Severity of sarcopenia is associated with postural balance and risk of falls in community-dwelling older women.

Background/Study context: Falls represent the leading cause of accidental deaths in the elderly. Sarcopenia is a geriatric syndrome defined as the loss of muscle mass and strength. However, the association between falls and sarcopenia is still unclear. Thus, the aim of the present study was to investigate the association between different stages of sarcopenia and postural balance, risk of falls, and fear of falling in community-dwelling older women. METHODS: A total of 196 women (68.6 ± 6.5 years) underwent body composition (Dual-energy X-ray Absorptiometry), muscle strength (isokinetic), and functional (Timed Up-and-Go) assessments. Sarcopenia was classified according to European Working Group on Sarcopenia in Older People. Center of pressure (CoP) sway, risk, and fear of falling were assessed through force platform, QuickScreen, and Falls Efficacy Scale, respectively. ANOVA models and chi-squared were used to compare groups. RESULTS: Severe sarcopenic subjects presented higher risk of falling when compared to the other stages (p < 0.01). Regarding CoP sway, both mean speed and mediolateral range were significantly higher in severe sarcopenia when compared to both nonsarcopenia and presarcopenia (p < 0.05). Fear of falling was higher in all sarcopenia stages when compared to nonsarcopenic individuals (p < 0.05). CONCLUSION: Sarcopenia negatively affects balance, and both risk and fear of falling in community-dwelling older women. Moreover, this study provides evidence that sarcopenia severity is further associated to reduced balance and imposes an even greater risk of falls in the elderly.

A Randomized Trial Investigating the Influence of Strength Training on Quality of Life in Ischemic Stroke.

BACKGROUND: Strength training post stroke is widely acknowledged as an important part of a rehabilitation program. Muscle strength has been shown to be a significant contributor to physical disability after stroke, which in turn has an immense impact on the reintegration of patients into society, affecting their quality of life. OBJECTIVE: This was a randomized intervention trial to determine the effect of a resistance training program on the quality of life in patients with stroke. METHODS: An experimental group (EG), consisting of 11 subjects aged 51.7 ± 8.0 years, and a control group (CG), consisting of 13 subjects aged 52.5 ± 7.7 years, were studied before and after 12 weeks. EG underwent 12 weeks of strength training three times a week. The CG did not undergo strength training during the 12-week study period. RESULTS: There was a significant increase in quality of life from pre-test to post-test (Δ% = 21.47%; p = 0.021) in EG. There were significant differences in all indicators of quality of life between groups at 12 weeks. There were greater gains in strength in EG than in CG (p ≤ 0.05). There was a negative correlation between the strength gains as determined with the 1RM test and the quality of life, especially in lower limb exercises. CONCLUSION: The results of this study indicate that there was an improvement in the measures of strength in EG, and that there was a correlation between improvements in strength and quality of life in these patients who had previously suffered a stroke at least one year prior to study.

Effects of short term elastic resistance training on muscle mass and strength in untrained older adults: a randomized clinical trial.

BACKGROUND: The current recommendations on resistance training involving older adults have reported an improvement of body composition variables. Despite this, there is a lack of knowledge on how elastic resistance training (ERT) affects the muscle mass in older adults population. The purpose of this study was to determine the effects of a short-term ERT on muscle mass of health and untrained older adults. METHODS: Forty older adults were randomized into two groups of 20 individuals each: Control Group (CG = 66.2 ± 6.6 years) and Training Group (TG = 69.1 ± 6.3 years). TG underwent an ERT twice a week during 8 weeks and control group did not receive any specific intervention. The primary outcome was the upper and lower limbs muscle mass, measured by Dual-energy x-ray absorptiometry. The secondary outcomes were knee isokinetic peak torque (PT) at 60°/s and 120°/s speeds and isometric handgrip strength. A 2×2 mixed model (group [TG and CG] × time [pre and post]) analysis of variance (ANOVA) was applied to determine the effect on primary and secondary outcomes. RESULTS: The results of the ANOVA showed no significant effects in group x time interaction for (1) upper limbs fat free mass (F [1.38] = 1.80, p = 0.19, effect size [ES] = 0.1) and for (2) lower limbs fat free mass (F [1.38] = 0.03, p = 0.88, ES = 0.02). Regarding muscle strength, the ANOVA showed no significant effects in group x time interaction for (3) PT at 60°/s (F [1.38] = 0.33, p = 0.56, ES = 3.0), for (4) PT at 120°/s (F [1.38] = 0.80, p = 0.38, ES = 4.1) and for handgrip strength (F [1.38] = 0.65, p = 0.42-value, ES = 0.9). Analysis of PT in TG showed a significant change of 4.5%, but only at 120°/s (p = 0.01) when comparing pre and post-training (time interaction). CONCLUSIONS: Eight weeks of ERT did not show significant changes in muscle mass and strength of untrained older adults. TRIAL REGISTRATION: NCT02253615 (09/25/14).

