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Physical disability is a common component of post-intensive care syndrome, but the importance of musculoskeletal health in this population is currently unknown. We aimed to determine the musculoskeletal health state of intensive care unit survivors and assess its relationship with health-related quality of life; employment; and psychological and physical function. We conducted a multicentre prospective cohort study of adults admitted to intensive care for > 48 h without musculoskeletal trauma or neurological insult. Patients were followed up 6 months after admission where musculoskeletal health state was measured using the validated Musculoskeletal Health Questionnaire score. Of the 254 participants, 150 (59%) had a musculoskeletal problem and only 60 (24%) had received physiotherapy after discharge. Functional Comorbidity Index, Clinical Frailty Scale, duration of intensive care unit stay and prone positioning were all independently associated with worse musculoskeletal health. Musculoskeletal health state moderately correlated with quality of life, rs = 0.499 (95%CI 0.392-0.589); anxiety, rs = -0.433 (95%CI -0.538 to -0.315); and depression, rs = -0.537 (95%CI -0.631 to -0.434) (all p < 0.001). Patients with a musculoskeletal problem were less physically active than those without a problem (median (IQR [range]) number of 30 min physical activity sessions per week 1 (0-3.25 [0-7]) vs. 4 (1-7 [0-7]), p < 0.001, respectively). This study found that musculoskeletal health problems were common after intensive care unit stay. However, we observed that < 25% of patients received physical rehabilitation after discharge home. Our work has identified potential high-risk groups to target in future interventional studies.
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Cuidados Críticos , Doenças Musculoesqueléticas , Qualidade de Vida , Humanos , Estudos Prospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/psicologia , Idoso , Estudos de Coortes , Adulto , Unidades de Terapia Intensiva , Modalidades de Fisioterapia , Nível de Saúde , Estado Terminal/psicologia , Estado Terminal/reabilitaçãoRESUMO
BACKGROUND: Physical activity (PA) may positively stimulate the brain, cognition and mental health during adolescence, a period of dynamic neurobiological development. High-intensity interval training (HIIT) or vigorous PA interventions are time-efficient, scalable and can be easily implemented in existing school curricula, yet their effects on cognitive, academic and mental health outcomes are unclear. The primary aim of the Fit to Study trial was to investigate whether a pragmatic and scalable HIIT-style VPA intervention delivered during school physical education (PE) could improve attainment in maths. The primary outcome has previously been reported and was null. Here, we report the effect of the intervention on prespecified secondary outcomes, including cardiorespiratory fitness, cognitive performance, and mental health in young adolescents. METHODS: The Fit to Study cluster randomised controlled trial included Year 8 pupils (n = 18,261, aged 12-13) from 104 secondary state schools in South/Mid-England. Schools were randomised into an intervention condition (n = 52), in which PE teachers delivered an additional 10 min of VPA per PE lesson for one academic year (2017-2018), or into a "PE as usual" control condition. Secondary outcomes included assessments of cardiorespiratory fitness (20-m shuttle run), cognitive performance (executive functions, relational memory and processing speed) and mental health (Strength and Difficulties Questionnaire and self-esteem measures). The primary intention-to-treat (ITT) analysis used linear models and structural equation models with cluster-robust standard errors to test for intervention effects. A complier-average causal effect (CACE) was estimated using a two-stage least squares procedure. RESULTS: The HIIT-style VPA intervention did not significantly improve cardiorespiratory fitness, cognitive performance (executive functions, relational memory or processed speed), or mental health (all p > 0.05). Subgroup analyses showed no significant moderation of intervention effects by sex, socioeconomic status or baseline fitness levels. Changes in cardiorespiratory fitness were not significantly related to changes in cognitive or mental health outcomes. The trial was marked by high drop-out and low intervention compliance. Findings from the CACE analysis were in line with those from the ITT analysis. CONCLUSION: The one-academic year HIIT-style VPA intervention delivered during regular school PE did not significantly improve fitness, cognitive performance or mental health, but these findings should be interpreted with caution given low implementation fidelity and high drop-out. Well-controlled, large-scale, school-based trials that examine the effectiveness of HIIT-style interventions to enhance cognitive and mental health outcomes are warranted. TRIAL REGISTRATION: ISRCTN registry, 15,730,512 . Trial protocol and analysis plan for primary outcome prospectively registered on 30th March 2017. ClinicalTrials.gov , NCT03286725 . Secondary measures (focus of current manuscript) retrospectively registered on 18 September 2017.
