Gamepad: utilizando exergames para a promoção da saúde e inclusão social de pessoas com deficiência / Gamepad: use of exergames for promoting health and social inclusion of people with disabilities

O objetivo desse artigo é relatar os resultados de um programa de exercícios para indivíduos adultos com deficiências cognitivas e transtornos, utilizando diferentes exergames como ferramentas pedagógicas. A intervenção foi realizada com a participação de 26 indivíduos adultos com deficiências cognitivas e transtornos com idades entre 25 e 59 anos. A pesquisa de abordagem qualitativa, de cunho exploratória, a qual foram utilizados a entrevista semiestruturada e o diário de campo como instrumentos de pesquisa. Para interação com os exergames, foram utilizados os consoles Xbox 360 com Kinect, Xbox One com Kinect e Nintendo Wii U. As intervenções foram realizadas no Exergame Lab Brazil, na Escola Superior de Educação Física da UFPel, por um período de duas horas, uma vez por semana, totalizando 25 encontros. A utilização de Exergames tem grande potencial, tanto nos aspectos relacionados à viabilidade, por ser uma tecnologia de baixo custo e de fácil implementação, quanto nos resultados esperados. O Just Dance e o Kinect Sports foram os games que mais contribuíram nesta pesquisa. Os participantes da pesquisa ganharam independência e socialização, bem como melhoraram as habilidades específicas em cada game. Além disso, a possibilidade de utilização dos Exergames em casa também poderá auxiliar pais e responsáveis a melhorar aspectos da vida diária de adultos com deficiências cognitivas e transtornos.

The purpose of this article is to report the results of an exercise program for adults with cognitive disabilities and disorders using different exergames as pedagogical tools. The intervention was carried out with the participation of 26 individuals with cognitive disabilities and disorders aged between 25 and 59 years old. The exploratory, qualitative research used a semi-structured interview and a field diary as research instruments. The Xbox 360 with Kinect, Xbox One with Kinect and Nintendo Wii U consoles were used for the interactions with the exergames. The interventions were carried out at Exergame Lab Brazil, at the Physical Education School at UFPel, for a period of two hours, once a week, totaling 25 meetings. The use of Exergames presents great potential, both in relation to feasibility, since it is a low-cost, easy-to-implement technology, and in terms of expected results. Just Dance and Kinect Sports were the games that contributed most to this research. Research participants gained independence and socialization, as well as the improvement of specific skills in each game. In addition, the possibility of using Exergames at home can also help parents and guardians to improve aspects of the daily life of adults with cognitive disabilities and disorders.

Exercise interventions for people diagnosed with cancer: a systematic review of implementation outcomes.

PURPOSE: Exercise is efficacious for people living after a cancer diagnosis. However, implementation of exercise interventions in real-world settings is challenging. Implementation outcomes are defined as 'the effects of deliberate and purposive actions to implement new treatments, practices, and services'. Measuring implementation outcomes is a practical way of evaluating implementation success. This systematic review explores the implementation outcomes of exercise interventions evaluated under real-world conditions for cancer care. METHODS: Using PRISMA guidelines, an electronic database search of Medline, PsycInfo, CINAHL, Web of Science, SportsDiscus, Scopus and Cochrane Central Registry of Controlled Trials was conducted for studies published between January 2000 and February 2020. The Moving through Cancer registry was hand searched. The Implementation Outcomes Framework guided data extraction. Inclusion criteria were adult populations with a cancer diagnosis. Efficacy studies were excluded. RESULTS: Thirty-seven articles that described 31 unique programs met the inclusion criteria. Implementation outcomes commonly evaluated were feasibility (unique programs n = 17, 54.8%) and adoption (unique programs n = 14, 45.2%). Interventions were typically delivered in the community (unique programs n = 17, 58.6%), in groups (unique programs n = 14, 48.3%) and supervised by a qualified health professional (unique programs n = 14, 48.3%). Implementation outcomes infrequently evaluated were penetration (unique programs n = 1, 3.2%) and sustainability (unique programs n = 1, 3.2%). CONCLUSIONS: Exercise studies need to measure and evaluate implementation outcomes under real-world conditions. Robust measurement and reporting of implementation outcomes can help to identify what strategies are essential for successful implementation of exercise interventions. IMPLICATIONS FOR CANCER SURVIVORS: Understanding how exercise interventions can be successful implemented is important so that people living after a cancer diagnosis can derive the benefits of exercise.

Evaluation of Awareness, Adherence, and Barriers of Pelvic Floor Muscle Training in Pregnant Women: A Cross-sectional Study.

