Impact of cardiac structure and function on exercise intolerance in Chagas cardiomyopathy: Insights from CPET and echocardiography.

INTRODUCTION: Chronic Chagas cardiomyopathy (CCC), the most severe clinical condition of Chagas disease, often leads to a reduction in functional capacity and the appearance of symptoms such as fatigue and dyspnea on exertion. However, its determinant factors remain unclear. We aimed to evaluate the peak oxygen consumption (VO2peak) in patients with CCC and identify its determining factors. METHODS: An observational study with 97 CCC patients was conducted. Patients underwent clinical examination, cardiopulmonary exercise test (CPET), and echocardiography as part of the standard clinical evaluation. Multivariate linear regression was used to identify independent clinical and echocardiographic predictors of VO2peak and percentage of predicted VO2. RESULTS: Mean age of study patients was 55.9 ± 13.4 years, median left ventricle ejection fraction (LVEF) was 40 (26-61.5) % and median VO2peak was 16.1 (12.1-20.8) ml/Kg/min. 36 patients presented preserved LVEF and 61 presented reduced LVEF. There were significant differences in almost all CPET variables (p < 0.05) between these two groups. VO2peak was associated with age, male sex, NYHA functional class, LVEF, left atrium diameter, LV diastolic diameter, E wave, LV mass index, and pulmonary artery systolic pressure (PASP). Age, male sex, LVEF, and E wave remained independently associated with VO2peak in the multivariate analysis (R2 = 0.69), furthermore, only LVEF and E wave were associated with the predicted VO2 percentage (R2 = 0.53). CONCLUSION: In patients with CCC, disease severity, male sex, LV systolic and diastolic function influence the functional capacity.

RELATIONSHIP BETWEEN RESIDUAL DIURESIS AND SARCOPENIA IN PATIENTS ON HEMODIALYSIS.

OBJECTIVE: To assess the association of residual diuresis with sarcopenia in patients with Chronic Kidney Disease (CKD) on hemodialysis. METHODS: Through a cross-sectional study, patients on hemodialysis were subjected to a Dual Energy Radiologic Absorption (DEXA) exam to record muscle mass. Based on the volume of urine collected in 24 hours, patients were classified as anuric (diuresis ≤ 100 mL/day) or non-anuric (diuresis > 100 mL/day). Functional performance was evaluated by Short Physical Performance Battery (SPPB) and muscle strength by handgrip strength and 5-repetition sit-to-stand test. The association between the absence of residual urine and the presence of sarcopenia, low SPPB, and low muscle strength was analyzed using a binary logistic regression model. RESULTS: Ninety-two patients, with a mean age of 54.4 years (95% CI 51.3 - 57.4) and with a mean diuresis volume of 476.3 mL/day (95% CI 320.4 - 632.2) were evaluated (48 anuric and 44 non-anuric). Anuric patients had a 2.77 (95% CI 1.14 - 6.73) times greater probability of sarcopenia and had a 3.55 (1.14 - 11.0) times greater probability of low SPPB, regardless of gender, age, and time on dialysis. Gender was the other associated variable for the presence of sarcopenia, with males having a 3.30 (95% CI 1.34 - 8.13) times higher risk. There were no associations with muscle strength. CONCLUSION: The absence of residual diuresis in patients on hemodialysis is associated with a higher risk of sarcopenia and low functional performance.

Factors associated with clinical severity in chronic venous disease: The role of functional parameters.