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Desempenho Acadêmico , Aptidão Cardiorrespiratória , Exercício Físico , Matemática , Saúde Mental , Processos Mentais , Adolescente , Encéfalo/fisiologia , Cognição , Inglaterra , Função Executiva , Treinamento Intervalado de Alta Intensidade , Humanos , Masculino , Educação Física e TreinamentoRESUMO
BACKGROUND AND PURPOSE: The aim was to evaluate the tolerability of, adherence to and efficacy of a community walking training programme with simultaneous cognitive demand (dual-task) compared to a control walking training programme without cognitive distraction. METHODS: Adult stroke survivors at least 6 months after stroke with a visibly obvious gait abnormality or reduced 2-min walk distance were included in a two-arm parallel randomized controlled trial of complex intervention with blinded assessments. Participants received a 10 week, bi-weekly, 30 min treadmill programme at an aerobic training intensity (55%-85% heart rate maximum), either with or without simultaneous cognitive demands. Outcome was measured at 0, 11 and 22 weeks. The primary assessment involved 2-min walk tests with and without cognitive distraction to investigate the dual-task effect on walking and cognition; secondary results were the Short Form Health Survey 36, EuroQol-5D-5L, the Physical Activity Scale for the Elderly (PASE) and step activity. RESULTS: Fifty stroke patients were included; 43 received allocated training and 45 completed all assessments. The experimental group (n = 26) increased their mean (SD) 2-min walking distance from 90.7 (8.2) to 103.5 (8.2) m, compared with 86.7 (8.5) to 92.8 (8.6) m in the control group, and their PASE score from 74.3 (9.1) to 89.9 (9.4), compared with 94.7 (9.4) to 77.3 (9.9) in the control group. Statistically, only the change in the PASE differed between the groups (P = 0.029), with the dual-task group improving more. There were no differences in other measures. CONCLUSIONS: Walking with specific additional cognitive distraction (dual-task training) might increase activity more over 12 weeks, but the data are not conclusive.
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Função Executiva , Terapia por Exercício/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Caminhada , Adulto , Idoso , Idoso de 80 Anos ou mais , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Caminhada/fisiologiaRESUMO
BACKGROUND AND PURPOSE: Approximately 9000 people in the UK are affected by Huntington's disease (HD). People with HD require ongoing health and social care support. There is a knowledge gap about costs of health and social care use associated with HD in the UK. This paper estimates the economic cost in the UK. METHODS: Data on UK patients for the year 2013 were extracted from the European Huntington's Disease Network REGISTRY study, a full clinical dataset, including the full medical history and medication history for patients with HD. National unit costs for the price year 2013 were applied to health and social care services. RESULTS: Data were available for 131 people. The mean annual cost per person with HD was £21 605. The largest proportion of this cost (65%) was due to informal care (£14 085). CONCLUSIONS: Informal care was the largest driver of costs across all stages of HD; thus there is a need to also consider the needs of carers when planning services for people with HD.
