Risk factors for non-specific low back pain in older people: a systematic review with meta-analysis.

PURPOSE: To conduct a systematic review about risk factors associated with non-specific low back pain (LBP) in older people. METHODS: The study protocol was prospectively registered with Prospero (CRD42020191619). This systematic review with meta-analysis included cohort studies that investigated risk factors for LBP in older people. The following databases were searched up to 12 December 2020: MEDLINE (Ovid), Embase, CINAHL, SCOPUS and Web of Science. Two independent reviewers appraised methodological quality using the Critical Appraisal Checklist for Cohort Studies instrument. RESULTS: We identified 3939 potentially relevant publications. After removing duplicates, screening title, and abstracts, we assessed 86 publications in full text. We included the remaining 11 publications for analysis. There is strong evidence that depressive symptoms are a risk of reporting future back pain onset (I2 = 52,7%, Odds ratio 1.4, CI 1.28-1.53). CONCLUSION: Depressive symptoms are a risk factor for LBP in older people. Due to the limitations of the literature, the role of some risk factors remains unclear. An additional high-quality prospective cohort is needed to better elucidate these relationships.

Functional Capacity and Inflammatory Mediators in Elderly Residents of Counties with Different Human Development Index.

A number of studies have indicated that certain factors, including socioeconomic status and education, are associated with the functional health status of the elderly. Another relevant factor in aging is chronic subliminal inflammation, with increased levels of circulating inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and soluble tumor necrosis factor receptor 1 (sTNFR-1), commonly seen in the elderly. High levels of these inflammatory mediators could impair the functional capacity. In this respect, the aim of this cross-sectional study was to compare plasma levels of inflammatory mediators and functional capacity of older women living in three Brazilian counties with different Human Development Index. We evaluated 154 women aged ≥65 years, regardless of race and/or social status. IL-6 and sTNFR-1 plasma levels were measured by ELISA and the functional capacity by the Short Physical Performance Battery (SPPB) test. Comparison among groups was performed using one-way ANOVA with Bonferroni post hoc correction, Kruskal-Wallis, and Mann-Whitney U tests. Women that lived in one of the counties with high HDI had lower functional capacity (p < 0.001). The population from the county with the highest HDI had lower plasma levels of sTNFR-1 (p < 0.05). There was no significant difference in plasma levels of IL-6 (p > 0.05). Besides this, women from the counties with lower HDI had a higher number of self-reported diseases and higher income (p < 0.05). Women that lived in the county with the highest HDI had a higher average education level (p < 0.05). The results showed differences in functional capacity and plasma levels of sTNFR-1 between the counties. In addition, the level of education, family income, and number of self-reported diseases show regional diversities in the aging process, suggesting these factors having an influence on inflammatory mediators and functional capacity.

Effects of a Long-term Pulmonary Rehabilitation Program on Functional Capacity and Inflammatory Profile of Older Patients With COPD.

PURPOSE: To evaluate the effects of a long-term pulmonary rehabilitation program (PRP) on functional capacity, maximal inspiratory pressure (MIP), quality of life, and plasma levels of tumor necrosis factor alpha (TNF-α), soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2, respectively), and cytokine interleukin 1beta (IL-1ß) in elderly patients with chronic obstructive pulmonary disease (COPD). METHODS: In a quasi-experimental study, PRP effectiveness was investigated in elderly patients with stage I-IV COPD undergoing a 6-mo training program. Participants took part in an 80-min PRP 3 times/wk. Before and after the intervention, the distance walked during a 6-min walk test (6MWD), MIP, St George's Respiratory Questionnaire (SGRQ), and plasma levels of TNF-α, sTNFR1, sTNFR2, and IL-1ß were evaluated. RESULTS: In 7 patients who completed the PRP and had markers evaluated, we observed improvement in 6MWD (range, 26-331 m) and MIP for most patients. There was an improvement in impact and total domains for all patients and in symptoms and activity for most patients on the SGRQ at the completion of the PRP. TNF-α, sTNFR1, sTNFR2, and IL-1ß increased in some patients at the end of the PRP. The 6-mo PRP improved functional capacity, MIP, and quality of life for most patients. CONCLUSIONS: Inflammatory markers showed various changes at the end of the study; however, only sTNFR2 levels improved after the PRP.

