Assessment of intrinsic capacity in the Brazilian older population and the psychometric properties of the WHO/ ICOPE screening tool: a multicenter cohort study protocol / Avaliação da capacidade intrínseca da população idosa brasileira e das propriedades psicométricas do instrumento de triagem do ICOPE/OMS: protocolo de estudo de coorte multicêntrico

Introduction: The World Health Organization (WHO) has proposed to monitor intrinsic capacity (IC) in the older population as a public health strategy through the Integrated Care for Older People (ICOPE) program. Although the program has been developed based on solid concepts, scientific evidence on its practical applicability is still scarce. Objectives: To evaluate IC in Brazilian older adults, its progress over time, and its association with sociodemographic and health factors and outcomes. To evaluate the psychometric properties of the WHO/ICOPE screening tool. Methods: This is a prospective multicenter cohort study with a 36-month follow-up. We will recruit 3838 people aged ≥60 years, registered in the health care units included in the study by the participating centers. We will collect sociodemographic and health data and will administer tools to assess IC domains, both those provided for in the ICOPE screening tool and the sequence of confirmatory assessments provided for in the program. Participants will be reassessed every 6 months for 36 months. Expected results: To establish the profile of IC in the study population and to understand its progress and the variables associated with the clinical outcomes of interest. To reveal the diagnostic and psychometric properties of the WHO/ICOPE screening tool. The project is funded by the Brazilian National Council for Scientific and Technological Development (CNPq). Relevance: Understanding the potential use of the ICOPE public health strategy proposed by the WHO within the scope of the Brazilian Unified Health System (SUS) by integrating several research centers in the field of Geriatrics and Gerontology throughout Brazil. (AU)

Introdução: A Organização Mundial da Saúde (OMS) propõe o monitoramento da capacidade intrínseca (CI) da população idosa como estratégia de saúde pública por meio do Programa ICOPE (Integrated Care for Older People). Embora construído com base em conceitos sólidos, a evidência científica sobre a aplicabilidade prática da proposta ainda é escassa. Objetivo: Avaliar a capacidade intrínseca da população idosa brasileira, sua trajetória e sua associação com variáveis sociodemográficas, de saúde e desfechos. Avaliar as propriedades psicométricas da ferramenta de triagem da estratégia ICOPE da OMS. Metodologia: Coorte multicêntrica prospectiva com seguimento de 36 meses. Serão recrutadas 3.838 pessoas com 60 anos ou mais, cadastradas nas unidades de saúde incluídas no estudo pelos centros participantes. Serão coletados dados sociodemográficos e de saúde e aplicados instrumentos para avaliação dos domínios da CI, tanto aqueles previstos no instrumento de triagem do ICOPE quanto a sequência de avaliações confirmatórias previstas no programa. Os participantes serão acompanhados semestralmente ao longo de 36 meses. Resultados esperados: Estabelecer o perfil da CI na população estudada, entender a sua trajetória e as variáveis associadas aos desfechos clínicos avaliados. Revelar as propriedades diagnósticas e o perfil psicométrico da ferramenta de triagem do ICOPE da OMS. O projeto tem financiamento do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Relevância: Compreensão sobre o potencial de utilização da estratégia ICOPE de saúde pública proposta pela OMS no âmbito do Sistema Único de Saúde (SUS) pela integração de diversos centros de pesquisa científica na área de Geriatria e Gerontologia de todo o Brasil. (AU)

Food consumption, physical activity and aerobic capacity in systemic lupus erythematosus patients with high cardiovascular risk

Abstract Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune and multisystemic rheumatic disease. Patients with SLE have decreased functional and aerobic capacity, as well as increased prevalence of Cardiovascular Diseases (CVD), which are the primary causes of morbimortality in this condition. Dietary intake and physical activity are well-known modifiable cardiovascular risk factors. The aim of this study is to describe food consumption, sedentary behavior, physical activity level, and functional and aerobic capacity in a sample of SLE patients with high cardiovascular risk. This was a cross-sectional study in which patients were assessed for (i) Demographic, anthropometric, and disease-related parameters; (ii) Food consumption; (iii) Physical activity level and sedentary behavior; (iv) Functional and aerobic capacity. Patients averaged 41.7 ± 9 years, and most were classified as overweight/obese (87%). Average macronutrient intake was within recommendations; however, fiber (16 ± 9g) and calcium (391 ± 217 mg) intakes were below, and sodium intake (2.9 ± 1.3 mg) was above recommendations. Besides, food consumption assessed by the Nova system showed a predominance of unprocessed foods (43.8 ± 14.0%TEI), although ultraprocessed food intake (20.0 ± 13.9%TEI) was slightly higher than that seen in the Brazilian population. Patients also exhibited high sedentary behavior (8.2 ± 2.2h) and only eighteen participants reached the minimum recommended amount of moderate-to-vigorous physical activity. Overall, patients had a low functional and aerobic capacity compared to the general population. Data from this study may help design dedicated clinical trials aiming to investigate the effects of lifestyle intervention to mitigate CVD in SLE.