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Custos de Cuidados de Saúde/estatística & dados numéricos , Doença de Huntington/economia , Assistência ao Paciente/economia , Sistema de Registros/estatística & dados numéricos , Humanos , Reino UnidoRESUMO
OBJECTIVE: To explore exercise response in people with Huntington's disease (HD). DESIGN: Experimental observational study with a randomly allocated subgroup before/after interventional study. SETTING: Community. SUBJECTS: People with HD (n=30) and a healthy comparator group (n=20). Thirteen people from the HD group were randomly allocated to an exercise training program. MAIN MEASURES: Heart rate (HR) and perceived exertion on the Borg-CR10 scale (RPE) during a submaximal cycle ergometer exercise test (three minute unloaded and nine minute 65%-75%HRmaximum phase). Expired air and lactate measures were available for 8 people with HD during the exercise. INTERVENTION: A 12 week gym and home walking exercise programme (n=13). RESULTS: People with HD achieved a lower work rate at nine minutes (82±42(0-195) v 107±35(50 -185) Watts (p<0.05)), but higher RPE at both three (3±2(0-7) v 1±1(0-4)) and nine minutes (7±3(1-10) v 5± 2(2-9)) both p<0.01, compared to the healthy group and did not achieve a steady state HR during unloaded cycling. People with HD also demonstrated higher than expected lactate at three 2.5±2.5(1.1-8)mmo.L-1 and nine 3.8±1.9(1.2-6.6)mmo.L-1 minutes and respiratory exchange ratio at three 0.78±0.03 (0.74-0.81) and nine minutes 0.94±0.11(0.81-1.15). After exercise training there were no changes observed in HR or RPE responses during the exercise test. CONCLUSIONS: There was a large variability in the observed metabolic and physiological responses to exercise in people with HD. The observed exercise responses suggest that altered exercise prescription parameters may be required for people with HD and that exercise response and factors' affecting this requires further investigation.
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Teste de Esforço , Terapia por Exercício , Doença de Huntington/fisiopatologia , Doença de Huntington/reabilitação , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Despite their movement difficulties, youngsters with Developmental Co-ordination Disorder (DCD) generally have sufficient capability for physical activity. However, they tend to be less physically active and less physically fit than their well co-ordinated age peers. The aim of this study was to use qualitative research methods to understand which factors constrain and facilitate participation in physical activity in teenagers with DCD, in order to help inform future health promotion programmes. METHOD: Semi-structured interviews were conducted with eight teenagers with DCD (aged 13-15) and their parents. The interviews focused on how much physical activity was typically undertaken by the child and the perceived constraints and facilitators to being physically active. Interviews were transcribed and subjected to categorical-content analysis. RESULTS: Half of the children and all but one of the parents reported that the children did little physical activity. Although most children disliked competitive team games, they reported many physical activities that they did enjoy and they reported wanting to be more physically active. Perceived internal constraints to participation included poor motor skill, lack of motivation and reports of fatiguing easily. Perceived external constraints included difficulty travelling to activities, negative comments from peers and teachers' lack of understanding of DCD. CONCLUSIONS: Reports of low levels of physical activity support previous literature and are a cause for concern for this group. The teenagers expressed the desire to be more active, yet the interviews revealed both personal and environmental constraints to engagement in physical activity. It is clear that these factors interact in a dynamic way and that teachers, schools and communities play an important role in creating a motivational environment for youngsters with DCD to engage in physical activity and learn to maintain an active lifestyle as they move into adulthood.
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Atividade Motora/fisiologia , Transtornos das Habilidades Motoras/reabilitação , Adolescente , Atitude Frente a Saúde , Fadiga/etiologia , Promoção da Saúde/métodos , Humanos , Entrevistas como Assunto , Estilo de Vida , Masculino , Motivação , Destreza Motora/fisiologia , Transtornos das Habilidades Motoras/complicações , Transtornos das Habilidades Motoras/fisiopatologia , Transtornos das Habilidades Motoras/psicologia , Pais/psicologia , Pesquisa Qualitativa , Meio Social , Esportes/psicologiaRESUMO
Flavonoids, plant compounds found in certain foods, may have the ability to improve fatigue and fatigability. However, to date, no well-designed intervention studies assessing the role of flavonoid consumption for fatigue management in people with Parkinson's (pwP) have been performed. OBJECTIVES: To determine the feasibility and estimate potential effect of flavonoid-rich cocoa on fatigue and fatigability in pwP. METHODS: This was a randomised (1:1) double-blind placebo controlled feasibility study in which 30 pwP were recruited from the European Parkinson Therapy Centre, Italy (trial registration: NCT03288155). During a six day intervention participants consumed a high (10.79 mg/g) or low flavonoid cocoa (1.02 mg/g) beverage (18 g Cocoa with 200 ml Rice milk) once daily. Potential effect on fatigue and fatigability was measured (baseline to day 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation. RESULTS: From July 2017 to May 2018, 30 pwP were recruited and randomised and allocated to high (n = 15) or low (n = 15) flavonoid groups and included in analysis. Missing data was less than 5% and adherence to intervention of all allocated individuals was 97%. There was a small effect on fatigability (6 min walk test: ES 0.11 (95%CI = -0.11-0.26); Z = 0.81). There were two adverse events (one in the control and one in the intervention group). CONCLUSION: The consumption of cocoa is feasible and well received in pwP, and further investigation on the effect on fatigability is warranted.
