Pilates method for low back pain in individuals with Parkinson's disease: A feasibility study.

BACKGROUND: Pain is one of the most common and troublesome non-motor symptoms in Parkinson's disease (PD), including low back pain (LBP). OBJECTIVE: This study aims to evaluate the feasibility, acceptability, and safety of using Pilates for individuals with PD and LBP, as well as the effect on pain intensity, disability, motor and nonmotor PD symptoms, and quality of life. METHODS: Participants received 24 sessions of supervised Pilates twice a week for 12 weeks, each session consisting of 60 min. The isometric contractions of the core muscles were emphasized. RESULTS: Fifteen (13%) of the screened patients were enrolled in the study and continued for the entire 2 months (100%). Participants completed the full training in 352 of 360 sessions (98%). Adverse effects were not reported. Pain and disability were significantly improved after intervention (Visual Analog Scale, p = 0.007; McGill Pain Questionnaire, p = 0.034; Roland-Morris Disability Questionnaire, p = 0.035). There were also significant improvements in depressive symptoms (Beck Depression Inventory, p = 0.028) and PD symptoms (Unified Parkinson's Disease Rating Scale - UPDRSI, UPDRSIII, UPDRS Total). However, there were no statistically significant changes in fatigue and quality of life. CONCLUSIONS: This study suggests that the 12-week Pilates program is feasible and well tolerated by people with PD in mild to moderate stages of the disease. It also appears to be a promising strategy to reduce pain intensity and LBP-related disability, as well as PD motor and non-motor symptoms, which can be associated with this painful symptom. This study provides a basis for future investigations, especially randomized clinical trials.

Acute exercise increases BDNF serum levels in patients with Parkinson's disease regardless of depression or fatigue.

Studies have consistently reported a decreased level of brain-derived neurotrophic factor (BDNF) in individuals with Parkinson's disease (PD). The benefits of exercise on BDNF levels are well-documented in humans, however, the effects of acute exercise are inconclusive in neurological disorders. In addition, there are no studies investigating a precursor molecule - proBDNF - and its comparison to patients with vs. without depression or fatigue. Thirty patients with PD were instructed to walk on a treadmill at light to moderate intensity for 30 min. Generalized Estimating Equation (GEE) showed a significant effect of time (pre- vs. post-exercise) when compared individuals with vs. without depression [Wald Chi Square (4.392), p = 0.036)] and with vs. without fatigue [Wald Chi Square (7.123), p = 0.008)] for mature BDNF (mBDNF) level. There was no effect of group, time, and group x time interaction for proBDNF level when compared individuals with vs. without depression or fatigue. The present study showed that a single bout of light to moderate-intensity exercise increases mBDNF serum levels in patients with PD regardless of depression and fatigue. Our finding is important because it is necessary investigate methods to enhance the gains made by rehabilitation, especially when considering a short period of rehabilitation in different health services. The increase in mBDNF level can lead to an enhancement of neuroplasticity and facilitate the improvement of motor performance. No effect on proBDNF level could be explained, as this precursor molecule is cleaved by intracellular or extracellular enzymes.

Cross-cultural adaptation of the Activities of Daily Living Questionnaire-Brazil in Parkinson's disease.

BACKGROUND: Culturally adapted measures to assess the performance of activities of daily living (ADL) in individuals with Parkinson's disease (PD) are limited in Brazil. OBJECTIVE: To adapt the ADL Questionnaire to the Brazilian culture and to analyze its reproducibility in individuals with PD. METHODS: The ADL Questionnaire was translated and cross-culturally adapted to Brazilian Portuguese language. Reproducibility was analyzed using test-retest reliability and agreement values. The test-retest reliability of the individual items and total scores were calculated. The limits of agreement were verified using the Bland-Altman plot. The standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated. Patients who were classified on a score of 1-4 on the modified Hoehn and Yahr scale were eligible. RESULTS: No divergence was identified between the original and the adapted version, which demonstrated adequate semantic and conceptual equivalence. The Bland-Altman plot showed no systematic changes in the mean test-retest scores. The intraclass correlation coefficient (ICC) was 0.98 (95% confidence interval [95%CI] 0.93-0.99), and all individual items showed good levels of reliability (>0.60). The SEM (SEM%) and MDC (MDC%) values were 3.0 (6.75%) and 8.2 (18.7%), respectively. These values are within the recommended values. CONCLUSIONS: The ADL-Brazil Questionnaire is a reliable instrument to be used for clinical and research purposes to assess self-perceptions of ADL performance in individuals with PD.