Risk of falls in Brazilian elders with and without low back pain assessed using the Physiological Profile Assessment: BACE study

ABSTRACT Background Low back pain (LBP) is a common musculoskeletal condition among elders and is associated with falls. However, the underlying biological risk factors for falling among elders with LBP has been poorly investigated. The Physiological Profile Assessment (PPA) is a validated fall-risk assessment tool that involves the direct assessment of sensorimotor abilities and may contribute to the understanding of risk factors for falls among elders with LBP. Objective To assess fall risk using the PPA in elders with and without LBP. Method This is an observational, comparative, cross-sectional study with elders aged ≥65 years. The present study was conducted with a subsample of participants from the Back Complaints in the Elders (BACE) - Brazil study. Fall risk was assessed using the PPA, which contains five tests: visual contrast sensitivity, hand reaction time, quadriceps strength, lower limb proprioception, and postural sway. Results Study participants included 104 individuals with average age of 72.3 (SD=4.0) years, divided into two groups: GI) 52 participants with LBP; GII) 52 participants without LBP. The participants with LBP had a significantly higher fall risk (1.10 95% CI 0.72 to 1.48), greater postural sway (49.78 95% CI 13.54 to 86.01), longer reaction time (58.95 95% CI 33.24 to 84.65), and lower quadriceps strength (–4.42 95% CI –8.24 to –0.59) compared to asymptomatic participants. There was no significant difference for vision and proprioception tests between LBP and non-LBP participants. Conclusion Elders with LBP have greater risk for falls than those without LBP. Our results suggest fall-risk screening may be sensible in elders with LBP.

Risk of falls in Brazilian elders with and without low back pain assessed using the Physiological Profile Assessment: BACE study.

Background: Low back pain (LBP) is a common musculoskeletal condition among elders and is associated with falls. However, the underlying biological risk factors for falling among elders with LBP has been poorly investigated. The Physiological Profile Assessment (PPA) is a validated fall-risk assessment tool that involves the direct assessment of sensorimotor abilities and may contribute to the understanding of risk factors for falls among elders with LBP. Objective: To assess fall risk using the PPA in elders with and without LBP. Method: This is an observational, comparative, cross-sectional study with elders aged ≥65 years. The present study was conducted with a subsample of participants from the Back Complaints in the Elders (BACE) - Brazil study. Fall risk was assessed using the PPA, which contains five tests: visual contrast sensitivity, hand reaction time, quadriceps strength, lower limb proprioception, and postural sway. Results: Study participants included 104 individuals with average age of 72.3 (SD=4.0) years, divided into two groups: GI) 52 participants with LBP; GII) 52 participants without LBP. The participants with LBP had a significantly higher fall risk (1.10 95% CI 0.72 to 1.48), greater postural sway (49.78 95% CI 13.54 to 86.01), longer reaction time (58.95 95% CI 33.24 to 84.65), and lower quadriceps strength (-4.42 95% CI -8.24 to -0.59) compared to asymptomatic participants. There was no significant difference for vision and proprioception tests between LBP and non-LBP participants. Conclusion: Elders with LBP have greater risk for falls than those without LBP. Our results suggest fall-risk screening may be sensible in elders with LBP.

Kinesiophobia is not associated with disability in elderly women with acute low back pain: Back Complaints in the Elders (BACE) Brazil study results.

BACKGROUND CONTEXT: The study of low back pain (LBP) is complex, and the physical and psychological aspects, including kinesiophobia, should be considered. Several studies have investigated the relationship between kinesiophobia and functionality in patients with chronic LBP. However, to the best of the authors' knowledge, no studies have investigated the association between kinesiophobia and self-reported assessments of disability and physical performance in elderly patients with acute LBP. PURPOSE: The study aimed to investigate the association between kinesiophobia and self-reported and physical performance measures among the elderly with acute LBP. DESIGN: This was an observational, cross-sectional, ancillary study of the Back Complaints in the Elders study, a longitudinal observational epidemiologic research project by an international consortium involving Brazil, the Netherlands, and Australia. PATIENT SAMPLE: Sample selection was carried out by convenience. The study included women from the community aged 60 years old and older who presented with a new episode of LBP. Volunteers with severe diseases, as well as visual, hearing, and mobility losses, or cognitive dysfunction, were excluded. Four hundred fifty nine elderly women (mean age: 69.0±6.1 years) were included. OUTCOME MEASURES: Kinesiophobia was evaluated by Fear Avoidance Beliefs Questionnaire (FABQ), subscale FABQ-Phys. Functionality was investigated by the Roland-Morris Questionnaire and the gait speed test. METHODS: Statistical analysis was performed using hierarchical linear regression model. Statistical significance was established at the level of .05. RESULTS: The additional predictive value because of the inclusion of the FABQ-Phys was 0.1%, using the Roland-Morris score, and 0.2% for the gait speed test. CONCLUSIONS: This was the first study to investigate the association between the FABQ-Phys and functionality in elderly patients with acute LBP. The results provide preliminary evidence that kinesiophobia assessed by the FABQ-Phys cannot be generalized to disability.

