Relationship Between Executive Function Subdomains and Postural Balance in Community-Dwelling Older Adults.

BACKGROUND: Executive function (EF) deficits are a significant risk factor for falls among older adults (OAs). However, relationship between EF subdomains (shifting, updating, and inhibition), postural balance (PB), and fall risk in healthy OAs, remains poorly understood. OBJECTIVE: This study aimed to investigate the relationship between EF subdomains (shifting, updating, and inhibition) and PB, and to assess their impact on risk of falls in community-dwelling OAs. METHODS: A cross-sectional study involving 50 OAs aged over 60 years (average age of 72 years) was conducted. Participants underwent assessments of EF subdomains and PB using validated tests. A correlation analysis was employed to examine the relationships between EF and PB. RESULTS: The study revealed significant correlations between subdomains and PB. Mental set shifting (r = -.539; p < .001) and inhibition (r = -.395; p = .050) exhibited inverse relationships with PB. Stepwise multiple linear regression showed that Trail Making Test Part B was associated with the PB (R2 = .42, p < .001). CONCLUSION: These findings highlight the importance of assessing EF subdomains, particularly shifting and inhibition, to identify risk of falls. Trail Making Test Part B largely explains the variability of the PB. Integrating PB assessments and EF training, such as the Mini-BESTest, into routine care can be vital for fall prevention strategies. Significance/Implications: This knowledge underscores the need for cognitive training interventions focusing on shifting and inhibition to enhance PB and potentially reduce falls. Additionally, incorporation of EF assessment tools as Trail Making Test Part B and the Mini-BESTest into routine clinical practice for community-dwelling OAs is recommended to address fall prevention strategies.

Burnout levels and associated factors among Intensive Care Unit workers during the first wave of the COVID-19 pandemic in Chile: A cross-sectional study.

Introduction: The COVID-19 pandemic resulted in an unpredictable healthcare crisis with a high psychological burden on healthcare workers. Objective: To evaluate burnout levels and their associated demographics and occupational factors among intensive care unit healthcare workers during the COVID-19 pandemic in a single hospital in the city of Temuco, Chile. Methods: A cross-sectional design in which a sociodemographic questionnaire and the Maslach Burnout Inventory for Human Services were sent to health care workers in a single Chilean Intensive Care Unit during the pandemic COVID-19. Burnout levels, demographic, and occupational factors are reported using descriptive statistics; correlations between burnout levels and demographic-occupational factors were analyzed using Spearman's and rank-biserial correlation coefficients; and multiple linear stepwise regression was used to assess the contribution of demographic and occupational factors to participants' burnout levels. Results: A total of 84 participants (46 women and 38 men) were included in the analysis. Depersonalization and low personal accomplishment were evidenced in 95.2% and 98.8% of the intensive care unit healthcare workers, respectively. Emotional exhaustion was positively correlated with having children ( = 0.72; < 0.01). Age ( = 0.79; < 0.05), sex ( = 0.30; < 0.05), and prior experience in intensive care unit facilities ( = 0.71; < 0.05) were correlated with depersonalization. Feeling of personal accomplishment was positively correlated with with sex ( = 0.70; < 0.05) and type of work shift ( = 0.29; < 0.01). Conclusions: The intensive care unit healthcare workers in this study reported high levels of depersonalization and low feelings of personal accomplishment during an advanced stage of the COVID-19 pandemic. Older age, being female, having children, having intensive care unit experience, and working at 4th shift were factors related to burnout dimensions.

Dose and time-response effect of photobiomodulation therapy on glycemic control in type 2 diabetic patients combined or not with hypoglycemic medicine: A randomized, crossover, double-blind, sham-controlled trial.

Photobiomodulation therapy (PBMt) combined or not with oral hypoglycemic medication has not been investigated in type 2 diabetes (T2DM) patients. All 10 T2DM patients were assessed randomly at 6 different occasions (3 with and 3 without regular oral hypoglycemic medication). Capillary glycemia was assessed after overnight fast (pre-prandial), 1 h postprandially (standardized meal, 338 kcal), and 30 min, 3 h, 6 h, 12 h post-PBMt (830 nm; 25 arrays of LEDs, 80 mW/array). Three doses (0 J-sham, 100 J, 240 J per site) were applied bilaterally on quadriceps femoris muscles, hamstrings, triceps surae, ventral upper arm and forearm; and randomly combined or not with oral hypoglicemic medication, totaling six different therapies applied for all 10 TDM2 patients (PBMt sham, PBMt 100 J, PBMt 240 J, PBMt sham + medication, PBMt 100 J + medication, PBMt 240 J + medication). Cardiac autonomic control was assessed by heart rate variability (HRV) indices. Without medication, there was reduction in glycemia after all PBMt doses, with 100 J as the best dose that persisted until 12 h and presented lower area under the curve (AUC). With medication, glycemia decreased similarly among doses. No differences between 100 J and sham + medication, but AUC was significantly lower after 100 J, suggesting better glycemic control. Low frequency component of HRV increased after sham + medication and 100 J, suggesting higher sympathetic activation. PBMt showed time- and dose-response effect to reduce glycemia in T2DM patients. Effects on HRV were consistent with glycemic control.

Effects of High Intensity Interval Training versus Sprint Interval Training on Cardiac Autonomic Modulation in Healthy Women.

