Measuring fatigue with multiple instruments in a Brazilian cohort of early rheumatoid arthritis patients / Mensuração da fadiga com múltiplos instrumentos em uma coorte brasileira de pacientes com artrite reumatoide em fase inicial

Abstract Objective: To assess the prevalence of fatigue in a Brazilian population with early rheumatoid arthritis using multiple instruments, and the predictors of these instruments by differents independent variables. Methods: Cross-sectional study with direct interview and medical records review. Fatigue, dependent variable, was assessed using eight instruments: Profile of Mood States (POMS), Multidimensional Assessment of Fatigue scale (MAF), Fatigue Severity Scale (FSS), Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), Numerical Rating Scales (BRAF-NRS), Short-form Survey 36 (SF-36), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) and Visual Analogic Scale for Fatigue (VASf). Independent variables: sociodemographic, clinical and serological, were measured using medical records and direct interview. Disability and disease activity were assessed using the Health Assessment Questionnaire (HAQ) and disease activity assessed using the Disease Activity Score 28 joints (DAS28). The scores of scales demonstrated the level of fatigue and multiple linear regression method used in statistical analysis to demonstrate prediction models. Results: A total of 80 patients was assessed, and 57 reported clinically relevant fatigue (VASf > 2), representing 71.25% prevalence point (51 women [89.5%], mean age 48.35 ± 15 years, and mean disease duration of 4.92 ± 3.8 years). Eight predictive models showed statistical significance, one for each fatigue instrument. The highest coefficient of determination (R 2) was 56% for SF-36 and the lowest (R 2 = 21%) for FSS. The HAQ was the only independent variable to predict fatigue on all instruments. Conclusion: Clinically relevant fatigue is a highly prevalent symptom and is mostly predicted by disability and age in the population assessed.

Resumo Objetivo: Avaliar a prevalência de fadiga em uma coorte brasileira de pacientes com artrite reumatoide em fase inicial com múltiplos instrumentos e os preditores desses instrumentos de acordo com diferentes variáveis independentes. Métodos: Estudo transversal com entrevista direta e revisão de prontuários. A fadiga, a variável dependente, foi avaliada por meio de oito instrumentos: Profile of Mood States (POMS), Multidimensional Assessment of Fatigue Scale (MAF), Fatigue Severity Scale (FSS), Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), Numerical Rating Scales (BRAF-NRS), Short-form Survey 36 (SF-36), Functional Assessment of Chronic Illness Therapy Fatigue Scale (Facit-F) e Escala Visual Analógica de fadiga (VASf). Variáveis independentes: mensuraram-se dados sociodemográficos, clínicos e sorológicos por meio da análise de prontuários e entrevista direta. A incapacidade e a atividade da doença foram avaliadas com o Health Assessment Questionnaire (HAQ). A atividade da doença foi avaliada com o Disease Activity Score 28 joints (DAS-28). As pontuações das escalas mostraram o nível de fadiga e usou-se o método de regressão linear múltipla na análise estatística para demonstrar os modelos de predição. Resultados: Avaliaram-se 80 pacientes; 57 relataram fadiga clinicamente relevante (VASf > 2), representaram uma prevalência de 71,25% (51 mulheres [89,5%], média de 48,35 ± 15 anos e duração média da doença de 4,92 ± 3,8 anos). Oito modelos preditivos mostraram significância estatística, um para cada instrumento de fadiga. O maior coeficiente de determinação (R2) foi de 56% para o SF-36 e o menor (R2 = 21%) foi para a FSS. O HAQ foi a única variável independente que predisse a fadiga em todos os instrumentos. Conclusão: A fadiga clinicamente relevante é um sintoma altamente prevalente e é principalmente predita pela incapacidade e idade na população avaliada.

Relação entre obesidade com a pressão arterial e força muscular de idosas obesas hipertensas / Relationship between obesity, blood pressure and muscle strength among obese elderly women

A hipertensão é uma doença complexa e multifatorial no qual fatores de risco como obesidade estão envolvidos. Cerca de 48% da população brasileira feminina já apresenta sobrepeso, sendo que a prevalência de excesso de peso acomete 58% da população com idade maior ou igual a 65 anos de idade. Deve-se considerar que a obesidade é um fator de risco para hipertensão nessa população. Em mulheres de meia idade já se verifica também a sua influência negativa sobre a força muscular, sugerindo reprodutibilidade dos resultados nessa população. O objetivo desse estudo é determinar se existe uma relação negativa do IMC sobre a força muscular e pressão arterial de idosas hipertensas e comparar a força muscular de idosas hipertensas com e sem obesidade. Quarenta e oito idosas sedentárias e hipertensas participaram voluntariamente do estudo e foram divididas em dois grupos: grupo com IMC < 30,0 (kg/m²) e com IMC ≥ 30,0 (kg/m²). Os resultados do estudo demonstraram que o grupo de idosas obesas apresentou significativamente maior pressão arterial sistólica (p ≤ 0,05), pressão arterial diastólica (p ≤ 0,05), medidas antropométricas superiores (p ≤ 0,05) e menor força muscular (p ≤ 0,05) quando comparado com idosas com IMC < 30,0 (kg/m²). Ademais, o IMC correlacionou-se negativamente com a força muscular e positivamente com a pressão arterial na população estudada. O presente estudo apresenta indícios de que o IMC influencia negativamente a força muscular e pressão arterial de mulheres idosas obesas. Além disso, sugere o ponto de corte de IMC >30 kg/m² como critério prático para avaliar seu efeito negativo sobre a força muscular e pressão arterial de idosas hipertensas. (AU)

