Inter-limb differences in in-vivo tendon behavior, kinematics, kinetics and muscle activation during running.

Overloading of tendon tissue may result in overuse tendon injuries in runners. One possible cause of overloading could be the occurrence of biomechanical inter-limb differences during running. However, scarce information exists concerning the simultaneous analysis of inter-limb differences in external and internal loading-related variables in habitual runners. In this study ground reaction force, joint kinematics, triceps surae and tibialis anterior activations, and medial gastrocnemius muscle-tendon junction displacement were assessed bilaterally during treadmill running at 2.7 m.s-1 and 4.2 m.s-1. Statistical parametric t-tests and effect sizes were calculated to identify eventual inter-limb differences across the stance phase and stride cycle. Hip flexion angle was 9° greater (p = 0.03, ES = 0.30) in the non-preferred limb during the flight phase at 4.2 m.s-1. Hip extension velocity was 45 deg.s-1 greater (p = 0.04, ES = 0.41) during ground contact and 25 deg.s-1 greater (p = 0.02, ES = 0.41) immediately after toe-off in the non-preferred limb at 4.2 m.s-1. Hip extension velocity was also 40 deg.s-1 greater (p = 0.01, ES = 0.46) in the non-preferred limb prior to touch-down at 4.2 m.s-1. Brief inter-limb differences in joint kinematics were not accompanied by inter-limb differences in variables associated to internal loading, suggesting they are unlikely to be underlying factors leading to tendon overloading in healthy non-injured runners.

Biomechanical and physiological implications to running after cycling and strategies to improve cycling to running transition: A systematic review.

OBJECTIVES: This systematic review summarises biomechanical, physiological and performance factors affecting running after cycling and explores potential effective strategies to improve performance during running after cycling. DESIGN: Systematic review. METHODS: The literature search included all documents available until 14th December 2021 from Medline, CINAHL, SportDiscus, and Scopus. Studies were screened against the Appraisal tool for Cross-sectional Studies to assess methodological quality and risk of bias. After screening the initial 7495 articles identified, fulltext screening was performed on 65 studies, with 39 of these included in the systematic review. RESULTS: The majority of studies observed detrimental effects, in terms of performance, when running after cycling compared to a control run. Unclear implications were identified from a biomechanical and physiological perspective with studies presenting conflicting evidence due to varied experimental designs. Changes in cycling intensity and cadence have been tested but conflicting evidence was observed in terms of biomechanical, physiological and performance outcomes. CONCLUSIONS: Because methods to simulate cycle to run transition varied between studies, findings were conflicting as to whether running after cycling differed compared to a form of control run. Although most studies presented were rated high to very high quality, it is not possible to state that prior cycling does affect subsequent running, from a physiological point of view, with unclear responses in terms of biomechanical outcomes. In terms of strategies to improve running after cycling, it is unclear if manipulating pedalling cadence or intensity affects subsequent running performance.

Bilateral in vivo neuromechanical properties of the triceps surae and Achilles tendon in runners and triathletes.

Inter-limb differences in Achilles tendon mechanical, material and morphological properties have previously been described in non-athletes and attributed to the preferential use of a given limb. Achilles tendon overuse tendon injury generally initiate unilaterally and alters triceps surae activation and Achilles tendon properties. The investigation of inter-limb differences in muscle activation and tendon properties may provide directions for injury prevention in habitual runners. In this study triceps surae and Achilles tendon properties were investigated bilaterally in habitual runners during unilateral maximal isometric contractions. Morphological, mechanical and material Achilles tendon properties were assessed using isokinetic dynamometry, motion capture and ultrasonography while triceps surae activation strategies were assessed using electromyography. Lower limb preference was assessed for inter-limb comparisons using the Waterloo questionnaire. Zero and one-dimensional statistical analysis and Cohen's d were employed to investigate possible inter-limb differences. Inter-limb associations in Achilles tendon properties and intra-limb associations between triceps surae activations were assessed using Pearson's correlation coefficients. No differences were observed between the preferred and non-preferred limb in terms of triceps surae muscle activation amplitude and Achilles tendon properties. However, intra-limb association among triceps surae activation ratios were not identical between limbs. Runners and triathletes present similar Achilles tendons properties between limbs, and thus initial observations of unilateral changes in the Achilles tendon properties might be used as a strategy to prevent the onset of overuse tendon injury. The non-similar associations within activation ratios between limbs should be further explored since triceps surae activation strategies may alter loading of the Achilles tendon.

Running after cycling induces inter-limb differences in muscle activation but not in kinetics or kinematics.

