Aquatic exercise for people with asthma: a systematic review with meta-analysis of randomized controlled trials.

INTRODUCTION: Aquatic exercises are among the types of exercise most tolerated by people with asthma. Therefore, the objective of this study was to synthesize the evidence on the effects of aquatic exercise on lung function and quality of life in asthmatic patients. DATA SOURCES: A systematic search encompassing the Medline, CINAHL, Cochrane Library, Embase, AMED, SPORTDiscus, and Physiotherapy Evidence Database databases was conducted to identify randomized controlled trials assessing the impact of aquatic exercise in comparison to control conditions or land-based exercise on lung function and quality of life in individuals diagnosed with asthma. STUDY SELECTIONS: The stages of selection, data extraction and methodological evaluation, and level of evidence of the manuscripts were carried out independently by two authors. RESULTS: Ten studies, comprising a total of 393 participants, were incorporated into this systematic review. Very low-quality evidence was found in favor of aquatic exercise in asthmatic patients for forced expiratory volume in 1 s (MD: 0.20 L, 95% CI: 0.02 L-0.38L N: 91) and for forced vital capacity (MD: 0.32 L, 95% CI: 0.08 L-0.56L N: 80). No effect of aquatic exercise was observed on the FEV1/FVC ratio (MD:1.11L, 95% CI: -1.28 L-3.49L N:80) compared with control. Only one study evaluated the effect of aquatic exercise on patients' quality of life. CONCLUSIONS: Improvements in lung function and quality of life in asthmatic patients undergoing aquatic exercise are not supported by high-quality evidence. The present findings will need to be confirmed by new, methodologically more rigorous clinical trials.

The effect of aquatic exercise on pulmonary function and quality of life in asthma patients is still uncertain.The current quality of evidence for aquatic exercise in asthma patients is low.There is an urgent need for higher-quality studies investigating the effects of aquatic exercise among asthma patients.

A qualidade do ambiente domiciliar influencia nas habilidades funcionais de crianças na primeiríssima infância? / ¿Influye la calidad del entorno del hogar en las habilidades funcionales de niños en la primera infancia? / Does the quality of the home environment influence the functional abilities of infants in early childhood?

RESUMO A literatura extensamente associa o desenvolvimento infantil à qualidade da estimulação ambiental. Entretanto, são escassos os estudos que verificam se tal associação tem relação com as habilidades funcionais da criança. Este estudo tem por objetivo investigar quais oportunidades no ambiente domiciliar estão associadas e explicam às habilidades funcionais de mobilidade e função social de crianças na primeiríssima infância. Trata-se de um estudo transversal e exploratório feito com 74 crianças entre 6 e 18 meses. Para avaliar as oportunidades presentes no ambiente domiciliar, foi utilizado o instrumento affordances in the home environment motor development - infant scale. Para avaliar as habilidades funcionais das crianças, foi utilizado o inventário de avaliação pediátrica de incapacidade. Observou-se que a mobilidade das crianças pode ser explicada em 45,6% (R² ajustado=0,45) e a função social em 30% (R² ajustado=0,30) pela quantidade de brinquedos de motricidade grossa, pelos equipamentos e pela variedade de estimulação presente no ambiente domiciliar. Conclui-se que posições, brinquedos e materiais que mantêm a criança mais restrita e menos ativa exercem influência negativa. Por outro lado, brinquedos que oportunizam um maior deslocamento e interação favorecem as habilidades funcionais de mobilidade e função social.

RESUMEN La literatura ha asociado ampliamente el desarrollo infantil con la calidad de la estimulación en el entorno. Sin embargo, pocos estudios han verificado si esta asociación está relacionada con las habilidades funcionales del niño. Este estudio tiene como objetivo analizar y explicar qué oportunidades en el entorno del hogar están asociadas con las habilidades funcionales de movilidad y función social de niños en la primera infancia. Se trata de un estudio transversal y exploratorio, realizado con 74 niños de los 6 a los 18 meses de edad. Para evaluar las oportunidades presentes en el entorno del hogar, se utilizó el instrumento affordances in the home environment motor development - infant scale. Para evaluar las habilidades funcionales de los niños, se utilizó el inventario para la evaluación pediátrica de la discapacidad. Se observó que la movilidad de los niños se puede explicar en un 45,6% (R² ajustado=0,45) y la función social en un 30% (R² ajustado=0,30) por la cantidad de juguetes de motricidad gruesa, equipos y por la variedad de estimulación presente en el entorno del hogar. Se concluye que las posiciones, juguetes y materiales que mantienen al niño más restringido y menos activo ejercen una influencia negativa. Por otro lado, los juguetes que aportan mayor movilidad e interacción favorecen las habilidades funcionales de movilidad y función social del niño.