Hypertension is a complex and multifactorial disease and obesity is one of the most important associated risk factors. Considering that 48% of the female Brazilian population presents overweight, the prevalence is higher in elderly people (65 years). Considering that obesity is an independent risk factor for this age group, there are indications from previous study that obesity affects muscle strength in middle-aged women, but no study was found for elderly women. The aim of this study is to determine whether there is a negative relationship between BMI and muscle strength and blood pressure and to compare muscle strength between obese and non-obese elderly hypertensive women. Forty-eight elderly hypertensive women volunteered and were divided into two groups: participants with BMI < 30.0 (kg / m²) and BMI ≥ 30.0 (kg / m²). In addition, elderly obese women presented a higher systolic blood pressure (p ≤ 0.05), higher diastolic blood pressure (p ≤ 0.05), lower muscle strength (p ≤ 0.05), and higher anthropometric values (p ≤ 0.05) than participants with BMI < 30.0 (kg / m²). Moreover, BMI predicted negative changes in muscle strength and SBP. These results suggest that BMI predict negative changes on muscle strength and blood pressure in elderly obese hypertensive women. Moreover, suggests that the BMI of >30 kg/m² score might be a practical tool to evaluate the negative effect of obesity on blood pressure and muscle strength. (AU)

Measuring fatigue with multiple instruments in a Brazilian cohort of early rheumatoid arthritis patients.

OBJECTIVE: To assess the prevalence of fatigue in a Brazilian population with early rheumatoid arthritis using multiple instruments, and the predictors of these instruments by differents independent variables. METHODS: Cross-sectional study with direct interview and medical records review. Fatigue, dependent variable, was assessed using eight instruments: Profile of Mood States (POMS), Multidimensional Assessment of Fatigue scale (MAF), Fatigue Severity Scale (FSS), Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), Numerical Rating Scales (BRAF-NRS), Short-form Survey 36 (SF-36), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) and Visual Analogic Scale for Fatigue (VASf). INDEPENDENT VARIABLES: sociodemographic, clinical and serological, were measured using medical records and direct interview. Disability and disease activity were assessed using the Health Assessment Questionnaire (HAQ) and disease activity assessed using the Disease Activity Score 28 joints (DAS28). The scores of scales demonstrated the level of fatigue and multiple linear regression method used in statistical analysis to demonstrate prediction models. RESULTS: A total of 80 patients was assessed, and 57 reported clinically relevant fatigue (VASf>2), representing 71.25% prevalence point (51 women [89.5%], mean age 48.35±15 years, and mean disease duration of 4.92±3.8 years). Eight predictive models showed statistical significance, one for each fatigue instrument. The highest coefficient of determination (R2) was 56% for SF-36 and the lowest (R2=21%) for FSS. The HAQ was the only independent variable to predict fatigue on all instruments. CONCLUSION: Clinically relevant fatigue is a highly prevalent symptom and is mostly predicted by disability and age in the population assessed.

Avaliação da capacidade funcional em pacientes com artrite reumatoide: implicações para a recomendação de exercícios físicos / Assessment of functional capacity in patients with rheumatoid arthritis: implications for recommending exercise

A artrite reumatoide (AR) é uma doença autoimune que se caracteriza por poliartrite crônica simétrica, de grandes e pequenas articulações, e rigidez matinal que pode levar a comprometimento musculoesquelético, com impotência funcional. O conceito da funcionalidade diz respeito à capacidade de o indivíduo realizar atividades e tarefas da vida diária e cotidiana, de forma eficaz e independente. O objetivo desta revisão é familiarizar o reumatologista com o conceito de avaliação da capacidade funcional e os testes que podem ser aplicados nessa população, pois são passos importantes para uma prescrição adequada de exercícios físicos, A partir de testes funcionais já utilizados em população idosa, o Laboratório de Aptidão Física e Reumatologia - LAR - Brasília, que acompanha os pacientes da Coorte Brasília de Artrite Reumatoide Inicial, descreve neste artigo um protocolo de testes para avaliação da capacidade funcional para aplicação nos pacientes com diagnóstico de AR, incluindo a descrição dos seguintes testes: 1) Sentar e Alcançar; 2) Agilidade/Equilíbrio Dinâmico; 3) Dinamometria Manual; 4) Sentar e Levantar; 5) Rosca Bíceps e 6) Teste da Caminhada de Seis Minutos.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic symmetric polyarthritis of large and small joints and by morning stiffness that may lead to musculoskeletal impairment, with functional impotence. The concept of functionality relates to the ability of an individual to perform effectively and independently daily activities and tasks of everyday life. The aim of this review is to familiarize the rheumatologist with the concept of functional capacity evaluation and with the tests that can be applied in this population, as these are important steps for a proper exercise prescription. From functional tests already used in the elderly population, the Physical Fitness and Rheumatology Laboratory - LAR - Brasilia, which is accompanying patients from Brasilia Cohort of Early Rheumatoid Arthritis, describes in this article a protocol of tests to assess functional capacity for application in patients with RA, including the description of tests: 1) Sit and Reach; 2) Agility/Dynamic Balance; 3) Manual Dynamometry; 4) Sit Back and Lift; 5) Biceps Curl and 6) Six-minute Walk Test.

Exercise and fatigue in rheumatoid arthritis.