Cross-cultural adaptation of the activities of daily living questionnaire-Brazil in parkinson's disease / Adaptação transcultural do questionário de atividades de vida diária-Brasil para doença de parkinson

ABSTRACT Background: Culturally adapted measures to assess the performance of activities of daily living (ADL) in individuals with Parkinson's disease (PD) are limited in Brazil. Objective: To adapt the ADL Questionnaire to the Brazilian culture and to analyze its reproducibility in individuals with PD. Methods: The ADL Questionnaire was translated and cross-culturally adapted to Brazilian Portuguese language. Reproducibility was analyzed using test-retest reliability and agreement values. The test-retest reliability of the individual items and total scores were calculated. The limits of agreement were verified using the Bland-Altman plot. The standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated. Patients who were classified on a score of 1-4 on the modified Hoehn and Yahr scale were eligible. Results: No divergence was identified between the original and the adapted version, which demonstrated adequate semantic and conceptual equivalence. The Bland-Altman plot showed no systematic changes in the mean test-retest scores. The intraclass correlation coefficient (ICC) was 0.98 (95% confidence interval [95%CI] 0.93-0.99), and all individual items showed good levels of reliability (>0.60). The SEM (SEM%) and MDC (MDC%) values were 3.0 (6.75%) and 8.2 (18.7%), respectively. These values are within the recommended values. Conclusions: The ADL-Brazil Questionnaire is a reliable instrument to be used for clinical and research purposes to assess self-perceptions of ADL performance in individuals with PD.

RESUMO Antecedentes: Medidas adaptadas transculturalmente para avaliar o desempenho nas atividades de vida diária (AVD) em indivíduos com doença de Parkinson (DP) são limitadas no Brasil. Objetivo: Adaptar transculturalmente o Questionário AVD e analisar sua reprodutibilidade em indivíduos com DP. Métodos: O Questionário AVD foi traduzido e adaptado transculturalmente para o português do Brasil. A reprodutibilidade foi analisada usando a confiabilidade teste-reteste e os valores de concordância. A confiabilidade dos itens individuais e as pontuações totais foram calculadas. Os limites de concordância foram verificados usando o gráfico Bland-Altman. O erro padrão da medida (EPM) e a diferença mínima detectável (DMD) foram calculadas. Pacientes classificados nos estágios 1-4 da escala de Hoehn e Yahr foram elegíveis. Resultados: Não foi identificada divergência entre a versão original e a versão adaptada, que demonstrou equivalência semântica e conceitual adequada. O gráfico Bland-Altman não mostrou mudanças sistemáticas nas pontuações médias do teste-reteste. O coeficiente de correlação intraclasse (CCI) foi de 0,98 (intervalo de confiança de 95% [IC95%] 0,93-0,99) e todos os itens individuais apresentaram bons níveis de confiabilidade (>0,60). Os valores do EPM (EPM%) e DMD (DMD%) foram 3,0 (6,75%) e 8,2 (18,7%), respectivamente. Esses valores estão em conformidade com os valores recomendados. Conclusões: O Questionário AVD-Brasil é um instrumento confiável para uso clínico e de pesquisa para avaliar a autopercepção do desempenho nas AVD em indivíduos com DP.

King's Parkinson's Disease Pain Scale (KPPS): Cross-cultural adaptation to Brazilian Portuguese and content validity.

Pain is one of the most common and troublesome non-motor symptoms of Parkinson's disease (PD). The King's Parkinson's Disease Pain Scale (KPPS) is the first scale of its kind to evaluate the burden and characterization of various phenotypes of pain in individuals with PD. The purpose of this study was to adapt the KPPS to Brazilian culture and to assess its content validity using the Delphi method. The process of adapting the original instrument to the Brazilian context occurred in six stages according to international standards. Following the pilot tests with individuals with PD, the pre-final version of the KPPS-Brazil was developed and submitted to judges to assess content validity. Three evaluation rounds were conducted, in which several corrections and changes suggested by the judges were accepted. The Content Validity Index (CVI) was calculated to determine the judges' degree of agreement. The results demonstrated that the KPPS-Brazil showed a quite satisfactory level of semantic, idiomatic, cultural, and conceptual equivalence. The judges' opinion showed adequate content validity for all of the KPPS-Brazil items and the scale. The use of the KPPS-Brazil will enable an adequate assessment of pain in individuals with PD, contributing to clinical practice and research.

The Distance Covered in Field Tests is more Explained by Walking Capacity than by Cardiorespiratory Fitness after Stroke.