BACKGROUND: For the prevention of cardiovascular diseases, the practice of physical exercises is an effective strategy in improving or maintaining cardiorespiratory health; however, a lack of time is a barrier to access and interval training appears as possible facilitator. This study aims to compare the effects of two interval training protocols on cardiac autonomic modulation in healthy women. METHODS: we conducted a randomized clinical trial with 43 women with a mean age of 29.96 ± 6.25 years, allocated into two groups; high-intensity interval training (HIIT) consisting of four four-minute high-intensity sprints interspersed with three minutes of active recovery and the Sprint interval training (SIT) with four 30-s sprints all-out, interspersed with four minutes of recovery (active or passive). RESULTS: the HIIT group presented better results for the patterns without variation (0V) variables (p = 0.022); Shannon entropy (p = 0.004) Conditional Entropy (p = 0.025). However, there was a significant group effect for some variables, Oxygen Volume (VO2) (p = 0.004), Square root of the mean quadratic differences between the adjacent normal R-R intervals (p = 0.002) and standard deviation of all normal R-R intervals recorded in a time interval (p = 0.003), demonstrating an improvement independent of the protocol. CONCLUSION: we conclude that eight weeks of interval training were able to produce positive effects on cardiac autonomic modulation in healthy women, with better results for HIIT in this population.

Effects of Supervised Physical Exercise as Prehabilitation on Body Composition, Functional Capacity and Quality of Life in Bariatric Surgery Candidates: A Systematic Review and Meta-Analysis.

BACKGROUND: Prehabilitation is a strategy used aiming to reduce the risk factors and complications of surgery procedures, but there is no consensus on the effectiveness of supervised physical exercise and its optimal prescription during this phase. OBJECTIVES: To determine the effects of exercise prehabilitation on body composition, functional capacity and quality of life in candidates for bariatric surgery. SEARCH METHODS: A search was conducted in PubMed, Web of Science, SciELO, Scopus, MEDLINE and CINAHL. SELECTION CRITERIA: Only randomized clinical trials that examined the effectiveness of supervised physical exercise were included. The main outcomes were body composition, functional capacity, quality of life and surgical outcomes. DATA COLLECTION AND ANALYSIS: Two researchers independently selected the literature, extracted the data and evaluated the risk of bias. A third researcher was consulted when a consensus was not reached. The risk of bias was assessed by the tool recommended by the Cochrane Collaboration, the quality of the evidence by GRADE, and to analyze the effects of prehabilitation on the primary objectives, RevMan software, version 5.3 was used. MAIN RESULTS: The search resulted in 4550 articles, of which 22 met the eligibility criteria, leaving 5 articles selected for this review. One article was assessed as a high bias risk and four as an uncertain risk, which included 139 candidates for bariatric surgery. Most of the studies evaluated the body composition, functional capacity and quality of life; none reported surgical outcomes. CONCLUSIONS: Supervised physical exercise has positive effects on the body composition, functional capacity and quality of life; there was no evidence for surgical outcomes, which opens up a field of study for future research of this population.

Effects of automatic mechanical peripheral stimulation on gait biomechanics in older adults with Parkinson's disease: a randomized crossover clinical trial.

BACKGROUND: Automated mechanical peripheral stimulation (AMPS) is a rehabilitation technique suggested to correct gait abnormalities on Parkinson's disease. Although previous studies have suggested increments in functional performance and gait speed after AMPS intervention, little is known about its effect on gait biomechanics. OBJECTIVE: To analyze the effect of an AMPS session on functional performance and gait biomechanics in subjects with Parkinson's disease. METHODS: Twenty-eight subjects aged 67±3 years old participated in this study. Kinematics and muscle activation were recorded during walking at a preferred gait speed before and after AMPS and sham interventions. Footswitches sensors were used to record the kinematic parameters. Electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius lateralis (GL) were recorded. Timed up and go (TUG) test and Short Physical Performance Battery (SPPB) were performed to assess functional performance. RESULTS: GL activation increased after AMPS intervention before and after heel strike (p = 0.04; p < 0.01) and before and after toe-off (p = 0.013; p = 0.038). Also, after AMPS intervention, TA activation increased after heel strike (p = 0.007); and after sham intervention, TA activation reduced before and after heel strike (p = 0.038; and p = 0.007) and before toe-off (p = 0.013). The time of TUG test was shorter after AMPS intervention (p = 0.015). CONCLUSION: AMPS intervention changed the EMG activation of ankle muscles during walking and functional performance. However, AMPS intervention did not change gait kinematics.

High Fasting Glycemia Predicts Impairment of Cardiac Autonomic Control in Adults With Type 2 Diabetes: A Case-Control Study.

Introduction: Type 2 diabetes (T2D) is characterized by a metabolic disorder that elevates blood glucose concentration. Chronic hyperglycemia has been associated with several complications in patients with T2D, one of which is cardiac autonomic dysfunction that can be assessed from heart rate variability (HRV) and heart rate recovery (HRR) response, both associated with many aspects of health and fitness, including severe cardiovascular outcomes. Objective: To evaluate the effects of T2D on cardiac autonomic modulation by means of HRV and HRR measurements. Materials and Methods: This study has an observational with case-control characteristic and involved ninety-three middle-aged adults stratified into two groups (control group - CG, n = 34; diabetes group - DG, n = 59). After signing the free and informed consent form, the patients were submitted to the evaluation protocols, performed biochemical tests to confirm the diagnosis of T2D, collection of R-R intervals for HRV analysis and cardiopulmonary effort test to quantify HRR. Results: At rest, the DG showed a reduction in global HRV (SDNN= 19.31 ± 11.72 vs CG 43.09 ± 12.74, p < 0.0001), lower parasympathetic modulation (RMSSD= 20.49 ± 14.68 vs 52.41 ± 19.50, PNN50 = 4.76 ± 10.53 vs 31.24 ± 19.24, 2VD%= 19.97 ± 10.30 vs 28.81 ± 9.77, p < 0.0001 for both indices) and higher HRrest when compared to CG. After interruption of physical exercise, a slowed heart rate response was observed in the DG when compared to the CG. Finally, a simple linear regression showed that fasting glycemia was able to predict cardiac autonomic involvement in volunteers with T2D. Conclusion: Patients with T2D presented lower parasympathetic modulation at rest and slowed HRR after physical exercise, which may be associated with higher cardiovascular risks. The findings show the glycemic profile as an important predictor of impaired cardiac autonomic modulation.