INTRODUCTION: Chronic venous disease (CVD) is a highly prevalent disease that presents a wide spectrum of clinical expressions due to abnormalities in the venous system. Patients often have major functional changes that can limit daily activities. However, the functional factors associated with the severity of the disease remain poorly understood. OBJECTIVE: To identify the functional factors associated with CVD severity. METHODS: Seventy-five patients with CVD (92.0% females, 49.6 ± 13.3 years) were evaluated through clinical examination, lower limb perimetry, ankle range of motion (AROM), and lower limb muscle strength by the Heel Rise test, and Sit-to-stand test. Patients were stratified according to the disease severity as mild (telangiectasia, varicose veins, or edema in the lower limbs) or severe CVD (trophic changes or venous ulcer). RESULTS: Patients with severe CVD (n = 13) were older (p = 0.002), predominantly male (p = 0.007), with reduced AROM in dorsiflexion (p = 0.028) and inversion (p = 0.009), reduced lower limb strength by the Heel Rise test (p = 0.040), and greater circumference of the calf (p = 0.020), ankle (p = 0.003), and plantar arch (p = 0.041) when compared to mild CVD (n = 62). Advanced age, male sex, lower ankle range of motion in dorsiflexion, and greater ankle and plantar arch circumferences were associated with CVD severity. However, the ankle circumference (OR 1.258, 95% CI: 1.008-1.570; p = 0.042), together with advanced age and male sex, was the only functional variable that remained independently associated with CVD severity. CONCLUSION: The increased ankle circumference was a determinant of the CVD severity and may assist in risk stratification and guide treatment goals in this population.

The usefulness of patient-reported outcome measures in decision making in Chagas cardiomyopathy: a scoping review.

Chagas cardiomyopathy (ChC) presents many biopsychosocial complexities, highlighting the need to have patient self-report questions. This study demonstrates the scope of the use of patient-reported outcome measures (PROMs) in patients with ChC and highlights the main research gaps. This is a scoping review and the search strategy was performed in the Online Medical Literature Analysis and Retrieval System (MEDLINE), Excerpta Medica database (EMBASE), Accumulated Index of Nursing and Allied Health Literature (CINAHL), Cochrane Central, Latin American Literature and Caribbean in Health Sciences (LILACS) and Diagnostic Test Accuracy (DITA). The search identified 4484 studies and 20 studies met the inclusion criteria. The Short-Form of 36 items (SF-36) had potential prognostic value and the ability to identify systolic dysfunction. The Human Activity Profile was able to screen for functional impairment, and the New York Heart Association showed potential prognostic value. The SF-36 and Minnesota Living with Heart Failure Questionnaire were responsive to interventions. The pharmaceutical care affected adherence to treatment as assessed by the Morisky score and also for SF-36. Despite the increased use of PROMs, there are still a large number of gaps in the literature, and further studies using PROMs are needed.

Effect of an exercise-based cardiac rehabilitation program on quality of life of patients with chronic Chagas cardiomyopathy: results from the PEACH randomized clinical trial.

To investigate the effect of an exercise-based cardiac rehabilitation program on the quality of life (QoL) of patients with chronic Chagas cardiomyopathy (CCC). PEACH study was a single-center, superiority randomized clinical trial of exercise training versus no exercise (control). The sample comprised Chagas disease patients with CCC, left ventricular ejection fraction < 45%, without or with HF symptoms (CCC stages B2 or C, respectively). QoL was assessed at baseline, after three months, and at the end of six months of follow-up using the SF-36 questionnaire. Patients randomized for the exercise group (n = 15) performed exercise training (aerobic, strength and stretching exercises) for 60 min, three times a week, during six months. Patients in the control group (n = 15) were not provided with a formal exercise prescription. Both groups received identical nutritional and pharmaceutical counseling during the study. Longitudinal analysis of the effects of exercise training on QoL, considering the interaction term (group × time) to estimate the rate of changes between groups in the outcomes (represented as beta coefficient), was performed using linear mixed models. Models were fitted adjusting for each respective baseline QoL value. There were significant improvements in physical functioning (ß = + 10.7; p = 0.02), role limitations due to physical problems (ß = + 25.0; p = 0.01), and social functioning (ß = + 19.2; p < 0.01) scales during the first three months in the exercise compared to the control group. No significant differences were observed between groups after six months. Exercise-based cardiac rehabilitation provided short-term improvements in the physical and mental aspects of QoL of patients with CCC.Trial registration: ClinicalTrials.gov Identifier: NCT02517632; August 7, 2015.

Chagas heart disease is associated with decreased physical activity levels: A cross-sectional analysis.