OBJECTIVES: To investigate if the distance covered in the Six-Minute Walk Test (6MWT) and in the Incremental Shuttle Walk Test (ISWT) is most strongly explained by walking capacity or cardiorespiratory fitness (CRF) measures in individuals after chronic stroke. MATERIALS AND METHODS: This is a cross-sectional study. Individuals after chronic stroke aged at least 20 years old and able to walk at least 10 minutes independently were included. The distance covered (meters) in the 6 MWT and ISWT (dependent variables), comfortable and fast gait speed obtained by the 10 m walk test (10 mWT) (walking capacity measures; independent variables) and peak oxygen consumption (VO2peak; CRF measure; independent variable) (ml.kg-1.min-1) obtained by the cardiopulmonary exercise test (CPET) were obtained. Linear regression analyses were performed (α = 5%). RESULTS: Fifty individuals (mean age of 55±12 years and mean time after stroke of 67±74 months) were included. Comfortable and fast gait speeds were the variables that most strongly explained the distance covered in the field tests: 6MWT (R² = 0.614, ß = 0.784, p < 0.001 and R² = 0.615, ß = 0.778, p < 0.001, respectively) and ISWT (R² = 0.450, ß = 0.671, p < 0.001 and R² = 0.456, ß = 0.746, p < 0.001, respectively). On the other hand, for the VO2peak, the following models were generated: 6MWT (R² = 0.280, ß = 0.530, p < 0.001) and ISWT (R² = 0.154, ß = 0.393, p = 0.005). CONCLUSIONS: The distance covered in the field tests (6MWT and ISWT) is more suitable to support inferences about the walking capacity than about the CRF of individuals after chronic stroke.

Functional mobility in Parkinson's disease: associations with motor and non-motor symptoms / Mobilidade funcional em indivíduos com doença de Parkinson: associações com alterações motoras e não motoras

Functional mobility (FM) is the ability of people to move in different environments, including at home, at work, and in the community, in order to perform functional activities or tasks, independently and safely. Objective: The aim of the present study was to investigate which motor and/or non-motor symptoms (severity of the motor symptoms, depressive symptoms, and fatigue) have the greatest impact on FM assessed by Modified Parkinson Activity Scale (mPAS) in individuals with Parkinson's disease (PD). Method: The outcome of interest was FM assessed by mPAS, which includes 14 activities covering three domains (chair transfers, gait akinesia, and bed mobility). Unified Parkinson's Disease Rating Scale (UPDRS) Part III, Beck Depression Inventory (BDI), and Parkinson's Disease Fatigue Scale-16 (PFS-16) were used. Results: Forty-four individuals (age: 65±11 years) with PD (PD duration: 7±4 years) were eligible to take part in this cross-sectional, exploratory study. The motor symptoms alone explained 36% (F= 17.85, p<0.001) of the variance in the FM scores. When depressive symptoms were included in the model, the explained variance increased to 45% (F= 12.77, p<0.001). This indicated that individuals who had lower motor and depressive symptoms were less likely to have limitations in FM. Conclusion: The findings of the present study demonstrated that motor symptoms were the best potential predictor of FM in individuals with PD, according to mPAS scores. Additionally, the presence of depressive symptoms should not be overlooked.

Mobilidade funcional (MF) é a capacidade das pessoas de se movimentarem em diferentes ambientes, incluindo em casa, no trabalho e na comunidade, a fim de realizar atividades ou tarefas funcionais, de forma independente e segura. Objetivo: Investigar quais variáveis (gravidade das alterações motoras, sintomas depressivos e fadiga) têm maior impacto na MF avaliada por meio da Escala Modificada de Atividade em Parkinson (mPAS) em indivíduos com doença de Parkinson (DP). Método: A MF avaliada por meio da mPAS, que inclui 14 atividades em três domínios (transferências de cadeira, acinesia da marcha, mobilidade na cama). Escala Unificada de Avaliação da Doença de Parkinson (UPDRS) Parte III, Inventário de Depressão de Beck (BDI) e Escala de Fadiga da Doença de Parkinson-16 (PFS-16) foram usados. Resultados: 45 indivíduos (idade: 65 ± 11 anos) com DP (duração do DP: 7 ± 4 anos) participaram deste estudo transversal e exploratório. A gravidade das alterações motoras explicou 36% (F= 17,85, p <0,001) da variância nos escores de MF. Quando os sintomas depressivos foram incluídos no modelo, a variância explicada aumentou para 45% (F= 12,77, p <0,001). Isso indicou que indivíduos com menor gravidade das alterações motoras e sintomas depressivos eram menos propensos a ter limitações na MF. Conclusão: As alterações motoras foram o principal preditor da MF em indivíduos com DP, de acordo com os escores da mPAS. Além disso, a presença de sintomas depressivos não deve ser negligenciada.

Prática de atividade física e fisioterapia em indivíduos com doença de Parkinson / The practice of physical activity and physical therapy in individuals with Parkinson's disease

Objetivo: Avaliar o perfil da prática de atividade física (AF) e de fisioterapia em indivíduos com doença de Parkinson (DP). Métodos: Pacientes foram recrutados a partir de dois centros de desordens de movimento de Belo Horizonte (Ambulatório Bias Fortes da Universidade Federal de Minas Gerais e Centro Metropolitano de Especialidades Médicas da Santa Casa de Belo Horizonte) entre fevereiro a dezembro de 2019. Resultados: Cento e oitenta e cinco indivíduos responderam um questionário para coleta de dados sociodemográficos, história médica e prática de AF e/ou fisioterapia. Ao comparar os indivíduos dos dois centros, houve diferença apenas em relação à frequência de comorbidades. A hipertensão arterial foi a comorbidade mais comum. Apenas 37,8% e 20,5% dos indivíduos relataram praticar AF ou fazer fisioterapia, respectivamente. A caminhada foi a atividade física mais comum. Pacientes sedentários tinham idade mais avançada, menor tempo de escolaridade, maior duração da DP, e eram mais acometidos por outras comorbidades quando comparados aos pacientes mais ativos. Conclusão: O presente estudo mostra a influência da idade, da escolaridade e do tempo de DP na adesão à prática de AF e fisioterapia. Iniciativas de saúde pública são necessárias para promover a mudança de comportamento e melhorar as oportunidades de AF entre os indivíduos com DP