Effect of the combination of automated peripheral mechanical stimulation and physical exercise on aerobic functional capacity and cardiac autonomic control in patients with Parkinson's disease: a randomized clinical trial protocol.

BACKGROUND: Automated peripheral mechanical stimulation (AMPS) has been proposed as a new complementary therapy with potential for improving motor and cardiovascular abnormalities in Parkinson's disease (PD). However, AMPS long-term effects and its combination with physical exercise are unknown. Thus, this study aims to compare the effects of a program of 12 weeks of physical exercise with a 12-week intervention program combining physical exercise and AMPS on the aerobic capacity, cardiac autonomic control, and gait parameters in patients with PD. METHODS: A randomized, controlled clinical trial will be conducted. Older volunteers with PD will be randomly assigned to one of the two groups studied: (1) exercise or (2) AMPS + exercise. Both groups will undergo an exercise program of 24 sessions, for 12 weeks, performed twice a week. Before exercise sessions, the group AMPS + exercise will receive a session of active AMPS, while the group exercise will receive an AMPS sham intervention. Shapiro-Wilk's and Levene's tests will be used to check for data normality and homogeneity, respectively. In case parametric assumptions are fulfilled, per-protocol and intention-to-treat analyses will be performed using a mixed model analysis of variance to check for group*time interaction. Significance level will be set at 5%. DISCUSSION: Several non-pharmacological treatment modalities have been proposed for PD, focusing primarily on the reduction of motor and musculoskeletal disorders. Regular exercise and motor training have been shown to be effective in improving quality of life. However, treatment options in general remain limited given the high prevalence and adverse impact of these disorders. So, developing new strategies that can potentiate the improvement of motor disabilities and also improve non-motor symptoms in PD is relevant. It is expected that the participants from both groups will improve their quality of life, gait parameters, and their cardiac autonomic control, with greater improvements being observed in the group combining active AMPS and physical exercise. TRIAL REGISTRATION: ClinicalTrials.gov NCT04251728 . Registered on February 05, 2020.

Effect of physical exercise in bariatric surgery patients: protocol of a randomized controlled clinical trial.

BACKGROUND: Bariatric surgery is an effective approach to weight loss and long-term comorbidity resolution. Although recommended in several guidelines, supervised exercise has not been systematically prescribed after bariatric surgery. The aim of this study is to determine the effects of two types of exercise, moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT), on body composition, cardiopulmonary function, and perceived quality of life in bariatric surgery patients. METHODS: This randomized controlled exploratory pilot trial will include 75 adults of both sexes scheduled for bariatric surgery. They will be randomly assigned to one of three groups: (1) MICT, (2) HIIT, or (3) a control group. The intervention will occur 2 days a week for 4 months. Outcomes will be assessed at four points: (1) 1 week before surgery, (2) 21 days after surgery (baseline before the exercise program), (3) 8 weeks after beginning the exercise program, and (4) 1 week after the end of intervention. Primary outcomes will include body composition, heart rate variability, and 6-min walk test and quality of life scores. Secondary outcomes will be maximal respiratory pressure, flowmeter, hand dynamometry, and 30-s sit-to-stand test results. DISCUSSION: Both exercise protocols in this study were developed according to evidence-based practice. It is expected that, after 16 weeks of intervention, body composition (measured by electrical bioimpedance), cardiopulmonary function (measured by heart rate variability, maximal inspiratory pressure, maximal expiratory pressure, peak expiratory flow, handgrip strength, and the 6-min walk test), and perceived quality of life (measured by the Moorehead-Ardelt quality of life questionnaire II and bariatric analysis and reporting outcome system scores) will improve, especially in the HIIT group. TRIAL REGISTRATION: ClinicalTrials.gov NCT04235842 . Registered on 22 January 2020.

Is Wii-based motor training better than task-specific matched training for children with developmental coordination disorder? A randomized controlled trial.