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Chocolate , Doença de Parkinson , Fadiga/tratamento farmacológico , Estudos de Viabilidade , Flavonoides/uso terapêutico , HumanosRESUMO
In many organisms, master control genes coordinately regulate sex-specific aspects of development. SDC-2 was shown to induce hermaphrodite sexual differentiation and activate X chromosome dosage compensation in Caenorhabditis elegans. To control these distinct processes, SDC-2 acts as a strong gene-specific repressor and a weaker chromosome-wide repressor. To initiate hermaphrodite development, SDC-2 associates with the promoter of the male sex-determining gene her-1 to repress its transcription. To activate dosage compensation, SDC-2 triggers assembly of a specialized protein complex exclusively on hermaphrodite X chromosomes to reduce gene expression by half. SDC-2 can localize to X chromosomes without other components of the dosage compensation complex, suggesting that SDC-2 targets dosage compensation machinery to X chromosomes.
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Proteínas de Caenorhabditis elegans , Caenorhabditis elegans/genética , Proteínas de Ligação a DNA , Mecanismo Genético de Compensação de Dose , Proteínas de Helminto/fisiologia , Proteínas Repressoras/fisiologia , Processos de Determinação Sexual , Cromossomo X/metabolismo , Animais , Caenorhabditis elegans/embriologia , Caenorhabditis elegans/fisiologia , Transtornos do Desenvolvimento Sexual , Feminino , Regulação da Expressão Gênica no Desenvolvimento , Genes de Helmintos , Proteínas de Helminto/genética , Masculino , Dados de Sequência Molecular , Mutação , Regiões Promotoras Genéticas , Proteínas Repressoras/genética , Transgenes , Cromossomo X/genéticaRESUMO
BACKGROUND: Early adolescence is a period of dynamic neurobiological change. Converging lines of research suggest that regular physical activity (PA) and improved aerobic fitness have the potential to stimulate positive brain changes, improve cognitive function and boost academic attainment in this age group, but high-quality studies are needed to substantiate these findings. The primary aim of the Fit to Study trial is to investigate whether short infusions of vigorous PA (VPA) delivered during secondary school physical education (PE) can improve attainment in maths, as described in a protocol published by NatCen Social Research. The present protocol concerns the trial's secondary outcome measures, which are variables thought to moderate or mediate the relationship between PA and attainment, including the effect of the intervention on cardiorespiratory fitness, cognitive performance, mental health and brain structure and function. METHOD: The Fit to Study project is a cluster-randomised controlled trial that includes Year 8 pupils (aged 12-13) from secondary state schools in South/Mid-England. Schools were randomised into an intervention condition in which PE teachers delivered an additional 10 min of VPA per PE lesson for one academic year, or a 'PE as usual' control condition. Intervention and control groups were stratified according to whether schools were single-sex or co-educational. Assessments take place at baseline (end of Year 7, aged 11-12) and after 12 months (Year 8). Secondary outcomes are cardiorespiratory fitness, objective PA during PE, cognitive performance and mental health. The study also includes exploratory measures of daytime sleepiness, attitudes towards daily PA and PE enjoyment. A sub-set of pupils from a sub-set of schools will also take part in a brain imaging sub-study, which is embedded in the trial. DISCUSSION: The Fit to Study trial could advance our understanding of the complex relationships between PA and aerobic fitness, the brain, cognitive performance, mental health and academic attainment during adolescence. Further, it will add to our understanding of whether school PE is an effective setting to increase VPA and fitness, which could inform future PA interventions and education policy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03286725 . Retrospectively registered on 18 September 2017. ClinicalTrials.gov, NCT03593863 . Retrospectively registered on 19 July 2018.