The utility of cardiopulmonary exercise testing in athletes and physically active individuals with or without persistent symptoms after COVID-19

INTRODUCTION: Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms. METHODS: Participants' assessment included medical history and physical examination, cardiac troponin T, resting electrocardiogram, spirometry and CPET. Persistent symptoms were defined as fatigue, dyspnea, chest pain, dizziness, tachycardia, and exertional intolerance persisting >2 months after COVID-19 diagnosis. RESULTS: A total of 46 participants were included; sixteen (34.8%) were asymptomatic and thirty participants (65.2%) reported persistent symptoms, with fatigue and dyspnea being the most reported ones (43.5 and 28.1%). There were a higher proportion of symptomatic participants with abnormal data for slope of pulmonary ventilation to carbon dioxide production (VE/VCO2 slope; p<0.001), end-tidal carbon dioxide pressure at rest (PETCO2 rest; p=0.007), PETCO2 max (p=0.009), and dysfunctional breathing (p=0.023) vs. asymptomatic ones. Rates of abnormalities in other CPET variables were comparable between asymptomatic and symptomatic participants. When assessing only elite and highly trained athletes, differences in the rate of abnormal findings between asymptomatic and symptomatic participants were no longer statistically significant, except for expiratory air flow-to-percent of tidal volume ratio (EFL/VT) (more frequent among asymptomatic participants) and dysfunctional breathing (p=0.008). DISCUSSION: A considerable proportion of consecutive athletes and physically active individuals presented with abnormalities on CPET after COVID-19, even those who had had no persistent cardiorespiratory symptomatology. However, the lack of control parameters (e.g., pre-infection data) or reference values for athletic populations preclude stablishing the causality between COVID-19 infection and CPET abnormalities as well as the clinical significance of these findings.

Emotional, hyperactivity and inattention problems in adolescents with immunocompromising chronic diseases during the COVID-19 pandemic

Abstract Objective: To assess factors associated with emotional changes and Hyperactivity/Inattention (HI) motivated by COVID-19 quarantine in adolescents with immunocompromising diseases. Methods: A cross-sectional study included 343 adolescents with immunocompromising diseases and 108 healthy adolescents. Online questionnaires were answered including socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and validated surveys: Strengths and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0). Results: The frequencies of abnormal emotional SDQ scores from adolescents with chronic diseases were similar to those of healthy subjects (110/343 [32%] vs. 38/108 [35%], p = 0.548), as well as abnormal hyperactivity/inattention SDQ scores (79/343 [23%] vs. 29/108 [27%], p = 0.417). Logistic regression analysis of independent variables associated with abnormal emotional scores from adolescents with chronic diseases showed: female sex (Odds Ratio [OR = 3.76]; 95% Confidence Interval (95% CI) 2.00-7.05; p < 0.001), poor sleep quality (OR = 2.05; 95% CI 1.08-3.88; p = 0.028) and intrafamilial violence during pandemic (OR = 2.17; 95% CI 1.12-4.19; p = 0.021) as independently associated with abnormal emotional scores, whereas total PedsQL score was inversely associated with abnormal emotional scores (OR = 0.95; 95% CI 0.93-0.96; p < 0.0001). Logistic regression analysis associated with abnormal HI scores from patients evidenced that total PedsQL score (OR = 0.97; 95% CI 0.95-0.99; p = 0.010], changes in medical appointments during the pandemic (OR = 0.39; 95% CI 0.19-0.79; p = 0.021), and reliable COVID-19 information (OR = 0.35; 95% CI 0.16-0.77; p = 0.026) remained inversely associated with abnormal HI scores. Conclusion: The present study showed emotional and HI disturbances in adolescents with chronic immunosuppressive diseases during the COVID-19 pandemic. It reinforces the need to promptly implement a longitudinal program to protect the mental health of adolescents with and without chronic illnesses during future pandemics.

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

Association of health vulnerability with adverse outcomes in older people with COVID-19: a prospective cohort study

OBJECTIVES: Health vulnerability is associated with a higher risk of mortality and functional decline in older people in the community. However, few studies have evaluated the role of the Vulnerable Elders Survey (VES-13) in predicting clinical outcomes of hospitalized patients. In the present study, we tested the ability of the VES-13 to predict mortality and the need for invasive mechanical ventilation in older people hospitalized with coronavirus disease 2019 (COVID-19). METHODS: This prospective cohort included 91 participants aged ≥60 years who were confirmed to have COVID-19. VES-13 was applied, and the demographic, clinical, and laboratory variables were collected within 72h of hospitalization. A Poisson generalized linear regression model with robust variance was used to estimate the relative risk of death and invasive mechanical ventilation. RESULTS: Of the total number of patients, 19 (21%) died and 15 (16%) required invasive mechanical ventilation. Regarding health vulnerability, 54 (59.4%) participants were classified as non-vulnerable, 30 (33%) as vulnerable, and 7 (7.6%) as extremely vulnerable. Patients classified as extremely vulnerable and male sex were strongly and independently associated with a higher relative risk of in-hospital mortality (p<0.05) and need for invasive mechanical ventilation (p<0.05). CONCLUSION: Elderly patients classified as extremely vulnerable had more unfavorable outcomes after hospitalization for COVID-19. These data highlight the importance of identifying health vulnerabilities in this population.