Immediate changes in electroencephalography activity in individuals with nonspecific chronic low back pain after cranial osteopathic manipulative treatment: study protocol of a randomized, controlled crossover trial.

BACKGROUND: Osteopathic medicine is based on a diagnostic and therapeutic system to treat tissue mobility/ motility dysfunctions in general, using different approaches (depending on the target tissue) known as osteopathic manipulative treatment. Among the available techniques those ones addressed to the cranial field are the most questioned because of the lack of scientific evidence; but the compression of the 4th ventricle technique has been largely studied in clinical trials. Studies have shown that the technique may affect both central and autonomous nervous system, modulating some reflexes (Traube-Hering baro signal), and modifying brain cortex electrical activity through central sensitization in subjects with chronic low back pain. Thus, investigators hypothesize that the compression of the 4th ventricle may modulate peak alpha frequency (eletroencephalographic assessment) and promote physical relaxation in subjects in vigil. METHODS/DESIGN: A randomized, controlled crossover trial with blinded assessor was designed to test the hypothesis. A total of 81 participants will be assigned to three treatment conditions, with seven days of washout: (I) compression of the 4th ventricle; (II) sham compression of the fourth ventricle; (III) control (no intervention). The (I) power amplitude and the (II) frequencies of the dominant peak in the alpha band will be the primary outcome measures of the study. All participants will be recruited at the Outpatient Rehabilitation Service of the University Hospital of Brasília-University of Brasília. All the electroencephalographic exams will be conducted by a blinded assessor. DISCUSSION: The investigators hypothesize that patients with chronic low back pain submitted to the technique would have the peak alpha frequency modulated and, thus, would experience physical relaxation. TRIAL REGISTRATION: NCT02111382.

Cardiorespiratory fitness and quality-of-life analysis posttreatment in breast cancer survivors.

This study compared VO(2peak), treatment frequency and dosage, and QOL between 22 post-treated breast cancer survivors (CATotal) and 22 apparently healthy, age-matched women (CO). The CATotal group included 11 with no history of any other co-morbidities (CA) and 11 with controlled hypertension (CA + H). VO(2peak) was measured using the Bruce Protocol. QOL was measured using the SF-36 survey. Significant differences were observed in VO(2peak) between CATotal and CO (p = 0.014), CA and CA + H (p = 0.001), and CA + H and CO (p = 0.001). Physical, emotional, and mental health domains of the SF-36 were significantly different between CATotal and CO (p = 0.006, 0.001, and 0.05 respectively). These results suggest that breast cancer survivors with controlled hypertension can experience a significant reduction in VO(2peak) when compared to apparently healthy, age-matched controls. Also, treatment frequency and dosage affected QOL in this group of survivors.

Lactate threshold prediction by blood glucose and rating of perceived exertion in people with type 2 diabetes.

The validity of rating of perceived exertion (RPE) in predicting lactate threshold during an incremental test was analyzed in 15 men with type 2 diabetes (M age = 53.4 yr., SD = 12.9). Blood glucose, lactate, and minute ventilation (VE)/VO2 responses identified the lactate, ventilatory, and glucose thresholds. Workloads (W) corresponding to RPEs 12, 13, 14, and 15 were determined. Second-order polynomials fit to VE/W and [lac]/W ratios corresponding to RPEs of 9-10, 12-13, and 16-17 also identified workloads above which there was an overproportional increase in VE and [lac]. These workload breakpoints did not differ, although at RPE 12 underestimated and at RPE 15 overestimated lactate threshold. RPE 13 and 14 and the responses of VE/W and [lac]/W to submaximal exercise accurately predicted lactate threshold.