Handgrip strength, functionality and plasma levels of IL-6 in elderly women / Força de preensão manual, funcionalidade e níveis plasmáticos de IL-6 em idosas

AbstractIntroduction Aging is associated with a chronic low-grade inflammatory process characterized by an increased production of inflammatory mediators. These elevated levels are predictors for muscle function (sarcopenia) and deterioration of physical performance in the elderly.Objective To investigate the correlation between sarcopenia, functional capacity, and interleukin-6 levels.Materials and methods This cross-sectional study assessed a convenience sample of elderly individuals (n = 130) using a handgrip dynamometer (JAMAR™), and the functional capacity test was performed by sitting and standing. Interleukin-6 levels were determined using high sensitivity ELISA kits. Spearman correlation coefficient was used to assess the correlation between these variables, at a significance level (α) of 0.05.Results There was significant inverse correlation between strength and function (rS = -0.273, p = 0.002) such that elderly individuals with lower peak force took longer to perform the sit-to-stand test, in contrast with the relationship between plasma interleukin-6 levels and strength (rS = -0.043, p = 0.624) or functionality (rS = -0.060, p = 0.501).Conclusion The outcome measures analyzed could predict the decline in muscle strength and functional capacity, and may be indicative of sarcopenia in elderly individuals. There was no correlation between the interleukin-6 levels and the grip strength and functional capacity of the sample investigated.

ResumoIntrodução O envelhecimento está relacionado a uma ativação crônica sublimiar do processo inflamatório, com aumento da produção de mediadores inflamatórios, cujos níveis elevados são preditores do declínio da função muscular (sarcopenia) e capacidade funcional na população idosa.Objetivo Verificar a correlação entre sarcopenia, capacidade funcional e interleucina-6.Materiais e métodos : Estudo transversal, amostra de conveniência de idosas da comunidade (n = 130), em que se avaliou a força de preensão manual com dinamômetro de JAMAR®, e a capacidade funcional pelo teste de sentar e levantar da cadeira cinco vezes. A interleucina-6 foi analisada por meio de kits de alta sensibilidade, pelo método de ELISA. Utilizou-se o coeficiente de Spearman para verificar a correlação entre as variáveis, considerando o nível de significância (α) de 0,05.Resultados Houve correlação significativa e inversa entre a força manual e o teste funcional (rS = -0,273; p = 0,002), ou seja, idosas com menores picos de força apresentaram pior desempenho no teste de sentar e levantar. Não foi observada correlação entre as demais variáveis: índices plasmáticos de interleucina-6 e força (rS =-0,043; p = 0,624) e funcionalidade (rS = -0,060; p = 0,501).Conclusão As medidas de desfechos analisadas conseguiram rastrear a diminuição da força muscular e da capacidade funcional, podendo ser indicativas de sarcopenia em idosas. Os níveis de interleucina-6 não se correlacionaram com a força de preensão manual e com a capacidade funcional na amostra avaliada.

Isokinetic performance of knee flexor and extensor muscles in community-dwelling elderly women / Desempenho dos músculos flexores e extensores de joelho de idosas da comunidade no dinamômetro isocinético

AbstractIntroduction The isokinetic dynamometer enables accurate assessment of muscle function. In Brazil, few studies have assessed the isokinetic muscle performance in older adults making interpretation and comparison of results with other studies.Objectives To conduct a descriptive analysis of the performance of the muscle flexor and extensor muscles of the knee joint in elderly community and compare the performance between the age groups 65-74 years and 75 years or more.Methods This is a cross sectional observational study with a convenience sample of 229 elderly community. For the analysis of muscle performance was used isokinetic dynamometer (Biodex System 3 Pro™) in the angular velocities of 60 °/s and 180 °/s. The variables evaluated were peak torque, peak torque normalized by body weight, total work normalized by body mass, total work, average power and agonist/antagonist ratio. Descriptive analysis was used to characterize the sample. For comparison between age groups was used Student's t-test with α = 0.05.Results The elderly women with older age showed a statistically significant decrease in most of the variables (p < 0.05) except for the agonist and antagonist knee (p = 0.398).Conclusions The isokinetic was a sensitive tool to characterize the modifications caused by aging on muscle function. Elderly with results below the lower limits of the confidence intervals for all variables certainly has a decreased strength for the age group evaluated and must be addressed therapeutically. The results can be used as a benchmark in clinical practice and future research.