Objective: The present study aimed to evaluate the profile of physical activity (PA) and physical therapy in individuals with Parkinson's disease (PD). Methods: Patients were recruited from two Outpatient Movement Disorder Clinics (Ambulatório Bias Fortes, Universidade Federal de Minas Gerais, and Centro Metropolitano de Especialidades Médicas, Santa Casa de Belo Horizonte) between February and December 2019. Results: One hundred and eighty-five individuals answered a questionnaire with sociodemographic profiles, medical conditions, and the practice of PA and physical therapy. When comparing individuals from the two centers, differences were only observed concerning the frequency of comorbidities. Arterial hypertension proved to be the most prevalent comorbidity. Only 37.8% and 20.5% of the individuals reported practicing PA or physical therapy, respectively. Walking was the most common physical activity. Sedentary patients were older, had lower levels of education, presented a longer duration of PD, and were more affected by other comorbidities, when compared to more physically active patients. Conclusion: The present study shows the influence of age, education, and PD time on adherence to the practice of PA and physical therapy. Public health initiatives are needed to promote behavioral change and improve PA opportunities among individuals with PD

Low back pain in Parkinson's disease: A cross-sectional study of its prevalence, and implications on functional capacity and quality of life.

OBJECTIVE: The aim of this study was to estimate the prevalence of low back pain (LBP) in patients with Parkinson's disease (PD) and its impact on functional capacity and quality of life. METHODS: Patients with idiopathic PD answered a questionnaire and were submitted to a clinical and functional assessment. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr Scale, Beck Depression Inventory (BDI), McGill Pain Questionnaire (McGill), Roland Morris Disability Questionnaire (RMDQ), 39-item Parkinson's Disease Questionnaire (PDQ-39) were used. In addition, the ability to contract transversus abdominis (TrA) was assessed. RESULTS: One hundred and fifteen patients answered the questionnaire, and 95 (82.6 %) reported painful symptoms. Of these, 67 (58.3 %) had chronic LBP, and approximately 40 % patients reported its onset before diagnosis of PD. Higher scores in pain intensity, depressive symptoms and UPDRS II and III, more advanced stages of PD, and absence of TrA contraction determined poor functional limitation induced by LBP. However, pain intensity (McGill), severity of PD symptoms (UPDRS III) and absence of TrA contraction were identified as predictive factors for functional limitation and explained 66.1 % of the variance in the RMDQ. Pain intensity and LBP-related disability caused negative impact on the quality of life. CONCLUSION: LBP is common in patients with PD and it causes disability and poor quality of life. Pain intensity, UPDRS III and absence of TrA contraction were the most significant predictive factors for disability assessed by the RMDQ.

Can fatigue predict walking capacity of patients with Parkinson's disease?

Although fatigue is an expressive symptom of Parkinson's disease (PD), few studies have investigated the association between fatigue, mobility and walking capacity of these patients. OBJECTIVE: To investigate whether fatigue is an independent factor associated with mobility and the walking capacity in patients with PD. METHODS: Forty-eight patients with PD (22 with fatigue) were tested for mobility and their walking capacity: Timed Up and Go (TUG), 10-Meter Walk Test (10MWT) at usual and fastest speed, and 6-Minute Walk Test (6MWT). Fatigue was measured with Parkinson's Fatigue Scale (PFS-16). Linear regression analysis was used to investigate if fatigue is an independent factor contributing to variance in mobility and walking capacity. RESULTS: There was a positive correlation between PFS-16 and TUG (rs=0.385; p=0.007). There was a negative correlation between PFS-16 and 10MWT at comfortable (r=-0.385; p=0.007) and fast speeds (r=-0.396; p=0.005), and 6MWT (r=-0.472; p=0.001). Linear regression analysis revealed that fatigue did not explain the variance of TUG and 10MWT. PFS-16, age and section III of UPDRS explained 49.6% (adjusted R2; p<0.001) variance in the 6MWT, and fatigue was the most significant predictor (F=-32.1; p=0.022). CONCLUSIONS: Fatigue is an independent factor contributing to the distance covered during 6MWT in patients with PD. Our results highlight the importance of recognition and management of this symptom.

Can fatigue predict walking capacity of patients with Parkinson's disease? / A fadiga pode predizer a mobilidade e a capacidade de marcha em pacientes com doença de Parkinson?