Determination of the lactate threshold and maximal blood lactate steady state intensity in aged rats.

The reliability of the lactate threshold (LT) determined in aged rats and its validity to identify an exercise intensity corresponding to the maximal blood lactate steady state (MLSS) were analyzed. Eighteen male aged Wistar rats (approximately 365 days) were submitted to two incremental swimming tests until exhaustion, consisting of an initial load corresponding to 1% of body mass (BM) and increments of 1% BM at each 3-min with blood lactate ([lac]) measurements. The LT was determined by visual inspection (LT(V)) as well by applying a polynomial function on the [lac]/workload ratio (LT(P)) by considering the vertices of the curve. For the MLSS, twelve animals were submitted, on different days, to 3-4 exercise sessions of 30-min with workload corresponding to 4, 5 or 6% BM. The MLSS was considered the highest exercise intensity at which the [lac] variation was not higher than 0.07 mM.min(-1) during the last 20-min. No differences were observed for the test-retest results (4.9 +/- 0.7 and 5.0 +/- 0.8 %BM for LTv; and 6.0 +/- 0.6 and 5.8 +/- 0.6 %BM for LTp) that did not differ from the MLSS (5.4 +/- 0.5 %BM). The LT identified for aged rats in swimming, both by visual inspection and polynomial function, was reliable and did not differ from the MLSS.

Association between ACE D allele and elite short distance swimming.

The influence of ACE gene on athletic performance has been widely explored, and most of the published data refers to an I/D polymorphism leading to the presence (I allele) or absence (D allele) of a 287-bp sequence in intron 16, determining ACE activity in serum and tissues. A higher I allele frequency has been reported among elite endurance athletes, while the D allele was more frequent among those engaged in more power-orientated sports. However, on competitive swimming, the reproducibility of such associations is controversial. We thus compared the ACE genotype of elite swimmers with that of non-elite swimming cohort and of healthy control subjects. We thus sought an association of the ACE genotype of elite swimmers with their competitive distance. 39 Portuguese Olympic swimming candidates were classified as: short (<200 m) and middle (400-1,500 m) distance swimmers, respectively. A group of 32 non-elite swimmers were studied and classified as well, and a control group (n = 100) was selected from the Portuguese population. Chelex 100 was used for DNA extraction and genotype was determined by PCR-RFLP methods. We found that ACE genotype distribution and allelic frequency differs significantly by event distance only among elite swimmers (P < or = 0.05). Moreover, the allelic frequency of the elite short distance swimmers differed significantly from that of the controls (P = 0.021). No associations were found between middle distance swimmers and controls. Our results seem to support an association between the D allele and elite short distance swimming.

Resistance exercise sessions do not provoke acute immunosuppression in older women.

It has been suggested that elderly people are more susceptible to infectious diseases because of immunosenescence. The well-described transient immunosuppressive effect of exercise may increase health risks in such populations. Although resistance training has been recommended to older individuals, little is known regarding its acute effects on immune indexes. This study examined the acute effects of resistance exercise sessions performed at different intensities (50 vs. 80% of one-repetition maximum [1RM]) on salivary immunoglobulin A (IgA), total leukocytes, lymphocytes and their subsets, and the cortisol levels of older women. Fifteen physically independent elderly women (mean age = 67.5 +/- 3.9 years) underwent, in a randomized manner, two experimental sessions comprising resistance exercise for the major muscular groups or one control session without exercise. Session 1 consisted of two sets of 13 repetitions at 50% 1RM, whereas session 2 consisted of two sets of eight repetitions at 80% 1RM. Blood and saliva samples were collected at rest, immediately after, and at 3 and 48 hours after the completion of the sessions. Blood cortisol, total leukocytes, lymphocytes and their subpopulations, and salivary IgA were measured by standard techniques. Overall, resistance exercise sessions failed to provoke significant decline on the examined immune function indexes. Instead, resistance exercise sessions induced significant elevation in salivary IgA levels, but this was not observed after the control session. Also, experimental sessions did not induce significant elevations in blood cortisol. It was concluded that resistance exercise sessions performed at 50 or 80% of 1RM do not present suppressive effects on the studied immune parameters. Conversely, a transient elevation was observed in salivary IgA levels, which requires support in future investigations. Taken together, the observed results suggest that elderly women can engage in resistance training programs without negative acute effects on the studied parameters of the immune system.