Overuse injuries are a common problem to triathletes' population. Overuse injuries may arise from inter-limb biomechanical differences during running, but the literature lacks information regarding inter-limb differences in triathletes. In this study inter-limb differences were investigated in injury-free triathletes during the running portion of a simulated cycle-run transition. Thirteen triathletes performed a 5 km run preceded by a 20 min cycling trial at 70% of maximal power output. During the Start, Mid and End stages of running, kinetic, kinematic and muscle activation variables were compared between the preferred and non-preferred limbs across the stance phase. A statistical parametric mapping analysis showed no differences between limbs when considering kinetic and kinematic variables (p > 0.05, ES<0.60). A lower soleus activation was observed in the preferred limb (p < 0.05, ES>0.60) from 53.40-75.9% of the stance phase at the End stage of running. In conclusion, inter-limb differences in kinetic or kinematic variables may not represent a risk for overloading in triathletes. However, inter-limb differences in triceps surae activation during running after cycling may represent one potential factor leading to overuse injuries in triathletes and should be further investigated.

Hemoglobina e sódio séricos:: marcadores prognósticos precoces na insuficiência cardíaca descompensada

Introdução. A insuficiência cardíaca (IC) descompensada apresenta elevada morbimortalidade. Marcadores prognósticos clínicos e laboratoriais foram identificados, porém a influência precoce da hemoglobina (Hb) e do sódio (Na) séricos é pouco conhecida. Este estudo teve como objetivo avaliar as características clínicas e desfechos em pacientes internados por IC descompensada, conforme dosagem sérica de Hb e Na nas primeiras 24 horas. Material e métodos. Estudo prospectivo observacional que avaliou pacientes adultos internados por IC descompensada acompanhados por até 30 dias após a alta. Os grupos analisados foram: Hb e Na iniciais normais (grupo 1), Hb inicial < 10,0 mg/dl (grupo 2), Na inicial < 135 mEq/l (grupo 3), ou ambas as alterações (grupo 4). O desfecho primário avaliado foi óbito hospitalar ou até 30 dias após a alta. Resultados. Da amostra total de 40 pacientes, 37,5% eram do grupo 1, 35,0% do grupo 2, 7,5% do grupo 3 e 20,0% do grupo 4. A média de idade nos grupos foi de 67,2 ±15 vs 66,4 ±13 vs 59,0 ±11 vs 55,7 ±14 anos (p=0,08). Eram do sexo masculino 60,0%, 35,7%, 100% e 62,5% (p=0,08). Os desfechos observados para cada grupo foram, respectivamente, mortalidade de 6,7% vs 21,4% vs 0% vs 37,5% (p=0,007), reinternação em 30 dias 6,7% vs 28,6% vs 0% vs 12,5% (p=0,12), insuficiência renal aguda 20,0% vs 42,8% vs 33,3% vs 25,0% (p=0,04), necessidade de ventilação mecânica invasiva 13,3% vs 7,1% vs 0% vs 0% (p=0,41) e tempo de internação 16 ±10 vs 17 ±12 vs 24 ±11 vs 33 ±19 dias (p=0,03). Conclusões. Nos pacientes com IC descompensada, Hb < 10 mg/dl nas primeiras 24 horas da internação associou-se à ocorrência de insuficiência renal aguda. A combinação de Hb < 10 mg/dl e Na < 135 mEq/l associou-se a maior mortalidade hospitalar e a aumento do tempo de internação.

Background. Acute decompensated heart failure (HF) has high morbidity and mortality. Clinical and laboratory prognostic markers have been identified, although the early influence of serum hemoglobin (Hb) and sodium (Na) is not precisely known. This study aimed to assess the clinical features and outcomes in patients with decompensated HF, according to serum dosage of Hb and Na within the first 24 hours of admission. Material and methods. Prospective observational study that included hospitalized patients with decompensated HF followed for up to 30 days after discharge. Groups were analyzed as follows: normal Hb and Na (group 1), initial Hb < 10.0 mg/dl (group 2), initial Na < 135 mEq/l (group 3), or both alterations (group 4). The primary outcome was in-hospital or 30-days death. Results. From the total 40 patients sample, 37.5% were in group 1, 35.0% group 2, 7.5% group 3, and 20.0% group 4. Average age was 67.2 ±15 vs 66.4 ±13 vs 59.0 ±11 vs 55.7 ±14 (p=0.08). Male subjects were 60.0%, 35.7%, 100% and 62.5% (p=0.08). Outcomes for each respective group were: mortality 6.7% vs 21.4% vs 0% vs 37.5% (p=0.007), 30-days re-admission 6.7% vs 28.6% vs 0% vs 12.5% (p=0.12), acute renal failure 20.0% vs 42.8% vs 33.3% vs 25.0% (p=0.04), invasive mechanical ventilation 13.3% vs 7.1% vs 0% vs 0% (p=0.41), and length of hospitalization 16 ±10 vs 17 ±12 vs 24 ±11 vs 33 ±19 days (p=0.03). Conclusions. In patients with acute decompensated HF, Hb < 10 mg/dl within the first 24 hours of admission was associated to the occurrence of acute renal failure. The combination of Hb < 10 mg/dl and was associated to higher mortality and higher length of hospitalization.