ResumoIntrodução O dinamômetro isocinético possibilita a avaliação acurada da função muscular. No Brasil, poucos estudos avaliaram o desempenho muscular isocinético em idosos, dificultando a interpretação e comparação dos resultados com outros estudos.Objetivos Realizar uma análise descritiva do desempenho muscular dos músculos flexores e extensores da articulação do joelho de idosas da comunidade e comparar o desempenho entre as faixas etárias de 65 a 74 anos e 75 anos ou mais.Métodos Trata-se de um estudo observacional transversal, com uma amostra de conveniência com 229 idosas da comunidade. Para a análise do desempenho muscular foi utilizado o dinamômetro isocinético (Biodex System 3 Pro®) nas velocidades angulares de 60 °/s e 180 °/s. As variáveis avaliadas foram o pico torque, pico de torque normalizado pela massa corporal, trabalho normalizado pela massa corporal, trabalho total, potência e a relação agonista/antagonista. Foi utilizada análise descritiva para caracterização da amostra. Para comparação entre as faixas etárias foi usado o teste-t de Student considerando α = 0,05.Resultados As idosas com idade mais avançada apresentaram um decréscimo estatisticamente significativo na maioria das variáveis analisadas (p < 0,05) com exceção da relação agonista e antagonista do joelho (p = 0,398).Conclusão O dinamômetro isocinético foi um instrumento sensível para caracterizar as modificações ocasionadas pelo envelhecimento na função muscular. Idosas com resultados abaixo dos limites inferiores dos intervalos de confiança para as variáveis pesquisadas apresentam uma força diminuída para a faixa etária avaliada e devem ser abordadas terapeuticamente. Os resultados podem ser utilizados como parâmetro de comparação na prática clínica e em futuras pesquisas.

Effects of physical exercise on plasma levels of brain-derived neurotrophic factor and depressive symptoms in elderly women--a randomized clinical trial.

OBJECTIVES: To investigate the effect of 2 standardized exercise programs, muscle strength exercises (SE) and aerobic exercises (AE), on the plasma levels of brain-derived neurotrophic factor (BDNF) and depressive symptoms in 451 elderly women. DESIGN: A randomized controlled trial. SETTING: Belo Horizonte/MG-Brazil. PARTICIPANTS: Community-dwelling older women (N=451; age, 65-89y). INTERVENTION: The participants were divided into 2 groups: SE and AE. Both protocols lasted 10 weeks, and 30 sessions (1-h sessions) in total were performed 3 times a week under the direct supervision of physical therapists. MAIN OUTCOME MEASURES: Plasma levels of BDNF (enzyme-linked immunosorbent assay) and depressive symptoms (Geriatric Depression Scale). RESULTS: There was a significant difference for BDNF plasma levels between the SE and AE groups (P=.009). Post hoc analysis revealed a pre-post intervention difference in BDNF levels only for the SE group (P=.008). A statistically significant difference was found for the pre- and postintervention Geriatric Depression Scale scores in both groups (P=.001), showing that the effects of both exercise protocols were comparable regarding depressive symptoms (P=.185). CONCLUSIONS: The present findings have demonstrated the positive effect of muscle strengthening and aerobic intervention on depressive symptoms in community-dwelling elderly women. Interestingly, only SE significantly increased the plasma levels of BDNF in our sample. The positive effects of physical exercise on depressive symptoms in the elderly were not mediated by BDNF.

Interaction between cytokine gene polymorphisms and the effect of physical exercise on clinical and inflammatory parameters in older women: study protocol for a randomized controlled trial.