Background: Studies evaluating physical activity (PA) levels in individuals with Chagas disease (CD) are still scarce. The present study aimed to evaluate PA levels in CD individuals and examine their association with Chagas heart disease (ChHD). Methods: We included patients with CD regularly followed in a reference center for treatment of infectious diseases. PA levels were assessed using the short version of the International Physical Activity Questionnaire (IPAQ). ChHD was determined following the Brazilian Consensus on Chagas Disease. The association between ChHD and levels of PA (total, walking, moderate, and vigorous) as a continuous variable was fitted using generalized linear models. Logistic regression models were fitted to evaluate the association between ChHD and meeting WHO's PA recommendations. Results: Among the 361 participants included in the analysis (60.7 ± 10.7 years; 56.2 % women), 58.1 % (n = 210) complied with the WHO's PA recommendations. After adjustments for potential confounders, regression analyses revealed that ChHD without heart failure was significantly associated with reduced vigorous PA (Exp ß 0.32 95 % CI 0.10 to 0.98). ChHD with heart failure had significantly lower levels of total (Exp ß 0.61 95 % CI 0.44 to 0.84) and moderate (Exp ß 0.59 95 % CI 0.39 to 0.89) PA. ChHD with heart failure had a lower odd of meeting the PA recommendation in comparison to those with no cardiac involvement (OR 0.48 95 % CI 0.24 to 0.97). Conclusions: We found low levels of PA among individuals with CD. Presence of ChHD (mainly with HF) was associated with decreased levels of PA.

Urinary incontinence in middle-aged and older women with hip and knee osteoarthritis: An outpatient study of frequency and risk factors.

AIMS: To investigate the frequency and the factors associated with urinary incontinence (UI) in a sample of middle-aged and older women with lower limb osteoarthritis (OA). METHODS: Women aged 50 years or older with clinical hip/knee OA diagnoses were recruited for this cross-sectional study. Self-reported UI and type, sociodemographic characteristics, medical conditions, physical activity level, anthropometric and body composition measurements, muscle strength, and physical function were assessed. Uni and multivariable logistic regression were used to investigate the factors associated with UI. RESULTS: Among 100 middle-aged and older women (mean 67.27 ± 8.77 SD years), 67% reported UI. In the UI group, 33% reported stress UI, 36% reported urgency UI, and 31% reported mixed UI. In the univariate analysis, age, level of physical activity, pulmonary disease, number of medications, body mass index (BMI), number of deliveries, and activity limitation were significantly associated with UI. In the multivariable analysis, older age (60-69 years OR: 4.91, 95% CI: 1.25-19.36; ≥70 years OR: 8.06, 95% CI: 1.96-33.22), compared to 50-59 years, morbid obesity (OR: 14.10, 95% CI: 1.36-146.48), compared to BMI < 30 kg/m2 , and activity limitation (OR: 5.31, 95% CI: 1.61-17.54), assessed as short physical performance battery ≤8, remained significantly associated with UI. CONCLUSIONS: UI was highly frequent among middle-aged and older women with hip/knee OA. Older age, activity limitation, and morbid obesity were independently associated with UI. Interventions targeting physical function and weight management must be considered to prevent and treat UI in this population.

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.

Assessment of health-related quality of life in patients with Chagas cardiomyopathy using Minnesota living with heart failure questionnaire: A validation study.