Poor Sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine

OBJECTIVE: To assess the possible factors that influence sleep quality in adolescents with and without chronic immunosuppressive conditions quarantined during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study included 305 adolescents with chronic immunocompromised conditions and 82 healthy adolescents. Online surveys were completed, which included questions on socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and the following validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), and Pediatric Outcome Data Collection Instrument (PODCI). RESULTS: The median current age [14 (10-18) vs. 15 (10-18) years, p=0.847] and frequency of female sex (62% vs. 58%, p=0.571) were similar in adolescents with chronic conditions compared with healthy adolescents. The frequency of poor sleep quality was similar in both groups (38% vs. 48%, p=0.118). Logistic regression analysis, including both healthy adolescents and adolescents with chronic conditions (n=387), demonstrated that self-reported increase in screen time (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.3-6.8; p=0.008) and intrafamilial violence report (OR 2.1; 95% CI 1.2-3.5; p=0.008) were independently associated with poor sleep quality in these adolescents. However, the PODCI global function score was associated with a lower OR for poor sleep quality (OR 0.97; 95% CI 0.94-0.99; p=0.001). Further logistic regression, including only adolescents with chronic conditions (n=305), demonstrated that self-reported increase in screen time (OR 3.1; 95% CI 1.4-6.8; p=0.006) and intrafamilial violence report (OR 2.0; 95% CI 1.2-3.4; p=0.011) remained independently associated with poor quality of sleep, whereas a lower PODCI global function score was associated with a lower OR for sleep quality (OR 0.96; 95% CI 0.94-0.98; p<0.001). CONCLUSION: Self-reported increases in screen time and intrafamilial violence report impacted sleep quality in both healthy adolescents and those with chronic conditions. Decreased health-related quality of life was observed in adolescents with poor sleep quality.

Strength and power training improve skill performance in volleyball players

Abstract Aim: This study aimed to test the influence of functional improvements in volleyball skills performance. Methods: Twenty-eight amateur female volleyball players were assigned to Skill (S: n = 14, 19.5 ± 4.6 yrs; 169.7 ± 7.2 cm; 62.9 ± 12.7 kg) or Skill and Strength/Power (S+SP: n = 14; 18.6 ± 3.5 yrs; 169.7 ± 5.1 cm; 63.3 ± 9.2 kg). S+SP performed eight weeks of volleyball and conditioning training. S maintained only volleyball training. Functional variables (i.e. strength, power, and agility measures) and volleyball skills performance in a game-situation context were assessed before and after training. Results: 1-RM squat and bench press, time at modified agility T-test, peak power at bench throw and medicine-ball throw distance improved for the S+SP (p<0,05). S group increased only in medicine-ball throw distance (p<0.05). There were no differences between groups in the functional variables tested (p>0.05). The probabilities of a perfect set and an attack 'kill' in S+SP improved (¶>0.90). Changes from pre to post-training were higher in S+SP than in S for a perfect set, 'stuff block' and defense with displacement (¶>0.90). Conclusion: Our data suggest that functional improvements may positively affect volleyball skills performance. Although functional variables revealed only within-group changes, S+SP produced greater improvements in skill performance than S, supporting the use of conditioning training to improve volleyball performance.

Increased Insulin Resistance and Glucagon Levels in Mild/Inactive Systemic Lupus Erythematosus Patients Despite Normal Glucose Tolerance

Objective. To assess insulin sensitivity in patients with systemic lupus erythematosus (SLE) in response to a meal tolerance test (MTT). Methods. In this cross-sectional study, 33 adult females with mild/inactive SLE (SLE group) and 16 age- and body mass index-matched female healthy controls (CTRL group) underwent an MTT and were assessed for insulin sensitivity and beta cell function. Skeletal muscle protein expressions of total and membrane insulin-dependent glucose transporter 4 (GLUT-4) were also evaluated (SLE group: n = 10, CTRL group: n = 5); muscle biopsies were performed after MTT. Further measurements included inflammatory cytokines, adipocytokines, physical activity level, body composition, and food intake. Results. SLE and CTRL groups showed similar fasting glucose, glucose response, and skeletal muscle GLUT-4 translocation after MTT. However, the SLE group demonstrated higher fasting insulin levels (P = 0.01; effect size [ES] 1.2), homeostatic model assessment insulin resistance (IR) (P = 0.03; ES 1.1), insulin-to-glucose ratio response to MTT (P = 0.02; ES 1.2), fasting glucagon levels (P = 0.002; ES 2.7), glucagon response to MTT (P = 0.0001; ES 2.6), and a tendency toward lower Matsuda index of whole-body insulin sensitivity (P = 0.06; ES 0.5) when compared with the CTRL group. Fasting proinsulin-to-insulin ratio and proinsulin-to-insulin ratio response to MTT were similar between groups (P > 0.05), while the SLE group showed a higher insulinogenic index when compared with the CTRL group (P = 0.02; ES = 0.9). Conclusion. We have identified that SLE patients had a bi-hormone metabolic abnormality characterized by increased IR and hyperglucagonemia despite normal glucose tolerance and preserved beta cell function and skeletal muscle GLUT-4 translocation. Strategies capable of ameliorating insulin sensitivity to reduce the risk of type 2 diabetes mellitus and cardiovascular disease in SLE may require more than targeting IR alone.