INTRODUCTION: Adherence to pelvic floor muscle training (PFMT) may be enhanced when the women become aware of its preventive/therapeutic role in pelvic floor disorders. OBJECTIVE: This study is conducted to evaluate the PFMT awareness, adherence, and barriers in pregnant women. METHOD: We studied the awareness, adherence, and barriers of PFMT in 200 pregnant women attended in prenatal care clinic in their third trimester of pregnancy using semistructured interviews with open and closed questions derived from recent literature review on PFMT. RESULT: Fifty-four (27%) of studied women were familiar with PFMT, 175 (87.5%) of patients thought that the UI is normal during pregnancy, and 25 (32.05%) had experienced UI episodes and had consulted with their obstetrician. Twenty-one (10.5%) of patients did the PFMT exercises before their pregnancy, 14 (66.6%) of them continued their PFMT exercises during their pregnancy, and 7 (33.4%) stopped it. Concerns about miscarriage were the main reason of discontinuing the exercises during pregnancy. Routes of knowledge acquisition were the Internet in 24 cases (44.4%), health system in 13 cases (24.07%), family and friends in 11 cases (20.3%), and books/magazines in 6 cases (11.1%). Main means of mass communication (including TV, radio, and newspapers) had no role in knowledge distribution in this filed. CONCLUSIONS: Pregnant women require more health education regarding PFMT. Health care professionals should be more involved in patient education process. Internet resources are used widely by women and need more academic/scientific supervision.

Frailty Intervention through Nutrition Education and Exercise (FINE). A Health Promotion Intervention to Prevent Frailty and Improve Frailty Status among Pre-Frail Elderly-A Study Protocol of a Cluster Randomized Controlled Trial.

The ageing process has been associated with various geriatric issues including frailty. Without early prevention, frailty may cause multiple adverse outcomes. However, it potentially may be reversed with appropriate interventions. The aim of the study is to assess the effectiveness of nutritional education and exercise intervention to prevent frailty among the elderly. A 3-month, single-blind, two-armed, cluster randomized controlled trial of the frailty intervention program among Malaysian pre-frail elderly will be conducted. A minimum of total 60 eligible respondents from 8 clusters (flats) of Program Perumahan Rakyat (PPR) flats will be recruited and randomized to the intervention and control arm. The intervention group will receive a nutritional education and a low to moderate multi-component exercise program. To date, this is the first intervention study that specifically targets both the degree of frailty and an improvement in the outcomes of frailty using both nutritional education and exercise interventions among Malaysian pre-frail elderly. If the study is shown to be effective, there are major potential benefits to older population in terms of preventing transition to frailty. The findings from this trial will potentially provide valuable evidence and serve as a model for similar future interventions designed for elderly Malaysians in the community.

The effect of comprehensive rehabilitation program plus chemotherapy on quality of life in patients with postoperative non-small-cell lung cancer: study protocol of a multicenter randomized clinical trial.

BACKGROUND: Comprehensive rehabilitation therapy based on traditional Chinese medicine (TCM) has been widely applied in various cancer treatments in China. Thus far, Chinese herbal medicine (CHM) has been shown effective in reducing the adverse effects of chemotherapy and improving the quality of life (QoL) during chemotherapy. The purpose of the present study is to compare the effects of CHM plus Liu Zi Jue (LZJ) exercises with CHM plus rehabilitation education and with placebo plus rehabilitation education in patients who have undergone complete resection for nonsmall-cell lung cancer (NSCLC) followed by postoperative adjuvant chemotherapy. METHODS AND DESIGN: A multicenter, randomized clinical trial will be performed with 354 stage Ib-IIIa NSCLC patients in five centers in China. Patients satisfying the inclusion criteria will be randomly divided into three groups according to a 1:1:1 ratio: intervention group A (IGA), intervention group B (IGB), and control group (CG). Each group will receive adjuvant platinum-based doublet chemotherapy for a total of four cycles. IGA participants will receive chemotherapy combined with CHM and LZJ exercises, IGB participants will receive chemotherapy combined with CHM and rehabilitation education, and CG participants will receive chemotherapy combined with placebo and rehabilitation education. The herbal treatment patients will be given granules daily and LZJ exercises will be performed four times per week during chemotherapy. The primary outcome is QoL, which will be assessed with the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C43 scale in each cycle. The secondary outcomes include the 2-year disease-free survival rate, disease-free survival, TCM symptoms, tumor markers, safety, and adverse events. After treatment, the patients will be followed up every 3 months within 2 years and every 6 months after 2 years until disease recurrence and/or metastasis. DISCUSSION: Our previous study reported that CHM in combination with chemotherapy could lower the overall incidence of adverse events but increased digestive and gastrointestinal side effects compared with chemotherapy alone in postoperative NSCLC patients. This study will lay a foundation for the effectiveness of chemotherapy with or without a comprehensive rehabilitation program for QoL in patients with postoperative NSCLC. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03372694. Retrospectively registered on 17 December 2018.