ABSTRACT Although fatigue is an expressive symptom of Parkinson's disease (PD), few studies have investigated the association between fatigue, mobility and walking capacity of these patients. Objective: To investigate whether fatigue is an independent factor associated with mobility and the walking capacity in patients with PD. Methods: Forty-eight patients with PD (22 with fatigue) were tested for mobility and their walking capacity: Timed Up and Go (TUG), 10-Meter Walk Test (10MWT) at usual and fastest speed, and 6-Minute Walk Test (6MWT). Fatigue was measured with Parkinson's Fatigue Scale (PFS-16). Linear regression analysis was used to investigate if fatigue is an independent factor contributing to variance in mobility and walking capacity. Results: There was a positive correlation between PFS-16 and TUG (rs=0.385; p=0.007). There was a negative correlation between PFS-16 and 10MWT at comfortable (r=-0.385; p=0.007) and fast speeds (r=-0.396; p=0.005), and 6MWT (r=-0.472; p=0.001). Linear regression analysis revealed that fatigue did not explain the variance of TUG and 10MWT. PFS-16, age and section III of UPDRS explained 49.6% (adjusted R2; p<0.001) variance in the 6MWT, and fatigue was the most significant predictor (F=-32.1; p=0.022). Conclusions: Fatigue is an independent factor contributing to the distance covered during 6MWT in patients with PD. Our results highlight the importance of recognition and management of this symptom.

RESUMO Embora a fadiga seja um sintoma importante na doença de Parkinson (DP), poucos estudos investigaram a associação entre fadiga, mobilidade e capacidade de marcha nesses pacientes. Objetivo: Investigar se a fadiga é um fator independente associado à mobilidade e à capacidade de marcha em pacientes com DP. Métodos: Quarenta e oito pacientes com DP (22 com fadiga) foram avaliados com testes de mobilidade e capacidade de marcha: Timed Up and Go (TUG), Teste de Caminhada de 10 metros (T10m) na velocidade usual e máxima, Teste de Caminhada de Seis Minutos (TC6m). A fadiga foi medida pela Escala de Fadiga no Parkinson (PFS-16). A análise de regressão linear foi utilizada para investigar se a fadiga é um fator independente que contribui para a variação na mobilidade e capacidade de marcha. Resultados: Houve correlação positiva entre PFS-16 e TUG (rs=0,385; p=0,007). Houve correlação negativa entre PFS-16 e T10m na velocidade usual (r=-0,385; p=0,007) e máxima (r=-0,396; p=0,005) e TC6m (r=-0,472; p=0,001). Análise de regressão linear revelou que a fadiga não explicava a variância do TUG e T10m. A PFS-16, a idade e a seção III da UPDRS explicaram 49,6% (R2 ajustado, p<0,001) da variância no TC6m e a fadiga foi o preditor mais significativo (F=-32,1; p=0,022). Conclusões: A fadiga é um fator independente que contribui para a distância percorrida durante o TC6m em pacientes com DP. Nossos resultados destacam a importância do reconhecimento e manejo desse sintoma.

Aerobic Training Efficacy in Inflammation, Neurotrophins, and Function in Chronic Stroke Persons: A Randomized Controlled Trial Protocol.

BACKGROUND: Neuroinflammation is an important part of stroke pathophysiology and has both detrimental and beneficial effects after stroke. Besides that the enhancement of neurotrophins seems to be related to improvements in stroke recovery. Evidences suggest that exercise plays a role in modulating anti-inflammatory and neurotrophic effects. However, little is known about its impact in stroke survivors, mainly in chronic stroke. The purpose of this study is to investigate the efficacy of moderate-intensity treadmill exercise in changing inflammatory mediators, interleukin-6 (IL-6), soluble tumor necrosis factor receptors I and II (sTNFRI, sTNFRII), interleukin-10 (IL-10), and brain-derived neurotrophic factor (BDNF) levels in chronic stroke patients. The secondary objective is to investigate the effects of training in improve mobility and exercise capacity. METHODS: This is a randomized controlled trial. Chronic stroke patients will be randomized to an experimental or control group, and will receive group interventions three times per week, over 12 weeks. The experimental group will receive moderate-intensity (60%-80% of maximum heart rate reserve) treadmill exercise. Control group will perform walking training on the ground (<40% of maximum heart rate reserve). Primary outcomes include IL-6, sTNFRI, sTNFRII, IL-10, and BDNF levels. Secondary outcomes include mobility and exercise capacity. Outcomes will be measured at baseline, postintervention, and at the 4-week follow-up. DISCUSSION: The findings of this trial have the potential to provide important insights regarding the effects of an aerobic physical program in the inflammatory process and in the neuronal plasticity in stroke persons and its impact on mobility and exercise capacity.