Purpose: To evaluate in children with developmental coordination disorder (DCD) the effects of Wii-training compared with task-specific matched training (TST).Material and methods: A randomized controlled trial (RCT) was conducted with 32 children having DCD, aged 7-10 years. Children were randomly assigned to the Wii or task-specific training. Both interventions consisted of 16, 60-min sessions over an 8-week period. The primary outcome measure of movement skill was the Movement Assessment Battery for Children-2 (MABC-2), administered by blinded assessors. Measures included total standard scores (TSS), manual dexterity, aiming/catching, and balance component scores.Results: From pre- to post-test, both groups improved significantly on TSS and balance after intervention. The Wii intervention group also improved on manual dexterity. Neither group improved significantly on aiming/catching.Conclusions: Both the Wii and task-specific training improved overall motor performance and balance. On other MABC-2 component scores, treatment effects differed between groups: Task-specific training had more pronounced effects on balance skills, while Wii training had slightly stronger treatment effects than task-specific training on manual dexterity. It was concluded that task-specific training affords stronger benefits for general motor skill than Wii-based training. Whether Wii training can promote clinically significant benefits for upper-limb function remains to be seen.Trial Registration: This study is registered in a clinical trials registry platform (Protocol: RBR-89YDGJ). Available on the Brazilian Clinical Trials Registry Implications for rehabilitationWii-training and task-specific matched training programs afforded gains in motor performance in children with developmental coordination disorder, similarly;The selected Wii tasks were able to improve the motor performance in children with developmental coordination disorder, but should not be used as an exclusive strategy for these children;Our findings suggest caution in recommending Wii-based training as a viable alternative to more task-specific matched training for children with developmental coordination disorder.

Acute effects of photobiomodulation therapy applied to respiratory muscles of chronic obstructive pulmonary disease patients: a double-blind, randomized, placebo-controlled crossover trial.

To investigate the effects of photobiomodulation applied to respiratory muscles on lung function, thoracoabdominal mobility, respiratory muscle strength, and functional capacity in COPD patients. This is a randomized double-blind crossover clinical trial. Twelve male COPD patients participated in the study. Participants were randomly allocated to receive two photobiomodulation sessions, 1 week apart: (1) an effective photobiomodulation session applied at the main respiratory muscles by means of a cluster with 69 light-emitting diodes (LEDs), containing 35 red (630 ± 10 nm; 10 mW; 0.2 cm2) and 34 near-infrared (830 ± 20 nm; 10 mW; 0.2 cm2) LEDs and (2) a sham photobiomodulation session, following the same procedures without emitting light. The primary outcomes were pulmonary function (spirometric indexes); thoracoabdominal mobility (cirtometry); respiratory muscle strength (maximal respiratory pressures), assessed at three moments: (1) baseline, (2) 1 h after intervention, and (3) 24 h after intervention; and the functional capacity, assessed by the 6-min walk test (6MWT) at baseline and 24 h after intervention. No significant interactions were found for spirometric variables, maximal respiratory pressures, and cirtometry. However, there was a Time × Condition interaction (F = 18.63; p = 0.001; η2p = 0.62) in the walked distance on the 6MWT, with a significant increase after photobiomodulation intervention (p < 0.01) compared with the baseline. Photobiomodulation applied to respiratory muscles was effective in improving acute functional capacity in COPD patients. To the best of our knowledge, this is the first study assessing the effects of photobiomodulation applied to respiratory muscles in patients with COPD.

Association between Cardiac Autonomic Control and Postural Control in Patients with Parkinson's Disease.

Parkinson's disease (PD) is a neurodegenerative disorder that affects postural and cardiac autonomic control. However, since it is unknown whether these changes are associated, the objective of this study was to determine whether such a relationship exists. Twenty-three patients with PD participated. The RR intervals were recorded in different positions and heart rate variability (HRV) was analyzed. Postural sway was analyzed based on the center of pressure. No significant differences on HRV indices were induced by postural change. A correlation was found between these indices and postural control, high frequency (HF), and anterior-posterior (AP) root mean square (RMS-AP) (r = 0.422, p = 0.045), low frequency (LF)/HF, and AP mean velocity (r = 0.478, p = 0.021). A correlation was found between HRV induced by postural change and postural control, Δ LF/HF and RMS-AP (r = 0.448, p = 0.032), Δ LF/HF and ellipse area (r = 0.505, p = 0.014), Δ LF/HF and AP mean velocity (r = -0.531; p = 0.009), and Δ LF and AP mean velocity (r = -0.424, p = 0.044). There is an association between the autonomic and postural systems, such that PD patients with blunted cardiac autonomic function in both the supine and orthostatic positions have worse postural control.

Impact of deep water running in interval training (DWR-IT) on body composition, functional capacity, and quality of life in overweight adults: study protocol for a randomized controlled trial.

BACKGROUND: Interval training in deep water running (DWR-IT) is a training method to improve cardiovascular fitness, functional health, and quality of life and to help control body weight. Its main advantages are the reduction of joint overload and a low risk of musculoskeletal injuries. The aim of the study is to investigate the influence of DWR-IT on functional capacity, body composition, and quality of life of overweight middle-aged adults. METHODS: This is a randomized controlled, two-arm, open, parallel clinical trial with overweight adults. Volunteers will be allocated to a water group (WG), which will be submitted to the intervention, or a control group, which will not be subjected to any kind of intervention. The evaluation will be composed of anamnesis, electrical bioimpedance, six-minute walk test (6MWT), questionnaire on the Impact of Weight on Quality of Life-lite (IWQOL-LITE), Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, chair stand test, arm curl test, and food frequency questionnaire. The DWR-IT will last for 12 weeks, systematically increasing the intensity and training volume. DISCUSSION: The objective of this clinical trial is to evaluate the effect of DWR-IT on overweight adults. The study is guided through practice based on scientific evidence for the use of training and aquatic rehabilitation. It is expected that after 12 weeks of aquatic intervention there will be a decrease in body fat by about 10%, evaluated by electrical bioimpedance, an increase of about 25% of cardiorespiratory endurance, evaluated by 6MWT, and an improvement of about 25% of physical function domains, self-esteem, distress in public places, and work, analyzed by IWQOL-LITE in the WG. TRIAL REGISTRATION: The study protocol was published in the Brazilian Registry of Clinical Trials (ReBEC) on June 16, 2016. Registration number: RBR-6dmh7d.