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Desempenho Acadêmico , Comportamento do Adolescente , Encéfalo/fisiologia , Comportamento Infantil , Cognição , Saúde Mental , Educação Física e Treinamento/métodos , Aptidão Física , Serviços de Saúde Escolar , Adolescente , Fatores Etários , Encéfalo/diagnóstico por imagem , Criança , Inglaterra , Exercício Físico , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de TempoRESUMO
We investigated the association between the degree of lesion overlap with the corticospinal tract and walking performance before and after 4-weeks of partial body weight support (PBWS) treadmill training in 18 individuals (ten male, eight female) with a mean age 59 +/- 13 years (mean +/- SD), range 32-74 years, who were ambulant and 6 months from a subcortical ischaemic stroke. Lesion volumes were manually defined on high resolution T1-weighted 3T-MRI scans and a probabilistic map of the corticospinal tract created using diffusion tensor imaging data collected previously in healthy subjects. The percentage overlap between the lesion and the corticospinal tract was calculated for each patient. Walking performance was determined by measures of 10 m speed, spatiotemporal parameters, percentage recovery of centre of mass (CoM), walking symmetry and 2-min endurance walk prior to and following 4 weeks of treadmill training with PBWS that emphasised normal fast walking. Lesion overlap measures weakly correlated with walking performance measures. Spatiotemporal and performance measures changed in response to training, but spatial symmetry and mechanical energy recovery did not. Walking speed at entry to the study predicted change in response to training of 10 m walk time and swing time asymmetry. Age and lesion overlap did not add to prediction of outcome models. The extent of lesion overlap with the corticospinal tract was not strongly associated with either walking performance or response to gait retraining, despite the correlation of these parameters with upper limb recovery.
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Desempenho Psicomotor/fisiologia , Tratos Piramidais/fisiologia , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Caminhada/fisiologia , Adulto , Idoso , Doença Crônica , Feminino , Transtornos Neurológicos da Marcha/patologia , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tratos Piramidais/patologia , Acidente Vascular Cerebral/patologia , Reabilitação do Acidente Vascular CerebralRESUMO
Symptoms of Parkinson's can result in low physical activity and poor sleep patterns which can have a detrimental effect on a person's quality of life. To date, studies looking into exercise interventions for people with Parkinson's (PwP) for symptom management are promising but inconclusive. The aim of this study is to estimate the effect of a clearly defined exercise prescription on general physical activity levels, fatigue, sleep, and quality of life in PwP. Method. PwP randomised into either an exercise group (29; 16 males, 13 females; mean age 67 years (7.12)) or a control handwriting group (36; 19 males; 17 females; mean age 67 years (5.88)) as part of a larger trial were included in this substudy if they had completed a 6-month weekly exercise programme (intervention group) and had complete objective physical activity data (intervention and control group). Sleep and fatigue were recorded from self-reported measures, and physical activity levels measured through the use of accelerometers worn 24 hours/day over a seven-day testing period at baseline and following the 24-week intervention. A Wilcoxon's test followed by a Mann-Whitney post hoc analysis was used, and effect sizes were calculated. Results. Participants showed a significant increase in time spent in sedentary and light activities during the overnight period postintervention in both exercise and handwriting groups (p < 0.05) with a moderate effect found for the change in sedentary and light activities in the overnight hours for both groups, over time (0.32 and 0.37-0.38, resp.). There was no impact on self-reported fatigue or sleep. Conclusion. The observed moderate effect on sedentary and light activities overnight could suggest an objective improvement in sleep patterns for individuals participating in both exercise and handwriting interventions. This supports the need for further studies to investigate the role of behavioural interventions for nonmotor symptoms.
