High-velocity resistance training improves executive function in mobility-limited older adults.

OBJECTIVES: To examine the effect of high-velocity resistance training (HVRT) on the executive function of middle-aged and older adults with and without mobility limitations. METHODS: Participants (n = 41, female: 48.9%) completed a supervised 12-week HVRT intervention (2 sessions/week; at 40-60% of one-repetition maximum). The sample included 17 middle-aged adults (40-55 years); 16 older adults (>60 years) and 8 mobility-limited older adults (LIM). Executive function was assessed before and after the intervention period and was reported as z-scores. Maximal dynamic strength, peak power, quadriceps muscle thickness, maximal isometric voluntary contraction (MVIC), and functional performance were also measured pre and post intervention. Training-related adaptations in cognitive measures were calculated using a Generalized Estimating Equation model. RESULTS: HVRT improved executive function in LIM (adjusted marginal mean differences [AMMD]: 0.21; 95%CI: 0.04, 0.38; p = 0.040) although no effect on middle-aged (AMMD: 0.04; 95%CI: -0.09; 0.17; p = 0.533) and older (AMMD: -0.11; 95%CI: -0.25; 0.02; p = 0.107) participants was observed. Improvements in maximal dynamic strength, peak power, MVIC, quadriceps muscle thickness, and functional performance were all associated with changes in executive function, and changes in the first four also seem to mediate the association between changes in functional performance and executive function. CONCLUSIONS: HVRT-induced improvement in executive function of mobility-limited older adults were mediated by changes in lower-body muscle strength, power, and muscle thickness. Our findings reinforce the relevance of muscle-strengthening exercises to preserve cognition and mobility in older adults.

Short-term impact of COVID-19 pandemic on low back pain: data from the PAMPA Cohort, Brazil.

BACKGROUND: To evaluate the short-term impact of COVID-19 pandemic on low back pain (LBP) outcomes in southern Brazil. METHODS: Data from the PAMPA Cohort were analyzed. Adults were recruited between June and July 2020 in the Rio Grande do Sul state using online-based strategies. Participants responded a self-reported, online questionnaire on LBP with two timepoints: before (retrospectively) and during COVID-19 pandemic. We assessed LBP experience, LBP-related activity limitation (no/yes), and LBP intensity (0 to 10 [strongest pain]). RESULTS: From a total sample of 2,321 respondents (mean age: 37.6 ± 13.5; 75.4% women), the prevalence of LBP did not change significantly from before (74.7% [95%CI 72.3; 76.9]) to the first months of pandemic (74.2% [95%CI 71.9; 76.3]). However, an increased pain levels (ß: 0.40; 95%CI 0.22; 0.58) and a higher likelihood for activity limitation due to LBP was observed (PR 1.14; 95%CI 1.01; 1.29). Longitudinal analyzes showed that age, gender, BMI, chronic diseases, physical activity, and anxiety and depression symptoms, were associated with LBP in the first pandemic months. CONCLUSION: Although the prevalence of LBP did not change at the first months of COVID-19 pandemic, LBP-induced impairment in daily activities and pain intensity was higher when compared to before the pandemic.

Effects of exercise training on inflammatory, neurotrophic and immunological markers and neurotransmitters in people with depression: A systematic review and meta-analysis.