ABSTRACT The literature associates child development with the quality of the environment stimulation. However, few studies verify if this is associated with the infant's functional abilities. This study aims to assess which opportunities in the home environment are associated with functional mobility skills and social function of infants in early childhood and explain them. This is a cross-sectional and exploratory study with 74 infants aged from six to 18 months. The affordances in the home environment motor development - infant scale instrument was used to evaluate the opportunities in the home environment. The pediatric evaluation of disability inventory was used to assess the infants' functional abilities. We observed that infants' mobility can be explained in 45.6% (Adjusted R²=0.45) and social function in 30% (Adjusted R²=0.30) by the amount of gross motor skills toys, equipment and variety of stimulation in the home environment. We concluded that positions, toys, and materials that keep the infant more restricted and less active have a negative effect. On the other hand, toys that offer greater displacement and interaction favor the functional mobility skills and social function.

Evaluation of clinical and radiographic measures and reliability of the quadriceps angle measurement in elderly women with knee osteoarthritis / Avaliação das medidas radiográficas e clínicas e confiabilidade do ângulo do quadríceps em idosas com osteoartrite de joelhos

Introduction Knees osteoarthritis (OA) is a complex degenerative disease with intra-articular changes affecting the amplitude of the quadriceps angle (Q). To measure this variable, it is necessary to use reliable protocols aiming at methodological reproducibility. The objective was to evaluate the intra-examiner and inter-examiner reliability of clinical and radiographic measures of the Q angle and to investigate the relationship between the degree of OA and the magnitude of this angle in the elderly. Materials and methods 23 volunteers had the Q angle measured by two evaluators at 48-h interval. Clinical measurements were collected by using the universal goniometer in the same position adopted in the radiographic examination. Results The intra-examiner reliability was good (0.722 to 0.763) for radiographic measurements and low (0.518 to 0.574) for clinical assessment, while inter-examiner reliability was moderate (0.634) for radiographic measurements and low (0.499) to the clinics. The correlation analysis between the radiographic values with the OA classification showed no correlation between them (p = 0.824 and r = -0.024). Conclusion Clinically, it is suggested that the radiographic examination is preferable to evaluate the Q angle of elderly women with knee osteoarthritis. Moreover, the magnitude of this angle did not correlate with the degree of impairment of OA in this population.

Introdução A osteoartrite (OA) de joelhos é uma doença degenerativa complexa com alterações intra-articulares que comprometem a amplitude do ângulo do quadríceps (Q). Para mensuração dessa variável, é necessária a utilização de protocolos que apresentem confiabilidade, visando reprodutibilidade metodológica. Objetivo Avaliar a confiabilidade intra e interexaminadores das medidas clínicas e radiográficas do ângulo Q e verificar se existe relação entre o grau de OA e a magnitude deste ângulo em idosas. Materiais e métodos 23 voluntárias, tiveram o ângulo Q mensurado por 2 avaliadores, com intervalo de 48 horas. As medidas clínicas foram coletadas por meio do goniômetro universal na mesma posição adotada no exame radiográfico. Resultados A confiabilidade intraexaminador foi boa (0,722–0,763) nas medidas radiográficas e baixa (0,518–0,574) nas medidas clínicas, enquanto a confiabilidade interexaminadores foi moderada (0,634) nas medidas radiográficas e baixa (0,499) nas clínicas. A análise da correlação entre os valores radiográficos com a classificação da OA não demonstrou correlação entre os mesmos (p = 0,824 e r = -0,024). Conclusão Clinicamente, sugere-se que o exame radiográfico seja preferível para avaliação do ângulo Q de idosas com OA de joelhos. Além disto, a magnitude deste ângulo não se relacionou com o grau de acometimento da OA nesta população.

Soluble TNF receptors are produced at sites of inflammation and are inversely associated with self-reported symptoms (WOMAC) in knee osteoarthritis.