Association between sarcopenia-related phenotypes and aerobic capacity indexes of older women.

The purpose of the present study was to examine the association between fat-free mass (FFM), quadriceps strength and sarcopenia with aerobic fitness indexes of elderly women. A total of 189 volunteers (66.7 ± 5.46 years) underwent aerobic capacity measurement through a symptom-limited cardiopulmonary exercise test to determine their individual ventilatory thresholds (VT) and peak oxygen uptake (VO2 peak). Quadriceps muscle strength was assessed using an isokinetic dynamometer. Also, dual energy X-ray absorptiometry was used to assess FFM and cutoff values were used to classify subjects as sarcopenic or nonsarcopenic. Correlations, student t-test and analysis of variance were used to examine the data. Both FFM and quadriceps strength variables were positively and significantly correlated with the measured aerobic capacity indexes. These results were observed for peak exercise as well as for ventilatory thresholds. Individuals classified as sarcopenic presented significantly lower muscle strength and (VO2 peak) when compared to nonsarcopenic. It can be concluded that FFM and quadriceps strength are significantly related to aerobic capacity indexes in older women, and that besides presenting lower quadriceps strength, women classified as sarcopenic have lower peak oxygen consumption. Taken together, the present results indicate that both FFM and strength play a role in the age-related decline of aerobic capacity. Key pointsMaximal aerobic capacity, generally expressed as peak oxygen consumption (VO2 peak), declines with advancing age and this process is associated with an increased risk for cardiovascular diseases.Also, the aging process is associated with a progressive loss of muscle mass and strength and this phenomenon has been referred to as Sarcopenia. Sarcopenia has been described in both elderly men and women and has been linked to multiple negative clinical outcomes.The present study provide evidence that muscle-related phenotypes are associated with aerobic capacity of older individuals, thus suggesting that sarcopenia explains in part the decline in aerobic fitness observed with advancing age.

Stages of sarcopenia, bone mineral density, and the prevalence of osteoporosis in older women.

A better understanding of the relationship between osteoporosis and sarcopenia may help to develop effective preventive and therapeutic strategies. In the present study, the association between different stages of sarcopenia, BMD, and osteoporosis was examined. The salient findings indicate that a dose-response relationship exists between sarcopenia stages and bone-related phenotypes. PURPOSE: To assess the association between sarcopenia stages, bone mineral density (BMD), and the prevalence of osteoporosis in older women. METHODS: Two hundred thirty-four women (68.3 ± 6.3 years) underwent body composition and BMD measurements using dual-energy X-ray absorptiometry. Quadriceps isokinetic torque was evaluated, and the timed up-and-go test was conducted as a measure of function. Sarcopenia stages were classified according to European Working Group on Sarcopenia in Older People (EWGSOP): nonsarcopenia, presarcopenia, sarcopenia, and severe sarcopenia. Osteoporosis was defined as BMD value (hip or spine) 2.5 standard deviations below a young-adult reference population. Between-group differences were examined using ANOVA for continuous variables and chi-squared for categorical variables. Logistic regression was performed to evaluate the association between sarcopenia stages and osteoporosis. RESULTS: Rates of osteoporosis were 15.8%, 19.2%, 35.3%, and 46.2% for nonsarcopenia, presarcopenia, sarcopenia, and severe sarcopenia, respectively (P = 0.002). Whole-body and femoral neck BMD values were significantly lower among all sarcopenia stages when compared to nonsarcopenia (all P values < 0.05, η2p 0.113 to 0.109). The severe sarcopenia group also showed significantly lower lumbar spine BMD values and T-scores (both P values < 0.05; η2p 0.035 and 0.037, respectively). When clustered, sarcopenia and severe sarcopenia exhibited lower BMD values for all sites (all P values < 0.01), and presented a significantly higher risk for osteoporosis (odds ratio 3.445; 95% CI 1.521-7.844). CONCLUSION: The observed results provide support for the concept that a dose-response relationship exists between sarcopenia stages, BMD, and the presence of osteoporosis. These findings strengthen the clinical significance of the EWGSOP sarcopenia definition and indicate that severe sarcopenia should be viewed with attention by healthcare professionals.

Normative Values of Knee Extensor Isokinetic Strength for Older Women and Implications for Physical Function.