Caracterização da dor em pacientes com doença de Parkinson / Pain characterization of Parkinson's disease patients

FUNDAMENTO: A dor é um sintoma não motor frequente em indivíduos com doença de Parkinson (DP). Pode estar associada aos sinais motores ou surgir no início da doença. Os mecanismos subjacentes à dor na DP ainda não são bem elucidados e muitos fatores podem influenciá-la, como o uso de levodopa e a presença de outros sintomas não motores, como depressão. OBJETIVOS: Descrever a prevalência e caracterizar a dor em pacientes com DP de um centro terciário referência em pesquisa e assistência clínica. MÉTODOS: Foram recrutados pacientes com diagnóstico de DP idiopática a partir do ambulatório de neurologia do Centro de Especialidades Médicas (CEM) da Santa Casa de Belo Horizonte/MG. Um questionário para coleta de dados sociodemográficos e clínicos foi aplicado. A função cognitiva, gravidade dos sinais e sintomas, depressão, distúrbios de sono e fadiga foram avaliados. A dor foi mensurada por meio do Questionário de McGill e Escala Visual Numérica. RESULTADOS: Participaram do estudo 45 pacientes, sendo que 19 (42,2%) apresentavam queixa de dor e, em sua maioria, após o diagnóstico de DP (74%). Não houve diferença entre os grupos com dor e sem dor para os parâmetros clínicos avaliados, com exceção da fadiga que foi mais prevalente (p=0,036) e mais grave (p=0,031) nos pacientes com dor. CONCLUSÃO: A dor é um sintoma prevalente em pacientes com DP atendidos no CEM. A partir dos resultados obtidos pelo McGill, observou-se que a dor crônica e profunda, acometendo principalmente os membros inferiores, com importantes aspectos sensoriais e afetivos, foi comum nos pacientes avaliados.

BACKGROUND: Pain is a common non-motor symptom in Parkinson´s Disease (PD). It can be associated to motor signs or can arise in the beginning of the disease. Mechanisms of pain in PD are not completely understood. Moreover, many factors can interfere, such as use of levodopa and presence of other non-motor symptoms as depression. OBJECTIVES: The aim of this study was to describe prevalence and characterization of pain in PD patients from a research and clinical terciary care center in Belo Horizonte, Minas Gerais, Brazil. METHODS: PD patients from the Neurology Center of Santa Casa Hospital (Belo Horizonte, MG, Brazil) were recruted. Socio-demographic and clinical data were collected. Cognitive function, severity of PD signs and symptoms, depression, sleep disturbance and fatigue were evaluated. Pain was measured by McGill Pain Questionnaire and Visual Numeric Scale (VNS). RESULTS: Forty-five PD patients participated in the study and 42,2% had pain complaints, mostly (74%) after PD diagnosis. No difference between group with pain or without pain for clinical parameters was detected, except for fatigue, which was more prevalent (p=0,036) and more severe (p=0.031) in patients with pain. CONCLUSION: Pain was very prevalent in PD patients from CEM. Results obtained from McGill showed that chronic and deep pain, mostly in lower limbs, with important physical and affective features was very common in this sample of PD patients.

Circulating levels of neurotrophic factors are unchanged in patients with Parkinson's disease.

There is great evidence linking neurotrophic factor (NF) dysfunction with Parkinson's disease (PD) pathophysiology. This study was conducted to evaluate plasma levels of NFs and their possible associations with clinical symptoms in PD. For this purpose, 40 PD patients and 25 controls were subjected to a clinical evaluation and peripheral blood draw. Plasma levels of brain-derived neurotrophic factor (BDNF), pro-BDNF, neurotrophin 3, neurotrophin 4, nerve growth, glial cell line-derived neurotrophic factor and ciliary neurotrophic factor were measured by enzyme-linked immunosorbent assay. There was no significant difference between PD patients and controls regarding the plasma levels of the evaluated NFs. In addition, NF levels were not associated with disease duration, degree of motor or functional impairment, cognitive performance or severity of depressive symptoms. In conclusion, although NFs may play relevant roles in the pathophysiology of PD, the circulating levels of these molecules are not necessarily changed in patients with PD.

Circulating levels of neurotrophic factors are unchanged in patients with Parkinson's disease / Os níveis circulantes de fatores neurotróficos não estão alterados em pacientes com doença de Parkinson

ABSTRACT There is great evidence linking neurotrophic factor (NF) dysfunction with Parkinson's disease (PD) pathophysiology. This study was conducted to evaluate plasma levels of NFs and their possible associations with clinical symptoms in PD. For this purpose, 40 PD patients and 25 controls were subjected to a clinical evaluation and peripheral blood draw. Plasma levels of brain-derived neurotrophic factor (BDNF), pro-BDNF, neurotrophin 3, neurotrophin 4, nerve growth, glial cell line-derived neurotrophic factor and ciliary neurotrophic factor were measured by enzyme-linked immunosorbent assay. There was no significant difference between PD patients and controls regarding the plasma levels of the evaluated NFs. In addition, NF levels were not associated with disease duration, degree of motor or functional impairment, cognitive performance or severity of depressive symptoms. In conclusion, although NFs may play relevant roles in the pathophysiology of PD, the circulating levels of these molecules are not necessarily changed in patients with PD.