Hemoglobina y sodio séricos:: marcadores pronósticos precoces en la insuficiencia cardíaca descompensada

Introducción. La insuficiencia cardíaca (IC) descompensada presenta una elevada morbimortalidad. Si bien los marcadores pronósticos clínicos y de laboratorio se han identificados, la influencia precoz de la hemoglobina (Hb) y del sodio (Na) séricos es poco conocida. Este estudio tuvo como objetivo evaluar las características clínicas y resultados en pacientes internados por IC descompensada, conforme a la dosificación sérica de Hb y Na en las primeras 24 horas. Material y métodos. Estudio prospectivo observacional que evaluó pacientes adultos internados por IC descompensada seguidos por hasta 30 días después del alta hospitalaria. Los grupos analizados fueron: Hb y Na iniciales normales (grupo 1), Hb inicial < 10,0 mg/dl (grupo 2), Na inicial < 135 mEq/l (grupo 3), o ambas alteraciones (grupo 4). El resultado primario evaluado fue muerte hospitalaria hasta 30 días después del alta. Resultados. De la muestra total de 40 pacientes, el 37,5% eran del grupo 1, el 35,0% del grupo 2, el 7,5% del grupo 3 y el 20,0% del grupo 4. La media de edad en los grupos fue 67,2 ±15 vs 66,4 ±13 vs 59,0 ±11 vs 55,7 ±14 (p=0,08). Eran del sexo masculino 60,0%, 35,7%, 100% y 62,5% años (p=0,08). Los resultados observados para cada grupo fueron, respectivamente, mortalidad de 6,7% vs 21,4% vs 0% vs 37,5% (p=0,007), readmisión en 30 días: 6,7% vs 28,6% vs 0% vs 12,5% (p=0,12), insuficiencia renal aguda: 20,0% vs 42,8% vs 33,3% vs 25,0% (p=0,04), necesidad de ventilación mecánica invasiva: 13,3% vs 7,1% vs 0% vs 0% (p=0,41) y tiempo de internación: 16±10 vs 17±12 vs 24±11 vs 33±19 días (p=0,03). Conclusiones. En los pacientes con IC descompensada, Hb <10 mg/dl en las primeras 24 horas de la internación se ha asociado a la aparición de insuficiencia renal aguda. La combinación de Hb <10 mg/dl y Na <135 mEq/l se ha asociado a mortalidad más alta y a tiempo de internación más prolongado.

Insuficiência cardíaca na população geriátrica: dados de um registro unicêntrico / Heart failure in the older population: data from a single-center registry

OBJETIVO: Analisar o perfil e o seguimento clínico de pacientes com insuficiência cardíaca. MÉTODOS: Estudo prospectivo observacional de pacientes com insuficiência cardíaca, que comparou a população geriátrica (≥ 65 anos) com o restante da amostra (18 a 64 anos). Todos eram acompanhados ambulatorialmente em clínica especializada de um hospital-escola e foram incluídos consecutivamente entre abril e novembro de 2013, tendo sido acompanhados por 3 anos ou óbito. RESULTADOS: Da amostra total de 100 pacientes, 56% eram idosos. Na comparação entre idosos (média de 74±7 anos) e não idosos (média de 52±8 anos), houve diferença significativa quanto a peso corporal (72,6±16 kg vs. 80,8±19kg; p=0,02), índice de massa corporal (28,6±5,7kg/m2 vs. 32,6±5,9kg/m2; p=0,001), fibrilação atrial (35,7% vs. 11,3%; p=0,005) e doença renal crônica (28,5% vs. 13,6%; p=0,04). A prescrição de betabloqueadores e de inibidores da enzima conversora de angiotensina ou bloqueadores do receptor de angiotensina não diferiu entre os grupos, e nem os dados ecocardiográficos e a ocorrência de desfechos no seguimento clínico. CONCLUSÃO: Idosos foram a maioria dentre pacientes com insuficiência cardíaca e apresentaram maior prevalência de doença renal crônica e fibrilação atrial, além de menores peso e índice de massa corporal. Tais diferenças não resultaram em maior incidência de desfechos adversos na evolução de médio prazo. (AU)