'There is a very distinct need for education' among people with rotator cuff tendinopathy: An exploration of health professionals' attitudes.

BACKGROUND: Clinical practice guidelines recommend non-surgical care in the management of rotator cuff tendinopathy prior to considering imaging or surgery. However, this requires effective education to promote adherence to treatment. OBJECTIVES: To explore expert shoulder clinician's experiences with managing rotator cuff tendinopathy including practice beliefs towards providing education. DESIGN: An in-depth qualitative study. METHOD: We conducted interviews (n = 8) with an international sample of expert shoulder clinician-researchers. Data were analysed using an inductive thematic approach with constant comparison. RESULTS: Three key themes emerged: (1) The need for early, focused education: "Some beliefs can be detrimental to rehabilitation options", (2) Developing therapeutic alliance: "If a patients trust you then you are generally going to get much better results" and (3) What is required moving forward in current day RT management: "Maybe we can get better." CONCLUSIONS: Our findings highlight the importance of education to alleviate potential barriers to effective conservative care (including exercise) and self-management for rotator cuff tendinopathy. We also identified actionable ways to promote a collaborative therapeutic alliance however, this hinges on sufficient clinical time to educate patients adequately, which may be a barrier in busy clinical settings. Further, there is need for targeted education to facilitate development of clinical skills required to implement effective patient education strategies.

Efecto de intervenciones con ejercicio y/o suplementación sobre la masa muscular de personas mayores con sarcopenia: un metaanálisis / Effect of interventions with exercise and/or supplementation on muscle mass of elderly people with sarcopenia: a meta-analysis / Efeito das intervenções com o exercício e / ou a suplementação na massa muscular de idosos com sarcopenia: uma meta-análise

Resumen Solano-García, W. & Carazo-Vargas, P. (2019). Efecto de intervenciones con ejercicio y/o suplementación sobre la masa muscular de personas mayores con sarcopenia: Un metaanálisis. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 17(1), 1-22. La sarcopenia se caracteriza por la pérdida de la masa muscular y la fuerza. El objetivo fue determinar el tamaño del efecto global del tratamiento con ejercicio y/o suplementación sobre la masa muscular de personas adultas mayores diagnosticadas con sarcopenia, así como identificar las variables que moderan el efecto del tratamiento. Con respecto al método, se realizó una búsqueda de literatura en las bases de datos EBSCOhost, Ovid, ProQuest, PubMed, ScienceDirect, SpringerLink, Embase. De 4770 estudios recuperados, se incluyeron los 14 que cumplieron los criterios de inclusión: analizar la masa muscular, emplear diseños experimentales, aportar la estadística descriptiva, administrar un programa de ejercicio, suplementación o combinado de estas intervenciones e incluir personas mayores de 60 años diagnosticadas con sarcopenia. Los estudios debían estar publicados en texto completo en inglés o español. El cálculo del tamaño de efecto global se siguió utilizando el modelo de efectos aleatorios. En los resultados, fueron analizados 818 sujetos pertenecientes al grupo experimental y 284 al grupo control. Se obtuvo un tamaño de efecto global de 0.16 (p=0.005), procedente de 38 tamaños de efecto. El gráfico de funnel plot y la prueba de Egger no evidenciaron la presencia de sesgo general, ni publicación. Se necesitan 23 estudios para que el tamaño de efecto global sea no significativo. En la conclusión, se evidencia un cambio significativo en la masa muscular de personas adultas mayores diagnosticadas con sarcopenia, utilizando el tipo de intervención de ejercicio contra-resistencia con o sin suplementación; asimismo, se establece una guía de recomendaciones sobre prescripción de ejercicio y suplementación.