Lipid profile, functional capacity and ankle-brachial index in active older adults / Perfil lipídico, capacidade funcional e índice tornozelo-braquial em idosos ativos / Perfil lipídico, capacidad funcional e índice tobillo-braquial en adultos de la tercera edad activos

ABSTRACT Introduction: Regular physical activity prevents cardiovascular diseases (CVD) and atherosclerosis, in addition to improving lipid levels and functional capacity in older adults. Objective: To evaluate and compare the lipid levels, functional performance and ankle brachial index (ABI) of sedentary and active older adults. Methods: This was a comparative cross-sectional study with 84 elderly (≥60 years) male and female subjects, divided into two groups: sedentary group (SG, n = 50) and active group (AG, n = 34) according to the International Physical Activity Questionnaire (IPAQ). Anthropometric and hemodynamic assessments, ankle brachial index (ABI) calculations, and functionality tests (Short Physical Performance Battery - SPPB and 6-minute walking test - 6MWT) were performed. The Shapiro-Wilk normality test was also used, and we conducted the Student's-t and Mann-Whitney tests for the intergroup comparison. For the categorical data, we used Fisher's exact test (p <0.05). Results: Higher values of high-density lipoprotein cholesterol (HDL-c) (p = 0.001) and lower triglycerides (TG) (p = 0.007) were found in AG compared to SG. In the ABI evaluation, AG presented better right (p = 0.012), left (p = 0.015) and end (p = 0.004) ABI rates when compared to SG. AG had better results in functional performance in the SPPB evaluation (p = 0.0007) and in the 6MWT with a greater distance covered (p = 0.0027). In the anthropometric measurements, AG had lower body mass index (BMI) (0.041) and a smaller abdominal circumference (WC) (0.029). In terms of the incidence of referred diseases, intergroup results were only different for hypertension (0.029), while AG had a lower incidence of hypertension. Conclusion: Active older adults had better lipid levels, higher ABI levels, better functional performance, lower body mass, a smaller abdominal circumference, and lower incidence of hypertension, in comparison to sedentary subjects. Level of evidence I; High quality prospective study.

RESUMO Introdução: A prática de atividade física regular previne doenças cardiovasculares (DCV) e aterosclerose, além de melhorar o perfil lipídico e a capacidade funcional em idosos. Objetivo: Avaliar e comparar o perfil lipídico, desempenho funcional e índice tornozelo-braquial (ITB) de idosos sedentários e ativos. Métodos: Trata-se de um estudo comparativo e transversal com 84 idosos (≥ 60 anos) de ambos os sexos, divididos em dois grupos: grupo sedentário (GS, n= 50) e grupo ativo (GA, n= 34) segundo o Questionário Internacional de Atividade Física (IPAQ). Foram realizadas avaliações antropométricas, hemodinâmicas, índice tornozelo-braquial (ITB) e testes de funcionalidade (Short Physical Performance Battery - SPPB e teste de caminhada de 6 minutos - TC6). Além disso, foi utilizado o teste de normalidade Shapiro-Wilk e na comparação entre os grupos utilizou-se o teste t-Student e o teste Mann-Whitney. Já para os dados categóricos, utilizou-se o teste exato de Fisher (p<0,05). Resultados: Foi verificado no GA valores maiores da lipoproteína de alta densidade (high-density lipoprotein cholesterol, HDL-c) (p = 0,001) e menores de triglicerídeo (TG) (p = 0,007) quando comparados ao GS. Na avaliação ITB, observou-se que o GA apresentou melhores índices de ITB direito (p = 0,012), esquerdo (p = 0,015) e final (p = 0,004) quando comparado ao GS. Houve melhores resultados do GA no desempenho funcional na avaliação SPPB (p = 0,0007) e no TC6 com maior distância percorrida (p = 0,0027). Nas medidas antropométricas, o GA apresentou menor índice de massa corporal (IMC) (0,041) e circunferência abdominal (CA) (0,029). Na incidência das doenças referidas, apenas a hipertensão apresentou resultados diferentes entre os grupos (0,029), sendo que o GA teve menor incidência de hipertensão. Conclusão: Os idosos ativos apresentaram melhor perfil lipídico, maiores níveis de ITB, melhor desempenho funcional, além de menor massa corpórea, menor circunferência abdominal e menor incidência de hipertensão em comparação aos sedentários. Nível de evidência I; Estudo prospectivo de alta qualidade.