Poor muscle strength and function in physically inactive childhood-onset systemic lupus erythematosus despite very mild disease / Redução na força muscular e capacidade funcional em pacientes fisicamente inativos com lúpus eritematoso sistêmico de início juvenil, apesar de doença muito leve

ABSTRACT Objective: To compare muscle strength (i.e. lower- and upper-body strength) and function between physically inactive childhood-onset systemic lupus erythematosus patients (C-SLE) and healthy controls (CTRL). Methods: This was a cross-sectional study and the sample consisted of 19 C-SLE (age between 9 and 18 years) and 15 CTRL matched by age, sex, body mass index (BMI), and physical activity levels (assessed by accelerometry). Lower- and upper-body strength was assessed by the one-repetition-maximum (1-RM) test. Isometric strength was assessed through a handgrip dynamometer. Muscle function was evaluated by the timed-stands test (TST) and the timed-up-and-go test (TUG). Results: When compared with CTRL, C-SLE showed lower leg-press and bench-press 1-RM (p = 0.026 and p = 0.008, respectively), and a tendency toward lower handgrip strength (p = 0.052). C-SLE showed lower TST scores (p = 0.036) and a tendency toward higher TUG scores (p = 0.070) when compared with CTRL. Conclusion: Physically inactive C-SLE patients with very mild disease showed reduced muscle strength and functionality when compared with healthy controls matched by physical activity levels. These findings suggest C-SLE patients may greatly suffer from a physically inactive lifestyle than healthy controls do. Moreover, some sub-clinical “residual” effect of the disease or its pharmacological treatment seems to affect C-SLE patients even with a well-controlled disease.

RESUMO Objetivo: Comparar a força muscular (ou seja, a força muscular dos membros superiores e inferiores) e a capacidade funcional de pacientes fisicamente inativos com lúpus eritematoso sistêmico de início juvenil (LESJ) com controles saudáveis (CTRL). Métodos: Estudo transversal cuja amostra foi composta por 19 pacientes com LESJ (entre 9 e 18 anos) e 15 CTRL pareados por idade, sexo, índice de massa corporal (IMC) e nível de atividade física (avaliada através do uso de acelerômetros). A força dos membros superiores e inferiores foi avaliada pelo teste de uma repetição máxima (1-RM). A força isométrica foi avaliada através do uso de um dinamômetro. A capacidade funcional foi avaliada pelo Timed-stands test (TST) e Timed-up-and-go test (TUG). Resultados: Quando comparados com os CTRL, os pacientes com LESJ apresentaram menor força em 1-RM no Leg press e supino (p = 0,026 e p = 0,008, respectivamente) e uma tendência a menor força de preensão manual (p = 0,052). Os pacientes com LESJ apresentaram menores escores no TST (p = 0,036) e uma tendência a maior pontuação no TUG (p = 0,070), quando comparados com o grupo CTRL. Conclusão Pacientes com LESJ, fisicamente inativos, com doença muito leve mostraram redução na força muscular e capacidade funcional quando comparados com controles saudáveis pareados por níveis de atividade física. Esses achados sugerem que pacientes com LESJ podem apresentar mais efeitos deletérios por manter um estilo de vida fisicamente inativo do que controles saudáveis. Além disso, alguns efeitos “residuais” subclínicos da doença ou do tratamento farmacológico parecem afetar pacientes com LESJ, mesmo com uma doença bem controlada.

Análise do desempenho em atletas de elite no "Ironman" Brasil entre os anos de 2003 a 2010 / Performance analysis of elite Brazil-Ironman athletes from 2003 to 2010

O objetivo do presente estudo foi analisar a evolução no desempenho no "Ironman" Brasil entre os anos de 2003 a 2010. Adicionalmente, verificamos qual modalidade apresentou maior influência sobre o desempenho final na prova. Foram analisados os 10 primeiros colocados da categoria elite masculino de cada ano avaliado. As diferenças entre os tempos foram analisadas por ANOVA, seguida por "post-hoc" de Tukey. O coeficiente de correlação de Pearson foi empregado para investigar a associação entre o desempenho total e o desempenho nas diferentes modalidades isoladas. Os resultados mostraram não ter havido evolução no desempenho ao longo dos anos, sendo observada grande variação nos resultados. Foi observada, ainda, correlação entre o tempo de prova no ciclismo e o tempo total (r = 0,82; p < 0,01), sendo que o atleta com melhor tempo no ciclismo foi, também, o campeão da prova em 75% das vezes. Por fim, concluímos que não houve evolução no desempenho ao longo dos anos analisados. Adicionalmente, o ciclismo parece ser a modalidade determinante para o sucesso do atleta no "Ironman" Brasil.

The aim of this study was to analyze the performance evolution on the Brazil-Ironman from 2003 to 2010. Additionally, we verified which of the modalities were the most influential on the overall performance. The first ten athletes for each year in the ELITE male category were analyzed. The differences between the racing times were analyzed by ANOVA, followed by Tukey post-hoc test. Pearson's correlation coefficient was utilized to investigate the association between races performance and the performance in each one of the different modalities. The results showed that there was no performance evolution over the years and a great variation in racing times was observed. We have found a important correlation between cycling performance and race time (r = 0.82; p < 0.01) and the fastest athlete in cycling was the Brazil-Ironman champion in 75% of the analyzed years. Thus, it was concluded that there was no evolution in race time over the analyzed years. Additionally, the cycling might be the most influential modality for athletes' success in Brazil-Ironman.

Cálcio e a regulação da adiposidade e do peso corporal / Calcium and the regulation of adiposity and body weight

Obesity is known to be an evolving pandemic and adequate nutrition is one of the major cornerstones of its treatment and prevention. However, not only the role of energy partitioning and macronutrient distribution, but also the influence of micronutrients on the control of body weight and adiposity have been recently discussed. In this regard, calcium has received a great deal of attention by the scientific community. Several studies using both animal and human models (observational and randomly controlled trials) have focused on the effects of calcium on obesity, showing controversial results. Several factors seem to influence the results obtained, and although a definite conclusion is still unclear, the literature points towards an interesting positive effect of the increased intake of dietary calcium (particularly from dairy sources) on the regulation of body weight and adiposity in the overweight and obese population undergoing restrictive energy intake.