BACKGROUND AND PURPOSE: Lower-limb strength is required for everyday activities and thus its evaluation has been especially emphasized in older adults. Isokinetic testing is a criterion standard method to assess muscle strength; however, lack of reference values limits its usefulness in geriatric evaluation and rehabilitation. The aim of this study was to develop reference values of knee extensor isokinetic strength for older women. As a secondary aim, functional tests were performed for clinical significance validation. METHODS: A total of 453 older women aged 60 to 84 years participated in this study. Knee extensor isokinetic strength was measured using the Biodex System dynamometer at 60° per second. The Timed Up and Go test and the 5 times Sit-to-Stand test were used for functional performance evaluation. Participants were categorized into age groups of 5 years range. The 20th, 40th, 60th, and 80th percentiles were used for stratification purposes. RESULTS AND DISCUSSION: As expected, mean strength values significantly decreased with advancing age groups. Isokinetic percentile groups are presented according to age. Individuals in the lower percentile strata showed significantly reduced performance in both the Timed Up and Go and 5 times Sit-to-Stand tests (P < .05). CONCLUSION: This study provides normative values of isokinetic knee extensor strength in older women. The association between lower isokinetic knee extensor strength strata and reduced functional capacity supports the potential application of these reference values in clinical and research settings. Future studies should ascertain these findings in different female populations.

Cancer-Related Fatigue and Muscle Quality in Hodgkin's Lymphoma Survivors.

The purpose of this study was to compare fatigue, strength, body composition, muscle thickness, and muscle quality between Hodgkin's lymphoma survivors (HLS) and apparently healthy subjects matched by age, gender, and physical activity levels (CON). Twelve HLS (32.16 ± 8.06) and 36 CON (32.42 ± 7.64) were enrolled in the study. Fatigue was assessed using the 20-item Multidimensional Fatigue Inventory, muscle strength using an isokinetic dynamometer, body composition using dual-energy X-ray absorptiometry, and thickness and muscle quality using B-mode ultrasound. Differences between HLS and CON were analyzed using independent samples t tests. No significant differences were observed between groups for any demographic characteristics: age ( P = .922), weight ( P = .943), height ( P = .511), body mass index ( P = .796), fat mass ( P = .688), fat-free mass ( P = .520), and percent body fat ( P = .446). No significant differences were observed for strength (peak torque; P = .552), relative peak torque ( P = .200), muscle thickness ( P > .05) and muscle quality ( P > .05). However, self-perceived fatigue was significantly higher in HLS than in CON ( P = .009). It appears that when HLS are matched by age and physical activity levels to CON, no significant difference in body composition, muscle thickness, muscle quality, or strength is observed. Self-perceived fatigue, as predicted, is higher in HLS, which may have implications and should be considered when prescribing exercise training to this cancer population.

Non-alcoholic fatty liver disease and metabolic syndrome in Brazilian middle-aged and older adults.

CONTEXT AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is a complex clinicopathological entity characterized by diffuse or focal fat accumulation in the hepatic parenchyma of patients who deny abusive alcohol consumption. This study aimed to assess idiopathic NAFLD in community-dwelling, middle-aged and older adults living in the Brazilian Federal District. Associations between NAFLD and components of metabolic syndrome and the whole syndrome were investigated. DESIGN AND SETTINGS: This was a cross-sectional study on 139 subjects aged 55 years or older. METHODS: NAFLD was diagnosed by means of clinical procedures, to exclude subjects with signs of liver disorders, abusive alcohol consumption and influence from hepatotoxic drugs. Phenotypes were graded based on ultrasound examination. Metabolic syndrome was defined using the NCEP ATP III criteria. Laboratory tests were performed to assist clinical examinations and define the syndrome. RESULTS NAFLD was present in 35.2% of the subjects. Taken together, the two most intense phenotypes correlated with increased serum fasting glucose, triglyceride and VLDL cholesterol levels. Metabolic syndrome was diagnosed in 25.9% of the sample. In addition to associating NAFLD with specific traits of metabolic syndrome, non-parametric analysis confirmed the existence of a relationship (p < 0.05) between the steatotic manifestation and the syndromic condition. CONCLUSION: Compared with the literature, this study reveals greater frequency of idiopathic NAFLD among Brazilian middle-aged and older adults than is described elsewhere. The findings also suggest that impaired glycemic metabolism coupled with increased fat delivery and/or sustained endogenous biosynthesis is the most likely physiopathogenic mechanisms underlying the onset of NAFLD in this population.