Abstract Solano-García, W. & Carazo-Vargas, P. (2019). Effect of interventions with exercise and/or supplementation on muscle mass of elderly people with sarcopenia: a meta-analysis. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 17(1), 1-22. Sarcopenia is characterized by the loss of muscle mass and strength. The objective of this paper was to determine the size of the overall effect of a treatment based on exercise and/or supplementation on muscle mass in elderly adults diagnosed with Sarcopenia, as well as identify the variables that can moderate the effect of the treatment. Regarding the method used, the EBSCOhost, Ovid, ProQuest, PubMed, ScienceDirect, SpringerLink, and Embase databases were consulted. Out of the 4770 studies recovered, 14 met the following criteria: analysis of muscle mass; use of experimental designs; use of descriptive statistics; administration of a program based on exercise, supplementation, or both; and subjects being over 60 diagnosed with sarcopenia. The studies were also required to be published completely in English or Spanish. The size of the global effect was calculated following the random effects model. A total of 818 and 284 subjects were analyzed in the experimental group and in the control group, respectively. An overall effect size of 0.16 (p = 0.005) was obtained from 38 effect sizes. The Funnel Plot graph and the Egger test did not reveal any evidence of presence of general bias or publication. A total of 23 studies are needed for the global effect size not to be significant. In conclusion, a significant change in the muscle mass of elderly adults diagnosed with sarcopenia was evident when having a resistance exercise intervention, with or without supplementation. A guide of recommendations on supplementation and exercise prescription was also established in the paper.

Resumo Solano-García, W. & Carazo-Vargas, P. (2019). Efeito das intervenções com o exercício e / ou a suplementação na massa muscular de idosos com sarcopenia: Uma meta-análise. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 17(1), 1-22. A sarcopenia é caracterizada pela perda de massa e força muscular. O objetivo foi determinar o tamanho do efeito global sobre a massa muscular no tratamento com exercício e/ou suplementação em idosos diagnosticados com sarcopenia e identificar as variáveis que moderam o efeito do tratamento. Com relação ao método, foi realizada uma pesquisa bibliográfica nas bases de dados EBSCOhost, Ovid, ProQuest, PubMed, ScienceDirect, SpringerLink, Embase. Dentre os 4770 estudos recuperados foram incluídos 14 que preencheram os critérios de inclusão, ou seja, analisar a massa muscular, usar desenhos experimentais, fornecer estatísticas descritivas, administrar um programa de exercício, suplementação ou a combinação dessas intervenções e incluir pessoas com mais de 60 anos de idade diagnosticadas com sarcopenia. Os estudos deveriam ter sido publicados em texto completo em inglês ou espanhol. Para o cálculo do tamanho do efeito global continuou-se usando o modelo de efeitos aleatórios. Nos resultados, 818 indivíduos pertencentes ao grupo experimental e 284 ao grupo controle foram analisados. Obteve-se um tamanho de efeito global de 0,16 (p = 0,005), a partir de 38 tamanhos de efeito. O gráfico de funnel plot e o teste de Egger não mostraram a presença de viés geral ou publicação. São necessários 23 estudos para que o tamanho do efeito global não seja significativo. Na conclusão, há uma mudança significativa na massa muscular de idosos diagnosticados com sarcopenia, utilizando o tipo de intervenção do exercício contrarresistência com ou sem suplementação; igualmente, fica estabelecido um guia de recomendações sobre prescrição de exercícios e suplementação.

Home-Based Cardiac Rehabilitation: A SCIENTIFIC STATEMENT FROM THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION, THE AMERICAN HEART ASSOCIATION, AND THE AMERICAN COLLEGE OF CARDIOLOGY.

Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.

All Levels of Providers Can Effectively and Efficiently Teach Pelvic Floor Strength Assessment at Time of Pelvic Examination.

OBJECTIVE: In women who undergo provider-guided vaginal biofeedback of pelvic floor muscle strength, we sought to determine whether the level of the provider correlates with the patient's ability to achieve adequate pelvic floor muscle contractions (PFMCs). METHODS: From August 2017 to April 2018, patients from 2 urogynecology clinics were recruited to participate in an institutional review board-approved, prospective study examining PFMCs. Pelvic examination and teaching session were done by providers who had specific training on how to assess pelvic floor muscle strength using the validated, modified Oxford scale. Patients were asked to perform a baseline PFMC during a 2-digit pelvic examination. Thereafter, patients were counseled to relax their muscles, identify the levator ani muscles during provider teaching, and perform 3 consecutive provider-guided PFMCs. The strength of each PFMC was measured, and the time-to-teach (TTT) was recorded. The level of provider and TTT were correlated with PFMC1 to PFMC3 using Spearman correlation coefficient. RESULTS: One hundred women participated. Obstetrics/gynecology (OB/GYN) residents (post-graduate years 1-4) evaluated 20 patients; female pelvic medicine and reconstructive surgery fellowship trainees (post-graduate years 5-7), 38 patients; OB/GYN nurse practitioners, 18 patients; generalist OB/GYN faculty, 9 patients; and female pelvic medicine and reconstructive surgery faculty, 15 patients. There was no correlation between level of provider and TTT or between level of provider and strength of PFMC1, PFMC2, or PFMC3. CONCLUSIONS: At the time of pelvic floor muscle assessment, the level of provider does not impact teaching time or PFMC1 to PFMC3. Teaching pelvic floor muscle exercise is a cost-effective, low-resource tool to improve patient care, and providers of any level should be encouraged to teach pelvic floor muscle exercise to patients at the time of office examination.