Se sabe que la obesidad es una pandemia en evolución. La dieta adecuada se ha constituido en uno de los pilares para su tratamiento y prevención.Sin embargo, recientemente, se ha discutido no sólo el papel de la restricción calórica y distribución de macronutrientes, sino, también, la influencia de los micronutrientes sobre el control del peso corporal y la adiposidad. En este sentido, el calcio ha recibido una atención especialpor parte de la comunidad científica. Diversos estudios, tanto los realizados con animales como con seres humanos, en ensayos clínicosaleatorizados y en modelos observacionales, se han centrado en esta temática, con resultados controvertidos. Varios factores parecen influiren los resultados obtenidos, y, aunque no haya una conclusión definitiva sobre el tema, la literatura señala un interesante efecto beneficiosoen el aumento de la ingesta de calcio (especialmente cuando proviene de los lácteos) sobre el control de la adiposidad y del peso corporal deindividuos con sobrepeso y obesidad sometidos a la dieta restrictiva.

A obesidade é, sabidamente, uma pandemia em evolução. A dieta adequada tem se constituído em um dos pilares no seu tratamento e na suaprevenção. Contudo, recentemente, tem sido discutido o papel não só da restrição calórica e da distribuição dos macronutrientes, mas, também, a influência dos micronutrientes sobre o controle da adiposidade e do peso corporal. Neste sentido, o cálcio tem recebido especial atenção da comunidade científica. Diversos estudos ? tanto com modelo animal quanto a partir da experimentação com humanos em modelos observacionais e em estudos clínicos controlados ? têm se debruçado sobre esta temática, com resultados controversos. Vários fatores parecem influenciar os resultados obtidos e, embora uma conclusão definitiva acerca do tema ainda não seja clara, a literatura aponta para um interessante efeito benéfico do aumentodo consumo de cálcio dietético (principalmente quando oriundo dos laticínios) sobre o controle da adiposidade e do peso corporal de indivíduoscom sobrepeso e obesidade submetidos à dieta restritiva.

Desenvolvimento de um método de familiarização individualizado para saltos verticais / Development of an individualized familiarization method for vertical jumps

OBJETIVO: Propor um método de familiarização individualizado para saltos verticais e verificar o seu efeito na variabilidade intrassujeito. MÉTODOS: Cinquenta e três homes (média ± DP; idade 23,5 ± 3,3 anos; estatura 1,76 ± 0,08 m; massa 72,8 ± 8,6 kg; percentual de gordura 12,9 ± 5,2%) realizaram sucessivos saltos até atingir o nível de estabilidade proposto. Após 48 h este processo era repetido e a estabilidade entre dias era verificada, se necessário, mais sessões eram realizadas. O nível de estabilidade foi determinado por um teste z, com intervalo de confiança de 95%. Após o processo de familiarização, duas sessões experimentais adicionais foram realizadas para determinar a confiabilidade do desempenho no salto agachado (SA) e no salto com contramovimento (SCM). O coeficiente de variação e o erro padrão de medida foram determinados individualmente (CVi e EPMi). Um teste t pareado foi realizado para verificar diferenças no CVi e EPMi antes e depois do processo de familiarização. RESULTADOS: O CVi apresentou uma redução significativa após o processo de familiarização (p < 0,001), alterando de 5,01 ± 2,40% para 2,95 ± 0,89% no SA e de 4,50 ± 2,19% para 2,58 ± 0,81% no SCM. O mesmo ocorreu para o EPMi variando de 1,29± 0,53 cm para 0,83 ± 0,25 cm no SA e de 1,35 ± 0,51 cm para 0,83 ± 0,26 cm no SCM. CONCLUSÃO: o método de familiarização individualizado proposto reduziu significativamente a variação intrassujeito, permitindo maior poder estatístico em estudos experimentais e maior sensibilidade para ferramentas de monitoramento do desempenho.

OBJECTIVE: The aim of the present study was to propose an individualized familiarization method for vertical jumps and to verify its effect on intra-subject variability. METHODS: Fifty three men (mean ± S.D.; age 23.5 ± 3.3; height 1.76 ± 0.08 m; mass 72.8 ± 8.6 Kg; body fat 12.9 ± 5.2%) performed successive jumps to reach the proposed stability level. After 48 hours, this process was repeated and the stability between the days was verified; if necessary, more sessions were performed. The stability level was determined by a Z-Test with a confidence interval of 95%. After the familiarization process, two additional experimental sessions were performed in order to determine the reliability of the performance in the Squat Jump (SJ) and the Countermovement Jump (CMJ). The coefficient of variation and standard error of measurement were determined individually (CVi and SEMi). A paired T-Test was performed to verify differences in the CVi and SEMi before and after the familiarization process. RESULTS: The CVi presented a significant reduction after the familiarization process (p < 0.001), changing from 5.01 ± 2.40% to 2.95 ± 0.89% in the SJ. The CVi also changed in the CMJ (from 4.50 ± 2.19% to 2.58 ± 0.81%). The same also occurred with the SEMi in both the SJ and the CMJ, changing from 1.29 ± 0.53 cm to 0.83 ± 0.25 cm in the SJ and from 1.35 ± 0.51cm to 0.83 ± 0.26 cm in the CMJ. CONCLUSION: The proposed individualized familiarization method significantly decreased intra-subject variability, which allows for a higher statistical power in the laboratorial setting and a greater sensitivity for performance monitoring tools.