Relationship between sarcopenic obesity-related phenotypes and inflammatory markers in postmenopausal women.

Ageing is associated with changes in body composition that may result in sarcopenic obesity (SO). Interleukin-6 (IL-6) and C-reactive protein (CRP) are important inflammatory markers related to ageing. SO has been examined as an important public health problem, but its association with inflammatory markers has yet to be investigated. The aim of this study was to investigate the association between SO-related phenotypes and inflammatory markers in postmenopausal women. A total of 130 women (66·7 ± 5·2 years) underwent body composition evaluation using dual-energy X-ray absorptiometry. Volunteers were classified according to a SO definition previously described in the literature. Waist circumference (WC) and handgrip strength (HG) were also measured. Blood samples were collected for CRP, tumour necrosis factor and IL-6 measurements. All the inflammatory markers were higher in SO individuals when compared to non-SO; however, only IL-6 reached statistical significance (median 3·34 versus 1·37 pg ml-1 ; P<0·05). Also, CRP was significantly correlated (P<0·01) with body mass index (rs  = 0·34), fat mass (FM; rs  = 0·25) and WC (rs  = 0·33). Similarly, IL-6 levels were significantly correlated (P<0·05) to age (rs  = 0·19), FM (rs  = 0·19) and WC (rs  = 0·17). HG was found to be significantly reduced among subjects with higher IL-6 levels (P = 0·02). In summary, the combination of reduced muscle mass and excess body fat (i.e. SO) is associated with elevated inflammatory markers in postmenopausal women. Moreover, CRP and IL-6 are associated with SO-related phenotypes in this population.

Effects of Elastic Resistance Exercise on Muscle Strength and Functional Performance in Healthy Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Elastic Resistance Exercise (ERE) has already demonstrated its effectiveness in older adults and, when combined with the resistance generated by fixed loads, in adults. This review summarizes the effectiveness of ERE performed as isolated method on muscle strength and functional performance in healthy adults. METHODS: A database search was performed (MEDLine, Cochrane Library, PEDro and Web of Knowledge) to identify controlled clinical trials in English language. The mean difference (MD) with 95% confidence intervals (CIs) and overall effect size were calculated for all comparisons. The PEDro scale was used assess the methodological quality. RESULTS: From the 93 articles identified by the search strategy, 5 met the inclusion criteria, in which 3 presented high quality (PEDro > 6). Meta-analyses demonstrated that the effects of ERE were superior when compared with passive control on functional performance and muscle strength. When compared with active controls, the effect of ERE was inferior on function performance and with similar effect on muscle strength. CONCLUSIONS: ERE are effective to improve functional performance and muscle strength when compared with no intervention, in healthy adults. ERE are not superior to other methods of resistance training to improve functional performance and muscle strength in health adults.

Effects of resistance training on sarcopenic obesity index in older women: A randomized controlled trial.

The purpose of this study was to examine the effects of resistance training (RT) on sarcopenic obesity (SO) in older women. 243 older women underwent body composition measurement using dual-energy X-ray absorptiometry, and the SO index was calculated. This randomized controlled trial adopted from the baseline sample, 113 volunteers (67.0±5.2years) were randomly assigned to a control group (CG, n=64) or an experimental group (EG, n=69). The EG took part in a 24-week RT program, conducted three times per week. Body composition measurements were repeated at the end of the training program. RT induced a significant increase in fat-free mass (P<0.01), but not decrease in fat mass in the EG. Moreover, the SO index was also significantly improved in the EG (P<0.01), while it decreased significantly in the CG (P<0.01). It is concluded that RT is an effective approach to promote body composition alterations in older women, and it might improve SO-related phenotypes.

Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis.