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BACKGROUND: Dietary interventions including consumption of flavonoids, plant compounds found in certain foods, may have the ability to improve fatigue. However, to date, no well-designed intervention studies assessing the role of flavonoid consumption for fatigue management in people with MS (pwMS) have been performed. The hypothesis is that the consumption of a flavonoid-rich pure cocoa beverage will reduce fatigue in pwMS. The aim of this study is to determine the feasibility and potential outcome of running a trial to evaluate this hypothesis. METHODS: Using a randomised (1:1) double-blind placebo-controlled feasibility study, 40 men and women (20 in each trial arm) with a recent diagnosis (< 10 years) of relapsing and remitting MS (RRMS) and who are over 18 years of age will be recruited from neurology clinics and throughout the Thames Valley community. During a 6-week nutrition intervention period, participants will consume the cocoa beverage, high flavonoid or low flavonoid content, at breakfast daily. At baseline, demographic factors and disease-related factors will be assessed. Fatigue, activity and quality of life, in addition to other measures, will be taken at three visits (baseline, week 3 and week 6) in a university setting by a researcher blinded to group membership. Feasibility and fidelity will be assessed through recruitment and retention, adherence and a quantitative process evaluation at the end of the trial.We will describe demographic factors (age, gender, level of education) as well as disease-related factors (disease burden scores, length of time diagnosed with MS) and cognitive assessment, depression and quality of life and general physical activity in order to characterise participants and determine possible mediators to identify the processes by which the intervention may bring about change. Feasibility (recruitment, safety, feasibility of implementation of the intervention and evaluation, protocol adherence and data completion) and potential for benefit (estimates of effect size and variability) will be determined to inform future planned studies. Results will be presented using point estimates, 95% confidence intervals and p values. Primary statistical analysis will be on an intention-to-treat basis and will use the complete case data set. DISCUSSION: We propose that a flavonoid-enriched cocoa beverage for the management of fatigue will be well received by participants. Further, if it is implemented early in the disease course of people diagnosed with RRMS, it will improve mobility and functioning by modifying fatigue. TRIAL REGISTRATION: Registered with ISRCTN Registry. Trial registration No: ISRCTN69897291; Date April 2016.
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BACKGROUND: Limited data suggests that an altered metabolic and cardiorespiratory exercise response may affect exercise performance in individuals with Huntington's disease (HD). There is no clear exploration of the response in individuals at different stages of the disease or in relation to genetic markers. This study aimed to examine the exercise response and recovery of HD participants, and the relationship to genetic and clinical markers. METHOD: HD gene-positive participants (nâ¯=â¯31; 9 pre-manifest; 22 manifest HD) and a healthy control group (nâ¯=â¯29) performed an incremental exercise test until exhaustion. Performance, cardiorespiratory, metabolic and perceptual responses to exercise were determined from a maximal cycle ergometer test throughout the exercise test and during a recovery period. RESULTS: During sub-maximal exercise, metabolic (lactate levels, oxygen uptake) and cardiorespiratory markers (heart rate) were elevated in HD participants compared to controls. Lactate elevation was specific to pre-manifest HD participants. Work capacity was reduced in both pre-manifest and manifest HD participants with tests terminated with no difference in metabolic, perceptual or cardiorespiratory markers. Submaximal oxygen uptake was correlated with motor score, whilst peak measures were unrelated to genetic or clinical markers. Heart rate recovery was attenuated in pre-manifest and manifest HD participants. CONCLUSIONS: Our findings confirm metabolic and cardiorespiratory deficits reduce exercise performance and affect recovery from an early stage in HD, with submaximal deficits related to phenotypic expression. Exercise capacity appears to be limited by an altered movement economy, thus clinicians should consider an altered exercise response and recovery may affect prescription in HD.
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Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Doença de Huntington/metabolismo , Doença de Huntington/fisiopatologia , Ácido Láctico/sangue , Consumo de Oxigênio/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Genomes: As researchers promote the value of different species in the competition for rare sequencing dollars, primate genomics can still make a case in the appeal for those funds, reports Heather Dawes.