Suplementação de ferro e sua associação com a incidência de diabetes mellitus gestacional / Iron supplementation and its association with the incidence of gestational diabetes mellitus

Iron requirements are significantly increased during pregnancy, which makes the daily dietary reference intake difficult to achieve through diet. Because iron deficiency may cause iron-deficiency anemia, which increases perinatal mortality, iron supplementation has been broadly adopted as a standard procedure during pregnancy. However, caution should be exercised as recent evidence suggests that iron excess may hamper fetus development and increase the risk for gestational diabetes mellitus (GDM). Literature is still scarce and it is inconclusive on this matter as the risks and benefits of prophylactic iron supplementation during pregnancy are still a source of controversy. However, it is imperative that a greater attention be given to the iron circulating levels individually. This practice would provide a better evaluation of the necessity and dosage determination of iron supplementation during pregnancy, being, therefore, potentially less likely to trigger the excess of iron-induced deleterious effects.

La demanda nutricional de hierro aumenta significativamente durante el embarazo siendo difícil alcanzar las dosis diarias recomendadas solamente a través de la alimentación. Dado que la deficiencia de hierro puede causar anemia y aumento de la mortalidad perinatal, la suplementación con hierro ha sido ampliamente utilizada como procedimiento estándar en las mujeres embarazadas. Sin embargo esta práctica debe usarse con cautela porque evidencias recientes sugieren efectos adversos de los niveles altos de hierro, que pueden perjudicar el desarrollo fetal y aumentar el riesgo de la diabetes mellitus gestacional (DMG). Aún no existe acuerdo, en la literatura, sobre la mejor manera de abordar el problema. Los riesgos y beneficios de la suplementación con hierro todavía son materia de debate. Sin embargo, es necesario que se preste más atención, de forma individual, a los niveles de hierro circulante Esta práctica permitiría una mejor evaluación de la necesidad de suplementación con hierro y de la determinación de la dosis a ser administrada, siendo de esta manera menos factible que se desencadenen los efectos deletéreos causados por el exceso de hierro.

A demanda nutricional de ferro aumenta significativamente durante a gestação, sendo difícil alcançar a ingestão diária recomendada apenas via alimentação. Como a deficiência de ferro pode ocasionar anemia ferropriva, aumentando a mortalidade perinatal, sua suplementação tem sido amplamente utilizada como procedimento padrão em gestantes. No entanto, tal prática deve ser vista com cautela, pois novas evidências sugerem efeitos adversos dos altos níveis férricos, que podem comprometer o desenvolvimento fetal e aumentar o risco para o diabetes mellitus gestacional (DMG). A literatura não é conclusiva sobre a melhor abordagem ao problema. Os riscos e benefícios da suplementação profilática de ferro ainda são motivo de controvérsia. Entretanto, é imperativo que maior atenção seja dada aos níveis circulantes de ferro de forma individualizada. Essa prática permitiria melhor avaliação da necessidade e da determinação da dosagem da suplementação de ferro durante a gestação, sendo então potencialmente menos passível de desencadear os efeitos deletérios induzidos pelo excesso de ferro.

Treinamento físico: considerações práticas e científicas / Physical training: scientific and practical considerations

O treinamento físico é uma importante área de atuação profissional da Educação Física e do Esporte. Ela tem por objetivo precípuo, a melhoria do desempenho físico-esportivo através da aplicação de um processo organizado e sistemático composto por exercícios físicos. Nos últimos anos, os progressos tecnológicos e nos métodos de investigação científica nas diferentes subáreas relacionadas ao treinamento físico trouxeram um avanço significativo na obtenção deste objetivo. Neste artigo será discutido, do ponto de vista acadêmico-científico e também da prática profissional, o estado da arte do conhecimento associado à avaliação do treinamento, ao controle da carga de treinamento, aos modelos de organização da carga de treinamento e ao desenvolvimento das capacidades motoras. Esperamos que ao final, o leitor possa ter um bom entendimento destes diferentes componentes, como eles contribuem para a modificação do desempenho motor e como aplicá-los para a elaboração, implementação, avaliação e reformulação de programas de treinamento físico.

Physical training is an important field of work for the Physical Education and Sport professional. Its main goal is to develop the physical capacity and sports performance of an individual by means of an organized and systematic application of physical exercises. In the past years, the technological progress in the scientific investigation within the different disciplines related to physical training have contributed a great deal towards the accomplishment of such goal. In this manuscript we discuss, from both an academic-scientific and from a practical application point-of-view, the state of the art of the knowledge associated with the physical training evaluation, loading control, loading scheming, and the development of physical abilities. Our goal is to provide a comprehensive overview of the different components of the physical training and how they contribute to the development of the physical performance as well as how to apply these concepts in the elaboration, implementation, and evaluation of physical training programs.