Fatigue, the enduring sensation of weakness, lack of energy, tiredness or exhaustion, is described by 40%-80% of patients with rheumatoid arthritis as their most disabling symptom with wide-ranging consequences for quality of life. Little attention has been paid to its multidimensional nature or to its reliability as a measure to evaluate progression of the disease. Low impact aerobic exercise affects the level of fatigue, and this same level of fatigue influences the exercise itself. We searched Medline, Cochrane Collaboration Register of Controlled Trials (CCRCT), Lilacs, PubMed and Scopus databases for randomized controlled trials (with appropriate description of methods, materials and results) on the assessment of fatigue and exercise. Review articles, case reports, letters to the editor and editorials were excluded. Of 121 references initially identified, 4 randomized controlled trials met the inclusion criteria. Two studies used the MAF scale (Multidimensional Assessment of Fatigue), one used the MAC (Mental Adjustment to Cancer) fatigue scale, and all trials used POMS (Profile of Mood States) to assess fatigue. All four trials conducted a 12 week program of two to three times/ week and different periods of follow-up. Two studies used low impact aerobic exercise, one used dance-based exercise, and another study followed a home cardiopulmonary conditioning program using a stationary bicycle. While fatigue appears to be a reliable outcome measure in the clinical management of RA, especially when related to exercise prescription, further research is needed to evaluate the correlation between exercise, fatigue and quality of life, using fatigue scales validated to explore the different components of fatigue and its wide-ranging consequences.

Sustained effect of resistance training on blood pressure and hand grip strength following a detraining period in elderly hypertensive women: a pilot study.

INTRODUCTION: Hypertension is the most prevalent modifiable risk factor with a high prevalence among older adults. Exercise is a nonpharmacological treatment shown to benefit all patients with hypertension. OBJECTIVE: This study examined the effects of a 14-week moderate intensity resistance training program (RT) on the maintenance of blood pressure and hand grip strength during an extended detraining period in elderly hypertensive women. METHODS: Twelve hypertensive sedentary elderly women completed 14 weeks of whole body RT at a moderate perceived exertion following a detraining period of 14 weeks. RESULTS: Following the training period, participants demonstrated an increase in absolute hand grip strength (P=0.001), relative hand grip strength (P=0.032) and a decrease of systolic (P=0.001), diastolic (P=0.008), and mean blood pressure (P=0.002) when compared to pre-exercise values. In addition, these effects were sustained after 14 weeks of detraining. CONCLUSION: Resistance training may be a valuable method to improve muscular strength and blood pressure in elderly people with benefits being maintained up to 14 weeks following training cessation.

[Assessment of functional capacity in patients with rheumatoid arthritis: implications for recommending exercise]. / Avaliação da capacidade funcional em pacientes com artrite reumatoide: implicações para a recomendação de exercícios físicos.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic symmetric polyarthritis of large and small joints and by morning stiffness that may lead to musculoskeletal impairment, with functional impotence. The concept of functionality relates to the ability of an individual to perform effectively and independently daily activities and tasks of everyday life. The aim of this review is to familiarize the rheumatologist with the concept of functional capacity evaluation and with the tests that can be applied in this population, as these are important steps for a proper exercise prescription. From functional tests already used in the elderly population, the Physical Fitness and Rheumatology Laboratory - LAR - Brasilia, which is accompanying patients from Brasilia Cohort of Early Rheumatoid Arthritis, describes in this article a protocol of tests to assess functional capacity for application in patients with RA, including the description of tests: 1) Sit and Reach; 2) Agility/Dynamic Balance; 3) Manual Dynamometry; 4) Sit Back and Lift; 5) Biceps Curl and 6) Six-minute Walk Test.

Comparação da força muscular entre mulheres de meia idade com e sem sobrepeso/obesidade / Comparison of muscle strenght between middle-aged women with and without overweight/obesity

A obesidade é atualmente um dos maiores problemas de saúde pública em países desenvolvidos e em desenvolvimento. Apesar de a redução da força muscular estar fortemente associada à doenças cardiovasculares, poucos estudos analisaram a força muscular relativa em mulheres com e sem sobrepeso e obesidade. O presente estudo teve como objetivo comparar a força muscular absoluta e relativa de mulheres de meia idade com e sem sobrepeso e obesidade, além de correlacionar a força muscular relativa com o índice de massa corporal (IMC), com a circunferência da cintura (CC) e com a razão cintura-estatura (RCE). A hipótese inicial era de que mulheres com sobrepeso e obesidade apresentariam menores valores de força muscular relativa. Foram avaliadas 20 mulheres obesas (36,7 ± 7,9 anos; 33,4 ± 2,4 kg/m2), 46 sobrepesadas (34,8 ± 7,8 anos; 27,7 ± 1,2 kg/m2) e 53 eutróficas (33,2 ± 9,3anos; 22,3 ± 1,7 kg/m2). A classificação de sobrepeso (IMC > 25 < 29,9 kg/m2) e obesidade (IMC > 30 kg/m2) foi definida de acordo com a Organização Mundial de Saúde. A força muscular relativa [força absoluta (kg)/massa corporal (kg)] foi mensurada por meio do teste de preensão manual. A força muscular relativa foi respectivamente menor nas mulheres com obesidade e sobrepeso quando comparado as mulheres eutróficas (0,35 ± 0,05 vs 0,42 ± 0,06 vs 0,48 ± 0,08; P=0,001). Houve uma relação negativa do IMC (r=-0,60; P=0,001), CC (r=-0,45; P=0,001) e RCE (r=-0,41; P=0,001) com a forca muscular relativa. A redução da força muscular relativa é um aspecto característico de mulheres com sobrepeso e obesidade.