Physical Therapist Coaching to Improve Physical Activity in Children With Brain Tumors: A Pilot Study.

PURPOSE: Children with brain tumors (BTs) experience fatigue and decreased quality of life (QOL). Physical activity (PA) is recommended during and after cancer treatment. We explored whether a fitness tracker intervention combined with tailored coaching by a physical therapist (PT) increased PA and QOL and decreased fatigue in children with BTs. METHODS: Participants were 7 to 18 years' old, within 2 years of diagnosis, and received a 12-week PA intervention using a fitness tracker combined with 5 PT coaching sessions. Steps/day measured by Fitbit and self-reports of QOL, fatigue, and PA were evaluated at baseline, 12 weeks, and 24 weeks. RESULTS: Participants had nonsignificant increase in steps/day. Total fatigue, general, and sleep/rest subscales improved while cognitive fatigue and QOL remained unchanged. Higher steps/day were associated with lower fatigue. CONCLUSION: This is a feasible intervention that may contribute to an increase in PA and improve fatigue in children with BTs.

A Physiological Profile of Ovarian Cancer Survivors to Inform Tailored Exercise Interventions and the Development of Exercise Oncology Guidelines.

OBJECTIVE: Physical activity has become increasingly important in supportive cancer care. However, physical activity and exercise guidelines for ovarian cancer survivors remain generic. The aim of this narrative review is to summarize existing data regarding the physiological characteristics (treatment-related adverse effects, concurrent comorbidities, body weight and composition, physical fitness and function, and physical activity behavior) of ovarian cancer survivors to further understanding of their cancer-specific physical activity and exercise needs. We also highlight gaps in the current knowledge base. METHODS: We undertook a narrative review of current literature on the physiological status of ovarian cancer survivors. We defined physiological status as treatment-related adverse effects, concurrent comorbidities, body weight and composition, physical fitness and function, and physical activity behavior. RESULTS: In addition to disease- and treatment-related symptoms and adverse effects, the majority of ovarian cancer survivors have comorbidities, which may adversely affect treatment effectiveness and safety, as well as survival. Despite high overweight and obesity rates, a large percentage of women are malnourished at diagnosis, with potentially compromised muscle mass and muscle density. Low muscle density at diagnosis and loss of muscle mass during treatment may be associated with worse survival outcomes. A small number of studies have observed impaired physical function and cardiorespiratory fitness in ovarian cancer survivors. The majority of ovarian cancer survivors are insufficiently active or sedentary. CONCLUSIONS: Our review suggests that ovarian cancer survivors could benefit from physical activity and exercise oncology interventions aimed at addressing detrimental changes to physiological status due to disease and treatment. However, current knowledge gaps regarding the physiological characteristics of ovarian cancer survivors throughout the entire survivorship spectrum challenge the development of tailored exercise intervention studies and exercise oncology guidelines.

A pesquisa em atividade física adaptada / Research on adapted physical activity / La investigación en la actividad física adaptada

O presente trabalho discute a construção da Atividade Física Adaptada (AFA) como área de conhecimento, abordando seu desenvolvimento, objetos de estudos, métodos e resultados al- cançados. Estudos epistemológicos definem a AFA como um campo de conhecimento inter- disciplinar, com foco em três pontos: 1) Adaptação; 2) Diferenças Individuais; 3) Atividade Física. Há predominância pelo design quantitativo com crescimento nos estudos qualitativos. No campo da educação física adaptada, a inclusão começa a ser defendida como melhoria da qualidade de ensino para todos e não apenas para alunos com deficiência. Há necessidade de reflexão sobre o acesso e o impacto das pesquisas na prática profissional.