OBJECTIVE: To assess the clinical profile and follow-up of patients with heart failure. METHODS: This is a prospective, observational study that compared the geriatric population (≥ 65 years old) with the remaining portion of the sample (18 to 64 years old). All of them were assisted in a specialized outpatient clinic of a university hospital, and were included consecutively from April to November 2013, being followed for three years or until death. RESULTS: From the sample of 100 patients, 56% were older people. In the comparison between older people (average 74 ± 7 years old) and non-older people (average 52 ± 8 years old), a significant difference was found for body weight (72.6 ± 16Kg vs. 80.8 ± 19Kg, p=0.02), body mass index (28.6 ± 5.7Kg/m2 vs. 32.6 ± 5.9 Kg/m2, p=0.001), atrial fibrillation (35.7% vs. 11.3%, p=0.005), and chronic kidney disease (28.5% vs. 13.6%, p=0.04). The prescription of beta-blockers and angiotensin converting enzyme inhibitors, or angiotensin receptor blockers did not differ between the groups, neither did the echocardiographic values and the occurrence of outcomes at clinical follow-up. CONCLUSION: Older people were the majority among patients with heart failure, and presented a higher prevalence of chronic kidney disease and atrial fibrillation, and lower body weight and body mass index. Those differences did not result in greater incidence of adverse outcomes at mid-term follow-up. (AU)

Anthracycline-associated cardiotoxicity in adults: systematic review on the cardioprotective role of beta-blockers

SUMMARY OBJECTIVES This study aimed at assessing the role of beta-blockers on preventing anthracycline-induced cardiotoxicity in adults. METHODS A systematic review was performed on electronic databases, including relevant studies that analysed beta-blockers as cardioprotective agents before the use of anthracyclines by adult oncologic patients. RESULTS After application of eligibility and selection criteria, eight articles were considered as high quality, complying with the proposed theme; all eight clinical trials, four of them placebo-controlled, with a total number of 655 patients included. From this sample, 281 (42.9%) used beta-blocker as intervention, and carvedilol was the most frequent (167 patients - 25.5%). Six studies were considered positive regarding the cardioprotection role played by beta-blockers, although only four demonstrated significant difference on left ventricle ejection fraction after chemotherapy on groups that used beta-blockers compared to control groups. Carvedilol and nebivolol, but not metoprolol, had positive results regarding cardioprotection. Other beta-blockers were not analysed in the selected studies. CONCLUSIONS Despite the potential cardioprotective effect of beta-blockers, as demonstrated in small and unicentric clinical trials, its routine use on prevention of anthracycline-associated cardiotoxicity demands greater scientific evidence.

RESUMO OBJETIVO Este estudo teve como objetivo analisar o papel dos betabloqueadores na prevenção da cardiotoxicidade induzida pelas antraciclinas em adultos. MÉTODOS Foi realizada uma revisão sistemática em bases de dados eletrônicos, incluindo os estudos relevantes que analisaram fármacos betabloqueadores como agentes cardioprotetores antes do início do uso de antraciclinas por pacientes oncológicos adultos. RESULTADOS Após aplicação dos critérios de elegibilidade e seleção, foram obtidos oito artigos considerados de boa qualidade, que se adequavam à temática proposta, sendo todos ensaios clínicos, quatro placebo-controlados, totalizando 655 pacientes incluídos. Destes, 281 (42,9%) fizeram uso de algum betabloqueador como intervenção, sendo o carvedilol o mais utilizado (167 pacientes - 25,5%). Seis estudos foram considerados positivos quanto à cardioproteção exercida pelos betabloqueadores, porém apenas quatro demonstraram diferença na fração de ejeção do ventrículo esquerdo após a quimioterapia nos grupos que usaram betabloqueadores em relação aos grupos controle. O carvedilol e o nebivolol, mas não o metoprolol, tiveram resultados positivos quanto à cardioproteção. Outros betabloqueadores não foram avaliados nos estudos incluídos. CONCLUSÕES Apesar de haver um potencial efeito cardioprotetor dos betabloqueadores, conforme demonstrado em ensaios clínicos pequenos e unicêntricos, sua utilização rotineira na prevenção da cardiotoxicidade associada às antraciclinas requer maiores comprovações científicas.

Anthracycline-associated cardiotoxicity in adults: systematic review on the cardioprotective role of beta-blockers.