Obesity is currently one of the major public health problems in developed and developing countries. Although the decrease in muscle strength is highly associated with cardiovascular diseases, few studies analyzed the relative muscle strength in women with and without overweight and obesity. The present study aimed to compare absolute and relative muscle strength of middle-aged women with and without overweight and obesity, as well as, to correlate relative muscle strength with body mass index (BMI), waits circumference (WC) and waist-to-height ratio (WHR). The initial hypothesis was that overweight and obese women would present lower values of relative muscle strength. Twenty obese (36.7 ± 7.9 years; 33.4 ± 2.4 kg/m2), 46 overweight (34.8 ± 7.8 years; 27.7 ± 1.2 kg/m2) and 53 eutrophic women (33.2 ± 9.3 years; 22.3 ± 1.7 kg/m2) were evaluated. The cut-off point for overweight (IMC > 25 < 29.9 kg/m2) and obesity (IMC > 30 kg/m2) was defined according to the World Health Organization. Relative muscle strength [absolute strength (kg)/body mass (kg)] was measured by the handgrip test. Relative muscle strength was lower for women with obesity and overweight as compared with eutrophic women (0.35 ± 0.05 vs 0.42 ± 0.06 vs 0.48 ± 0.08; P=0.001), respectively. There was a negative correlation of BMI (r=-0.60; P=0.001), WC (r=-0.45; P=0.001) and RCE (r=-0.41; P=0.001) with relative muscle strength. The reduction of relative muscle strength is a characteristic aspect of women with overweight and obesity.

Resistance exercise leading to failure versus not to failure: effects on cardiovascular control.

BACKGROUND: The aim of the present study was to evaluate the acute effects of resistance exercise (RE) leading to failure and RE that was not to failure on 24 h blood pressure (BP) and heart rate variability (HRV) in sedentary normotensive adult women. METHODS: Ten women (33.2 ± 5.8 years; 159.3 ± 9.4 cm; 58.0 ±6.4 kg; body fat 28.4 ± 2.8%) randomly underwent three experimental sessions: control (40 minutes of seated rest), RE leading to failure with 3 sets of 10 repetitions maximum (10-RM), and RE not to failure at 60% of 10-RM with 3 sets of 10 repetitions. Immediately post session BP and HRV were measured for 24 h. RESULTS: Ratings of perceived exertion and heart rate were higher during the 10-RM session when compared with 60% of 10-RM (6.4 ± 0.5 vs 3.5 ± 0.8 and 123.7 ± 13.9 vs 104.5 ± 7.3 bpm, respectively). The systolic, diastolic and mean BP decreased at 07:00 a.m. after the 10-RM session when compared with the control session (-9.0 ± 7.8 mmHg, -16.0 ± 12.9 mmHg and -14.3 ± 11.2 mmHg, respectively). The root mean square of the squared differences between R-R intervals decreased after both the 60% of 10-RM and 10-RM sessions compared with the control session. CONCLUSIONS: An acute RE session leading to failure induced a higher drop of BP upon awakening, while both RE sessions reduced cardiac parasympathetic modulation. RE may be an interesting training strategy to acutely decrease BP in adult women.

Exercise order influences number of repetitions and lactate levels but not perceived exertion during resistance exercise in adolescents.

The purpose of this study was to analyze the effects of resistance training (RT) order on number of repetitions, total training volume, ratings of perceived exertion (RPE), and the lactate response in male adolescents. Twelve adolescents (age: 15.7 ± 1.4 yrs) completed two RT sessions in a counterbalanced crossover design: one with exercises for smaller muscle groups followed by larger muscle groups (SM-LM), whereas the other session was performed in the opposite sequence (LM-SM). The exercise order for SM-LM was standing triceps extension (TE), dumbbell biceps curl (BC), bench press (BP), and seated row machine (RM), while the order for LM-SM was the opposite. Subjects performed three sets of a predetermined 10 repetition maximum for each exercise. Total repetitions completed for each exercise and RPE were assessed after each set, and blood lactate (BL) was measured before RT, 1 m after the first exercise, 1 m after the third exercise, and 10 m after each RT session. Blood lactate (BL) was higher for the LM-SG compared with SM-LM 10 m after exercise (7.4 ± 1.8 versus 6.5 ± 2.1 mmol/L; p < 0.05). More repetitions were completed on the TE and BC in the SM-LM compared with LM-SG (24.9 ± 3.4 and 16.2 ± 3.2 versus 16.3 ± 4.2 and 14.6 ± 3.0, respectively; p < 0.02), while more repetitions were completed on the BP and RM following the LM-SM (14.3 ± 2.3 and 23.4 ± 4.5 versus 12.4 ± 4.2 and 13.6 ± 5.1, respectively; p < 0.02). No differences were found for RPE. It may be appropriate to perform multijoint exercises first to improve general coordination and force, while the use of smaller muscle groups first may be interesting to target specific muscle weaknesses.

Low dynamic muscle strength and its associations with fatigue, functional performance, and quality of life in premenopausal patients with systemic lupus erythematosus and low disease activity: a case-control study.