OBJECTIVE: Chagas cardiomyopathy (ChC) is the most severe clinical form of Chagas disease and, in association with psychosocial factors, can compromise the health-related quality of life (HRQoL) of affected patients. To date, there is no specific instrument to assess the HRQoL of these patients, and the Minnesota Living with Heart Failure Questionnaire (MLwHFQ), specific for heart failure, is being used both in research and current clinical practice. Therefore, we aimed to verify the validity of the MLwHFQ in the assessment of HRQoL of patients with ChC. METHODS: Fifty patients with ChC (50.6 ± 10.1 years, NYHA I-III) were evaluated. The MLwHFQ, Short-Form of Health Survey (SF-36), Beck Depression Inventory (BDI), and Human Activity Profile (HAP) were applied. All patients underwent echocardiography and Cardiopulmonary Exercise Testing (CPET). RESULTS: The MLwHFQ score correlated with almost all SF-36 domains (with r-value ranging from -0.38 to -0.69), except pain (p = 0.118). The MLwHFQ score also correlated with the BDI score (r = 0.748; p < 0.001), HAP score (r = -0.558; p = 0.001), peak oxygen uptake (r = -0.352; p = 0.01), and left ventricular ejection fraction (r = -0.329; p = 0.021). There was no significant difference in the score found on the MLwHFQ among NYHA classes (p = 0.101), as well as between patients with systolic dysfunction (n = 30) and preserved cardiac function (n = 20) (p = 0.058). Similarly, there was no significant difference in the score found on the physical (p = 0.423) and mental (p = 0.858) components of SF-36 between patients with systolic dysfunction and preserved cardiac function (p = 0.271 and p = 0.609, respectively). There was also no difference in the mental component of SF-36 among NYHA classes (p = 0.673). However, the HRQoL using the physical component of SF-36 was worse in advanced NYHA classes (p = 0.014). CONCLUSION: MLwHF correlated with most SF-36 HRQoL domains, depressive symptoms, physical activity, and systolic function and seems to be valid in assessing the HRQoL of ChC patients.

Reliability and validity of the Patient Generated Index (PGI) in patients with chronic kidney disease (CKD) on dialysis, a new approach to quality of life.

PURPOSE: To evaluate the test-retest reliability and validity of the Patient Generated Index (PGI) in individuals with Chronic Kidney Disease (CDK) undergoing hemodialysis. METHODS: Through a non-experimental study with repeated measures, PGI was applied twice to assess internal consistency and test-retest reliability. Correlations with the Kidney Disease Quality of Life Short Form (KDQOL-SF), the Human Activity Profile (HAP) questionnaire, the Social Participation Scale, and the Glittre ADL Test were used. RESULTS: 91 individuals with CKD were evaluated. There was high reliability for the PGI (ICC= 0.97) PGI correlated with KQDOL - SF in Functional Capacity r = 0.38 (p < 0.001), Emotional Well-Being r = 0.31 (p = 0.003), Social Aspect r = 0.22 (p = 0.036), Emotional Function r = 0.22 (p = 0.038) and Effect of Kidney Disease r = 0.21 (p = 0.042), and Physical scores r = 0.24 (p = 0.021)), Mental r = 0.21 (p = 0.05) and General r = 0.22 (p = 0.037) summarized. There was a significant correlation between PGI and HAP r = 0.40 (p < 0.001) and the Social Participation Scale r = -0.36 (p < 0.001). There was no correlation between the PGI and Glittre ADL scores r = 0.12 (p = 0.247). CONCLUSION: In adults receiving hemodialysis, the PGI proved to be an accurate and reliable instrument for the assessment of the quality of life from the perspective of the patient.IMPLICATIONS FOR REHABILITATIONAlthough hemodialysis treatment is associated with increased survival and symptom control, there is a significant change in the patient's lifestyle.In order to provide a more focused view of the individual, the Patient Generated Index (PGI) was created to evaluate the quality of life.PGI is reliable and correlates with KQDOL - SF and the Social Participation Scale in this population.

Construction and validation of the community health workers perception questionnaire on conditions amenable to physiotherapy in primary health care / Construção e validação do questionário de percepção dos Agentes Comunitários de Saúde sobre condições sensíveis à fisioterapia na Atenção Primária

Abstract Introduction Community health workers, like the physiotherapist, perform essential functions in primary health care, being an important element in the transformation of public policies. There are no reported studies investigating the knowledge of community health workers about health conditions amenable to physiotherapy intervention in primary health care. Objective To construct a questionnaire to investigate the perception of community health workers about health conditions that could be remedied by physiotherapy intervention in primary health care. Methods This was a methodological study in which it was initially an analysis matrix with the aim of encompassing the ideas contemplated in the questionnaire. To construct the instrument, a literature review was carried out, and health conditions treatable with physiotherapy in primary health care were chosen. To validate the content and appearance of the items, twelve physiotherapists specialized in primary health care judged the suitability of the items contained. The content validity index was used to determine the degree of agreement during the response analysis process. Subsequently, a semantic analysis was carried out through the understanding of the items by 15 community health workers. In the validation stage, two rounds of evaluation were carried out. Adjustments were made to 17 questions. Results The study investigated a questionnaire with 20 questions containing hypothetical situations of home visits, in which the resident's situation could or could not constitute a health risk amenable to physiotherapeutic intervention. Conclusion The community health workers perception instrument on health conditions amenable to physiotherapy intervention in primary health care proved to be valid for use in this context. The use of the instrument may contribute to the development of community health worker training programs, with the aim of facilitating team communication.