The text discusses the construction of Adapted Physical Activity (APA) as an area of knowledge, addressing its development, objects of study, methods and results achieved. Epis- temological studies define APA as an area of interdisciplinary knowledge, focusing on three points:1) Adaptation; 2) Individual Differences; 3) Physical Activity. Quantitative design studies predominate, but the number of qualitative studies is increasing. In the field of adapted physical education, inclusion has been understood as an improvement in the quality of educa- tion for all and not just for students with disabilities. It is necessary to re-think the access and impact of research in professional practice.

Este trabajo discute la construcción de la Actividad Física Adaptada (AFA) como área de conocimien- to, enfocando su desarrollo, sus objetos de estudio , sus métodos y los resultados alcanzados. Estu- dios epistemológicos definen la AFA como un campo de conocimiento interdisciplinar, centrándose en tres puntos:1) Adaptación; 2) Diferencias individuales; 3) Actividad Física. Predomina el diseño cuantitativo, con crecimiento en los estudios cualitativos. En el campo de la educación física adaptada, la inclusión comienza a ser defendida como sinónimo de mejoría de la calidad de la enseñanza para todos y, no sólo para los estudiantes con discapacidades. Se necesita reflexión sobre el acceso y el impacto de las investigaciones en la práctica profesional.

Disminución de la grasa corporal mediante ejercicio físico intermitente de alta intensidad y consejería nutricional en sujetos con sobrepeso u obesidad / Effects of 12 sessions of high intensity intermittent training and nutrition counseling on body fat in obese and overweight participants

Background: The search of efficient exercise alternatives to treat obesity is worthwhile. Aim: To demonstrate the effect of high intensity intermittent exercise on body fat reduction in overweight and obese subjects. Material and Methods: A group of 65 overweight and obese adult subjects (25 men), aged 18-65 years, participated during 12 sessions in a high intensity physical exercise program, 3 days/week. Weight, height and body fat was measured before and after the intervention by bioimpedance. Each session consisted of 1 min stationary cycling exercise at high intensity, followed by 2 min inactive rest. This cycle was repeated 10 times, thus the method is called 1*2*10. Results: There was a significant reduction of body fat of -1.88 ± 2.8 and -3.44 ± 2.7 kg, in women and men, respectively (p < 0.05). Conclusions: The 1*2*10 training protocol lasting 12 weeks in association with nutrition counseling is effective in reducing body fat in overweight persons.

The prevalence of exercise prescription-related course offerings in United States pharmacy school curricula: Exercise is Medicine.

Exercise training has proven to be beneficial in the prevention of disease. In addition, exercise can improve the pathogenesis and symptoms associated with a variety of chronic disease states and can attenuate drug-induced adverse effects. Exercise is a drug-free polypill. Because the benefits of exercise are clear and profound, Exercise is Medicine, a joint initiative between the American Medical Association and American College of Sports Medicine, was launched in 2007 to call on all health care providers to counsel patients and prescribe exercise in the prevention and treatment of chronic disease states. Pharmacists play an increasing role in direct patient care and are the most accessible health care providers in the community. Thus, pharmacists should be knowledgeable in counseling patients on the frequency, intensity, time, and type of exercise that is appropriate for various conditions and disease states. The aim of the present study was to determine the prevalence of didactic course offerings in United States pharmacy school curricula regarding training in exercise prescription. School websites were accessed for information regarding course offerings in PharmD programs. No United States pharmacy schools offered courses that were dedicted to the role of exercise in disease prevention or exercise prescription in disease management. Ninety percent of pharmacy schools did not offer courses with the keywords "exercise," "fitness, or "physical activity" in the title or description. The data suggest that student pharmacists are not adequately trained to counsel patients on the benefits of exercise or exercise prescription.

Physical activity initiated by employer and its health effects; an eight week follow-up study.