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Primatas/genética , Animais , Humanos , Macaca mulatta/genética , Pan troglodytes/genética , Papio/genética , Apoio à Pesquisa como Assunto/economiaRESUMO
CONTEXT: Current research suggests that dark cocoa may reduce fatigue; however, the effect on fatigue in people with MS (pwMS) has never been established. The objective of this feasibility study was to explore the acute effect of high flavonoid cocoa on measures of fatigue and glycaemic response. METHODS: This was a randomised crossover participant blind exploratory study in 12 participants (2 male and 10 female) with MS-related fatigue (>4 on the Fatigue Severity Scale; FSS). After fasting overnight, participants consumed the high flavonoid cocoa drink (350 mg gallic acid equivalents {GAE}/g) or a low flavonoid cocoa control (120 mg GAE/g), consuming the alternative drink on the next visit. Fatigue was self-reported on a 100 mm visual analogue scale at 30-min time intervals for 2 h post cocoa consumption and every 2 h for the rest of the day. Fatigability was monitored using a 6 min walk test (6MWT) at the end of the visit (2 h), and activity monitors worn for 24 h commencing at 12 noon on the day of testing. The feasibility of performing the trial including outcome measures was documented. RESULTS: A moderate effect was found in self-reported fatigue throughout the day in favour of the high flavonoid group (Cohen's d 0.32, 95% non-central t CI -0.57 to 1.20). Fatigability measures did not change. Participants consumed and enjoyed the cocoa, all participants completed the study and outcome measures were accepted. CONCLUSION: The results of this study support further trials to investigate the feasibility and efficacy of pure cocoa as a dietary supplement for fatigue in pwMS.
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Glicemia/metabolismo , Cacau/química , Fadiga/prevenção & controle , Flavonoides/administração & dosagem , Esclerose Múltipla/terapia , Adulto , Estudos Cross-Over , Dieta , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
AIM: To investigate the feasibility and effect of a home-based exercise programme on walking endurance, muscle strength, fatigue and function in people with neuromuscular disorders (NMDs). METHODS: 20 adults with NMDs recruited to a control (n = 11) or exercise (n = 9) group were assessed by blinded assessors at baseline and at week 8. Walking and strengthening exercises were given to the exercise group in an 8-week home exercise programme. A 2-min walk distance was the main outcome measurement; isometric muscle strength, fatigue and function were secondary measurements. RESULTS: 2-min walk distances were not found to change in either group (p>0.05; control: mean 14.50 (SD 22.06) m; exercise: mean 2.88 (SD 20.08) m), and no difference was observed in the change scores between groups (p>0.05). Leg muscle strength increased in the exercise group (p<0.05) but not in the control group (p>0.05). Significance was reached between the groups with respect to the difference in change in muscle strength scores in the right quadriceps (p<0.05; control: mean -2.82 (SD 4.87) kg; exercise: mean -7.08 (SD 2.82) kg). No change was observed in fatigue or function scores (p<0.05). CONCLUSIONS: A home-based approach aimed at improving endurance in adults with NMDs is feasible and further investigation on a larger sample is warranted.
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Terapia por Exercício , Doenças Neuromusculares/terapia , Resistência Física , Adolescente , Adulto , Fadiga , Feminino , Humanos , Masculino , Debilidade Muscular , Músculo Esquelético/fisiologia , Doenças Neuromusculares/complicações , Método Simples-Cego , Resultado do Tratamento , CaminhadaRESUMO
OBJECTIVES: To assess the feasibility of Zumba Gold(®) in people with PD, and to investigate the effects of dance styles and number of sessions on activity levels and physiological load. DESIGN: Repeated measure uncontrolled (single group) feasibility study. SETTING: Eleven participants (age: 64.0±8.1years) with mild-to-moderate idiopathic PD (Hoehn & Yahr stage<3.0) took part in a screening session, followed by six Zumba Gold(®) workouts each separated by one week, and a follow-up interview six months later. MAIN OUTCOME MEASURES: The main feasibility parameters measured were retention, compliance, and adverse events. Furthermore, during each Zumba Gold(®) session, physical activity levels were measured using tri-axial accelerometers, while physiological load was assessed by average heart rate (HRmean). A two-way ANOVA with repeated measures assessed the effects of dance styles and session number on activity level and HR. RESULTS: 73% retention and 81% compliance were achieved, and no adverse events were recorded. Participants' enjoyment was high and 38% started Zumba Gold(®) classes in the community after intervention. HR values were similar between dance styles and within the American College of Sports Medicine (ACSM)'s recommendations in 50% of participants. Backwards steps reduced physiological load but improvements in activity levels between the first and last sessions show that steps could be learnt with time. CONCLUSIONS: Zumba Gold(®) is safe and enjoyable for people with PD. The excellent compliance and positive participants' feedback suggest the need for a larger-scale trial.