BACKGROUND: Major depressive disorder is the most common type of mental disorder. The biological pathway by which exercise promotes its antidepressant effects remains uncleared. This study aimed to systematically review the chronic effect of exercise on blood biomarkers and its association with changes in depressive symptoms in adults with major depressive disorder. METHODS: Randomized controlled trials (RCT) published until February 2020 were screened in seven databases. Studies were systematically reviewed by two independent reviewers. Random effect meta-analysis was performed and reported as standardized mean differences (SMD) and 95 % confidence interval (CI). The meta- analysis protocol was registered with PROSPERO (CRD42021221177). RESULTS: From 3865 records, 12 studies (N = 757 participants, mean age [SD]: 43.0 [11.0], 66.2 % women) were included in this review. Exercise training resulted in superior increase in circulating BDNF (SMD: 0.44, 95%CI: 0.15, 0.73) and kynurenine (SMD: 0.29, 95%CI: 0.04, 0.54), and decrease depressive symptoms (SMD: -0.72, 95%CI: -1.08, -0.37) in adults with major depression disorder compared to control groups. Multivariate meta-regression analysis showed that improvements in circulating levels of BDNF, kynurenine and interleukyn-6 were associated with decreases in depressive symptoms. LIMITATIONS: Results were not stratified by the type of medication used by participants due to the lack of reporting of the included studies. Few studies provided data on other biomarkers (e.g., TNF-α and IL-10) besides BNDF and kynurenine. CONCLUSIONS: Antidepressant effect of exercise may be triggered by improved circulating levels of BNDF, kynurenine, and interleukine-6 in adults with major depressive disorder.

Prevalence of anxiety during the COVID-19 pandemic: A systematic review and meta-analysis of over 2 million people.

INTRODUCTION: Uncertainty, disruptions in daily routines, and concerns for the health and well-being during the COVID-19 pandemic are likely associated with increases in generalized anxiety. The present study aimed to systematically review the literature in order to identify the update prevalence of anxiety in the general population during the COVID-19 pandemic. METHODS: A systematic review and meta-analysis. It included studies that assessed the prevalence of anxiety among the general population during the COVID-19 pandemic. RESULTS: In total, we included 194 studies. The general prevalence of anxiety was 35.1 %, affecting approximately 851,000 participants. The prevalence in low and middle-income countries (35.1 %; 95%CI: 29.5 % to 41.0 %) was similar compared to high-income countries (34.7 %; 95%CI: 29.6 % to 40.1 %). In studies that provided the proportion of cases in each level of anxiety disorder, mild-to-moderate anxiety affected one quarter of the participants. One in ten cases with anxiety during the COVID-19 may be living with severe or extremely anxiety disorder. Most instruments estimated similar prevalence of anxiety disorders with notable difference in the prevalence estimated by the Generalized Anxiety Disorder 2-item (GAD-2), Zung Self-Rating Anxiety Scale (SAS), and State-Trait Anxiety Inventory (STAI). CONCLUSION: One in three adults were living with anxiety disorder during the COVID-19 pandemic worldwide.

Physical activity and the incidence of depression during the COVID-19 pandemic in Brazil: Findings from the PAMPA cohort.

We examined the longitudinal association between physical activity (PA) and the incidence of self-reported diagnosed depression in adults in southern Brazil during the COVID-19 pandemic. Data from the PAMPA (Prospective Study About Mental and Physical Health) cohort was used. Data collection for baseline was carried out on June-July 2020, with two follow-up assessments taking place six months apart. An online, self-reported questionnaire assessed depression and PA. Depression was assessed by asking participants whether they were ever diagnosed with depression. We included 441 participants (women: 75.9%; mean age [SD]: 38.0 [13.5]) in southern Brazil. Over the follow-up, 21.8% (95% confidence interval [CI]: 18.1%-25.9%) were diagnosed with depression. Insufficiently active (<150 min per week of physical activity) (Incidence rate [IR]: 61.9; 95%CI: 39.5-102.4; p = 0.047) and active (≥150 min per week of physical activity) (IR: 50.4; 95%CI: 31.9-84.0; p = 0.015) participants had reduced IR of depression per 1000 persons-year at risk compared to inactive ones (0 min per week of physical activity) (IR: 99.9; 95%CI: 79.7-126.8). In the adjusted analyses, participants in the insufficient active (hazard ratio [HR]: 0.58; 95%CI: 0.34-0.98) and active (HR: 0.53; 95%CI: 0.31-0.93) group had a lower risk of developing depression than the inactive group. PA both at and out of home reduced the risk of incident depression (HR: 0.49; 95%CI: 0.25-0.98) compared to no physical activity. Endurance (HR: 0.52; 95%CI: 0.28-0.97) and endurance plus strengthening (HR: 0.40; 95%CI: 0.17-0.95) PA reduced the risk of incident depression compared to none. Being physically active during pandemic, regardless of the amount of PA practiced, reduced the incidence of depression in adults in southern Brazil.