OBJECTIVES: This study aimed at assessing the role of beta-blockers on preventing anthracycline-induced cardiotoxicity in adults. METHODS: A systematic review was performed on electronic databases, including relevant studies that analysed beta-blockers as cardioprotective agents before the use of anthracyclines by adult oncologic patients. RESULTS: After application of eligibility and selection criteria, eight articles were considered as high quality, complying with the proposed theme; all eight clinical trials, four of them placebo-controlled, with a total number of 655 patients included. From this sample, 281 (42.9%) used beta-blocker as intervention, and carvedilol was the most frequent (167 patients - 25.5%). Six studies were considered positive regarding the cardioprotection role played by beta-blockers, although only four demonstrated significant difference on left ventricle ejection fraction after chemotherapy on groups that used beta-blockers compared to control groups. Carvedilol and nebivolol, but not metoprolol, had positive results regarding cardioprotection. Other beta-blockers were not analysed in the selected studies. CONCLUSIONS: Despite the potential cardioprotective effect of beta-blockers, as demonstrated in small and unicentric clinical trials, its routine use on prevention of anthracycline-associated cardiotoxicity demands greater scientific evidence.

Effectiveness of pedalling retraining in reducing bilateral pedal force asymmetries.

Previous studies have been limited to describe asymmetries during pedalling and suggest possible repercussion on performance and/or injury risks. However, few studies have presented strategies to mitigate asymmetries. The purpose of this study was to assess the effectiveness of a pedalling retraining intervention to reduce bilateral pedal force asymmetries. Twenty cyclists were assessed and 10 enrolled in a pedalling retraining method receiving visual and verbal feedback of pedal forces. The asymmetry index was computed for comparison of bilateral peak pedal forces and used during retraining (12 trials at 70% of peak power). Significantly larger asymmetry was observed for asymmetrical cyclists at the first three trials (P < 0.01 and ES = 1.39), which was reduced when post-retraining was compared to measures from symmetrical cyclists (P = 0.69 and ES = 0.18). Cyclists with larger asymmetry (>20%) in bilateral pedal forces reduce their asymmetries using sessions of pedalling retraining and achieve asymmetry indices similar to symmetrical cyclists.

Acompanhamento de Gestante Portadora de Síndrome de Marfan com Tubo Valvado Metálico Aórtico / Management of Pregnant Woman with Marfan Syndrome and Mechanical Aortic Valved Conduit

Relata-se o acompanhamento de paciente gestante, 29 anos, primigesta, portadora da Síndrome de Marfan e tubo valvado metálico aórtico encaminhada ao cardiologista com sete semanas de gestação.Ao ecodopplercardiograma apresentava diâmetro da raiz da aorta de 35 mm, tubo valvado e prótese aórtica metálica normofuncionante. Realizou acompanhamento cardiológico especializado desde então. Na 38a semana de gestação foi submetida ao parto cesariana com anestesia geral, profilaxia de endocardite infecciosa, monitorização cardíaca no centro cirúrgico e pós-operatório na unidade coronariana por 24 horas. Os períodos gestacional e puerpério transcorreram sem eventos hemorrágicos. O acompanhamento clínico e obstétrico de gestantes com Síndrome de Marfan é desafiador, e a condição de prótese valvar mecânica previamente implantada aumenta o risco destas paciente

Joint Torques and Patellofemoral Force During Single-Leg Assisted and Unassisted Cycling.

CONTEXT: Unassisted single-leg cycling should be replaced by assisted single-leg cycling, given that this last approach has potential to mimic joint kinetics and kinematics from double-leg cycling. However, there is need to test if assisting devices during pedaling effectively replicate joint forces and torque from double-leg cycling. OBJECTIVES: To compare double-leg, single-leg assisted, and unassisted cycling in terms of lower-limb kinetics and kinematics. DESIGN: Cross-sectional crossover. SETTING: Laboratory. PARTICIPANTS: 14 healthy nonathletes. INTERVENTIONS: Two double-leg cycling trials (240 ± 23 W) and 2 single-leg trials (120 ± 11 W) at 90 rpm were performed for 2 min using a bicycle attached to a cycle trainer. Measurements of pedal force and joint kinematics of participants' right lower limb were performed during double- and single-leg trials. For the single-leg assisted trial, a custom-made adaptor was used to attach 10 kg of weight to the contralateral crank. MAIN OUTCOME MEASURES: Peak hip, knee, and ankle torques (flexors and extensors) along with knee-flexion angle and peak patellofemoral compressive force. RESULTS: Reduced peak hip-extensor torque (10%) and increased peak knee-flexor torque (157%) were observed at the single-leg assisted cycling compared with the double-leg cycling. No differences were found for peak patellofemoral compressive force or knee-flexion angle comparing double-leg with single-leg assisted cycling. However, single-leg unassisted cycling resulted in larger peak patellofemoral compressive force (28%) and lower knee-flexion angle (3%) than double-leg cycling. CONCLUSIONS: These results suggest that although single-leg assisted cycling differs for joint torques, it replicates knee loads from double-leg cycling.

