a common disorder that affects approximately 1 billion people worldwide. Advanced age is a significant risk factor. Various treatment options have been explored to reduce the severity of OSA symptoms and physical exercise has emerged as a potential alternative therapy. Therefore, this study aims to investigate the effects of a combined exercise program with sleep education on sleep quality and on the severity of OSA in older adults. Methods: This is a randomized clinical trial with two parallel groups that will involve individuals of both genders aged between 60 and 79 years who have an apnea-hypopnea index (AHI) of more than 15 events per hour and who have not received or are currently undergoing treatment for OSA. Older adults who have engaged in regular exercise in the last six months and individuals with contraindications to exercise will be excluded. The study will assess outcomes related to OSA, including AHI, oxygen desaturation index, minimum and mean oxyhemoglobin saturation, sleep efficiency, sleep latency, and the type of respiratory events. Additionally, sleep quality-related outcomes, daytime sleepiness, physical activity, physical fitness, aerobic capacity, cognitive status, anthropometric measures, and health-related quality of life will be analyzed. Participants will be randomized to two groups: a combined exercise group (involving both resistance and aerobic training) with sleep education, and a control group that will receive only educational recommendations for managing OSA. The intervention will last 12 weeks and will consist of three sessions per week, totaling 36 exercise sessions. Sample size calculation indicates a minimum number of 36 participants. Discussion: If the hypothesis is confirmed, this clinical trial will indicate an effective non-pharmacological intervention for treating OSA in older adults. This intervention could be used as an adjunct to existing approaches designed to improve OSA management. Clinical trail registration: Brazil Clinical Trials Registry (ReBEC), identifier RBR-9hk6pgz.

Effect of exercise on female pelvic floor morphology and muscle function: a systematic review.

INTRODUCTION AND HYPOTHESIS: The objective was to synthesize the scientific evidence on the relationship of exercise with morphology and muscle function parameters of the female pelvic floor. The design was a systematic review. METHODS: Searches were performed in MEDLINE, PubMed, CINAHL, Web of Science, SCOPUS, SportDiscuss, and Google Scholar up to April 2021. Observational and experimental studies evaluating the morphology and/or function of the pelvic floor muscles (PFMs) in women were eligible. Studies reporting exercise or sports disciplines as exposure/intervention were included. RESULTS: Twenty-five studies were included. Compared with the control group, women performing vigorous and high-impact exercises exhibited lower maximum voluntary contraction of the PFM and those performing moderate exercise had better maximum voluntary contraction. Exercise practitioners had a larger hiatal area at rest, during contraction, and during Valsalva, and greater bladder neck descent than the control group. CONCLUSIONS: The results of this review demonstrate an inverse relationship of PFM maximum voluntary contraction with exercise intensity. Qualitative synthesis showed that the studies found favorable outcomes for the control group in terms of hiatal area during contraction and Valsalva and bladder neck displacement.

Handgrip strength, functional capacity and cognitive status of centenarians / Força de preensão manual, capacidade functional e estado cognitivo em centenários

Objective: To compare and correlate handgrip strength (HGS) with functional capacity and cognitive status in centenarians. Method: This is a cross-sectional study. The study population consisted of 127 centenarians, of which 78 met the inclusion criteria, with a mean age of 101.7 ± 2.52 years. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) and functional capacity using the Katz Scale. To investigate HGS, we used a manual dynamometer. The level of significance was 5%. Results: Centenarian men have higher right (p= 0.005) and left (p<0.001) HGS compared to women. About functional capacity, centenarians more functional present higher right and left HGS (p<0.001) when compared to intermediate and less functional. Furthermore, when analyzing cognition, centenarians with preserved cognitive status have higher right and left HGS (p<0.001) than cognitively impaired elderly. In the relationship analysis, it was possible to verify that the lower the MMSE score, the higher the right (rho= 0.59; p<0.001) and left (rho= 0.57; p<0.001) HGS. Furthermore, the lower the Katz Scale score, the higher the right (rho= -0.53; p<0.001) and left (rho= -0.57; p<0.001) HGS. Conclusion: Our results show that male centenarians, more functional and with preserved cognitive status have higher HGS in both hands. Moreover, we found a moderate negative relationship between HGS and functional capacity and a moderate positive relationship between HGS and cognitive status of centenarians.