How do different interventions impact stair climbing? A systematic review and meta-analysis.

OBJECTIVES: This study aimed to analyze the effect of interventions to increase stair use. STUDY DESIGN: Systematic review and meta-analysis. METHODS: An online search was conducted in January 2021 in five databases (Web of Science, SPORTDiscus, MedLine/PubMed, PsycINFO, and CINAHL). Experimental studies (randomized and non-randomized) conducted in adults, which provided stair use measures with pre- and post-intervention periods were included. A random-effect meta-analysis, as well as subgroup analyses were conducted to evaluate the quantitative effect of interventions on stair use. RESULTS: Overall, 34 studies were included in qualitative analyses, and 15 in the meta-analysis. Most of the studies were conducted in Europe and private settings (e.g., office buildings). Overall, interventions increased stair use in adults (odds ratio (OR) 1.48; 95% confidence intervals (CI) 1.38-1.58; I2 = 99.6%). Subgroup analyses showed that interventions increased stair use regardless of the continent and observer type (manual or electronic). However, different settings (shopping malls and office buildings), as well as studies (time of intervention) and intervention characteristics (sign size and location, message characters) were associated with increased stair use. CONCLUSIONS: Different interventions can increase stair use in several continents and settings. Sign and message characteristics should be considered when designing interventions or policies to promote physical activity by increasing stair use.

Incidence of multimorbidity and associated factors during the COVID-19 pandemic in Brazil: a cohort study

ABSTRACT BACKGROUND: Due to the coronavirus disease 2019 (COVID-19) pandemic, access to healthcare services may have become difficult, which may have led to an increase in chronic diseases and multimorbidity. OBJECTIVES: To assess the incidence of multimorbidity and its associated factors among adults living in the state of Rio Grande do Sul, Brazil. DESIGN AND SETTING: Cohort study conducted in Rio Grande do Sul, Brazil. METHODS: We included data from the two waves of the Prospective Study About Mental and Physical Health (PAMPA). Data were collected via online questionnaires between June and July 2020 (wave 1) and between December 2020 and January 2021 (wave 2). Multimorbidity was defined as the presence of two or more diagnosed medical conditions. RESULTS: In total, 516 individuals were included, among whom 27.1% (95% confidence interval, CI: 23.5-31.1) developed multimorbidity from wave 1 to 2. In adjusted regression models, female sex (hazard ratio, HR: 1.97; 95% CI: 1.19-3.24), middle-aged adults (31-59 years) (HR: 1.78; 95% CI: 1.18-2.70) and older adults (60 or over) (HR: 2.41; 95% CI: 1.25-4.61) showed higher risk of multimorbidity. Back pain (19.4%), high cholesterol (13.3%) and depression (12.2%) were the medical conditions with the highest proportions reported by the participants during wave 2. CONCLUSION: The incidence of multimorbidity during a six-month period during the COVID-19 pandemic was 27.1% in the state of Rio Grande do Sul, Brazil.

Incidence of multimorbidity and associated factors during the COVID-19 pandemic in Brazil: a cohort study.

BACKGROUND: Due to the coronavirus disease 2019 (COVID-19) pandemic, access to healthcare services may have become difficult, which may have led to an increase in chronic diseases and multimorbidity. OBJECTIVES: To assess the incidence of multimorbidity and its associated factors among adults living in the state of Rio Grande do Sul, Brazil. DESIGN AND SETTING: Cohort study conducted in Rio Grande do Sul, Brazil. METHODS: We included data from the two waves of the Prospective Study About Mental and Physical Health (PAMPA). Data were collected via online questionnaires between June and July 2020 (wave 1) and between December 2020 and January 2021 (wave 2). Multimorbidity was defined as the presence of two or more diagnosed medical conditions. RESULTS: In total, 516 individuals were included, among whom 27.1% (95% confidence interval, CI: 23.5-31.1) developed multimorbidity from wave 1 to 2. In adjusted regression models, female sex (hazard ratio, HR: 1.97; 95% CI: 1.19-3.24), middle-aged adults (31-59 years) (HR: 1.78; 95% CI: 1.18-2.70) and older adults (60 or over) (HR: 2.41; 95% CI: 1.25-4.61) showed higher risk of multimorbidity. Back pain (19.4%), high cholesterol (13.3%) and depression (12.2%) were the medical conditions with the highest proportions reported by the participants during wave 2. CONCLUSION: The incidence of multimorbidity during a six-month period during the COVID-19 pandemic was 27.1% in the state of Rio Grande do Sul, Brazil.