Efeito do número e intensidade das ações excêntricas nos indicadores de dano muscular / Effect of the number and the intensity of eccentric muscle actions on muscle damage markers

A realização de uma sessão de treinamento de força, especialmente de ações excêntricas, provoca danos à estrutura muscular. Algumas características da realização das ações excêntricas parecem agravar a ocorrência do dano. O número de contrações realizadas e o grau de tensão desenvolvida em cada uma delas parecem afetar a magnitude o dano. Dessa maneira, o objetivo deste estudo foi investigar se o número e a intensidade das ações excêntricas contribuem para o aumento do dano muscular, avaliado através das alterações de marcadores indiretos. Vinte e quatro jovens adultos do sexo masculino foram divididos aleatoriamente em três grupos. Um dos grupos realizou 30 ações excêntricas para os flexores do cotovelo com 70 por cento de 1RM (EXC30-70, n = 8). Outro grupo realizou o mesmo número de repetições, porém com 110 por cento de 1RM (EXC30110, n = 8). Um terceiro grupo realizou um número maior de repetições (60) com 70 por cento de 1RM (EXC60-70, n = 8). A amplitude de movimento, a circunferência do braço, a força máxima (1RM) e a dor muscular tardia foram avaliadas antes, imediatamente, 48 e 96 horas após o exercício. Os resultados foram analisados através de análise de variância com dois fatores e revelaram que as alterações foram maiores no grupo EXC30-110 comparadas com EXC30-70 e EXC60-70. Esses dados sugerem que a intensidade das ações excêntricas afeta mais a ocorrência de dano do que o número de contrações.

A single bout of resistance training, especially with eccentric actions, induces damage to the muscle structure. Characteristics of eccentric actions may increase muscle damage. The number and intensity of contractions seem to affect the magnitude of muscle damage. Thus, the aim of this study was to investigate if the number and the intensity of contraction increase muscle damage, evaluated through alterations in indirect markers of muscle damage. Twenty-four young male adults were randomly placed into three groups. One of the groups performed 30 eccentric actions of the elbow flexors at 70 percent of 1RM (EXC30-70, n = 8). Another group performed the same number of repetitions, but at 110 percent of 1RM (EXC30-110, n = 8). A third group performed a higher number of repetitions (60) at 70 percent of 1RM (EXC60-70, n = 8). Range of motion, limb girth, maximal dynamic strength (1RM) and muscle soreness were assessed before, immediately after, 48h and 96h post exercise. Results were analyzed by a 2-way ANOVA and showed that alterations were more remarkable larger in EXC30-110 compared to EXC30-70 and EXC60-70. These data suggest that eccentric action intensity affects the magnitude of muscle damage more than the number of contractions.

Efeito da ordem dos exercícios no número de repetições e na percepção subjetiva de esforço em homens treinados em força / The effect of the exercises order on number of repetitions and rate of perceived effort in resistance trained men

A ordem dos exercícios refere-se à sequência de execução durante uma sessão de treinamento. Evidências demonstram que essa ordem pode afetar o número de repetições realizadas nos exercícios. A percepção subjetiva de esforço (PSE), assim como o número de repetições realizadas, depende da sobrecarga utilizada. Assim, alterações no número de repetições podem afetar a PSE. O volume total de trabalho (VTT) influencia nas adaptações crônicas ao treinamento e também pode ser afetado pela ordem dos exercícios. O objetivo foi verificar o efeito da ordem dos exercícios para membros inferiores no número de repetições realizadas, na PSE e no VTT. Doze homens treinados (19,3 ± 2,1 anos, 71,1 ± 9,8 kg, 172,4 ± 6,1 cm, 23,3 ± 11,5 meses/treino) realizaram duas sessões com os exercícios "leg-press" (L), mesa flexora (F) e cadeira extensora (E) em diferentes ordens (LFE ou EFL). Foram utilizados testes t de "Student" pareados com ajuste de Bonferroni para comparações múltiplas. O número de repetições em L e E diminuiu quando realizados no final da sessão. As repetições realizadas em F diminuíram na LFE. A PSE de E foi maior quando realizada no final da sessão, porém de L e de F não foram afetadas pelas diferentes ordens. O volume de trabalho total de LFE foi maior. Em conclusão, a ordem dos exercícios envolvendo membros inferiores afeta o número de repetições e a PSE de um exercício além do VTT, ressaltando a importância da ordem dos exercícios como uma importante variável na prescrição do treinamento.

The order of exercises refers to the sequence during a training bout. Some evidence shows that the number of repetitions may be affected by the order of exercises. Both the number of repetitions and the rate of perceived effort (PSE) are influenced by exercise load. Thus, changes in the number of repetitions may affect PSE. Additionally, total work volume influences long term training adaptations and can be affected by the order of exercises. The aim of this study was to evaluate the effect of order of lower limb exercises on the number of repetitions, RPE and total work volume. Twelve resistance trained male (19.3 ± 2.1 years, 71.1 ± 9.8 kg, 172.4 ± 6.1 cm, 23.3 ± 11.5 months of training) performed leg-press (L), leg extension (E) and leg curl (F) exercises, in different orders (LFE or EFL). Number of repetitions, PSE and total work volume were compared by paired t-test with Bonferroni adjustment. Number of repetitions on both L and E decreased when they were performed last in the bout. The number of repetitions on F also decreased, when F was preceded by L. PSE for E was greater when performed at the end of the bout. However, PSE after L and F were not affected by the order. Total work volume was greater in LFE. In conclusion, the order of lower limb exercises affects the number of repetitions, PSE and total work performed, supporting the importance of the order of exercises as an important variable in training prescription.