BACKGROUND: Aging is associated with chronic low-grade inflammatory activity with an elevation of cytokine levels. An association between regular physical activity and reduction of blood levels of anti-inflammatory cytokines is demonstrated in the literature pointing to an anti-inflammatory effect related to exercise. However, there is no consensus regarding which type of exercise and which parameters are the most appropriate to influence inflammatory markers. Evidence indicates that the single nucleotide polymorphism (SNP) can influence the synthesis of those cytokines affecting their production. METHODS/DESIGN: The design of this study is a randomized controlled trial. The aim of this study is to investigate the interaction between the cytokine genes SNP and the effect of physical activity on older women. The main outcomes are: serum levels of sTNFR-1, sTNFR-2, interleukin (IL)-6, IL-10, measured by the ELISA method; genotyping of tumor necrosis factor- (TNF)-alpha (rs1800629), IL6 (rs1800795), IL10 (rs1800896) by the TaqMan Method (Applied Biosystems, Foster City, CA, USA); and physical performance assessed by Timed Up and Go and 10-Meter Walk Tests. Secondary outcomes include: Geriatric Depression Scale, Perceived Stress Scaleand aerobic capacity, assessed by the six-minute walk; and lower limb muscle strength, using an isokinetic dinamometer (Biodex Medical Systems, Inc., Shirley, NY,USA). Both exercise protocols will be performed three times a week for 10 weeks, 30 sessions in total. DISCUSSION: Investigating the interaction between genetic factors and exercise effects of both protocols of exercise on the levels of inflammatory cytokine levels can contribute to guide clinical practice related to treatment and prevention of functional changes due to chronic inflammatory activity in older adults. This approach could develop new perspectives on preventive and treatment proposals in physical therapy and in the management of the older patient. TRIAL REGISTRATION: (ReBEC) RBR9v9cwf.

Impact of resistance exercise program on functional capacity and muscular strength of knee extensor in pre-frail community-dwelling older women: a randomized crossover trial.

BACKGROUND: Frailty syndrome in elderly people is characterized by a reduction of energy reserves and also by a decreased of resistance to stressors, resulting in an increase of vulnerability. OBJECTIVE: The aim of this study was to verify the effect of a muscle-strengthening program with load in pre-frail elder women with regards to the functional capacity, knee extensor muscle strength and their correlation. METHODS: Thrity-two pre-frail community-dwelling women participated in this study. Potential participants with cognitive impairment (MEEM), lower extremities orthopedic surgery, fractures, inability to walk unaided, neurological diseases, acute inflammatory disease, tumor growth, regular physical activity and current use of immunomodulators were excluded. All partcipants were evaluated by a blinded assessor using: Timed up and go (TUG), 10-Meter Walk Test (10MWT) and knee extensor muscle strength (Byodex System 3 Pro® isokinetic dynamometer at angular speeds of 60 and 180(0)/s). The intervention consisted of strengthening exercises of the lower extremities at 70% of 1RM, three times/ week for ten weeks. The statistical analysis was performed using the ANOVA and Spearman tests RESULTS: After the intervention, it was observed statistical significance on the work at 180(0)/s (F=12.71, p=0.02), on the power at 180(0)/s (F=15.40, p=0.02) and on the functional capacity (TUG, F=9.54, p=0.01; TC10, F=3.80, p=0.01). There was a good negative and statistically significant correlation between the TUG and work at 60(0)/s, such as the TUG and work at 180(0)/s (r=-0.65, p=0.01; r=-0.72, p=0.01). CONCLUSION: The intervention improved the muscular power and the functional capacity. The increase of the power correlated with function, which is an important variable of the quality of life in the pre-frail elders. Article registered in the ISRCT register under number ISRCTN62824599.

Clinical, functional and inflammatory factors associated with muscle fatigue and self-perceived fatigue in elderly community-dwelling women.

BACKGROUND: Fatigue is a common and nonspecific symptom associated with chronic health problems in the elderly. The modifications and adaptations of the aging process associated with complex and multidimensional nature of fatigue favors the interaction of multiple factors in the genesis of this phenomenon. OBJECTIVES: To investigate the association of clinical, functional and inflammatory factors with muscle fatigue and self perceived fatigue in elderly women. METHODS: Participated in the study one hundred and thirty five community elderly women, all sedentary, with a mean age of 71.2±4.57. A structured questionnaire and functional testing were used to evaluate clinical and functional characteristics. Plasma concentrations of inflammatory mediators (IL-6 and sTNFR1) were measured by ELISA method. Muscle fatigue was measured by isokinetic dynamometer and self-perceived fatigue was measured by a visual analog scale. Statistical analysis was performed by multiple linear regression and Spearman correlation coefficient with statistical significance of 5%. RESULTS: The regression models showed that the variables age, body mass index, physical activity level, functional capacity and peak torque were associated with muscle fatigue (R²=0.216, p<0.01). Self-perceived fatigue was associated with number of comorbidities, depression, physical activity level, functional capacity, peak torque and perceived health (R²=0.227, p<0.01). CONCLUSION: This study showed a psychophysical interaction of the fatigue, by identifying the main factors associated with muscle fatigue and self-perceived fatigue in elderly women. These findings demonstrate the importance of evaluation and treatment of modifiable factors in both muscle fatigue and self-perceived fatigue, seeking a better physical and functional performance of elders.