Objetivo: Comparar e correlacionar a força de preensão manual (HGS) com a capacidade funcional e o estado cognitivo em centenários. Método: Este é um estudo de corte transversal. A população do estudo consistiu em 127 centenários, dos quais 78 preenchiam os critérios de inclusão, com uma idade média de 101,7 ± 2,52 anos. O estado cognitivo foi avaliado utilizando o Mini-Mental State Examination (MMSE) e a capacidade funcional utilizando a Escala Katz. Para investigar o HGS, utilizamos um dinamômetro manual. O nível de significância foi de 5%. Resultados: Os homens centenários têm o HGS mais alto à direita (p= 0,005) e à esquerda (p<0,001) em comparação com as mulheres. Quanto à capacidade funcional, os centenários mais funcionais apresentam HGS mais altos à direita e à esquerda (p<0,001) quando comparados com os intermediários e menos funcionais. Além disso, ao analisar a cognição, os centenários com estado cognitivo preservado têm HGS direito e esquerdo mais elevados (p<0,001) do que os idosos com deficiência cognitiva. Na análise da relação, foi possível verificar que quanto mais baixa a pontuação MMSE, mais alta a direita (rho= 0,59; p<0,001) e esquerda (rho= 0,57; p<0,001) HGS. Além disso, quanto mais baixa a pontuação da Escala Katz, mais alta a direita (rho= -0,53; p<0,001) e esquerda (rho= -0,57; p<0,001) HGS. Conclusão: Os nossos resultados mostram que os centenários masculinos, mais funcionais e com estatuto cognitivo preservado, têm HGS mais elevado em ambas as mãos. Além disso, encontramos uma relação negativa moderada entre HGS e capacidade funcional e uma relação positiva moderada entre HGS e estado cognitivo dos centenários.

Comparação entre os domínios da função cognitiva e a capacidade funcional de centenários / Relationship between the domains of cognitive function and functional capacity in centenarians

Objetivo: Comparar os domínios da função cognitiva com a capacidade funcional para as atividades básicas de vida diária de centenários. Métodos: Trata-se de um estudo descritivo com 66 idosos com 100 anos ou mais de idade, 45 do sexo feminino e 21 do masculino, com média de idade 102,14 ± 2,71 anos, residentes na Grande Florianópolis/SC. Foram avaliados os domínios da função cognitiva (Mini Exame do Estado Mental- MEEM) e a capacidade funcional (escala de Katz) dos centenários. Os dados foram tratados por meio do Kruskal-Wallis e o post hoc de Bonferroni, com nível de significância de 5%. Também analisou-se com o modelo de regressão multinominal, com intervalo de confiança de 95%. Resultados: Houve diferença significativa entre os centenários MF (Mais Funcional) e Mf (Menos Funcional) em todos os domínios do MEEM: orientação temporal (p<0,001), orientação espacial (p<0,002), memória imediata (p<0,001), atenção e cálculo (p<0,013), memória e evocação (p<0,012) e linguagem (p<0,001) e, os Mf e com FI nos domínios do MEEM memória imediata (p<0,004) e linguagem (p<0,004). Conclusão: Os domínios da função cognitiva estão relacionados à capacidade funcional, ou seja, centenários que apresentam uma boa funcionalidade nas atividades da vida diária básica, possuem uma boa função cognitiva, no que diz respeito a orientação temporal e espacial, memória, cálculo, evocação e linguagem.

Objective: To verify the relationship between the domains of cognitive function and functional capacity for basic activities of daily living in centenarians. Methods: This is a descriptive study with 66 elderly aged 100 years or more, 45 females and 21 males, mean age 102.14 ± 2.71 years, residents in Greater Florianópolis/SC. The domains of cognitive function (Mini Mental State Examination - MMSE) and functional capacity (Katz scale) of the centenarians were evaluated. The data were treated by Kruskal-Wallis and Bonferroni post hoc, with a 5% significance level. Results: There was significant difference between MF and Mf centenarians in all domains of MMSE: temporal orientation (p<0.001), spatial orientation (p<0.002), immediate memory (p<0.001), attention and calculation (p<0.013), memory and recall (p<0.012) and language (p<0.001) and, Mf (More Functional) and with FI (Less Functional) in the domains of MMSE immediate memory (p<0.004) and language (p<0.004). Conclusion: the domains of cognitive function are related to functional capacity, that is, centenarians who have good functionality have good cognitive function, with respect to temporal and spatial orientation, memory, calculation, evocation and language.

Effects of Exercise on Sleep in Older Adults: An Overview of Systematic Reviews and Meta-Analyses.