Número de repetições e intensidade relativa em membros superiores e inferiores: implicações para o treinamento / Number of repetitions and relative intensity in upper and lower limbs: implications to training

Tradicionalmente, as recomendações para a prescrição do treinamento de força podem ser baseadas tanto na intensidade relativa ao 1RM quanto no número de repetições máximas. Entretanto, sabe se que o número máximo de repetições realizadas com a mesma carga relativa varia de acordo com o exercício e o tamanho do grupo muscular envolvido. Além disso, considerando tal diferença nas respostas musculares a diferentes cargas, é possível especular que o número máximo de repetições em cada série de exercício em uma sessão tradicional de treinamento de força (com múltiplas séries) pode também ser diferentemente afetado ao compararmos os membros superiores e superiores. Isto se torna particularmente importante, ao considerarmos as sugestões recentes de que o número total de repetições realizadas em um treinamento de força pode afetar as adaptações oriundas do mesmo. Assim, o presente trabalho teve o objetivo de comparar o número de repetições realizadas com uma mesma intensidade relativa tradicionalmente recomendada para hipertrofia muscular em séries múltiplas de exercícios para os membros superiores e inferiores. Doze homens jovens treinados foram testados para força dinâmica máxima (1RM) nos exercícios leg-press e supino reto. Uma semana depois, os participantes realizaram três séries até a falha concêntrica com carga igual a 80% de 1RM com dois minutos de intervalo entre séries. O número máximo de repetições realizadas em cada série foi anotado e utilizado para análise estatística. A análise por modelos mistos revelou que o número de repetições realizadas no leg-press foi maior do que no supino reto (p<0,05). Além disso, o número de repetições diminui ao longo das três séries sem diferença entre os exercícios. Assim, é possível sugerir que as recomendações para o treino de força que visa hipertrofia devem ser revistas e possivelmente incluir recomendações diferenciadas para exercícios distintos.

Traditionally, the recommendations to resistance training prescription are based on the relative intensity or on the number of repetition maximum. However, it is well known that the maximal number of repetitions performed with the same relative intensity varies according to both the exercise and the muscle size. Besides, considering the different muscle response to different loads, it is plausible to speculate that the maximal number of repetitions performed in each set of a traditional bout of resistance exercise (multiple-set scenario) may also differ between upper- and lower-limbs. This is of particular interest if we take into account the recent suggestions that the total number of repetitions may play an important role in the adaptations to strength training. Hence, the aim of this study was to compare the number of repetitions performed in multiple sets of exercises performed with the traditionally recommended hypertrophy-oriented intensity in upper- and lower-limb exercises. Twelve trained male adults were tested for one repetition maximum (1RM) in the leg-press and bench press exercises. After one week, participants performed three sets to concentric failure with 80% 1RM with 2-min interval between sets. The maximal number of repetition was recorded and used for statistical analyses. Mixed model analyses showed that number of repetitions performed on the leg-press was higher than on the bench press (p<0.05). In addition, the number of repetitions decreased similarly in both exercises along the three sets. Therefore, it is possible to suggest that hypertrophy oriented resistance training recommendation should be revised, and possibly include distinct recommendation to different exercises.

É possível determinar a economia de corrida através do teste progressivo até a exaustão? / Is possible to predict running economy using maximal incremental exercise test?

O objetivo do presente estudo foi verificar a possibilidade de se estimar a economia de corrida (EC) a partir do coeficiente angular gerado pela relação VO2 vs. intensidade de testes progressivos até a exaustão (EC INCLINA). Para tanto, 16 corredores de provas de longa duração (idade 32 ± 7 anos, massa corporal 70,0 ± 6,7 kg, estatura 173,3 ± 5,0 cm, O2máx 57,9 ± 5,8 ml·kg-1·min-1) foram submetidos a um teste incremental e a dois testes de cargas constantes (12 km·h-1 e a intensidade de 90 por cento do segundo limiar ventilatório) para a mensuração da EC. Foram detectadas correlações fracas entre o EC INCLINA e a EC estabelecida a 12 km·h-1 (r = 0,49; p = 0,054) e na intensidade de 90 por cento do segundo limiar ventilatório (r = 0,55; p = 0,027). Além disso, o EC INCLINA também estava negativamente correlacionado com a concentração sanguínea de lactato (r = -0,75; p = 0,001) e a razão de troca respiratória (r = -0,80; p < 0,001) mensuradas ao final no teste progressivo. Portanto, esses achados sugerem que, embora a sua aplicação para determinar a EC seja limitada, o EC INCLINA pode ser um parâmetro alternativo empregado para o diagnóstico da aptidão de corredores de provas de longa duração devido a sua relação com o metabolismo anaeróbio.

The purpose of the present study was to investigate the association between running economy (RE) and the slope of the regression line obtained as the individual relationship between oxygen uptake and the corresponding intensity in the incremental test (EC INCLINA). Sixteen recreational long-distance runners (age 32 ± 7 years, body mass 70,0 ± 6.7 kg, height 173.3 ± 5.0 cm, VO2max 57.9 ± 5.8 ml·kg-1·min-1) performed a progressive incremental test and two submaximal workload tests (at 12 km·h-1 and 90 percent second ventilatory threshold) to determine the RE. There was significant correlation between EC INCLINA and RE measured at 12 km·h-1 (r = 0.49; p = 0.054) and at 90 percent second ventilatory threshold (r = 0.55; p = 0.027). In addition, EC INCLINA also was negatively correlated with peak blood lactate (r = -0.75; p = 0.001) and peak respiratory exchange rate (r = -0.80; p < 0.001). These findings suggest that EC INCLINA would be an alternative parameter employed to determine the endurance performance in recreational long-distance runners.