Efeito de um programa de resistência muscular na capacidade funcional e na força muscular dos extensores do joelho em idosas pré-frágeis da comunidade: ensaio clínico aleatorizado do tipo crossover / Impact of resistance exercise program on functional capacity and muscular strength of knee extensor in pre-frail community-dwelling older women: a randomized crossover trial

CONTEXTUALIZAÇÃO: Na síndrome de fragilidade em idosos, há diminuição das reservas de energia e resistência aos estressores, com aumento da vulnerabilidade. OBJETIVO: Verificar o efeito do treinamento de força muscular com carga na capacidade funcional e força muscular dos extensores do joelho e sua associação, após treinamento, em idosas pré-frágeis da comunidade. MÉTODOS:Participaram 32 idosas, pré-frágeis, da comunidade. Excluíram-se aquelas com Miniexame do Estado Mental (MEEM) incompatível; cirurgias ortopédicas dos membros inferiores; fraturas; doenças neurológicas; doenças inflamatórias agudas; neoplasias; atividade física regular; uso de medicamento com ação no sistema imunológico e sem marcha independente. Avaliou-se a capacidade funcional (Timed Up and Go - TUG e velocidade de marcha - TC10) e a força muscular dos extensores do joelho (Byodex System 3 Pro®) nas velocidades angulares de 60 e 180(0)/s. Para o fortalecimento muscular, utilizou-se carga de 75 por cento de resistência máxima (1RM), durante dez semanas, três vezes/semana. A análise estatística foi feita pela ANOVA e Spearman (α=5 por cento). RESULTADOS: Após o treinamento, houve melhora estatística do trabalho normalizado em 180(0)/s (F=12,71, p=0,02), na potência, em 180(0)/s (F=15,40, p=0,02) e na capacidade funcional (TUG, F=9,54, p=0,01; TC10, F=3,80, p=0,01). Houve boa correlação negativa significativa do TUG com as medidas de trabalho normalizado em 60 e 180(0)/s (r=-0,65, p=0,01; r=-0,72, p=0,01). CONCLUSÃO: O treinamento produziu melhora da potência muscular e capacidade funcional. A melhora da potência associou-se à melhora funcional, importante variável para a qualidade de vida de idosas pré-frágeis. Artigo registrado no ISRCT register sob o número ISRCTN62824599.

BACKGROUND: Frailty syndrome in elderly people is characterized by a reduction of energy reserves and also by a decreased of resistance to stressors, resulting in an increase of vulnerability. OBJECTIVE: The aim of this study was to verify the effect of a muscle-strengthening program with load in pre-frail elder women with regards to the functional capacity, knee extensor muscle strength and their correlation. METHODS: Thrity-two pre-frail community-dwelling women participated in this study. Potential participants with cognitive impairment (MEEM), lower extremities orthopedic surgery, fractures, inability to walk unaided, neurological diseases, acute inflammatory disease, tumor growth, regular physical activity and current use of immunomodulators were excluded. All partcipants were evaluated by a blinded assessor using: Timed up and go (TUG), 10-Meter Walk Test (10MWT) and knee extensor muscle strength (Byodex System 3 Pro® isokinetic dynamometer at angular speeds of 60 and 180(0)/s). The intervention consisted of strengthening exercises of the lower extremities at 70 percent of 1RM, three times/ week for ten weeks. The statistical analysis was performed using the ANOVA and Spearman tests RESULTS: After the intervention, it was observed statistical significance on the work at 180(0)/s (F=12.71, p=0.02), on the power at 180(0)/s (F=15.40, p=0.02) and on the functional capacity (TUG, F=9.54, p=0.01; TC10, F=3.80, p=0.01). There was a good negative and statistically significant correlation between the TUG and work at 60(0)/s, such as the TUG and work at 180(0)/s (r=-0.65, p=0.01; r=-0.72, p=0.01). CONCLUSION: The intervention improved the muscular power and the functional capacity. The increase of the power correlated with function, which is an important variable of the quality of life in the pre-frail elders. Article registered in the ISRCT register under number ISRCTN62824599.