Impacto da clínica de insuficiência cardíaca no teste de caminhada de seis minutos / Impact of heart failure clinic on six-minute walk test

Fundamentos: O teste de caminhada de seis minutos (TC6M) é de fácil aplicação e baixo custo, utilizado paraavaliar objetivamente o grau de limitação funcional e prognóstico da insuficiência cardíaca (IC).Objetivo: Avaliar os TC6M de indivíduos com IC recém-diagnosticada, realizados na consulta admissional e apósseis meses, analisando a diferença mínima importante (Minimal important difference - MID) entre os dois testes.Métodos: Estudo tipo coorte histórico. O primeiro TC6M foi avaliado em pacientes com IC sistólica referenciadosà Clínica de IC entre julho de 2012 e outubro de 2014 e o segundo TC6M após seis meses. O grupo que atingiu adistância MID no segundo teste foi comparado com o que não a atingiu. Delta-distância e necessidade dehospitalizações foram avaliados conforme adesão ao tratamento, classe funcional (CF) da New York Heart Associationna primeira consulta e grau de disfunção ventricular esquerda.Resultados: A diferença de distância percorrida entre os TC6M foi 48,79 m na população estudada, e distânciaMID calculada de 49 m. Trinta pacientes (58,8%) apresentaram delta-distância menor que a MID, com média deidade maior que o outro grupo (p=0,01). A média do delta-distância foi significativamente maior nos pacientesaderentes ao tratamento e nos que estavam em CF III na primeira consulta.Conclusão: Houve aumento geral da distância média percorrida do primeiro para o segundo TC6M nos pacientescom IC, porém menos da metade dos pacientes obteve incremento significativo.

Background: The six-minute walk test (6MWT) is an easy-to-use low-cost test that is employed to objectively evaluate the degreeof functional limitation and the prognosis of heart failure (HF).Objective: To evaluate the 6MWT of individuals with newly diagnosed HF, performed on admission and after six months, analyzingthe minimal important difference — MID between the two tests.Methods: Historical cohort study. The first 6MWT was evaluated in patients with systolic HF referred to the HF clinic from July2012 to October 2014 and the second 6MWT after six months. The group that reached the MID distance in the second test wascompared to the group that did not reach it. Delta-distance and need for hospitalizations were assessed as adherence to treatment,functional class (FC) of the New York Heart Association at the first visit and degree of left ventricular dysfunction.Results: The difference in the distance covered between the 6MWT was 48.79 m in the study population and the MID distancecalculated was 49 m. Thirty patients (58.8%) had lower delta-distance than the MID distance, with an average age higher than theother group (p=0.01). The average delta-distance was significantly higher in patients adhering to treatment and in those who werein FC III at the first visit.Conclusion: There was general increase in the average distance covered from the first to the second 6MWT in patients with HF,but less than half of patients achieved significant incremente.

Study on Lifestyles and Stress Levels in Medicine Student / Estudo sobre Estilos de Vida e Níveis de Estresse em Estudantes de Medicina

Estilos de vida pouco saudáveis são fatores de risco preveníveis para doenças crônicas. Intervir sobre eles constitui estratégia fundamental de saúde preventiva. Objetivo: Avaliar o estilo de vida, os níveis de estresse, as doenças e os fatores de risco cardiovascular de estudantes de medicina. Métodos: Estudo transversal, observacional, com alunos de uma escola de medicina estratificados em: Grupo 1(G1) - do 1º ao 4º período do curso, Grupo 2 (G2) - do 5º ao 8º e Grupo 3 (G3) - do 9º ao 12º. Foram aplicados dois questionários: Estilo de vida Fantástico e outro relacionado a níveis de estresse, doenças e fatores de risco cardiovascular. Resultados: Foram avaliados 482 estudantes, média de idade 21,7±2,7 anos. A pontuação média no questionário Estilo de vida Fantástico classificou o G1 e o G3 em Muito bom (72,1 e 71,3 pontos, respectivamente) e o G2 em Bom (69,2 pontos) (p=0,007). Quanto aos níveis de estresse, responderam Alto ou Muito Alto 22,3% no G1, 34,9%no G2 e 30,7% no G3 (p=0,008). As doenças mais prevalentes foram dislipidemia (7,4%), hipertensão arterial (2,6%)e transtorno depressivo (2,2%). Conclusões: Houve piora considerável do estilo de vida e dos níveis de estresse a partir do 5º período, com melhora parcial nos dois últimos anos do curso. Observou-se expressiva prevalência de dislipidemia, hipertensão e transtorno depressivo...