The aim of the study was to analyze the concentrations of sTNFR1 and sTNFR2 in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and to determine their relationship to self-reported pain, stiffness and physical function. Twenty-seven patients with knee OA and 19 healthy subjects were enrolled in the study. The Western Ontario and McMaster University Osteoarthritis Index questionnaire was used to evaluate self-reported physical function, pain and stiffness. The sTNFR1 and sTNFR2 levels in the plasma and synovial fluid were measured by enzyme-linked immunosorbent assay. The sTNFR1 levels in synovial fluid of OA patients (2,587 ± 66.12 pg/mL) were 2.5-fold higher than in corresponding blood samples and were 1.5-fold higher than in the plasma of healthy controls. The plasma sTNFR2 levels in the patients with knee OA were lower than in healthy controls (2,249 ± 126.3 vs. 2,700 ± 126.3 pg/mL, p < 0.05), and sTNFR2 levels in synovial fluid of knee OA patients (2,021 ± 107.0 pg/mL) were lower than in the plasma of healthy controls. Synovial fluid sTNFR1 levels were negatively correlated with pain and physical function self-reported (r s - 0.6785, p < 0.0001 and r s - 0.4194, p = 0.03, respectively). Synovial fluid sTNFR2 levels were negatively correlated with pain and joint stiffness (r s - 0.5433, p = 0.01 and r s - 0.4249, p = 0.02, respectively). The findings of this study demonstrated the presence of soluble receptors for TNF-alpha, particularly sTNFR1, in the synovial fluid of patients with primary knee OA and the relationship of these receptors with clinical parameters.

Involvement of BDNF in knee osteoarthritis: the relationship with inflammation and clinical parameters.

The aim of this study was to analyze the levels of brain-derived neurotrophic factor (BDNF) in both the plasma and synovial fluid of patients with primary knee osteoarthritis compared with control individuals and to investigate the relationship between BDNF levels and self-reported pain. Twenty-seven patients with knee osteoarthritis (OA) and 19 healthy subjects were enrolled in the study. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. Radiographic grading of OA in the knee was performed using the Kellgren-Lawrence criteria. The BDNF levels in the plasma and synovial fluid were measured by enzyme-linked immunosorbent assay. The mean plasma BDNF levels of the knee OA patients were significantly higher than that of the healthy controls (2,378 ± 1,067.2 vs. 1,756 ± 804.3 pg/mL, p < 0.05). BDNF levels in the synovial fluid of OA patients (358.9 ± 178.4 pg/mL) were sixfold lower than in corresponding blood samples (p < 0.0001) and fourfold lower than in the plasma of healthy controls (p < 0.0001). Subsequent analyses showed that the plasma BDNF levels significantly correlated with self-reported pain (Western Ontario and McMaster Universities Osteoarthritis Index) (r s = 0.39, p = 0.04). Furthermore, no correlation was found between the plasma and synovial fluid BDNF concentrations and knee OA severity. The findings of this study suggest that systemic BDNF levels are most likely associated with the mechanism of joint pain in knee OA in the acute stage of joint inflammatory process. Further studies are necessary to address the functional role of BDNF in the modulation of pain to establish new therapeutic implications.

Effect of aerobic training on plasma cytokines and soluble receptors in elderly women with knee osteoarthritis, in response to acute exercise.

The aim of this study was to evaluate levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and soluble forms of the TNF-α receptor (sTNFR1 and sTNFR2) from plasma taken from the peripheral blood of elderly individuals presenting with osteoarthritis (OA) of the knee. These patients underwent aerobic treatment through the use of physical exercises. The study consisted of a longitudinal analysis of older individuals presenting clinical and radiographic diagnosis of knee OA that were submitted to 12 weeks of aerobic treatment. The individuals were evaluated during acute exercise or after chronic exercise. During acute exercise (walking slowly on the mat), blood samples of the patients were collected before, immediately after, and 30 min following the end of training. After chronic exercise (aerobic walking training, three times/week for 12 weeks), patient blood samples were obtained for comparison. Additionally, clinical and functional assessments (WOMAC test and 6-min walk) were performed at the end of all physical exercises. Plasma concentrations of cytokines and soluble receptors were measured by ELISA. Aerobic training increased the plasma concentration of sTNR1; however, it decreased the plasma concentration of sTNFR2, when compared with levels of resting patients. Acute exercise differentially affects the levels of sTNFR1 dependent on when the samples were taken, before and after aerobic training. However, the levels of sTNFR2 were not affected by training. For the population studied, we observed differences in the levels of sTNFR1 and sTNFR2 following acute and chronic exercise. Other additional factors, like the level of inactivity of the individual and the type of physical exercise that patients are exposed to, need to be considered as well. The variation in the levels of soluble receptors correlated with functional improvement; however, the inflammatory osteoarthritis markers (IL-6 and TNF-α) were unaffected by the walking exercises.