RESUMO Há evidências de que alteracões nas ações exercidas por fatores neurotróficos (FNs) estejam associadas à fisiopatologia da doença de Parkinson (DP). O presente estudo foi conduzido para avaliar os níveis plasmáticos de FNs e suas possíveis associações com sintomas clínicos na DP. Para este fim, 40 pacientes com DP e 25 controles foram submetidos à avaliação clínica e coleta de sangue periférico. Os níveis plasmáticos do fator neurotrófico derivado do cérebro (BDNF), pro-BDNF, neurotrofina 3, neurotrofina 4, fator de crescimento do nervo, fator neurotrófico derivado da glia e fator neurotrófico ciliar foram avaliados por ensaio de imunoadsorção enzimática. Não houve diferença significativa entre pacientes com DP e controles quanto aos níveis plasmáticos dos FNs avaliados. Além disso, não encontramos associação entre os níveis dos FNs e duração da doença, grau de comprometimento motor ou funcional, desempenho cognitivo e gravidade dos sintomas depressivos. Em conclusão, embora os FNs possam desempenhar papéis relevantes na fisiopatologia da DP, os níveis circulantes dessas moléculas não estão necessariamente alterados em pacientes com DP.

Reduced Activated T Lymphocytes (CD4+CD25+) and Plasma Levels of Cytokines in Parkinson's Disease.

Parkinson's disease (PD) is the second most common neurodegenerative disease. The cause of neurodegeneration in PD is not completely understood, and evidence has shown that inflammatory/immune changes may be involved in PD pathophysiology. Herein, we aimed to determine the profile of the peripheral immune system in patients with PD in comparison with controls. Forty patients with PD and 25 age- and gender-matched controls were enrolled in this study. From these, 23 PD patients and 21 controls were included in the immunophenotyping analyses. Peripheral blood was drawn on the same day of the clinical assessment and submitted to plasma separation for enzyme-linked immunosorbent assay or cytometric bead array. Immunophenotyping analyses of the peripheral blood were performed by flow cytometry. We found that patients with PD presented peripheral immune changes evidenced by decreased percentage of T lymphocytes (CD3+ cells), especially activated T lymphocytes (CD4+CD25+ cells), when compared with controls. In line with these results, we also found decreased plasma levels of the cytokines IL-4, IL-6, IL-10, TNF, IFN-γ, and IL-17A in the PD group. In vitro experiments demonstrated that the production of cytokines by peripheral blood mononuclear cells harvested from healthy young donors was reduced after exposure to the anti-parkinsonian drugs levodopa and pramipexole. Our data corroborate the hypothesis that immunological mechanisms are involved in PD. It is not clear whether the differences that we have found are due to adaptive mechanisms or to changes associated with PD, including pharmacological treatment, or even directly related to the disease pathophysiology. Future studies are needed in this regard.

A single session of moderate intensity walking increases brain-derived neurotrophic factor (BDNF) in the chronic post-stroke patients.

Background Aerobic exercise, even for short durations, may promote an increase in serum concentrations of brain-derived neurotrophic factor (BDNF). However, it is necessary to determine the optimal exercise types and intensities to increase BDNF levels. Objectives This aim of this study was investigate the effects of mild and moderate intensity acute aerobic exercise on serum BDNF levels in patients in the chronic post-stroke phase. Methods The participants answered a socio-demographic questionnaire, cognitive assessment (Mini Mental State Examination), assessment of depressive symptoms (Hamilton Depression Scale), fatigue (Fatigue Severity Scale) and functional capacity (6-minute walk test). Blood samples were collected before and after each session. The measurement of the concentration of BDNF was performed using the enzyme-linked immunosorbent assay . Patients were asked to walk for 30-min in the target training zone (mild intensity, 50-63% of maximum heart rate, and moderate intensity, 64-76% of maximum heart rate), once each week for 2 consecutive weeks. Results Our results indicate that 30 min of acute aerobic exercise at a moderate intensity, but not at a mild intensity, increases serum BDNF levels in the chronic post-stroke phase. Conclusions This study suggests a potential mechanism for the beneficial effects of exercise as a component of recovery from stroke, and provides the basis for future studies that will elucidate the specific parameters for clinical applications.

IL-6 serum levels are elevated in Parkinson's disease patients with fatigue compared to patients without fatigue.