Resumo Introdução O Agente Comunitário de Saúde (ACS), assim como o fisioterapeuta, desencadeia funções fundamentais na Atenção Primária à Saúde (APS), sendo ele-mento importante na transformação de políticas públicas. Inexistem estudos que investiguem o conhecimento dos ACS sobre as condições de saúde sensíveis à inter-venção da fisioterapia na APS. Objetivo Construir um questionário de investigação da percepção dos ACS sobre as condições de saúde sensíveis à intervenção da fisioterapia na APS. Métodos Trata-se de um estudo metodológico no qual, inicialmente, construiu-se uma matriz de análise com o intuito de englobar as ideias contempladas no questionário. Para a construção do instrumento, realizou-se uma revisão da literatura, sendo eleitas condições de saúde sensíveis à intervenção da fisioterapia na APS. Para a validação de conteúdo e aparente dos itens, 12 fisioterapeutas especialistas em APS julgaram a adequação dos itens contidos. Utilizou-se o índice de validade de conteúdo para verificar o grau de concordância durante o processo de análise das respos-tas. Posteriormente, realizou-se análise semântica por meio da compreensão dos itens por 15 ACS. Na etapa de validação, foram realizadas duas rodadas de avaliação. Foram feitos ajustes em 17 questões. Resultados O estudo resultou em um questionário com 20 questões contendo situações hipotéticas de visitas domiciliares, cuja situação do morador poderia ou não configurar um risco à saúde sensível à intervenção fisioterapêutica. Conclusão O instrumento de percepção dos ACS sobre as condições de saúde sensíveis à intervenção da fisioterapia na APS mostrou-se válido para ser utilizado no contexto da APS. A utilização do instrumento poderá contribuir na elaboração de programas de capacitação dos ACS, com o intuito de facilitar a comunicação da equipe.

Factors associated with fear of falling in older women with knee osteoarthritis: A cross-sectional study.

Knee instability in patients with knee osteoarthritis (KOA) is associated with fear of falling (FoF). This study aimed to investigate the prevalence and the factors associated with FoF in older women with KOA. A cross-sectional study was conducted with 93 older women with KOA. Sociodemographic variables, medical conditions, handgrip strength, and anthropometric and body composition measurements were assessed. The Short Physical Performance Battery was used to measure functional performance. The Western Ontario and McMaster Universities Osteoarthritis Index was applied to assess pain, stiffness, and disability. FoF was assessed by the Falls Efficacy Scale-International. The prevalence of FoF was high (88.2 %). Disability, history of falls, handgrip strength, obesity, number of medications, and pain were independently associated with FoF. Our findings suggest that health professionals should investigate FoF when evaluating older women with KOA and address these risk factors when developing strategies to prevent or minimize FoF in this population.

Análise da função respiratória em músicos instrumentistas de sopro / Analysis of the breathing function in wind instrumental musicians

Objetivo: realizar uma revisão integrativa a respeito da função pulmonar e da força muscular respiratória nos músicos de instrumentos de sopro. A relação da função respiratória com a utilização de instrumentos musicais de sopro é uma área do conhecimento ainda pouco explorada. Métodos: Realizada a revisão bibliográfica nas bases de dados MEDLINE, Embase, Cochrane, PeDro, BVS, Scopus, Web of Science e SciELO, através da combinação das palavras-chave "respiratory function test", "wind instrument", musician, "pulmonary ventilation" e "Lung Function Test". Resultados: Inicialmente foram encontrados 108 artigos, sendo que destes foram selecionados 11, totalizando 596 músicos instrumentistas de sopro, que fizeram parte dos grupos de estudo. Na maioria dos estudos os músicos apresentaram valores menores do volume expirado no primeiro segundo (VEF1) e da capacidade vital forçada (CVF) na espirometria que o grupo controle. No entanto, sem diferença quanto a relação VEF1/CVF. Assim como não há diferença na força muscular respiratória ou relação com doenças respiratórias. Conclusão: Os estudos atuais a respeito da consequência do instrumento de sopro em indivíduos não são capazes de evidenciar impactos positivos ou negativos na saúde respiratória desta população.