BACKGROUND: While the health benefits of physical activity are well established, little is known about health effects of physical activity programs initiated by employer. METHODS: Background data and level of physical activity were collected by questionnaire among 78 men and 43 women working in road maintenance pre and post an 8-week physical activity motivational program. As a part of the program steps measured by accelerometer were registered online where team and individual performances could be continuously monitored. The physical activity levels were registered as 1) those physical active ≤1 time per week, 2) 2-3 times per week and 3) ≥4 times a week. Maximal oxygen uptake (VO2max), blood pressure, resting heart rate (RHR) and blood samples (glycosylated hemoglobin, lipids and C-reactive protein) were obtained at baseline and after eight weeks. Mixed models were applied to evaluate associations between physical activity and health parameters. RESULTS: With ≤1 time per week as reference, exercising 2-3 times per week at baseline was associated with higher levels of VO2max. During follow-up, VO2max increased with 2.8 mL ∙ kg(-1)∙ min(-1) (95 % CI = 1.4, 4.3). Women had more favorable body mass index (BMI), blood pressure, RHR and lipid profile than men. Total cholesterol, low density lipoprotein (LDL), RHR and diastolic blood pressure (dBP) were lower among participants who exercised 2-3 times per week or ≥4 times a week, compared with those with ≤1 time per week. Half of the participants reported increased daily PA during follow-up, with high intensity PA such as jogging by 8.6 min (SD 14.6) and 8.3 min (SD 18.2), among women and men, respectively. During follow-up dBP increased among men. Further, total cholesterol and LDL were reduced by 0.12 mmol/L and 0.13 mmol/L, respectively (95 % CI = -022, -0.01 and -0.22,-0.04). CONCLUSIONS: Exercise several times a week was associated with lower blood pressure and a favorable lipid status compared to lower weekly activity. During the 8-week follow-up of an employer initiated exercise program VO2max increased, while total cholesterol and LDL were reduced. TRIAL REGISTRATION: Current Controlled Trials ISRCTN13033050 . Registered 21 August 2015.

[Effects of 12 sessions of high intensity intermittent training and nutrition counseling on body fat in obese and overweight participants]. / Disminución de la grasa corporal mediante ejercicio físico intermitente de alta intensidad y consejería nutricional en sujetos con sobrepeso u obesidad.

BACKGROUND: The search of efficient exercise alternatives to treat obesity is worthwhile. AIM: To demonstrate the effect of high intensity intermittent exercise on body fat reduction in overweight and obese subjects. MATERIAL AND METHODS: A group of 65 overweight and obese adult subjects (25 men), aged 18-65 years, participated during 12 sessions in a high intensity physical exercise program, 3 days/week. Weight, height and body fat was measured before and after the intervention by bioimpedance. Each session consisted of 1 min stationary cycling exercise at high intensity, followed by 2 min inactive rest. This cycle was repeated 10 times, thus the method is called 1*2*10. RESULTS: There was a significant reduction of body fat of -1.88 ± 2.8 and -3.44 ± 2.7 kg, in women and men, respectively (p < 0.05). CONCLUSIONS: The 1*2*10 training protocol lasting 12 weeks in association with nutrition counseling is effective in reducing body fat in overweight persons.

Effectiveness of an illustrated home exercise guide on promoting urinary continence during pregnancy: a pragmatic randomized clinical trial / Efetividade de um manual de exercícios domiciliares na promoção da continência urinária durante a gestação: um ensaio clínico aleatorizado pragmático

PURPOSE: To evaluate the effectiveness of an illustrated home exercise guide targeting the pelvic floor muscles in promoting urinary continence during pregnancy.METHODS: A randomized clinical trial was performed with 87 participants, evaluated six times during pregnancy and divided into three groups: Gsup, supervised; Gobs, not supervised, and Gref, women who did not perform the home exercises program. A miction diary and perineometry were used to evaluate urinary incontinence (primary outcome) and pelvic floor muscle strength (secondary outcome), respectively. The Kruskal-Wallis test with post hoc Dunn's and chi-square and Z tests with Bonferroni correction were used for continuous variables and proportions, respectively, with the level of significance set at 5%.RESULTS: At the end of the study, 6.9% of pregnant women in the Gsup and Gobs had urinary incontinence, while 96.6% of Gref women were incontinent. Regarding pelvic floor muscle function, Gsup and Gobs had mean contractions of 10 and 8.9 cmH2O, respectively, while Gref had a value of 4.7 cmH2O. Both results were significant.CONCLUSION: An illustrated home exercise guide targeting the pelvic floor muscles is effective in promoting urinary continence during pregnancy, even without permanent supervision.

