The eight-week concurrent training effect on functional capacity in person living with unilateral transtibial amputation: A randomized controlled trial.

INTRODUCTION: The main causes of amputation include vascular diseases, trauma, cancer, and congenital limb abnormalities. The person with transtibial amputation (TA) is affected by a greater cardiorespiratory, metabolic, and muscular load to walk and perform daily activities. The sedentary lifestyle contributes to the process of chronic non-communicable diseases. The purpose of the study was to compare the effects of eight-week concurrent training (CT) for dependent variables as muscle strength, cardiorespiratory fitness, agility, and postural balance in persons with unilateral TA. METHODS: A eight-week, randomized, controlled trial. Thirty-one people using prostheses for three or more months were selected. They were randomly divided into two groups: Experimental Group (EG; n = 17) - concurrent training and Control group (CG; n = 14) - no training. All patients were evaluated at the baseline and after eight weeks by the functional performance, isokinetic knee evaluation, static and dynamic posturography and cardiopulmonary test. RESULTS: The patients showed improvements in all measures after training (size effect >0.80). CONCLUSION: The main limitations are the sample size, related to the socioeconomic status and availability training and no comparison to other types of training. Eight weeks of CT was effective and favorably modified the dependent variables in TA patients. Therefore, CT is a good option to improve functional performance after the regular rehabilitation program discharge and decreases the metabolic and functional deficits of these patients.

Resting metabolic rate and weight loss after bariatric surgery.

BACKGROUND: There is an increased interest in understanding how variation in body composition (BC) and energy expenditure is related to successful weight loss after surgery. It has been suggested that low resting metabolic rate (RMR) could be associated with poor weight loss. OBJECTIVES: To determine the relation among changes in BC, RMR, and weight loss after bariatric surgery. SETTING: University tertiary care hospital, Brazil. METHODS: A cohort of 45 patients submitted to bariatric surgery was prospectively studied. BC was evaluated by bioelectrical impedance analysis and RMR by indirect calorimetry before and 6 months after surgery. The RMR value was adjusted per kilogram of weight (RMR/kg). The patients were divided in 4 groups, based on patterns of change in the RMR/kg after surgery. The RMR/kg could decrease (group 1), remain stable (group 2), have a small increase (group 3), or have a major increase (group 4). RESULTS: A significant relation between fat-free mass and RMR for both pre- (P<.01) and postoperative periods (P<.01) was observed. Excess weight loss had a significantly correlation only with post-RMR/kg (P<.01). The pattern of change in RMR/kg was strongly correlated with weight loss, considering an excess weight loss>50% a successful weight loss: No patients achieved success in group 1; 61% of patients did in group 2; 80% di in group 3; and all patients in group 4 had successful weight loss. CONCLUSIONS: We demonstrate a clearly correlation between the postoperative RMR and weight loss. The increase in RMR/kg after surgery is a major factor related to a satisfactory excess weight loss after surgery.

Isokinetic strength and endurance in proximal and distal muscles in patients with peripheral artery disease.

BACKGROUND: The objective of this study was to analyze the muscle strength and endurance of the proximal and distal lower-extremity muscles in peripheral artery disease (PAD) patients. METHODS: Twenty patients with bilateral PAD with symptoms of intermittent claudication and nine control subjects without PAD were included in the study, comprising 40 and 18 legs, respectively. All subjects performed an isokinetic muscle test to evaluate the muscle strength and endurance of the proximal (knee extension and knee flexion movements) and distal (plantar flexion and dorsiflexion movements) muscle groups in the lower extremity. RESULTS: Compared with the control group, the PAD group presented lower muscle strength in knee flexion (-14.0%), dorsiflexion (-26.0%), and plantar flexion (-21.2%) movements (P < 0.05) but similar strength in knee extension movements (P > 0.05). The PAD patients presented a 13.5% lower knee flexion/extension strength ratio compared with the control subjects (P < 0.05), as well as lower muscle endurance in dorsiflexion (-28.1%) and plantar flexion (-17.0%) movements (P < 0.05). The muscle endurance in knee flexion and knee extension movements was similar between PAD patients and the control subjects (P > 0.05). CONCLUSION: PAD patients present lower proximal and distal muscle strength and lower distal muscle endurance than control patients. Therefore, interventions to improve muscle strength and endurance should be prescribed for PAD patients.