Objective: To conduct an integrative review of lung function and respiratory muscle strength in wind instrument musicians. The relationship between respiratory function and the use of wind musical instruments is an area of knowledge that has not been extensively explored. Methods: A bibliographic review was carried out in the MEDLINE, Embase, Cochrane, PeDro, BVS, Scopus, Web of Science, and SciELO databases by combining the keywords "respiratory function test", "wind instrument", musician, "pulmonary ventilation" and "Lung Function Test". Results: Initially, 108 articles were found, of which 11 were selected, totaling 596 wind instrumentalists who were part of the study groups. In most studies, musicians showed lower values of expired volume in one second (FEV1) and forced vital capacity (FVC) in spirometry than in the control group. However, there was no difference regarding the FEV1/FVC ratio, just as there was no difference in respiratory muscle strength or relationship with respiratory diseases. Conclusion: Current studies regarding the effect of wind instruments on individuals are unable to show positive or negative impacts on the respiratory health of this population.

Functional predictors of poor outcomes in Chagas cardiomyopathy: The value of end-tidal carbon dioxide at peak exercise.

BACKGROUND: Functional impairment can be detected from the onset of heart disease in patients with Chagas cardiomyopathy (ChC) and the prognostic value of the end-tidal carbon dioxide at peak exercise (PETCO2 peak) should be investigated. OBJECTIVE: To verify the prognostic value of PETCO2 peak in patients with ChC. METHODS: Seventy-six patients with ChC (49.2 ± 9.8 years, NYHA I-III) were evaluated by echocardiography and Cardiopulmonary Exercise Testing. Patients were followed up to four years and the end-point was defined as cardiovascular death, stroke, or cardiac transplantation. RESULTS: At the end of the follow-up period (29.0 ± 16.0 months), 16 patients (21%) had experienced adverse events. The area under the receiver operating characteristic (ROC) curve to identify the risk of adverse events by PETCO2 peak in patients with ChC was 0.83 (95% CI: 0.69 to 0.97), and the value of 32 mmHg was the optimal cut point (70% of sensitivity and 85% of specificity). In the Kaplan-Meier diagram, there was a significant difference (p<0.001) between patients with reduced (≤ 32 mmHg) and preserved PETCO2 peak (>32 mmHg). In the final Cox multivariate model, only reduced PETCO2 peak (HR 4.435; 95% CI: 1.228 to 16.016, p = 0.023) and VO2peak (HR 0.869; 95% CI: 0.778 to 0.971, p = 0.013) remained as independent predictors of poor outcome in ChC patients. CONCLUSION: Reduced PETCO2 peak and VO2peak demonstrated valuable prognostic value in patients with ChC. The cutoff points for both functional variables can be used during risk stratification and may help in the development of therapeutic strategies in ChC patients.

Inflammatory biomarkers at different stages of Sarcopenia in older women.

In recent years, studies have found that Sarcopenia alters inflammatory biomarkers. However, the behavior of inflammatory biomarkers at different stages of Sarcopenia is not well understood. This study aimed to compare a broad panel of inflammatory biomarkers in older women at different stages of Sarcopenia. The study included 71 Brazilian community-dwelling older women. Muscle Strength was assessed by using handgrip strength (Jamar dynamometer). The Short Physical Performance Battery (SPPB) was performed to assess the physical performance, and body composition was assessed by DEXA. Sarcopenia was diagnosed and classified according to the EWGSOP2 criteria. Blood was drawn, and inflammatory biomarkers associated with Sarcopenia (IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNF, adiponectin, leptin, resistin, BDNF, sTNFr-1 and sTNFr-2) was analysed. After diagnosis and classification of sarcopenia, 45% of women did not present Sarcopenia (NS, N = 32), 23.9% were diagnosed with Sarcopenia Probable (SP, N = 17), 19,7% with Sarcopenia Confirmed (SC, N = 14), and 11.3% with Severe Sarcopenia (SS, N = 8). The analysis of inflammatory biomarkers revealed that the more advanced the stage of Sarcopenia, the higher the levels of BDNF, IL-8, sTNFr-1, and sTNFr-2. The assessment of BDNF, IL-8, sTNFr-1, and sTNFr-2 levels may be an adjuvant tool in diagnosis and severity classification of Sarcopenia in older Brazilian women.