Unhealthy lifestyles are preventable risk factors for chronic diseases. Intervening on them is a fundamental strategy of preventive health. Objective: To evaluate lifestyle, stress levels, diseases and cardiovascular risk factors of medical students. Methods: Cross-sectional, observational study with students from a medical school stratified into: Group 1 (G1) - from the 1st to the 4th period of the course, Group 2 (G2) - from the 5th to the 8th and Group 3 (G3) - from the 9th to the 12th. Two questionnaires were given: Fantastic Lifestyle and another one related to stress levels, diseases and cardiovascular risk factors. Results: The study included 482 students, average age 21.7±2.7 years. The average score on the Fantastic Lifestyle questionnaire ranked G1 and G3 at Very good (72.1 and 71.3 points, respectively) and G2 in Good (69.2 points) (p=0.007). As for the stress levels, they responded High or Very High 22.3% in G1, 34.9% in G2 and 30.7% in G3 (p=0.008). The most prevalent diseases were dyslipidemia (7.4%), hypertension (2.6%) and depressive disorder (2.2%). Conclusions: There was considerable worsening of lifestyle and stress levels from the 5th period, with partial improvement in the last two years of the course. There was a significant prevalence of dyslipidemia, hypertension and depressive disorder...

Comparison of kinetics, kinematics, and electromyography during single-leg assisted and unassisted cycling.

To use single-leg cycling training for varying populations, it is important to understand whether a counterweight attached to the contralateral crank during single-leg cycling drills replicates the effects of the opposite leg in the ipsilateral leg. Therefore, we compared single-leg assisted cycling using a counterweight on the contralateral crank for joint kinetics, kinematics, and lower-limb muscle activation. Fourteen healthy nonathletes performed 2 bilateral cycling trials (240 ± 23 W and 90 ± 2 rpm) and 2 single-leg trials (120 ± 11 W and 90 ± 2 rpm) for measurements of pedal force, joint kinematics, and muscle activation of their right lower limb. For 1 single-leg trial, a custom-made adaptor was used to attach 10 kg of weight to the contralateral leg. Total force applied on the pedal, pedal force effectiveness, the mean joint angles and range of motion, mechanical work at the crank, hip, knee, and ankle joints, electromyography, pedaling cadence, and right crank mechanical work were assessed. Biceps femoris (87%), vastus lateralis (15%), rectus femoris (57%), tibialis anterior (57%), and gastrocnemius medialis (12%) activations were larger in the single-leg assisted trial compared with the bilateral trial. Lower total pedal force (17%) and increased index of effectiveness (16%) also indicate mechanical differences in single-leg cycling using a counterweight on the contralateral crank than conventional bilateral cycling. Single-leg assisted training should be used with caution because of potential differences in muscle recruitment and pedaling kinetics compared with bilateral cycling.

Implicações da cadência de pedalada sobre a potência mecânica e o período de contração muscular no ciclismo / Pedaling cadence effects on mechanical power and muscle contraction timing during cycling

A energia mecânica necessária para a pedalada no ciclismo depende de ações musculares concêntricas e excêntricas. Contudo, até o momento não se tem conhecimento de como variações na cadência de pedalada podem influenciar o tipo de ação muscular utilizada. O presente estudo investigou os efeitos de alterações na cadência nas ações musculares concêntricas e excêntricas durante a pedalada. A absorção e a produção de potência pelas articulações foram calculadas para monitorar possíveis repercussões das mudanças na cadência sobre a cinética articular. Vinte e um ciclistas participaram do estudo (VO2pico: 64,1 ± 5.0 ml/kg/min; volume de treinamento: 368,2 ± 69,5 km/semana). Na primeira sessão de avaliação, a potência máxima (POMAX) e a potência produzida relativa ao segundo limiar ventilatório (POLV2) foram determinadas durante teste incremental até a exaustão. Na segunda sessão, os ciclistas realizaram dois testes de dois minutos de duração a 70 e 90 rpm e carga constante (POLV2). A ativação de seis músculos, a força aplicada no pedal e a cinemática do membro inferior direito foram avaliadas. Um maior tempo de ativação foi observado em fase excêntrica para os músculos vasto medial (8%; p < 0,01) e bíceps femoral (20%; p = 0,04) a 70 rpm em relação a 90 rpm, além de maior tempo de ativação em fase concêntrica para o músculo vasto medial (10%; p = 0,04) a 90 rpm em relação a 70 rpm. Não se observou diferença nas potências articulares entre as cadências testadas. A não alteração da potência articular sugere uma tendência de conservação do padrão do movimento com a alteração da cadência de pedalada. A ativação excêntrica de músculos da articulação do joelho pode estar relacionada com o controle articular, transmissão de força e redução do custo energético