We aimed to systematically analyze reviews of randomized clinical trials that investigate the overall effect of exercise and of different types of exercise on sleep in older adults. Meta-analysis was performed to obtain the standardized mean difference of the effect of the different types of exercise. Twenty systematic reviews published between 2012 and 2020 met the inclusion criteria of this overview. Moderate significant effects of exercise were observed on overall sleep quality and its subjective components (quality, duration, latency, habitual efficiency, medication use, and daytime dysfunction). Among the types of exercise, sensitivity analysis revealed significant effects of Pilates, Tai Chi, and Baduanjin Qigong on sleep quality. Exercise has a positive effect on sleep quality in older people. Our findings are extremely important, especially for decision makers in the health area, permitting the planning of actions and evidence-based decision making. PROSPERO registration number: CRD42020222469.

Sleep quality and urinary incontinence in elderly female exercise practitioners.

Objectives: Older women with urinary incontinence (UI) commonly report sleep problems. However, little is known about sleep problems in older women with UI who exercise. We aimed to evaluate the relationship of sleep quality with the presence or absence of UI, urine loss, and nocturia episodes in elderly female practitioners of physical exercise. Material and Methods: We conducted a cross-sectional study on older women participating in an extension program, southern Brazil. Data were collected in 2018. Sociodemographic and health characteristics were collected by interview. The International Consultation on Incontinence Questionnaire - short form was applied to evaluate the presence of UI, as well as the frequency and amount of urine loss. The International Consultation on Incontinence Questionnaire Overactive Bladder was used to analyze nocturia episodes. Sleep quality was assessed using the Pittsburgh sleep quality index. Results: The study group included 142 older women with a mean age of 68.8±6.8 years. The prevalence of UI was 33.8% (95% CI: 0.26-0.42). Women with UI had higher use of medication, daytime dysfunction, and total sleep quality scores than women without UI (p<0.05). Older women who leak urine several times a day exhibited worse sleep quality than those who lose urine once a week or less (p=0.036). Women with three or more episodes of nocturia also showed worse sleep quality than those without any episode (p=0.029). Conclusion: Exercising older women with UI have worse sleep quality than those without this dysfunction. Furthermore, participants who lose large amounts of urine and have more episodes of nocturia also exhibit worse sleep quality.

Impact of Social Isolation on Physical Activity and Factors Associated With Sedentary Behavior in Older Adults During the COVID-19 Pandemic.

The objective was to analyze the impact of social isolation on moderate physical activity and factors associated with sedentary behavior of older adults during the COVID-19 pandemic. This was a cross-sectional study involving 111 older adults (aged 71.0 ± 6.87 years). The data were collected at two time points: in November 2019 and in June 2020. There was a decline in moderate physical activity when the minutes/week were compared before and during social isolation (p < .001). Sedentary behavior was associated with the condition of living alone. Older adults who lived alone were 3.29 times more likely to spend 4 hr or more in sedentary behavior than those who lived with a partner (95% confidence interval [1.01, 10.74]). Government agencies must establish PA-related health promotion strategies, especially in developing and low-income countries. Therefore, home exercises need to be encouraged to prevent the consequences of this pandemic period.

Força de preensão manual e velocidade máxima da caminhada de acordo com o nível de atividade física e o sexo de centenários / Handgrip strenght and maximum walking speed according to the physical activity and sex of centenarians

Objetivo: comparar a força de preensão manual (FPM) e a velocidade máxima da caminhada de acordo com o nível de atividade física (NAF) e o sexo em idosos centenários. Método: participaram do estudo 48 centenários (101,73±2,52 anos), sendo 29 mulheres e19 homens. Dados sociodemográficos, de saúde e hábitos de vida foram analisados por meio do Protocolo de Avaliação Multidimensional do Idoso Centenário ­ PAMIC. A FPM foi mensurada por meio de dinamômetro, o NAF por meio de pedômetro e a velocidade máxima da caminhada por meio de teste físico. Foram classificados como centenários ativos os que atingiram no mínimo 1.000 passos/semana e como insuficientemente ativos aqueles abaixo deste valor. O nível de significância adotado foi de 5%. Resultados: centenários do sexo masculino apresentaram maior FPM direita (17,47±6,94kgf) e esquerda (16,63±6,28kgf) quando comparados ao sexo feminino (11,90±4,84kgf; 10,48±5,00kgf) (p<0,05). Quando analisados de acordo com o NAF, centenários ativos apresentaram maior FPM direita (22,86±8,01 kgf) e esquerda (22,14±5,55kgf) em comparação aos insuficientemente ativos (14,33±3,82kgf; 13,42±4,14kgf) (p<0,05). Para o sexo feminino, a FPM direita foi maior nas centenárias ativas (15,75±4,68kgf) quando comparadas às insuficientemente ativas (10,43±4,12kgf) (p=0,006). Na FPM esquerda, o grupo ativo apresentou maior valor médio (14,00±4,63 kgf) em comparação ao grupo insuficientemente ativo (9,14±4,55kgf) (p=0,017). A velocidade máxima da caminhada não apresentou diferença significativa de acordo com o NAF ou o sexo dos idosos. Conclusão: o estudo evidencia que a atividade física está intimamente relacionada a melhores valores de FPM, indicando que idosos centenários ativos possuem melhor força corporal global.(AU)