Whole-Body Vibration Training on Oxidative Stress Markers, Irisin Levels, and Body Composition in Women with Fibromyalgia: A Randomized Controlled Trial.

(1) Background: Mitochondrial dysfunction and redox imbalance seem to be involved in fibromyalgia (FM) pathogenesis. The results of our previous studies suggest that whole-body vibration training (WBVT) would improve redox status markers, increase blood irisin levels, and ameliorate the body composition of women with FM. (2) Objective: The current study aimed to investigate WBVT on oxidative stress markers, plasma irisin levels, and body composition in women with FM. (3) Methods: Forty women with FM were randomized into WBVT or untrained (UN) groups. Before and after 6 weeks of WBVT, body composition was assessed by dual-energy radiological absorptiometry (DXA), and inflammatory marker activities were measured by enzymatic assay. (4) Results: Body composition, blood irisin levels, and oxidative stress markers were similar between UN and WBVT groups before the intervention. After 6 weeks of intervention, the WBVT group presented higher irisin levels (WBVT: 316.98 ± 109.24 mg·dL³, WBVT: 477.61 ± 267.92 mg·dL³, p = 0.01) and lower TBARS levels (UN: 0.39 ± 0.02 nmol MDA/mg protein, WBVT: 0.24 ± 0.06 nmol MDA/mg protein, p = 0.001) and visceral adipose tissue mass (UN: 1.37 ± 0.49 kg, WBVT: 0.69 ± 0.54 kg, p = 0.001) compared to the UN group. (5) Conclusions: Six weeks of WBVT improves blood redox status markers, increases irisin levels, and reduces visceral adipose tissue mass, favoring less cell damage and more outstanding oxidative balance in women with FM.

Accuracy of handgrip and respiratory muscle strength in identifying sarcopenia in older, community-dwelling, Brazilian women.

Certain cut-off points for sarcopenia screening and diagnosis are arbitrary and based on European populations, with normative references often obtained from healthy young adults. Although respiratory skeletal muscle strength tests represent low-cost clinical measures commonly performed in clinical practice by health professionals, a gap remains regarding whether respiratory skeletal muscle strength tests are adequate and sensitive measures for sarcopenia screening. This study aimed to verify the value of handgrip and respiratory muscle strength as possible discriminators to identify sarcopenia and to establish cut-off points for sarcopenia screening in community-dwelling, Brazilian women. In a cross-sectional study, 154 community-dwelling, Brazilian women (65-96 years) were assessed for appendicular skeletal muscle mass, handgrip (HGS), and respiratory muscular strength, including maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). The data were analyzed using the ROC curve and the Youden Index determined cut-off points. Statistical significance was set at 5%. 88 participants (57%) were sarcopenic. MEP (OR 0.98 [95%CI 0.97, 1.00], p = 0.023) and HGS (OR 0.82 [95% CI 0.75, 0.90], p < 0.001) were independent factors for sarcopenia in older. The optimal cut-off points for identifying sarcopenia were ≤ 77 cmH2O for MEP (AUC = 0.72), and ≤ 20 kg for HGS (AUC = 0.80). Simple muscular strength tests, including HGS and MEP, may be considered in the identification of sarcopenia in older, community-dwelling, Brazilian women. Future work is still needed to assess external validation of the proposed cut-offs before the clinical application.

Comparative effects of a cardiovascular rehabilitation program on functional capacity in patients with chronic chagasic cardiomyopathy with or without heart failure.