RESUMEN Introducción: La práctica de actividad física regular previene enfermedades cardiovasculares (ECV) y aterosclerosis, además de mejorar el perfil lipídico y la capacidad funcional en adultos de la tercera edad. Objetivo: Evaluar y comparar el perfil lipídico, desempeño funcional e índice tobillo-braquial (ITB) en adultos de la tercera edad sedentarios y activos. Métodos: Se trata de un estudio comparativo y transversal, con 84 adultos de la tercera edad (≥ 60 años) de ambos sexos, divididos en dos grupos: grupo sedentario (GS, n = 50) y grupo activo (GA, n = 34) según el Cuestionario Internacional de Actividad Física (IPAQ). Fueron realizadas evaluaciones antropométricas, hemodinámicas, índice tobillo-braquial (ITB) y tests de funcionalidad (Short Physical Performance Battery - SPPB y Test de Caminata de 6 minutos - TC6). Además, se utilizó el test de normalidad Shapiro-Wilk y en la comparación entre los grupos se usó el test t-Student y el test Mann-Whitney. Ya para los datos categóricos se usó el test exacto de Fisher (p <0,05). Resultados: Se verificaron en el GA valores mayores de lipoproteína de alta densidad (high-density lipoprotein cholesterol, HDL-c) (p = 0,001) y menores de triglicéridos (TG) (p = 0,007) cuando comparados al GS. En la evaluación ITB, se observó que el GA mostró mejores índices de ITB derecho (p = 0,012), izquierdo (p = 0,015) y final (p = 0,004) cuando comparado al GS. Hubo mejores resultados del GA en el desempeño funcional en la evaluación SPPB (p = 0,0007) y en el TC6 con mayor distancia recorrida (p = 0,0027). En las medidas antropométricas, el GA presentó menor índice de masa corporal (IMC) (0,041) y circunferencia abdominal (CA) (0.029). En la incidencia de las enfermedades referidas, sólo la hipertensión presentó resultados diferentes entre los grupos (0.029), siendo que el GA tuvo menor incidencia de hipertensión. Conclusión: Los adultos de la tercera edad activos presentaron mejor perfil lipídico, mayores niveles de ITB, mejor desempeño funcional, además de menor masa corpórea, menor circunferencia abdominal y menor incidencia de hipertensión en comparación a los sedentarios. Nivel de evidencia I; Estudio prospectivo de alta calidad.

Impact of water therapy on pain management in patients with fibromyalgia: current perspectives.

Exercise-related interventions have been recommended as one of the main components in the management of fibromyalgia syndrome (FMS). Water therapy, which combines water's physical properties and exercise benefits, has proven effective in improving the clinical symptoms of FMS, especially pain, considered the hallmark of this syndrome. However, to our knowledge, the mechanisms underlying water therapy effects on pain are still scarcely explored in the literature. Therefore, this narrative review aimed to present the current perspectives on water therapy and the physiological basis for the mechanisms supporting its use for pain management in patients with FMS. Furthermore, the effects of water therapy on the musculoskeletal, neuromuscular, cardiovascular, respiratory, and neuroendocrine systems and inflammation are also addressed. Taking into account the aspects reviewed herein, water therapy is recommended as a nonpharmacologic therapeutic approach in the management of FMS patients, improving pain, fatigue, and quality of life. Future studies should focus on clarifying whether mechanisms and long-lasting effects are superior to other types of nonpharmacological interventions, as well as the economic and societal impacts that this intervention may present.

Fisioterapia aquática no aumento da força muscular em idosas com doenças crônicas não transmissíveis: estudo piloto / Aquatic physical therapy in increasing muscle strength in elderly women with noncommunicable diseases: a pilot study

Introdução: A força muscular é um importante componente da aptidão física relacionada à saúde e o seu declínio leva ao aumento do risco de quedas e limitações nas atividades cotidianas, além de influenciar negativamente na percepção da qualidade de vida em idosas com Doenças Crônicas Não Transmissíveis (DCNT). Objetivo: Investigar a influência do programa de treinamento aquático na força muscular e qualidade de vida em idosas com DCNT. Métodos: Trata-se de um estudo piloto. Participaram 24 idosas, aleatorizadas e alocadas em dois grupos: GA - Intervenção Aquática (n = 12) e GC - Controle (n = 12). A força muscular foi avaliada por meio do teste de 1RM e a avaliação da qualidade de vida foi realizada pelo questionário WHOQOL-bref. O programa de fisioterapia aquática teve duração de 12 semanas e foi constituído de três componentes: aquecimento; exercícios resistidos e desaquecimento. Resultados: Somente o GA apresentou aumento significativo da força muscular avaliada pelos testes de 1 RM no exercício de supino reto (55,5%) e leg press 45º (58,3%) e no domínio físico de qualidade de vida (9,1%). Conclusão: O programa de fisioterapia aquática, composto de exercícios resistidos, contribui para o aumento da força muscular e melhora da qualidade de vida em idosas com DCNT. (AU)

Introduction: Muscular strength is an important component of physical fitness related to health and its decline leads to an increased risk of falls and limitations in daily activities, as well as negatively influencing the perception of quality of life in older women with Chronic Noncommunicable Diseases (CNCD). Objective: The aim of this study was to investigate the influence of the aquatic training program on muscle strength and quality of life in older women with CNCD. Methods: This is a pilot study. 24 elderly women were randomized and allocated to two groups: AG - Aquatic Intervention (n = 12) and CG - Control (n = 12). Muscle strength was assessed through the 1RM test and for the quality of life assessment we used the WHOQOL-bref questionnaire. The aquatic physical therapy program lasted 12 weeks and consisted of three components: warm-up; resisted exercises and cool down. Results: Only AG showed a significant increase in muscle strength assessed by 1 RM tests in the bench press exercise (55.5%) and leg press 45o (58.3%) and in the physical quality of life domain (9.1%). Conclusion: We concluded that the aquatic physical therapy program, composed of resistance exercises, contributes to increase muscular strength and improves the quality of life in older women with CNCD. (AU)

Deep Water Running na redução da gordura corporal e aumento da força muscular em mulheres obesas: estudo piloto / Deep water running on body fat reduction and increased muscle strength in obese women: pilot study