Physical activity trajectory in the first 10 months of the COVID-19 pandemic in Southern Brazil: a follow-up study.

BACKGROUND: A continuous tracking of the PA level during the COVID-19 pandemic is important to understand how people's behaviour has varied along time. The aim of this study was to evaluate the physical activity (PA) trajectory over the first 10 months of the COVID-19 pandemic in the south of Brazil. METHODS: Data from three timepoints of the PAMPA Cohort were used, as follows: (1) pre-COVID-19 (retrospective); (2) Jun/Jul 2020; (3) Dec 2020/Jan 2021. Self-reported PA practice, frequency, duration, as well as place where activities were performed (at or out of home) were assessed. RESULTS: A reduction in any (from 68.7 to 47.7%), sufficient (from 41.5 to 22.1%) and out of home PA (from 59.4 to 30.1%) was observed from the first (pre-COVID-19) to the second (Jun/Jul 2020) timepoint, followed by an increase in the third timepoint (Dec 2020/Jan 2021) (60.1%, 37.9%, and 54.3% for any, sufficient, and out of home PA, respectively). The PA trajectory was similar, regardless of sex, educational level or income. Only any (p = 0.0007) and sufficient (p = 0.0012) PA showed significant interaction with time by sex. Female participants were less likely to engage in any (OR 0.45 95% CI 0.26; 0.77) and sufficient PA (OR 0.40 95% CI 0.24; 0.66). CONCLUSION: During the first 10 months of COVID-19 pandemic there was a marked fluctuation on PA pattern in adults from southern Brazil. An ongoing tracking of PA behaviour during COVID-19 pandemic is important to understand how this behaviour varies. Public policies should focus on increasing PA in a higher standard than pre-COVID levels.

Are gender differences in physical inactivity associated with the burden of dementia in low- and lower-middle income countries?

We explore the association between gender differences in physical inactivity and dementia in low and lower-middle-income countries (LLMIC). Data were extracted from the Repository of the Global Health Observatory and the United Nations Development Program with 2016 as reference year. Sample was composed using countries with a Human Development Index lower than 0.700. We calculated the population attributable fraction for physical inactivity in dementia. Absolute and relative gender differences in physical inactivity were calculated by subtracting and dividing the prevalence of physical inactivity among men from women's prevalence, respectively. Physical inactivity accounts for 12.25% cases of dementia in LLMIC. Women account for 58% of deaths and 56% of DALY's due to dementia in LLMIC. Adjusted prevalence of dementia was associated with prevalence and absolute gender difference in physical inactivity. DALYs and deaths due to dementia were associated with absolute and relative gender differences in physical inactivity. A reduction of 10% in physical inactivity only among women might reproduce a similar decline in the burden of dementia compared to the same 10% decrease in physical inactivity in the whole LLMIC population. Decreasing gender gap in physical inactivity may be an alternative approach to reduce the burden of dementia in LLMIC.

Ethnoracial disparity among patients with dementia during COVID-19 pandemic.