BACKGROUND: The purpose of the present study was to compare dynamic muscle strength, functional performance, fatigue, and quality of life in premenopausal systemic lupus erythematosus (SLE) patients with low disease activity versus matched-healthy controls and to determine the association of dynamic muscle strength with fatigue, functional performance, and quality of life in SLE patients. METHODS: We evaluated premenopausal (18-45 years) SLE patients with low disease activity (Systemic lupus erythematosus disease activity index [SLEDAI]: mean 1.5 ± 1.2). The control (n = 25) and patient (n = 25) groups were matched by age, physical characteristics, and the level of physical activities in daily life (International Physical Activity Questionnaire IPAQ). Both groups had not participated in regular exercise programs for at least six months prior to the study. Dynamic muscle strength was assessed by one-repetition maximum (1-RM) tests. Functional performance was assessed by the Timed Up and Go (TUG), in 30-s test a chair stand and arm curl using a 2-kg dumbbell and balance test, handgrip strength and a sit-and-reach flexibility test. Quality of life (SF-36) and fatigue were also measured. RESULTS: The SLE patients showed significantly lower dynamic muscle strength in all exercises (leg press 25.63%, leg extension 11.19%, leg curl 15.71%, chest press 18.33%, lat pulldown 13.56%, 1-RM total load 18.12%, P < 0.001-0.02) compared to the controls. The SLE patients also had lower functional performance, greater fatigue and poorer quality of life. In addition, fatigue, SF-36 and functional performance accounted for 52% of the variance in dynamic muscle strength in the SLE patients. CONCLUSIONS: Premenopausal SLE patients with low disease activity showed lower dynamic muscle strength, along with increased fatigue, reduced functional performance, and poorer quality of life when compared to matched controls.

Resistance training versus weight-bearing aquatic exercise: a cross-sectional analysis of bone mineral density in postmenopausal women.

INTRODUCTION: Many studies have shown that resistance training has a positive effect on bone mineral density (BMD). However, few studies have compared the BMD of individuals undergoing resistance training and those training aquatic weight-bearing exercises. OBJECTIVE: To compare, in a cross-sectional study, the BMD of postmenopausal women undergoing resistance training and postmenopausal women training aquatic weight-bearing exercises. METHODS: The sample comprised 63 women divided into the following three groups: resistance training (STRENGTH: n = 15; 51.4 ± 2.7 years); aquatic weight-bearing exercises (WA-TER: n = 22; 54.5 ± 3.3 years); and non-trained controls ( CONTROL: n = 26; 52.0 ± 3.3 years). All volunteers were on hormone replacement therapy for at least one year. The STRENGTH and WATER groups were training for at least one year prior to study beginning (mean years of training - STRENGTH: 4.5 ± 2.0; WATER: 4.2 ± 2.2). RESULTS: The STRENGTH group had higher BMD of total body, femoral neck, lumbar spine L2-L4 as compared with the CONTROL group (all P < 0.05). The WATER group had higher BMD of total body, total hip, lumbar spine L2-L4 as compared with the CONTROL group (all P < 0.05). However, no difference was observed between the STRENGTH and WATER groups regarding the sites assessed. CONCLUSIONS: Those findings suggest that not only the resistance training, but also aquatic weight-bearing exercises might be a non-pharmacological strategy to prevent BMD loss in postmenopausal women.

Effectiveness of exercise on cognitive impairment and Alzheimer's disease.

Physical activity has a protective effect on brain function in older people. Here, we briefly reviewed the studies and results related to the effects of exercise on cognitive impairment and Alzheimer's disease. The main findings from the current body of literature indicate positive evidence for structured physical activity (cardiorespiratory and resistance exercise) as a promising non-pharmacological intervention for preventing cognitive decline. More studies are needed to determine the mechanisms involved in this preventative effect, including on strength, cardiorespiratory, and other types of exercise. Thus, the prevention of Alzheimer's disease may depend on healthy lifestyle habits, such as a structured physical fitness program.

The quality of life of patients with lupus erythematosus influences cardiovascular capacity in 6-minute walk test.

OBJECTIVE: To assess the association between quality of life and distance walked in the 6-minute walk test (6MWT) in Brazilian premenopausal patients with systemic lupus erythematosus (SLE) and compare their results with those of healthy controls. METHODS: Twenty-five premenopausal (18-45 years) patients diagnosed with low-activity SLE (mean SLEDAI: 1.52 ± 1.61) and 25 controls were matched for age, physical characteristics, and physical activity level (International Physical Activity Questionnaire/s-IPAQ). Both groups should not be involved in regular physical activity for at least six months before the study. The 6MWT distance (American Thoracic Society protocol), posttest heart rate (HRpost), posttest oxygen saturation (SpO2post) and the Borg scale of subjective perception of effort (SPE/CR10) were evaluated. The quality of life was assessed by use of the Short Form Health Survey 36 (SF-36). RESULTS: Patients with SLE had a significantly poorer quality of life, a shorter 6MWT distance (598 ± 45 m versus 642 ± 14 m, P < 0.001), and greater values of SPE/CR10 (6.28 ± 2.0 versus 5.12 ± 1.60, P< 0.05) and HRpost (134 ± 15 bpm versus 123 ± 23 bpm, P< 0.05) when compared with controls. The linear regression model suggested that quality of life was a significant predictor of 70% of the 6MWT distance. CONCLUSION: When compared with controls, patients with SLE walked a shorter distance in the 6MWT, which was associated with poorer quality of life.