To investigate the influence of interleukin-6 (IL-6) and soluble tumor necrosis factor receptors (sTNFR) in fatigued Parkinson's disease (PD) patients. Forty-four PD patients were evaluated, and fatigue was assessed with the Parkinson Fatigue Scale. Logistic regression analysis was used to evaluate the contribution of disease severity scores and cytokine levels on fatigue scores. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic values of IL-6 in fatigue. Fatigued PD patients had worse cognitive function and depressive symptoms. These patients had worse PD signs and symptoms, displayed more advanced stages of PD, and had greater functional dependence. There was a significant difference in IL-6 serum levels (p=0.026), but there was no difference in sTNFR levels. Total scores on the Unified Parkinson Disease Rating Scale (ß=1.108; p=0.004) and IL-6 levels (ß=12.843; p=0.020) were found to be significant predictors of fatigue scores. A ROC curve revealed that IL-6 concentrations of 1.18pg/ml represented the best cut-off value for detecting fatigue (sensitivity of 0.941 and specificity of 0.704). Fatigued PD patients have poor clinical outcomes and elevated IL-6 serum levels when compared with non-fatigued patients. These results suggest that IL-6 may play a role in the pathophysiology of fatigue in PD.

Effects of resistance training in individuals with knee osteoarthritis / Efeitos de um treinamento de resistência muscular em indivíduos com osteoartrite de joelho

Abstract Introduction: Osteoarthritis (OA), the most common form of arthritis, is considered the main cause of pain and disability in the elderly. Objective: To evaluate the effect of systematic muscle strength training on functional performance and quality of life in individuals with knee OA. Methods: Subjects with knee OA (n = 27, 46 - 76 years) completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Medical Outcomes Short-Form 36-item Health Survey (SF-36), and visual analog scale (VAS) questionnaires, musculoskeletal assessments, and 10-repetition maximum and timed 10-meter walk tests both before and after training. The training consisted of an exercise resistance program and stretches for 12 weeks (three sessions of 80 each per week). Results: Twenty-two subjects completed the training. Reduced overall scores and WOMAC physical function indicated improved functional performance (p < 0.001) as well as increased gait speed (p < 0.001). The perception of pain decreased after training, as evidenced by the VAS, WOMAC pain domain, and SF-36 scores (p < 0.001). Quality of life improvements occurred primarily in the areas of pain, functional capacity, and SF-36 physical aspects. No change in body mass index was noted (p = 0.93). Conclusion: Our results indicate that the combination of resistance training for the quadriceps, gluteus, and abdominal muscles could be a viable alternative to improving functionality and quality of life in patients with knee OA. However, more studies are necessary to confirm our findings.

Resumo Introdução: A osteoartrite (OA) é a forma mais comum de artrite, considerada a principal causa de dor e incapacidade em idosos. Objetivo: Avaliar o impacto de um treinamento sistematizado de resistência muscular no desempenho funcional e na qualidade de vida em indivíduos com OA de joelho. Métodos: Voluntários com OA do joelho (n = 27, 46 - 76 anos) foram submetidos, antes e após o período de treinamento, à aplicação dos questionários de WOMAC e SF-36 e da Escala Visual Analógica (EVA), à avaliação musculoesquelética, teste de 10 RM e teste de caminhada de dez metros. O treinamento realizado consistiu em um programa de resistência muscular e alongamentos, por 12 semanas (3 sessões de 80' por semana). Resultados: 22 indivíduos concluíram o treinamento. As reduções nos escores globais e de função física do WOMAC indicam melhoria no desempenho funcional (p < 0,001), assim como o aumento da velocidade da marcha (p < 0,001). A percepção da dor diminuiu após o treinamento, como demonstram os resultados da VAS e dos domínios dor do WOMAC e SF-36 (p < 0,001). A melhoria da qualidade de vida ocorreu principalmente por modificações nos domínios de dor, capacidade funcional e aspectos físicos do SF-36. Não houve alteração no IMC (p = 0,93). Conclusão Os resultados indicam que a combinação de exercícios de resistência dos músculos quadríceps, glúteos e abdômen pode ser uma estratégia viável para melhorar a funcionalidade e a qualidade de vida de pacientes com OA de joelho. No entanto, mais estudos são necessários para investigar a questão.

Peripheral levels of angiotensins are associated with depressive symptoms in Parkinson's disease.

BACKGROUND: The pathogenesis of PD remains elusive. The renin-angiotensin-system (RAS) has recently been implicated in the degeneration of dopaminergic neurons. This study aimed to compare plasma levels of components of the RAS of individuals with PD with controls. We also investigated the association between these circulating markers and motor, depressive and cognitive parameters. METHODS: Thirty PD patients and twenty controls were subjected to clinical evaluation, including cognitive and depressive symptoms assessment. Plasma levels of Angiotensin (Ang) I, Ang II, Ang- (1-7), angiotensin-converting enzyme (ACE) and ACE2 were measured by Enzyme-Linked Immunosorbent Assay (ELISA). RESULTS: PD patients presented lower plasma levels of Ang I, Ang II and Ang- (1-7) than control individuals. Among PD patients, lower circulating levels of angiotensins were associated with increased severity of depressive symptoms. CONCLUSIONS: This is the first study showing that peripheral levels of RAS components are changed in PD and associated with depressive symptoms.