OBJETIVO: Avaliar a efetividade de um manual de orientação de exercícios domiciliares (MOED) para o assoalho pélvico (AP) na promoção da continência urinária em gestantes primigestas.MÉTODOS: Ensaio clínico com 87 participantes, avaliadas 6 vezes durante a gestação e divididas aleatoriamente em 3 grupos: Grupo supervisionado (Gsup), que praticou exercícios com supervisão; Grupo observado (Gobs), que praticou exercícios sem supervisão, e Grupo referência (Gref), que não praticou exercícios. Incontinência urinária (IU) (desfecho primário) e força muscular perineal (FMP) (desfecho secundário) foram avaliadas por intermédio de diário de perdas urinárias e perineometria, respectivamente. Foram utilizados o teste de Kruskal-Wallis, seguido do teste post hoc de Dunn, para variáveis contínuas, e o teste do χ2 e testes Z, com correções de Bonferroni, para proporções, com nível de significância de 5%.RESULTADOS: O Gsup e o Gobs apresentaram 6,9% de gestantes incontinentes, enquanto o Gref apresentou 96,6% de incontinentes. Quanto à FMP, o Gsup e o Gobs apresentaram valores médios de contração de 10 e 8,9 cmH2O, respectivamente, enquanto o Gref apresentou valor de 4,7 cmH2O. Ambos os resultados significantes.CONCLUSÃO: A utilização de um MOED é eficaz na promoção da continência urinária e no aumento da FMP em gestantes primigestas, independentemente de supervisão permanente.

Nutrition Education in an Era of Global Obesity and Diabetes: Thinking Outside the Box.

In an era when rates of obesity, diabetes, and other lifestyle-related diseases challenge medical educators and governments worldwide, it is necessary to consider novel educational strategies, both didactic and experiential, whereby current and future health professionals can be better prepared to proactively advise and teach patients enhanced self-care skills (e.g., diet, movement, stress management, and enhanced behavioral change).In this Perspective, the authors summarize current circumstances involving rising rates of obesity and diabetes worldwide, the lack of nutrition- and lifestyle-related curricular requirements for professional medical certification, societal trends regarding modern food culture and food availability in health care settings, and the misalignment of financial incentives to promote health.The authors assess what elements of self-care should or should not be required within future curricula and certification exams. They consider how best to educate trainees about diet and how to "translate" nutrition, exercise, and behavioral science knowledge into practical advice. They explore several ideas for reforming nutrition education, including "teaching kitchens" as required laboratory classes for nutrition and lifestyle instruction, wearable technologies for tracking behaviors and physiological data relating to lifestyle choices, and the prospect of hospitals and other medical venues serving as exemplars of healthy, delicious food options. Finally, the authors argue that "salutogenesis"-the study of the creation and maintenance of health and well-being-should assume its rightful position alongside the study of "pathogenesis"-disease diagnosis and treatment-in medical education and practice.

[Cardiac rehabilitation: physiologic basis, beneficial effects and contraindications]. / La réadaptation cardiaque: bases physiologiques, effets bénéfiques, contre-indications.

Cardiac rehabilitation can reduce morbidity and mortality cost-effectively among patients with many types of cardiovascular disease yet is widely underutilized. Rehabilitation is helpful not only for patients who have had myocardial infarction but also for those with stable angina or congestive heart failure and those who have undergone myocardial revascularization, transplantation, or valve surgery. The beneficial effects of rehabilitation include a reduction in mortality from cardiovascular disease, improved exercise tolerance, and fewer cardiac symptoms. This method includes improved risk factor management, more successful smoking cessation, better psychosocial well-being, and an increased likelihood of return to work. Rehabilitation requires a multidisciplinary team focusing on therapeutic education, individually tailored exercise, and optimization of functional status and mental health. Current research trends in this area include the evaluation of new secondary prevention modalities and alternatives such as home-based rehabilitation.

Actividad física en la prevención y tratamiento de la obesidad infantil / Physical activity in the prevention and treatment of childhood obesity

La obesidad ha aumentado en forma alarmante en los niños. Los factores que influyen en el desarrollo de esta enfermedad son genéticos y ambientales y, dentro de estos últimos, se encuentran la alimentación y los altos niveles de sedentarismo. Las enfermedades asociadas a la obesidad están apareciendo cada vez a edades más tempranas, siendo las más frecuentes la hipertensión arterial, dislipidemia, resistencia insulínica y las complicaciones psicológicas. El tratamiento es complejo y está enfocado en la dieta, la actividad física y en el cambio de hábitos de toda la familia. La actividad física es importante en el tratamiento de la obesidad, en el manejo de sus comorbilidades, así como también en su prevención.

The current increase in childhood overweight and obesity reflects the convergence of genetic and environmental factors. One of them is a low level of habitual physical activity. With increasing frecuency, serious medical sequelae of obesity have their onset during childhood. Hypertension, dyslipidemia, insulin resistance and poor-self esteem are among the comorbidities seen more commonly in affected children. The treatment is not easy and should focus on diet, physical activity and lifestyle changes involving the whole family. Physical activity is important in the obesity treatment and obesity-associated complications management, as well as in its prevention.