Treinamento de força versus hidroginástica: uma análise transversal comparativa da densidade mineral óssea em mulheres na pós-menopausa / Resistance training versus weight-bearing aquatic exercise: a cross-sectional analysis of bone mineral density in postmenopausal women

INTRODUÇÃO: Há um grande número de estudos mostrando que o treinamento de força tem um efeito positivo sobre a densidade mineral óssea (DMO). Porém, existem poucos estudos comparando a DMO entre praticantes de hidroginástica e treinamento de força. OBJETIVO: Comparar, em uma análise transversal, a DMO de mulheres praticantes de treinamento de força com mulheres praticantes de hidroginástica, na pós-menopausa. MÉTODOS: A amostra foi composta de 63 mulheres, divididas em três grupos: treinamento de força (FORÇA: n = 15; 51,4 ± 2,7 anos), hidroginástica (HIDRO: n = 22; 54,5 ± 3,3 anos) e controles não treinadas (CONTROLE: n = 26; 52,0 ± 3,3 anos). Todas as voluntárias estavam em terapia de reposição hormonal há no mínimo um ano. Os grupos FORÇA e HIDRO treinavam há pelo menos um ano antes do início do estudo (média de anos de treinamento - FORÇA: 4,5 ± 2,0; HIDRO: 4,2 ± 2,2). RESULTADOS: O grupo FORÇA apresentou maior DMO de corpo total, colo femoral e coluna lombar L2-L4 quando comparado ao grupo-controle (todos P < 0,05). O grupo HIDRO apresentou maior DMO no corpo total, quadril total e coluna lombar L2-L4 quando comparado ao grupo-controle (todos P < 0,05). Entretanto, não foram observadas diferenças entre os grupos FORÇA e HIDRO em nenhum dos sítios avaliados. CONCLUSÕES: Estes achados sugerem que não apenas o treinamento de força, mas também a hidroginástica podem ser estratégias não farmacológicas para prevenção da perda de DMO em mulheres na pós-menopausa.

INTRODUCTION: Many studies have shown that resistance training has a positive effect on bone mineral density (BMD). However, few studies have compared the BMD of individuals undergoing resistance training and those training aquatic weight-bearing exercises. OBJECTIVE: To compare, in a cross-sectional study, the BMD of postmenopausal women undergoing resistance training and postmenopausal women training aquatic weight-bearing exercises. METHODS: The sample comprised 63 women divided into the following three groups: resistance training (STRENGTH: n = 15; 51.4 ± 2.7 years); aquatic weight-bearing exercises (WA-TER: n = 22; 54.5 ± 3.3 years); and non-trained controls (CONTROL: n = 26; 52.0 ± 3.3 years). All volunteers were on hormone replacement therapy for at least one year. The STRENGTH and WATER groups were training for at least one year prior to study beginning (mean years of training - STRENGTH: 4.5 ± 2.0; WATER: 4.2 ± 2.2). RESULTS: The STRENGTH group had higher BMD of total body, femoral neck, lumbar spine L2-L4 as compared with the CONTROL group (all P < 0.05). The WATER group had higher BMD of total body, total hip, lumbar spine L2-L4 as compared with the CONTROL group (all P < 0.05). However, no difference was observed between the STRENGTH and WATER groups regarding the sites assessed. CONCLUSIONS: Those findings suggest that not only the resistance training, but also aquatic weight-bearing exercises might be a non-pharmacological strategy to prevent BMD loss in postmenopausal women.

Effects of eight weeks of resistance training on the risk factors of metabolic syndrome in overweight /obese women - "A Pilot Study".

BACKGROUND: The purpose of the present study was to examine the effects of eight weeks of resistance training (RT) on anthropometric, cardiovascular and biochemical risk factors of metabolic syndrome (MetS), and neuromuscular variables on overweight/obese women. METHODS: Fourteen middle-aged (33.9 ± 8.6 years) overweight/obese women (body mass index - BMI 29.6 ± 4.1 kg/m2) underwent 24 sessions (3 times/week) of a whole body RT program with 3 sets of 8-12 repetitions maximum (RM). The following variables were evaluated: maximum strength on chest press and frontal lat pull-down; isometric hand-grip strength; biceps brachii (BB) and rectus femoris (RF) muscle thickness, body mass; BMI; body adiposity index (BAI); waist, hip and neck circumferences; visceral fat volume; blood glucose; glycated hemoglobin (HbA1c); insulin; HDL-C and triglycerides. RESULTS: There was an increase of chest press (from 52.9 ± 9.7 to 59.8 ± 7.7 kg; P = 0.02) and front lat pull-down (from 51.5 ± 7.5 to 57.6 ± 9.2 kg; P = 0.01) muscle strength, isometric handgrip (P = 0.02) and RF muscle thickness (from 42.2 ± 8.5 to 45.1 ± 7.3 mm; P = 0.02) after the 8 week RT program. There were no statistically significant alterations on plasma glucose, HbA1c, insulin, triglycerides, HDL-C, anthropometric indexes and BB muscle thickness (p > 0.05). CONCLUSIONS: A RT program without caloric restriction promotes an increase on muscle thickness and strength, with no effects on risk factors of MetS in overweight/obese women.

Qualidade de vida de pacientes com lúpus eritematoso influencia a capacidade cardiovascular em teste de caminhada de 6 minutos / The quality of life of patients with lupus erythematosus influences cardiovascular capacity in 6-minute walk test