Aim: to compare the handgrip strength (HGS) and the maximum walking speed according to the level of physical activity (PA) and sex in elderly centenarians. Method: 48 centenarians (101.73 ± 2.52 years old) participated in the study, 29 women and 19 men. Sociodemographic, health, and lifestyle data were analyzed using the Multidimensional Assessment Protocol for the Elderly Centenary ­ PAMIC. HGS was measured using a dynamometer, PA utilizing a pedometer, and the maximum gait speed through a physical test. Those who reached at least 1,000 steps/week were classified as active centenarians and those below this value as insufficiently active. The level of significance adopted was 5%. Results: centenarians of the male sex had higher HGS on the right (17.47 ± 6.94kgf) and left (16.63 ± 6.28kgf) when compared to the female sex (11.90 ± 4.84kgf; 10.48 ± 5, 00kgf) (p<0.05). When analyzed according to PA, active centenarians had a higher right (22.86 ± 8.01 kgf) and left (22.14 ± 5.55kgf) HGS compared to insufficiently active (14.33 ± 3.82kgf; 13, 42 ± 4.14 kgf) (p <0.05). For females, the right HGS was higher in active centenarians (15.75 ± 4.68kgf) when compared to insufficiently active women (10.43 ± 4.12kgf) (p = 0.006). In the left HGS, the active group had a higher mean value (14.00 ± 4.63 kgf) compared to the insufficiently active group (9.14 ± 4.55kgf) (p = 0.017). The maximum gait speed did not show any significant difference according to PA or the gender of the elderly. Conclusion: the study shows that physical activity is closely related to better values of HGS, indicating that active elderly centenarians have better overall body strength.(AU)

Association of Physical Activity With Urinary Incontinence in Older Women: A Systematic Review.

OBJECTIVE: To analyze the scientific evidence on the association of physical activity with urinary incontinence in older women. DESIGN: Searches were performed in MEDLINE, PubMed, CINAHL, Web of Science, SCOPUS, and ScienceDirect. Observational studies were included. The following search terms were used: urinary incontinence, older adult, and physical activity. Methodological quality was assessed using the checklist proposed by Downs and Black. RESULTS: Ten articles were included. Sedentary lifestyle and <150 min/week of physical activity are at risk of developing urinary incontinence. Walking (at least 30 min) and physical activities (600-1,500 and 600 METs/min per week) prevent urinary incontinence. Seven of the 10 studies indicated a good level of methodological quality. CONCLUSIONS: Sedentary lifestyle is at risk of urinary incontinence, and walking, moderate and vigorous physical activities are associated with prevention of urinary incontinence.

Alcance das intervenções em atividade física na saúde pública de Santa Catarina / Reach of physical activity interventions in the public health of Santa Catarina

Para verificar o alcance das intervenções em atividade física (IAF) na saúde pública de Santa Cata-rina (SC), quanto ao porte dos municípios, ao vínculo com as estratégias de promoção de atividade física, aos grupos populacionais atendidos e as características de participação, foram questionados 146 coordenadores de IAF das Secretarias Municipais de Saúde de SC. O alcance foi calculado dividindo o número de participantes nas IAF pela população total e estratificada, e pelos grupos etários (crianças, adolescentes, adultos e idosos). O alcance absoluto das IAF foi de 3,8% e o relativo de 4,9%. Os maiores valores de alcance absoluto e relativo foram da população idosa (8,4% e 8,8%, respectivamente) e os vinculados ao programa Academia da Saúde, em todos os grupos populacionais atendidos (5% e 7%, respectivamente). Das IAF, 56,3% atendem menos de 100 usuários, com maior participação do público adulto e idoso. Destaca-se o agente comunitário de saúde como a estratégia de recrutamento dos participantes para as IAF (95,3%) e "ter indicação ou autorização do médico" como critério para participação (79,2%). Conclui-se que há um baixo alcance da população nas IAF das Secretarias Municipais de Saúde de SC, tornando-se necessário repensar os seus programas