Desempenho muscular, dor, rigidez e funcionalidade de idosas com osteoartrite de joelho / Muscle performance, pain, stiffness, and functionality in elderly women with knee osteoarthritis

OBJETIVO: Verificar a correlação do desempenho dos músculos do joelho e os domínios dor, rigidez e funcionalidade do Questionário Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) de idosas com osteoartrite de joelho (OA). MÉTODOS: Estudo transversal observacional com uma amostra de 80 idosas (71,2 ¡¾ 5,3 anos) com diagnóstico clínico de OA de joelho. Força, resistência e equilíbrio musculares foram avaliados por meio do dinamômetro isocinético Biodex System 3 Pro, nas velocidades angulares de 60¨¬/s e 180¨¬/s; a funcionalidade, presença de dor e rigidez foram avaliadas pelo questionário WOMAC. A correlação entre as variáveis foi analisada pelo teste de Spearman. RESULTADOS: Houve correlação inversa significativa da força e resistência musculares do quadríceps (QUA) e isquiossurais (IQS) nas velocidades de 60¨¬/s e 180¡Æ/s, respectivamente, e da relação de equilíbrio muscular IQS/QUA a 180¡Æ/s com todos os domínios do WOMAC (p<0.05). CONCLUSÕES: A redução da força e da resistência e a presença de desequilíbrio dos músculos do joelho correlacionaram-se inversamente com todos os domínios do WOMAC, apontando para a necessidade de intervenções que envolvam um trabalho de fortalecimento, resistência e equilíbrio muscular de extensores e flexores de joelho, visando a redução do impacto da OA na dor, rigidez e funcionalidade do idoso. Nivel de Evidência I, Estudos diagnósticos, Investigação de um exame para diagnóstico.

OBJECTIVE: To determinethe correlation between performance of the knee muscles and pain, stiffness, and functionality, through theWestern Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Questionnaire applied to an elderly population with osteoarthritis of the knee (OA). METHODS: This study uses an observational, cross-sectional approach applied to a convenience sample of 80 elderly individuals (71.2 ¡¾ 5.3 years of age) with a clinical diagnosis of OA of the knee. Muscle strength, resistance, and balance of the knee were evaluated using the Biodex System 3 Pro isokinetic dynamometer at angularspeedsof 60¨¬/s and 180¨¬/s. The self-reported functionality, presence of pain, and stiffness were evaluated by the WOMAC questionnaire. The correlation between the variables was analyzed bySpearman's coefficient of correlation (¥á = 0.05). RESULTS: A significant inverse correlation was observed between muscle strength and resistance of the quadriceps muscle (Q) and the hamstring muscle (H) at speeds of 60¨¬/s and 180¡Æ/s, respectively, as well as in the relation between H/Q muscle balance at 180¡Æ/s and all domains of the WOMAC (p?0.05). CONCLUSIONS: The reduction in strength, resistance, and presence of imbalance in the knee muscles are inversely correlated with all the domains of the WOMAC in elderly individuals with OA. These results indicate a need for intervention that involves strengthening, resistance, and balance of the knee extensor and flexor muscles, aimed at reducing the impact of OA in relation to pain, stiffness, and functionality in elderly individuals. Level I, diagnostic studies - investigating a diagnostic test.

Effectiveness of aquatic and non-aquatic lower limb muscle endurance training in the static and dynamic balance of elderly people.

BACKGROUND: Aging compromises the ability of the central nervous system to maintain body balance and reduces the capacity for adaptive reactions. To prevent falls, the reception conditions for sensory information need to be improved. OBJECTIVES: To evaluate the impact of a structured aquatic and a non-aquatic exercise program for lower-limb muscle endurance on the static and dynamic balance of elderly people. METHODS: This was a prospective randomized clinical study in which the variables were assessed before and after the training program. Thirty-six elderly people were evaluated using four tests: the Berg Balance Scale, Dynamic Gait Index, gait speed and tandem gait. The participants were randomized into three groups: aquatic exercise group, non-aquatic exercise group and control group. The exercise groups underwent a program for lower-limb muscle endurance that consisted of 40-minute sessions twice a week for six weeks. The participants were reevaluated after six weeks. The data were analyzed statistically using the univariate ANOVA test for comparisons between the groups before and after the intervention. RESULTS: The program for lower-limb muscle endurance significantly increased balance (p<0.05) in the evaluation tests after the training program. CONCLUSION: The muscle endurance program provided a significant improvement in static and dynamic balance among community-dwelling elderly people. It was also possible to infer that this improvement occurred regardless of the environment, i.e. aquatic or non-aquatic. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN 12609000780257.