OBJETIVO: Examinar a associação entre a qualidade de vida e a distância percorrida no teste de caminhada de 6 minutos (6TC) em pacientes com lúpus eritematoso sistêmico (LES) na pré-menopausa, bem como comparar os resultados com controle saudáveis. MÉTODO: Foram pareadas por idade, características físicas e nível de atividade física (Questionário Internacional de Atividade Física: s-IPAQ) 25 pacientes com LES na pré-menopausa (18-45 anos) com baixa atividade da doença (SLEDAI médio: 1,52 ± 1,61) e 25 controles. Ambos os grupos não deviam estar envolvidos em atividade física regular por pelo menos 6 meses antes do estudo. Além da distância percorrida no 6TC (protocolo American Thoracic Society), foi avaliada a frequência cardíaca (FCpós) e a saturação de oxigênio (SpO2pós) pós-teste, e a percepção subjetiva de esforço de Borg (PSE/CR10). A qualidade de vida foi avaliada pelo Short Form Health Survey 36 (SF-36). RESULTADOS: Pacientes com LES apresentaram pior qualidade de vida, percorreram menor distância no 6TC (598 ± 45 m versus 642 ± 14 m; P < 0,001) e obtiveram maior PSE (6,28 ± 2 versus 5,12 ± 1,60; P < 0,05), FCpós (134 ± 15 bpm versus 123 ± 23 bpm; P < 0,05) quando comparadas aos controles. A qualidade de vida foi preditora significativa de 70% da distância percorrida no 6TC. CONCLUSÃO: Quando comparadas aos controles, as pacientes com LES percorrem menor distância no 6TC, o que foi associado a pior qualidade de vida.

OBJECTIVE: To assess the association between quality of life and distance walked in the 6-minute walk test (6MWT) in Brazilian premenopausal patients with systemic lupus erythematosus (SLE) and compare their results with those of healthy controls. METHODS: Twenty-five premenopausal (18-45 years) patients diagnosed with low-activity SLE (mean SLEDAI: 1.52 ± 1.61) and 25 controls were matched for age, physical characteristics, and physical activity level (International Physical Activity Questionnaire/s-IPAQ). Both groups should not be involved in regular physical activity for at least six months before the study. The 6MWT distance (American Thoracic Society protocol), posttest heart rate (HRpost), posttest oxygen saturation (SpO2post) and the Borg scale of subjective perception of effort (SPE/CR10) were evaluated. The quality of life was assessed by use of the Short Form Health Survey 36 (SF-36). RESULTS: Patients with SLE had a significantly poorer quality of life, a shorter 6MWT distance (598 ± 45 m versus 642 ± 14 m, P < 0.001), and greater values of SPE/CR10 (6.28 ± 2.0 versus 5.12 ± 1.60, P< 0.05) and HRpost (134 ± 15 bpm versus 123 ± 23 bpm, P< 0.05) when compared with controls. The linear regression model suggested that quality of life was a significant predictor of 70% of the 6MWT distance. CONCLUSION: When compared with controls, patients with SLE walked a shorter distance in the 6MWT, which was associated with poorer quality of life.

Exercício físico resistido: um fator modificável na sarcopenia em idosos / Resistive exercise: a modifiable factor in sarcopenia in elderly

Até 2050 haverá dois bilhões de idosos no mundo todo, sendo que 80% dos idosos estarão locados nos países em desenvolvimento. Nessa população, verificam-se mudanças qualitativas e quantitativas em aspectos corporais (físicos) e cognitivos. A redução de massa muscular em idosos, conhecida como sarcopenia, é um exemplo de uma mudança quantitativa, pois ocorre a perda de 1% da massa muscular ao ano após a quarta década de vida, podendo ser acentuada com o avanço da idade (maior incidência em adultos com idade superior a 65 anos). Diversos fatores podem interferir na sarcopenia, sendo um deles o exercício físico resistido, logo o objetivo deste trabalho foi realizar uma revisão da literatura vigente a respeito desse fator modificável da sarcopenia na população idosa. Os métodos utilizados foram buscas sistemáticas nas plataformas do Scielo e Medline, cujos anos de publicações revisadas compreendeu-se de 2000 a 2011. Os resultados mostraram que pode haver reversão da sarcopenia quando os idosos são submetidos aos exercícios resistidos através do aumento da massa muscular, assim como o inverso também é verdadeiro, ou seja, ocorre o declínio da mesma e a elevação da infiltração do tecido adiposo na fibra muscular (myosteatosis) quando o treinamento resistido é suspenso. Porém, quando submetidos ao retreinamento ocorre novamente a progressão no ganho de massa muscular. Conclui-se que o presente artigo de revisão demonstrou que a sarcopenia pode ser a principal causadora de quedas em idosos, pois a perda de massa muscular ocasiona a redução da força muscular, proporcionando um desequilíbrio da musculatura do idoso e facilitando, assim as quedas.

By 2050 there will be two billion older people worldwide, with 80% of the elderly will be leased in developing countries. In this population, there are qualitative and quantitative changes aspects (physical) and cognitive. The reduction in muscle mass in older, known as sarcopenia, is an example of a change quantitative, as there is a loss of one percent muscle mass per year after the fourth decade of life and may be marked with increasing age (incidence in adults aged over 65 years). Several factors may interfere with sarcopenia, one being the resistive exercise, so the aim of this study was to review the current literature regarding this modifiable factor of sarcopenia in the elderly. The methods used were systematic searches in Medline and Scielo platforms, whose year-reviewed publications it was realized from 2000 to 2011. The results showed that there may be sarcopenia when reversal of the elderly are subjected to resistance exercises by increasing muscle mass. The reverse is also true, if resistance training is discontinued and this decline is increased infiltration of adipose tissue in the muscle fiber (myosteatosis). However, when subjected to retraining progression occurs in muscle mass. It follows that sarcopenia can contribute to the increased number of falls among the elderly, as loss of muscle mass results in the reduction of force by providing an imbalance in the elderly, however, the resistive exercise assists in the reversal of sarcopenia.