In order to verify the reach of Physical Activity Interventions (PAI) in the public health of Santa Catarina, the size of municipalities, the link with physical activity promotion strategies, population groups served and characteristics of the participants, 146 PAI coordinators of the Municipal Health Secretariats of Santa Catarina were questioned. The reach was calculated by dividing the number of participants in PAI by the total and stratified population and by the age groups (children, adolescents, adults and the elderly). The PAI absolute reach was 3,8% and the relative 4,9%. The highest values of absolute and relative reach were among the older adults (8.4% and 8.8%, respectively) and those linked to the Health Academy program, in all populations groups served (5% and 7%, respectively). About 56.3% of the IAF serve less than 100 people, with greater participation of the adult and elderly public. Community agent was the most prevalent form of recruitment (95,3%) and "have physician's indication or authorization" as a criterion for participation (79.2%). It is concluded that there is a low population reach in the Municipal Health Secretariat's PAI of Santa Catarina, and it is necessary to rethink its programs

Neck circumference as a discriminator of obesity in older women enrolled in a physical activity program / Perímetro do pescoço: discriminador de obesidade em idosas praticantes de atividade física

Abstract The aim of this study was to evaluate neck circumference (NC) as a discriminator of overweight and obesity and to establish cut-off points for physically active older women. The sample consisted of 170 older women (69.5 ± 6.8 years) practicing physical activity. Anthropometric measures (body weight, height, waist circumference - WC, and NC) were obtained and the body mass index (BMI) was calculated. Correlation analysis was performed and ROC curves were constructed. NC was significantly correlated with BMI (rho = 0.656; p<0.0001) and WC (r = 0.561; p<0.0001). Correlating BMI with NC, areas under the ROC curve of 0.819 (p=0.0001) for overweight and of 0.902 (p=0.0001) for obesity were obtained, with suggested cut-off points of 33.07 and 34.05 cm, respectively. Correlating WC with NC, areas under the ROC curve of 0.711 (p=0.0014) for moderate risk (WC) and of 0.864 (p=0.0001) for high risk were obtained, with suggested cut-off points of 32.15 and 34.15 cm, respectively. NC was associated with BMI and WC. An NC ≥ 34 cm was a risk factor for obesity and abnormal body fat distribution in the older women studied. This anthropometric parameter is an alternative to discriminate overweight and obesity in physically active older women.

Resumo Objetivou-se analisar o perímetro de pescoço (PPescoço) como um método discriminador de sobrepeso e obesidade e estabelecer pontos de corte para idosas praticantes de atividade física. A amostra foi composta por 170 idosas (69,5 ± 6,8 anos) praticantes de atividade física. Foram realizadas medidas antropométricas de massa corporal, estatura, perímetro de cintura (PCintura) e do pescoço (PPescoço). Também foi calculado o índice de massa corporal (IMC) erealizada a estatística correlacional e curvas ROC. O PPescoço correlacionou significativamente com o IMC (rho = 0,656; p<0,0001) e com o PCintura (r = 0,561; p<0,0001). Ao relacionar IMC com PPescoço, obteve-se valores para área da curva ROC de 0,819 (p=0,0001) para sobrepeso e 0,902 (p=0,0001) para obesidade, além de pontos de corte sugeridos de 33,07 cm e 34,05 cm, respectivamente. Ao relacionar PCintura com o PPEscoço, obteve-se valores para área curva ROC de 0,711 (p=0,0014) para risco moderado (PCintura) e 0,864 (p=0,0001) para alto risco, além de pontos de corte sugeridos de 32,15 cm e 34,15, respectivamente. O PPescoçoapresentou relação com o IMC e o PCintura. O PPescoço ≥34cm apresentou-se ser o valor de risco para obesidade e distribuição de composição corporal em idosas deste estudo. Essa medida antropométrica é uma alternativa para discriminar o sobrepeso e obesidade de idosas praticantes de atividade física.