We aim to examine the effect of the COVID-19 pandemic on the ethnoracial disparities in hospitalizations due to dementia and its related outcomes, in Brazil. A longitudinal panel study was carried out with data extracted from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS). We assessed the number of hospital admission per 100,000 inhabitants, mean inpatient spending, and inpatient mortality rate due to dementia during the first semester of 2019 and 2020. Data were stratified by geographic region and ethnoracial groups (black, mixed, and white) based on skin color. We observed an overall reduction in hospital admissions, mean inpatient spending, and mortality rate between the first semester of 2019 and 2020. However, the reduction of hospitalization rates among black and mixed people was 105.3% and 121.1% greater than in whites, respectively. Mortality rate was decreased by 9% in whites and was increased by 65% and 43% in the black and mixed population, respectively. In the first semester of 2020, black and mixed patients had a higher risk of losing their lives due to dementia than white people. This disparity was not observed in the same period of 2019. In 2020, the inpatient mortality ratio reached the highest values among black individuals in all regions but the North (no data available). Since the beginning of the COVID-19 epidemic in Brazil, ethnoracial disparity in hospital admissions and mortality rates due to dementia has been heightened. Governmental actions and policies to mitigate this indirect effect of the pandemic on the Brazilian population are urgent.

Physical activity attenuates the risk for dementia associated with aging in older adults with mild cognitive impairment. Findings from a population-based cohort study.

From 2016 to 2040 the number of people with dementia in the United Kingdom is expected to increase by 57%, while 70% percent of it is due to a higher life expectancy. Thus, we analyzed the overall and age-stratified effect of physical activity on risk of dementia in participants with mild cognitive impairment (MCI) of the English Longitudinal Study of Ageing (ELSA). Participants of the ELSA, aged over 50 with MCI, were followed-up nine times between 2002 and 2019. Physical activity was assessed using a self-reported, validated questionnaire and participants were classified as inactive, low, or moderate-to-high active. Medical diagnosis of dementia was self-reported or determined using the Informant Questionnaire on Cognitive Decline in the Elderly. Data from 521 participants with MCI were analyzed (56% women; mean [SD] age, 68.7 [10.6]). Over 17-year follow-up, 20.5 (95%CI: 17.3 to 24.2)% were diagnosed with dementia. The risk of incident dementia was reduced in participants engaging in low (HR: 0.34; 95%CI: 0.22 to 0.54) or moderate-to-high (HR: 0.16; 95%CI: 0.08 to 0.33) levels of physical activity. Risk of dementia in adults aged 80 or more engaging in low or moderate-to-high levels of physical activity was not different from inactive adults aged between 50 and 69 years. Results were sustained after competing risk regression model and sensitivity analyses to reduce the impact of reverse causality. Physical activity appears to minimize the risk associated with aging in older adults with MCI.

Increasing physical activity by Gamification among Brazilian high school students: a pilot study / Aumento da atividade física por gamificação em estudantes brasileiros do ensino médio: um estudo piloto

This pilot study aimed to evaluate the effectiveness of a Gamification-based intervention on physical activity levels of High School students. This quasi-experimental study was conducted in two federal high schools in Southern Brazil. One class from each school was selected to be either intervention (INT) or control (CON) group. Experiment duration was two weeks, and both groups downloaded My Active Life app. INT group (n = 69) participants received daily app alerts with messages of en-couragement to practice physical activity. They also received a score based on the percentage of goal achieved. CON group (n = 35) only had access to total number of steps per day. INT group showed a lower decrease in physical activity at school compared to CON group (p = 0.024). No effect of inter-vention was observed in physical activity out of school (p = 0.911). Gamification-based intervention prevented a decrease in physical activity at school among male (F = 10.680; p = 0.004), students at first half of high school (F = 12.668; p = 0.002), and adequate body mass index (F = 4.640; p = 0.037), and with lower perception of barriers to physical activity (F = 5.437; p = 0.024). Although we did not observe an increase in physical activity at school, gamification-based intervention may mitigate its decrease among adolescents