Influência da estimulação aquática no desenvolvimento de crianças de 0 a 18 meses: um estudo piloto / Influence of aquatic stimulation on 0 to 18-month child development: a pilot study

O desenvolvimento humano envolve fatores biológicos e ambientais que interagem de forma dinâmica e complexa ao longo da vida. Para alguns autores, o meio aquático pode oferecer diversos benefícios ao desenvolvimento infantil; no entanto, estudos sobre estimulação aquática e desenvolvimento típico são escassos. O objetivo deste estudo foi verificar a influência de um programa de estimulação aquática no desenvolvimento de crianças de 0 a 18 meses, com ênfase no desenvolvimento motor. Participaram do estudo 12 crianças de classe média com nível de escolaridade materna igual ou superior a ensino médio completo. As crianças foram submetidas a uma avaliação antes e após um programa de estimulação aquática de 50 minutos por semana, durante quatro a oito semanas. A avaliação consistiu na aplicação de dois testes: Denver II, para avaliar desenvolvimento global, e a escala motora infantil de Alberta (Aims), para avaliar desenvolvimento motor amplo. Os dados foram tratados statisticamente. Não foram encontradas diferenças significativas entre os resultados dos testes antes e após o programa. Portanto, o programa de estimulação aquática infantil não teve influência nas áreas de desenvolvimento avaliadas. Embora o ambiente aquático forneça muitos benefícios para a criança, este estudo não permite afirmar que o estímulo precoce nesse meio favoreça o desenvolvimento infantil. Requerem-se novos estudos, com maior tempo de intervenção, grupo controle e maior número de participantes...

Human development involves biological and environment factors that interact in a dynamic and complex way throughout life. For some authors, the aquatic environment may offer several benefits to infantile development, but studies on the relationship between aquatic stimulation and typical development are scarce. The purpose of this study was to assess the influence of a program of aquatic stimulation (a 50-minute session once a week during four to eight weeks) on the development of 12 children aged 0 to 18 months, with emphasis on motor development. Children were from middle class families, their mothers having high school or higher educational background. They were assessed before and after the program by two tests: Denver II, to assess global development, and the Alberta infant motor scale, to evaluate gross motor development. Data were statistically analysed. Results showed no significant score differences between tests applied before and after the program. Hence the program had no influence on children’s development areas assessed. Although the aquatic environment offers the child many benefits, this study does not allow asserting that it favours infant development. Further studies must include a greater sample, longer lasting programs, and a control group...

Ombro doloroso após lesão cerebral / Painful shoulder after brain injury

O ombro doloroso (OD) após acidente vascular encefálico (AVE) é frequentemente investigado. Entretanto, sua prevalência após outros tipos de lesão cerebral permanece desconhecida. Os objetivos deste estudo foram identificar a prevalência de OD após diferentes tipos de lesões cerebrais, os fatores associados a essa condição em pacientes admitidos na reabilitação e investigar a associação entre suas características clínicas. Foram avaliados os prontuários do universo de pacientes (n = 109) com diagnóstico clínico e imaginológico de LC admitidos no período de um ano para tratamento em um hospital da rede pública de saúde de Minas Gerais. Itens como, idade, gênero, etiologia da lesão, tempo de lesão, deficiência física, ombro acometido, tônus muscular, subluxação glenoumeral, amplitude de movimento (ADM) e distrofia simpático-reflexa (DSR) foram incluídos neste estudo. A prevalência de ombro doloroso foi de 52,29 por cento. Dentre os fatores previamente relacionados, apenas o tempo de lesão em meses, espasticidade grau 1 na escala de Ashworth, limitação da ADM e subluxação glenoumeral apresentaram associação significativa com essa complicação. As manifestações clínicas identificadas nos prontuários com registro de OD apresentaram significância apenas para a associação do tipo de tônus muscular com o grau de tônus e a ADM.

The painful shoulder after stroke is often investigated. However, its prevalence after other types of brain injury remains unknown. The objectives of this study were to identify the prevalence of painful shoulder after different types of brain injury, the factors associated with this condition in patients admitted to the rehabilitation and investigate the association between its clinical features. The records were evaluated of the universe of patients (n = 109) with clinical and imaginologic diagnosis of brain injury admitted within a year for treatment at a general hospital of Minas Gerais. Items such as age, gender, etiology and time of injury, disability, affected shoulder, muscle tone, glenohumeral subluxation, range of motion and reflex sympathetic dystrophy were included in this study. The prevalence of shoulder pain was 52.29 percent. Among the factors previously listed, only the time of injury in months, spasticity grade 1 on the scale of Ashworth, limitation of range of motion and glenohumeral subluxation showed significant association with this complication. Clinical manifestations identified in records with shoulder painful had significance only for the combination of the type of tone to the degree of muscle tone and range of motion.