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Dança/fisiologia , Doença de Parkinson/terapia , Dançaterapia/métodos , Exercício Físico/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The purpose of this study was to explore the within session and test-retest consistency of motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) from the resting tibialis anterior (TA) muscle of 10 patients (two men, eight women) with clinically definite multiple sclerosis (MS). Dual stimulators were configured to produce a single pulse (DS/SP) through a hand-held coil. MEP were recorded in five blocks of five trials with a repeat test occurring 7-14 days later. Analysis of a trial sequence revealed the area of the first MEP trial of each block to be significantly different to subsequent trials (trials 2-5; p<0.05). We therefore discarded T1 from further analysis. Thereafter, repeated measures of analysis of variance of MEP characteristics and blocks of MEP (average of four trials) revealed no significant differences (p>0.05). The results of the repeat session revealed no significant differences in motor thresholds, MEP latency, MEP amplitude or MEP area between sessions (p>0.05). Test-retest intra-class coefficients of correlation and their 95% confidence intervals indicated high reliability (>0.80). Our results show that consistent, repeatable TMS measures can be obtained from the resting TA of MS patients using the DS/SP method.
Assuntos
Potencial Evocado Motor/fisiologia , Esclerose Múltipla/fisiopatologia , Estimulação Magnética Transcraniana/métodos , Adulto , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiologia , Músculo Esquelético/fisiologia , Reprodutibilidade dos TestesRESUMO
Phenolic compounds in kiwifruit pulp were separated and characterized by reversed-phase HPLC, and the effect of juice processing on the phenolic composition was studied. Fractionation of phenolic compounds was achieved through selective elution from C-18 cartridges prior to preconcentration and subsequent separation by HPLC. Strongly acidic compounds were identified as derivatives of coumaric and caffeic acids, including chlorogenic acid, protocatechuic acid, and a derivative of 3,4-dihydroxybenzoic acid. The weakly acidic fraction contained epicatechin, catechin, and procyanidins (B3, B2, or B4 and oligomers). Flavonols were present as the glycosides of quercetin (glucoside, rhamnoside, and rutinoside) and kaempferol (rhamnoside and rutinoside). Phenolic compounds were present, at levels of <1-7 mg/L, in clarified juice. The concentration of phenolics was highest after high-temperature short-time treatment (HTST) of juice. Hydrolysis of hydroxycinnamic acids occurred after enzyme addition and HTST treatment. The flavonol glycoside composition is the best identifier of kiwifruit juice.
Assuntos
Bebidas/análise , Frutas/química , Fenóis/análise , Cromatografia Líquida de Alta PressãoRESUMO
BACKGROUND: Guidelines for optimal exercise doses in people with multiple sclerosis (MS) have to be established. We need to ascertain the basic physiological and perceptual response and adaptation to different exercise doses in this clinical population. AIM: The aim of this paper was to explore the response during maximal and sub-maximal exercise in people with MS prior to and following two different twelve week exercise programmes. DESIGN: Sub-analysis of per protocol exercise data of a two group, single blinded, randomised control trial. SETTING: Multicentre (community leisure and rehabilitation centres). POPULATION: Participants with MS assigned to a continuous (N.=12; mean±SE age=52.3±2.08; Barthel index median & range=19&13-20) or interval (N.=9; mean±SE age=49.3±3.5; Barthel index median & range=19&18-20) exercise programme. METHODS: Cardiovascular, respiratory and perceptual exercise response and adaption was measured at maximal and sub-maximal levels of physical exercise prior to and following a twelve week exercise programme, delivered at different intensities. RESULTS: Irrespective of the type of exercise programme followed, there was a significant increase in peak power (z=-1.98; P=0.05) and normalised oxygen uptake during unloaded cycling (z =-2.00; P=0.05). At discharge from the exercise programmes, the cardiovascular response to sub-maximal exercise had significantly changed (t(360) =-4.62; p<0.01). CONCLUSION: The response in people with MS at maximal and sub-maximal levels of physical exercise following a twelve week programme is analogous to non-diseased adults. CLINICAL REHABILITATION IMPACT: Cardiovascular adaptation in people with MS following a twelve week exercise programme suggests deconditioning rather than autonomic dysfunction caused by the disease.