Este estudo piloto teve como objetivo avaliar a eficácia de uma intervenção baseada em gamificação nos níveis de atividade física de alunos do ensino médio. Este estudo quase-experimental foi realizado em duas escolas federais de ensino médio no sul do Brasil. Uma turma de cada escola foi selecionada para ser um grupo de intervenção (INT) ou controle (CON). A duração do experimento foi de duas semanas, e ambos os grupos baixaram o aplicativo My Active Life. Os participantes do grupo INT (n = 69) receberam alertas diários no app com mensagens de incentivo à prática de atividade física. Eles também receberam uma pontuação com base no percentual de meta alcançada. O grupo CON (n = 35) só teve acesso ao número total de passos por dia. O grupo INT apresentou menor diminuição da atividade física na escola em comparação ao grupo CON (p = 0,024). Nenhum efeito da intervenção foi observado na atividade física fora da escola (p = 0,911). A intervenção baseada na gamificação evitou uma diminuição da atividade física na escola entre meninos (F = 10,680; p = 0,004), alunos na primeira metade do ensino médio (F = 12,668; p = 0,002) e índice de massa corporal adequado (F = 4,640; p = 0,037), e com menor percepção de barreiras à atividade física (F = 5,437; p = 0,024). Embora não tenhamos observado aumento da atividade física na escola, a intervenção baseada na gamificação pode atenuar sua diminuição entre os adolescentes

Ethnoracial disparity among patients with dementia during COVID-19 pandemic / Disparidade étnico-racial entre pacientes com demência durante a pandemia da COVID-19 / Disparidad étnico-racial entre pacientes con demencia durante la pandemia de COVID-19

Abstract: We aim to examine the effect of the COVID-19 pandemic on the ethnoracial disparities in hospitalizations due to dementia and its related outcomes, in Brazil. A longitudinal panel study was carried out with data extracted from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS). We assessed the number of hospital admission per 100,000 inhabitants, mean inpatient spending, and inpatient mortality rate due to dementia during the first semester of 2019 and 2020. Data were stratified by geographic region and ethnoracial groups (black, mixed, and white) based on skin color. We observed an overall reduction in hospital admissions, mean inpatient spending, and mortality rate between the first semester of 2019 and 2020. However, the reduction of hospitalization rates among black and mixed people was 105.3% and 121.1% greater than in whites, respectively. Mortality rate was decreased by 9% in whites and was increased by 65% and 43% in the black and mixed population, respectively. In the first semester of 2020, black and mixed patients had a higher risk of losing their lives due to dementia than white people. This disparity was not observed in the same period of 2019. In 2020, the inpatient mortality ratio reached the highest values among black individuals in all regions but the North (no data available). Since the beginning of the COVID-19 epidemic in Brazil, ethnoracial disparity in hospital admissions and mortality rates due to dementia has been heightened. Governmental actions and policies to mitigate this indirect effect of the pandemic on the Brazilian population are urgent.

Resumo: O estudo teve como objetivo examinar o efeito da pandemia da COVID-19 sobre disparidades étnico-raciais nas hospitalizações e desfechos relacionados à demência no Brasil. Foi realizado um estudo de painel longitudinal com dados extraídos do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Avaliamos o número de internações hospitalares por 100 mil habitantes, média de gastos hospitalares e taxa de mortalidade por demência durante o primeiro semestre de 2019 e de 2020. Os dados foram estratificados por região geográfica e grupo étnico-racial (preto, pardo e branco) com base na cor da pele. Observamos uma redução geral nas internações, média de gastos hospitalares e taxa de mortalidade entre o primeiro semestre de 2019 e o mesmo período em 2020. Entretanto, as reduções nas taxas de hospitalização entre pretos e pardos foram 105,3% e 121,1% maiores que em brancos, respectivamente. A taxa de mortalidade diminuiu em 9% entre brancos e aumentou em 65% e 43% entre pretos e pardos, respectivamente. No primeiro semestre de 2020, pacientes pretos e pardos tiveram um risco mais alto de perder a vida por demência quando comparados aos brancos, disparidade essa não havia sido observada no mesmo período de 2019. Em 2020, a razão de mortalidade hospitalar atingiu os níveis mais altos em indivíduos pretos em todas as regiões exceto a Norte (dados não publicados). Desde o início da epidemia de COVID-19 no Brasil, aumentou a disparidade étnico-racial nas internações e taxas de mortalidade por demência. São necessárias medidas e políticas governamentais para mitigar esse efeito indireto da pandemia sobre a população brasileira.