Introdução: DWR-IT é um método de treinamento que visa melhorar a capacidade funcional, aptidão física e qualidade de vida, além de contribuir para controle da obesidade. Objetivo: investigar a influência do DWR-IT na composição corporal, circunferência abdominal, qualidade de vida, capacidade funcional, força e resistência muscular em mulheres obesas de meia idade. Método: trata-se de um estudo piloto de ensaio clínico não controlado, do tipo antes e depois. Foi avaliada a circunferência abdominal, a composição corporal e aplicados 6MWT, CST, ACT e IWQOL-LITE pré e pós-intervenção em sete mulheres obesas de meia idade. O período da intervenção foi de 10 semanas com frequência de três dias por semanas. Resultados e Discussão: houve redução da circunferência abdominal (de 94,71 ± 8,32 cm para 88,43 ± 6,29cm) e da massa gorda (29,50 ± 4,35 kg para 26,47 ± 4,85 kg),aumento da força e resistência muscular dos membros superiores (de 12,86 ±3,44 para 22,71 ±5,71 repetições) e inferiores (de10, 43 ± 2,30 para 14,14±2,67 repetições) e melhora nos domíniosfunção física (de 38,0; 37,0 - 45,0 para 47,00; 46,0 -49,50) e autoestima (de 27,00; 26,50-27,50 para 30,00; 28,0-33,00) do questionário IWQOL-LITE. Conclusão: 10 semanas de DWR-IT foramefetivas em promover melhora da composição corporal, da força eresistência muscular, da função física, da autoestima e melhoras em relação ao sobrepeso e obesidade.

Introduction: DWR-IT is a training method that aims to improve functional capacity, physical fitness and quality of life, in addition to contribute to the control of obesity. Objective: the objective was to investigate the influence of DWR-IT on body composition, abdominal circumference, quality of life, functional capacity, strength and muscular endurance in obese middle-aged women. Methods: this is a pilot study of an uncontrolled clinical trial, before and after. Abdominal circumference, body composition, and the application of 6MWT, CST, ACT and IWQOL-LITE were evaluated before and after intervention in seven obese middle-aged women. The intervention period lasted 10 weeks with a frequency of three days per week. Results and Discussion: there was a reduction in abdominal circumference (94.71 ± 8.32 cm for 88.43 ± 6.29 cm) and fat mass (29.50 ± 4.35 kg for 26.47 ± 4.85 kg), increase of muscle strength and endurance of the upper limbs (from 12.86 ± 3.44 to 22.71 ± 5.71 repetitions) and lower limbs (from 10.43 ± 2.30 to 14.14 ± 2.67 repetitions) and improvement in the physical function domains (from 38.0; 37.0 - 45.0 to 47.00; 46.0 - 49.50) and self-esteem (from 27.00 to 26.50-27.50 for 30.00; 28.0-33.00) in the IWQOL-LITE questionnaire. Conclusion: ten weeks of DWR-IT were effective to promote the improvement of body composition, strength and muscular endurance, physical function and self-esteem, and the improvement in overweight and obesity.

Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: A single-arm study.

BACKGROUND: Although hydrotherapy is widely used to treat women with fibromyalgia, no studies have investigated the effects of this intervention on scapular kinematics in this population. This study verified the effectiveness of a hydrotherapy program on scapular kinematics, pain and quality of life in women with fibromyalgia. METHODS: Twenty women completed the study and performed three evaluations before treatment (to establish a baseline), and two other evaluations (after 8 and 16weeks of hydrotherapy) at the end of treatment. Three-dimensional kinematics of the scapula was evaluated during arm elevation in two different planes with the Flock of Birds® system. Patients also answered quality of life and Fibromyalgia Impact Questionnaires and had pain assessed with a digital algometer. Treatment consisted of 2 weekly hydrotherapy sessions, lasting 45min each, for 16weeks. Data were analyzed with a two-way ANOVA (for kinematics results) and one-way ANOVA (for the other variables). Effect size was assessed with Cohen's d coefficient for all quantitative variables. RESULTS: Although an important improvement was achieved in terms of pain and quality of life (P<0.05, effect sizes varied from -1.93 to 1.61 depending on the variable), scapular kinematics did not change after treatment (P>0.05, effect sizes from -0.40 to 0.46 for all kinematic variables). INTERPRETATION: The proposed program of hydrotherapy was effective to improve quality of life, pain intensity and fibromyalgia impact in women with fibromyalgia. However, scapular kinematics did not change after the period of treatment. Although symptoms improved after the treatment, the lack of changes in scapular kinematics may indicate these women have an adaptive movement pattern due to their chronic painful condition.

The Borg CR-10 scale is suitable to quantify aerobic exercise intensity in women with fibromyalgia syndrome / A escala CR-10 de Borg é viável para quantificar a intensidade do exercício aeróbio em mulheres com síndrome fibromiálgica / La escala Borg CR-10 es adecuada para cuantificar la intensidad del ejercicio aeróbico en mujeres con síndrome de fibromialgia

ABSTRACT Patients with Fibromyalgia syndrome (FMS) report higher ratings of perceived exertion (RPE) compared to healthy individuals for the same exercise intensity; however, to our knowledge, no studies have evaluated RPE at the ventilatory anaerobic threshold (VAT) for this population. This study aimed to assess RPE using the Borg CR-10 scale during a cardiopulmonary exercise test (CPET) in women with FMS. Twenty-four women with FMS and twenty healthy control subjects (HC) voluntarily participated in this study. Near the end of every 1-minute period during CPET, subjects were asked to report their RPE for fatigue in the lower limbs (RPE-L) and dyspnea (RPE-D), respectively, according to the Borg CR-10 scale. FMS subjects showed higher RPE-L and RPE-D compared to HC subjects at free wheel and at the first load increment. However, no significant difference was observed between groups for power output. There was no significant difference between groups for RPE-L and RPE-D reported at VAT and peak CPET. However, FMS subjects showed lower power output compared to HC subjects. The present results showed that FMS subjects present higher RPE compared to HC subjects. However, RPE reported at VAT and at peak CPET was not different between groups. The Borg CR-10 scale scores obtained at VAT can be used as an additional parameter for prescribing exercise intensity in aerobic training protocols for women with FMS.