The mechanical energy required to propel the crank may depend on eccentric and concentric muscle actions. However, it is uncertain whether pedaling cadence would elicit changes in concentric and eccentric contributions. Therefore, the purpose of the present study was to investigate the effects of alterations in pedaling cadence on the eccentric and concentric muscle actions. Joint power production and absorption were calculated to assess potential effects from variations in pedaling cadence on joint kinetics. Twenty-one cyclists participated in this study (VO2pico: 64.1 ± 5.0 ml/kg/min; training volume: 368.2 ± 69.5 km/week). In their first session, maximal power output (POMAX) and power output related to the second ventilation threshold (POVT2) were determined during an incremental maximal cycling test to exhaustion. In their second session, cyclists performed two 2-min trials with workload from their POVT2 at two different cadences (70 and 90 rpm). Muscle activation of six muscles, pedal forces and lower limb joint kinematics were evaluated. Longer eccentric contraction at 70 rpm for vastus medialis (8%; p < 0.01) and biceps femoris (20%; p = 0.04) were observed compared to 90 rpm. Longer concentric contraction for vastus medialis muscle (10%; p = 0.04) at 90 rpm was observed compared to 70 rpm. There were no differences in joint power production and absorption among pedaling cadences. No alterations in joint power could indicate maintenance of movement when pedaling cadence is changed. Eccentric contractions from knee muscles could be related to joint control, force transmission and reduced energy cost

Análise da qualidade de vida em homens e mulheres portadores de insuficiência cardíaca / Quality of life analysis among men and women with heart failure

Fundamentos: A insuficiência cardíaca (IC) é capaz de exercer grande impacto sobre a qualidade de vida (QV), e as diferenças na QV de homens e mulheres portadores de IC são pouco conhecidas. O Minnesota Living with Heart Failure Questionnaire (MLHFQ) é uma ferramenta que avalia a QV dos portadores de IC. Objetivo: Avaliar a QV de pacientes com IC, comparando os sexos masculino e feminino. Métodos: Estudo unicêntrico transversal e descritivo, no qual se aplicou o MLHFQ a pacientes com IC com fração de ejeção reduzida, acompanhados na clínica de IC de hospital universitário entre outubro 2012 e março 2013. Foram analisados os resultados do MLHFQ dos pacientes incluídos comparando-os por sexo. Resultados: Foram incluídos 74 pacientes: sexo masculino (n=42; 56,8 %) e sexo feminino (n=32; 43,2 %). Comparando-se os dois grupos, não houve diferença nas características clínicas e nas medicações utilizadas. No grupo masculino ocorreram 0,27 internações/paciente/ano vs. 0,17 internações/paciente/ano no grupo feminino (p=0,32). O escore médio obtido pelo MLHFQ foi 35,6±18,9 para homens e 47,8±24, para mulheres (p=0,02). Conclusão: Apesar do menor número de internações hospitalares, observou-se pior QV em pacientes com IC do sexo feminino em comparação ao masculino.

Background: Heart failure (HF) can severely impact the quality of life (QOL), and little is known about QOL and differences between men and women with HF. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is tool that assesses the QOL of HF patients. Objective: To assess the QOL of HF patients, comparing men and women. Methods: A single-center transversal descriptive study applying the MLHFQ to HF patients with reduced ejection fraction monitored at the HF Clinic of a University Hospital between October 2012 and March 2013. The MLHFQ findings were analyzed for these patients and compared by gender. Results: This study encompassed 74 patients: male (n=42; 56.8%) and female (n=32; 43.2%). A comparison of these two groups revealed no differences in their clinical characteristics and medications. The male group presented 0.27 hospitalizations/patient/year vs. 0.17 hospitalizations/patient/year in the female group (p=0.32). The average MLHFQ score was 35.6±18.9 for men and 47.8±24.0 for women (p=0.02). Conclusions: Despite fewer hospitalizations, a poorer QOL was noted among female HF patients, compared to the male group.