BACKGROUND: Temporomandibular joint disorder (TMD) requires a complex diagnostic and therapeutic approach, which usually involves a multidisciplinary management. Among these treatments, musculoskeletal manual techniques are used to improve health and healing. OBJECTIVES: To assess the effectiveness of musculoskeletal manual approach in temporomandibular joint disorder patients. DESIGN: A systematic review with meta-analysis. METHODS: During August 2014 a systematic review of relevant databases (PubMed, The Cochrane Library, PEDro and ISI web of knowledge) was performed to identify controlled clinical trials without date restriction and restricted to the English language. Clinical outcomes were pain and range of motion focalized in temporomandibular joint. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at every post treatment. The PEDro scale was used to demonstrate the quality of the included studies. RESULTS/FINDINGS: From the 308 articles identified by the search strategy, 8 articles met the inclusion criteria. The meta-analysis showed a significant difference (p < 0.0001) and large effect on active mouth opening (SMD, 0.83; 95% CI, 0.42 to 1.25) and on pain during active mouth opening (MD, 1.69; 95% CI, 1.09 to 2.30) in favor of musculoskeletal manual techniques when compared to other conservative treatments for TMD. CONCLUSIONS: Musculoskeletal manual approaches are effective for treating TMD. In the short term, there is a larger effect regarding the latter when compared to other conservative treatments for TMD.

Fatigue and depression improvements on breast cancer survivors practitioners of strength training / Melhorias na fadiga e na depressão em sobreviventes de câncer de mama praticantes de treinamento de força

ABSTRACT Due to the high incidence of breast cancer worldwide, it is important to research and understand the physiological and psychological effects of this disease, like fatigue, depression, and capacity to do daily life tasks and how they modify physical activity. This study aimed to analyze the effects of strength training practice on physical fatigue (IMF-20), depression (Beck questionnaire), handgrip strength, and functional performance (time up and go). The sample was composed of 17 women breast cancer survivors, in which 8 volunteers were strength training practitioners for at least 6 months (P), and 9 volunteers were non-practitioners (NP). The T-test identified significant differences (p>0.05) between groups on fatigue (P=7.37±1.76; NP= 10.77±3.41; p=0.02) and depression (P= 8.75±5.20; NP= 14.55±4.21). There was no significant difference between groups on handgrip strength and functional performance.

RESUMO Devido à alta incidência de câncer de mama em todo o mundo, é importante pesquisar e entender os efeitos fisiológicos e psicológicos dessa doença, como fadiga, depressão e capacidade de realizar tarefas da vida diária e como elas se modificam com a atividade física. O objetivo deste estudo foi analisar os efeitos do treinamento de força na fadiga física (IMF-20), depressão (questionário de Beck), força de preensão manual e desempenho funcional (timed up and go). A amostra foi composta por 17 mulheres sobreviventes de câncer de mama, das quais 8 voluntárias eram praticantes de treinamento de força há pelo menos 6 meses (P) e 9 voluntárias eram não-praticantes (NP). O teste T identificou diferenças significativas (p> 0,05) entre os grupos sobre fadiga (P = 7,37 ± 1,76; NP= 10,77 ± 3,41; p = 0,02) e sobre depressão (P= 8,75 ± 5,20; NP= 14,55 ± 4,21). Não houve diferença significativa entre os grupos em força de preensão manual e desempenho funcional.

The effects of rest interval on quadriceps torque during an isokinetic testing protocol in elderly.

The purpose of this study was to compare three different intervals for a between sets rest period during a common isokinetic knee extension strength-testing protocol of twenty older Brazilian men (66.30 ± 3.92 yrs). The volunteers underwent unilateral knee extension (Biodex System 3) testing to determine their individual isokinetic peak torque at 60, 90, and 120°s(-1). The contraction speeds and the rest periods between sets (30, 60 and 90 s) were randomly performed in three different days with a minimum rest period of 48 hours. Significant differences between and within sets were analyzed using a One Way Analysis of Variance (ANOVA) with repeated measures. Although, at angular velocity of 60°s(-1) produced a higher peak torque, there were no significant differences in peak torque among any of the rest periods. Likewise, there were no significant differences between mean peak torque among all resting periods (30, 60 and 90s) at angular velocities of 90 and 120°s(-1). The results showed that during a common isokinetic strength testing protocol a between set rest period of at least 30 s is sufficient for recovery before the next test set in older men. Key PointsThe assessment of muscular strength using isokinetics muscle contraction in older individuals is very important for exercise prescription and rehabilitation.The minimal time between intraset isokinetics knee extension assessment in older individuals need to be more investigated, however 30 s appear to besufficient time for strength recover.