Resumen: El objetivo fue examinar el efecto de la pandemia de COVID-19 respecto a las disparidades étnico-raciales en hospitalizaciones, así como los resultados informados de las mismas, debido a la demencia en Brasil. Se trata de un estudio longitudinal en panel, realizado con datos extraídos del Sistema de Informaciones Hospitalarias del Sistema Único de Salud (SIH/SUS). Evaluamos el número de admisiones hospitalarias por 100.000 habitantes, la media del gasto hospitalario, además de la tasa de mortalidad hospitalaria, debido a la demencia, durante el primer semestre de 2019 y 2020. Los datos fueron estratificados por región geográfica y grupos étnico-raciales (negros, mestizos, y blancos), basados en su color de piel. Observamos en general una reducción en las admisiones hospitalarias, media del gasto hospitalario, y tasa de mortalidad entre el primer semestre de 2019 y 2020. No obstante, la reducción de las tasas de hospitalización entre negros y mestizos fue 105.3% y 121.1% superior, respecto a la de los blancos, respectivamente. La tasa de mortalidad decreció un 9% en blancos y aumentó en un 65% y un 43% en la población negra y mestiza, comparativamente. En el primer semestre de 2020, los pacientes negros y mestizos tenían un riesgo más alto de fallecer, debido a la demencia que la gente blanca, esta disparidad no se observó en el mismo periodo de 2019. En 2020, la ratio de mortalidad hospitalaria alcanzó los valores más altos entre individuos negros en todas las regiones, salvo en el Norte (no había datos disponibles). Desde el principio de la epidemia de COVID-19 en Brasil, la disparidad étnico-racial en las admisiones hospitalarias y tasas de mortalidad, debido a la demencia, se ha incrementado. Son urgentes acciones gubernamentales y políticas para mitigar este efecto indirecto de la pandemia en la población brasileña.

Effect of combined physical training on cognitive function in people with epilepsy: Results from a randomized controlled trial.

OBJECTIVE: To examine the effect of 12-week exercise program on cognitive function in people with epilepsy. METHODS: Twenty-one physically inactive subjects were randomized into two groups: the exercise group (EG) or the control group (CG). EG performed 12 weeks of combined physical training. CG was advised to maintain usual daily activities. EG received a structured, individually supervised exercise program with two 60-minute sessions per week. Each session included warmup (5-minutes), aerobic (15-20 minutes at 14-17 on Borg scale), strength (2-3 sets, 10-15 repetitions), and 5-minute active stretches. Sociodemographic characteristics, clinical information, memory (Digit Span Test [DST]), executive function (Trail Making Test [TMT] A and B), Stroop Color and Word Test, a verbal fluency task, global cognitive function (Montreal Cognitive Assessment [MoCA]), anthropometric measurements (weight, height, and hip and waist circumferences), cardiorespiratory fitness (maximal oxygen consumption [VO2 max]), and strength (dynamometer) were measured at baseline and after the 12-week intervention. RESULTS: Exercise decreased time spent on TMT-A from baseline to postintervention (difference = -7.9 seconds, 95% confidence interval [CI] = -14.5 to -1.3, P = .023). EG improved total number of words on the verbal fluency task after intervention (difference = 8.1 words, 95% CI = 3.0 to 13.2, P = .002). EG also improved the score on MoCA at 1.7 (95% CI = 0.1 to 3.3, P = .043) points. We observed a 22.4% (95% CI = 13.1 to 31.6, P = .021) improvement in executive function in EG. No effect of group, time, or group × time was observed on any other cognitive test. Changes in VO2 max were negatively associated with changes in performance on DST (r = -.445, P = .049) and overall memory score (r = -.544, P = .042). SIGNIFICANCE: This randomized controlled trial provided the first evidence that combined physical training improves executive function in adults with epilepsy, showing main improvements in attention and language tasks. Physical exercise should be encouraged for people with epilepsy to reduce the burden on cognitive function associated with this disease.