Exercício físico resistido: um fator modificável na sarcopenia em idosos / Resistive exercise: a modifiable factor in sarcopenia in elderly

Até 2050 haverá dois bilhões de idosos no mundo todo, sendo que 80% dos idosos estarão locados nos países em desenvolvimento. Nessa população, verificam-se mudanças qualitativas e quantitativas em aspectos corporais (físicos) e cognitivos. A redução de massa muscular em idosos, conhecida como sarcopenia, é um exemplo de uma mudança quantitativa, pois ocorre a perda de 1% da massa muscular ao ano após a quarta década de vida, podendo ser acentuada com o avanço da idade (maior incidência em adultos com idade superior a 65 anos). Diversos fatores podem interferir na sarcopenia, sendo um deles o exercício físico resistido, logo o objetivo deste trabalho foi realizar uma revisão da literatura vigente a respeito desse fator modificável da sarcopenia na população idosa. Os métodos utilizados foram buscas sistemáticas nas plataformas do Scielo e Medline, cujos anos de publicações revisadas compreendeu-se de 2000 a 2011. Os resultados mostraram que pode haver reversão da sarcopenia quando os idosos são submetidos aos exercícios resistidos através do aumento da massa muscular, assim como o inverso também é verdadeiro, ou seja, ocorre o declínio da mesma e a elevação da infiltração do tecido adiposo na fibra muscular (myosteatosis) quando o treinamento resistido é suspenso. Porém, quando submetidos ao retreinamento ocorre novamente a progressão no ganho de massa muscular. Conclui-se que o presente artigo de revisão demonstrou que a sarcopenia pode ser a principal causadora de quedas em idosos, pois a perda de massa muscular ocasiona a redução da força muscular, proporcionando um desequilíbrio da musculatura do idoso e facilitando, assim as quedas.(AU)

By 2050 there will be two billion older people worldwide, with 80% of the elderly will be leased in developing countries. In this population, there are qualitative and quantitative changes aspects (physical) and cognitive. The reduction in muscle mass in older, known as sarcopenia, is an example of a change quantitative, as there is a loss of one percent muscle mass per year after the fourth decade of life and may be marked with increasing age (incidence in adults aged over 65 years). Several factors may interfere with sarcopenia, one being the resistive exercise, so the aim of this study was to review the current literature regarding this modifiable factor of sarcopenia in the elderly. The methods used were systematic searches in Medline and Scielo platforms, whose year-reviewed publications it was realized from 2000 to 2011. The results showed that there may be sarcopenia when reversal of the elderly are subjected to resistance exercises by increasing muscle mass. The reverse is also true, if resistance training is discontinued and this decline is increased infiltration of adipose tissue in the muscle fiber (myosteatosis). However, when subjected to retraining progression occurs in muscle mass. It follows that sarcopenia can contribute to the increased number of falls among the elderly, as loss of muscle mass results in the reduction of force by providing an imbalance in the elderly, however, the resistive exercise assists in the reversal of sarcopenia.(AU)

Relação da circunferência do pescoço com a força muscular relativa e os fatores de risco cardiovascular em mulheres sedentárias / Relation of neck circumference and relative muscle strength and cardiovascular risk factors in sedentary women

OBJETIVO: O objetivo do presente estudo foi verificar a relação da circunferência do pescoço com a força muscular relativa e os fatores de risco cardiovascular em mulheres sedentárias. MÉTODOS: Estudo transversal, realizado com 60 mulheres pré-menopausadas (33,9±9,1 anos; 67,4±13,6kg; 1,57±0,06cm e 27,2±5,3kg/m²). Com base no valor da circunferência do pescoço, a amostra foi dividida em dois grupos: Grupo Circunferência <35cm (n=27) e Grupo Circunferência >35cm (n=33), para efeito de comparação da força muscular relativa e dos fatores de risco cardiovascular. A correlação entre as variáveis foi testada por meio da correlação de Pearson e de Spearman; o nível de significância foi estabelecido em p<0,05. RESULTADOS: Os resultados demonstram que as mulheres com circunferência do pescoço >35cm apresentaram maiores valores de massa corporal, circunferência da cintura, índice de adiposidade corporal, índice de massa corporal, pressão arterial sistólica, glicemia, hemoglobina glicada e volume de gordura visceral, quando comparadas ao grupo com circunferência do pescoço <35cm. Adicionalmente, o grupo com maior circunferência do pescoço apresentou menores valores de força relativa. CONCLUSÃO: A circunferência do pescoço parece ser um importante fator de predição de risco cardiovascular e perda de força relativa em mulheres sedentárias de meia idade.

OBJECTIVE: To verify the relation of neck circumference and relative muscle strength and cardiovascular risk factors in sedentary women. METHODS: A cross-sectional study with 60 premenopausal women (33.9±9.1 years; 67.4±13.6kg; 1.57±0.6cm and 27.2±5.3kg/m²). Based on the neck circumference, the sample was divided into two groups: Group Circumference <35cm (n=27) and Group Circumference >35cm (n=33) to compare relative muscle strength and cardiovascular risk factors. The correlation between variables was tested by Pearson and Spearman correlations, with a significance level established at p<0.05. RESULTS: The findings revealed that women with neck circumference >35cm presented higher values of body mass, waist circumference, body adiposity index, body mass index, systolic blood pressure, blood glucose, glycated hemoglobin and volume of visceral fat when compared with the group with neck circumference <35cm. Additionally, the group with larger neck circumference presented lower values of relative strength. CONCLUSION: Neck circumference seems to be an important predictive factor of cardiovascular risk and of relative strength loss in middle-aged sedentary women.