RESUMO Pacientes com síndrome fibromiálgica (SFM) relatam elevados níveis de percepção subjetiva de esforço (PSE) em comparação com indivíduos saudáveis para a mesma intensidade de exercício; no entanto, a nosso conhecimento, nenhum estudo avaliou a PSE no limiar de anaerobiose ventilatório (LAV) para essa população. Este estudo buscou avaliar PSE usando a escala CR-10 de Borg durante um teste de exercício cardiopulmonar (TECP) em mulheres com SFM. Vinte e quatro mulheres com SFM e vinte indivíduos saudáveis (GS) participaram deste estudo voluntariamente. Perto do final de cada período de 1 minuto durante CPET, os indivíduos foram convidados a relatar sua PSE para fadiga nos membros inferiores (PSE-MMII) e dispneia (PSE-D), respectivamente, de acordo com a escala CR-10 de Borg. Os indivíduos com SFM mostraram maior PSE-MMII e PSE-D, em comparação com indivíduos GS tanto na carga livre como no primeiro incremento de carga. No entanto, não houve diferença significativa entre os grupos para a potência e nem para PSE-MMII e PSE-D relatado no LAV e no pico TECP. No entanto, indivíduos com SFM mostraram baixa potência em comparação com indivíduos GS. Esses resultados mostraram que indivíduos com SFM apresentam a PSE mais elevada em comparação com indivíduos GS. No entanto, a PSE relatada no LAV e no pico TECP não foi diferente entre os grupos. As pontuações de escala CR-10 de Borg obtidas no LAV podem ser usadas como um parâmetro adicional para a prescrição da intensidade de exercício nos protocolos de treinamento aeróbio para mulheres com SFM.

RESUMEN Los pacientes con síndrome de fibromialgia (FMS) reportan índices más altos de esfuerzo percibido (RPE) en comparación con individuos sanos para la misma intensidad de ejercicio; sin embargo, a nuestro conocimiento, ningún estudio ha evaluado el RPE en el umbral ventilatorio anaeróbico (VAT) para estas personas. Este estudio tuvo como objetivo evaluar el RPE utilizando la escala Borg CR-10 durante un test de ejercicio cardiopulmonar (CPET) en mujeres con FMS. Veinticuatro mujeres con FMS y veinte individuos de control sanos (HC) participaron voluntariamente en este estudio. Cerca del final de cada período de 1 minuto durante el CPET, se pidió a los individuos que informaran su RPE para la fatiga en los miembros inferiores (RPE-L) y disnea (RPE-D), respectivamente, según la escala Borg CR-10. Los individuos con FMS mostraron mayores RPE-L y RPE-D comparados con los individuos HC en la rueda libre y en el primer incremento de carga. Sin embargo, no se observó diferencia significativa de potencia de salida entre los grupos. No hubo diferencias significativas entre los grupos en los RPE-L y RPE-D reportados en el VAT y en el máximo CPET. No obstante, los individuos FMS mostraron una menor potencia en comparación con los individuos HC. Los resultados actuales mostraron que los individuos con FMS presentan RPE más alto en comparación con los individuos HC. De todos modos, el RPE reportado en el VAT y en el CPET máximo no fue diferente entre los grupos. Las puntuaciones de la escala Borg CR-10 obtenidas en el VAT se pueden utilizarse como un parámetro adicional para prescribir la intensidad del ejercicio en protocolos de entrenamiento aeróbico para mujeres con FMS.

The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients.

Fibromyalgia syndrome (FMS) is a rheumatologic disorder characterized by chronic widespread pain, fatigue and other symptoms. Baroreflex dysfunction has been observed in women with FMS. However, it is unknown whether the limited involvement of the baroreflex control during an orthostatic stimulus has some impact on the quality of life of the FMS patient. Therefore, the aim of the study is evaluate the relationship between the quality of life of the FMS patient and indexes of the cardiovascular autonomic control as estimated from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP). We enrolled 35 women with FMS (age: 48.8±8.9 years; body mass index: 29.3±4.3 Kg/m2). The electrocardiogram, non-invasive finger blood pressure and respiratory activity were continuously recorded during 15 minutes at rest in supine position (REST) and in orthostatic position during active standing (STAND). Traditional cardiovascular autonomic control markers were assessed along with a Granger causality index assessing the strength of the causal relation from SAP to HP (CRSAP→HP) and measuring the degree of involvement of the cardiac baroreflex. The impact of FMS on quality of life was quantified by the fibromyalgia impact questionnaire (FIQ) and visual analog score for pain (VAS pain). No significant linear association was found between FIQ scores and the traditional cardiovascular indexes both at REST and during STAND (p>0.05). However, a negative relationship between CRSAP→HP during STAND and FIQ score was found (r = -0.56, p<0.01). Similar results were found with VAS pain. In conclusion, the lower the degree of cardiac baroreflex involvement during STAND in women with FMS, the higher the impact of FMS on the quality of life, thus suggesting that Granger causality analysis might be clinically helpful in assessing the state of the FMS patient.