PURPOSE: The aim of the present study was to evaluate the effects of cardiovascular rehabilitation (CR) on functional capacity of patients with chronic chagasic cardiomyopathy (CCC) and to compare the responses between CCC patients without and with heart failure (HF). MATERIALS AND METHODS: A longitudinal observational retrospective study was carried out including 36 patients with CCC without HF (stage B2 [n = 7]) and with HF (stage C [n = 29]), who participated in a CR program. Functional capacity was assessed by a maximal progressive cardiopulmonary exercise test performed on a treadmill. The longitudinal effects of the CR on functional capacity were determined by linear mixed models that included an interaction term to evaluate the differential responses between patients without and with HF. RESULTS: Significant improvements in peak oxygen consumption, resting heart rate and blood pressure, and maximum pulmonary ventilation were observed for the overall study sample, with no apparent differential effects according to the presence of HF. CONCLUSIONS: CR significantly improved functional capacity of patients with CCC. The responses to CR appear to be similar among patients without and with HF, reinforcing the need for its inclusion as a standard treatment strategy of CCC.Implications for rehabilitationExercise-based cardiovascular rehabilitation (CR) is a safe strategy that improves functional capacity, cardiac function, and quality of life in patients with several cardiovascular diseases, and recent studies also suggested a potential beneficial effect of CR in chronic chagasic cardiomyopathy (CCC).In this observational study, CR seems to equally improve exercise capacity, resting heart rate, resting blood pressure, and maximum pulmonary ventilation in patients with CCC without (stage B2) and with heart failure (stage C).Cardiovascular rehabilitation should be included as a standard treatment strategy for patients with CCC, regardless the severity of cardiomyopathy.

Factors Associated with Motor Competence in Preschoolers from a Brazilian Urban Area.

Background: Preschool is a crucial period for developing motor skills. Objective: This study evaluated factors associated with motor competence in preschoolers from a Brazilian urban area. Methods: A total of 211 preschoolers (51.2% girls and 48.8% boys) were evaluated. Body mass index was calculated; the Brazilian Economic Research Criterion, the Mini-Mental Scale (MMC) and the Early Childhood Environment Rating Scale®, Revised (ECERS-R™) were applied; the Habitual Physical Activity time was recorded; the Test of Gross Motor Development (TGMD-2) was performed. Univariate analysis was performed using simple linear regression for the independent variables, considering the motor test subscales as dependent variables. Variables with p < 0.20 in the univariate analysis were considered for the multiple linear regression model and were entered into the stepwise method. Results: The independent variables remaining in the Standard Score Locomotor model were BMI, presence of park at school, and MMC (R2 = 0.16). The independent variables remaining in the Standard Object Control score were MMC and gender (R2 = 0.03). The variables associated with the highest scores of Gross Motor Quotient were MMC, body mass index, and presence of a park at school, respectively (R2 = 0.11). Conclusion: Male eutrophic preschoolers who are physically active and attend schools with parks or courtyards in a Brazilian urban area have the highest scores for global cognitive function and motor competence.

Health-Related Quality of Life Reported by Patients With Chagas Disease: A Systematic Review of Qualitative Evidence With GRADE Recommendations.

Patients with Chagas disease have reduced health-related quality of life (HRQoL). Hence, we aimed to identify the factors that mostly affected their HRQoL. This was a systematic review of qualitative studies. The Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Web of Science, and SciVerse Scopus databases were searched for relevant studies without language or date restrictions. The search and data analysis were performed by independent reviewers; all qualitative studies that reported the factors that had an impact on the HRQoL of patients with Chagas disease were included. The risk of bias was assessed using the Critical Appraisal Skills Program Qualitative Study Checklist; confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative approach. Five studies were included in this review: four in Brazil and one in California, United States, with immigrants from Central and South America. The sample consisted of 207 patients with chronic Chagas disease. Stigma, physical limitations, work absenteeism, emotional or mental aspects, fear of treatment, and fear of the future had the strongest impact on the HRQoL. All items showed moderate confidence except for fear of treatment (low confidence). The physical, emotional, mental, and cultural aspects affected the HRQoL of patients with chronic Chagas disease. Identification of these factors is important in the development of strategies aimed at improving the HRQoL of this population.