Fatores clínicos, funcionais e inflamatórios associados à fadiga muscular e à fadiga autopercebida em idosas da comunidade / Clinical, functional and inflammatory factors associated with muscle fatigue and self-perceived fatigue in elderly community-dwelling women

CONTEXTUALIZAÇÃO: A fadiga é um sintoma comum e inespecífico associado aos problemas crônicos de saúde nos idosos. As alterações e adaptações do processo de envelhecimento associadas à natureza complexa e multidimensional da fadiga favorecem a interação de múltiplos fatores na gênese desse fenômeno. OBJETIVOS: Investigar a associação dos fatores clínicos, funcionais e inflamatórios com a fadiga muscular e a autopercebida em idosas. MÉTODOS: Participaram 135 idosas sedentárias da comunidade, com média de idade de 71,2±4,57. Questionário estruturado e teste funcional foram utilizados para avaliar as características clínicas e funcionais. As concentrações plasmáticas dos mediadores inflamatórios (IL-6 e sTNFR1) foram dosadas pelo método ELISA. A fadiga muscular foi mensurada pelo dinamômetro isocinético, e a fadiga autopercebida, pela Escala Visual Analógica (EVA). A análise estatística foi realizada pela regressão linear múltipla e pelo Coeficiente de Correlação de Spearman, com nível de significância de 5 por cento. RESULTADOS: Os modelos de regressão demonstraram que os fatores idade, índice de massa corporal (IMC), nível de atividade física, capacidade funcional e pico de torque foram associados à fadiga muscular (R²=0,216, p<0,01). A fadiga autopercebida foi associada ao número de comorbidades, estado depressivo, nível de atividade física, capacidade funcional, pico de torque e saúde percebida (R²=0,227, p<0,01). CONCLUSÃO: O presente estudo mostrou uma interação psicofísica da fadiga, identificando os principais fatores associados à fadiga muscular e à autopercebida em idosas. Esses achados demonstram a importância da avaliação e tratamento dos fatores modificáveis tanto na fadiga muscular quanto na autopercebida, buscando um melhor desempenho físico-funcional dos idosos.

BACKGROUND: Fatigue is a common and nonspecific symptom associated with chronic health problems in the elderly. The modifications and adaptations of the aging process associated with complex and multidimensional nature of fatigue favors the interaction of multiple factors in the genesis of this phenomenon. OBJECTIVES: To investigate the association of clinical, functional and inflammatory factors with muscle fatigue and self perceived fatigue in elderly women. METHODS: Participated in the study one hundred and thirty five community elderly women, all sedentary, with a mean age of 71.2±4.57. A structured questionnaire and functional testing were used to evaluate clinical and functional characteristics. Plasma concentrations of inflammatory mediators (IL-6 and sTNFR1) were measured by ELISA method. Muscle fatigue was measured by isokinetic dynamometer and self-perceived fatigue was measured by a visual analog scale. Statistical analysis was performed by multiple linear regression and Spearman correlation coefficient with statistical significance of 5 percent. RESULTS: The regression models showed that the variables age, body mass index, physical activity level, functional capacity and peak torque were associated with muscle fatigue (R²=0.216, p<0.01). Self-perceived fatigue was associated with number of comorbidities, depression, physical activity level, functional capacity, peak torque and perceived health (R²=0.227, p<0.01). CONCLUSION: This study showed a psychophysical interaction of the fatigue, by identifying the main factors associated with muscle fatigue and self-perceived fatigue in elderly women. These findings demonstrate the importance of evaluation and treatment of modifiable factors in both muscle fatigue and self-perceived fatigue, seeking a better physical and functional performance of elders.

Mobilidade funcional e função executiva em idosos diabéticos e não diabéticos / Functional mobility and executive function in elderly diabetics and non-diabetics

CONTEXTUALIZAÇÃO: Idosos diabéticos tendem a ter declínio da funcionalidade motora e a apresentar déficits cognitivos relacionados a processos mais complexos, como a função executiva, o que pode levar a um maior risco de quedas. OBJETIVOS: Comparar idosos com e sem diabetes tipo 2 quanto à mobilidade funcional, ao risco de quedas e à função executiva e verificar a correlação entre essas variáveis. MÉTODOS: Participaram do estudo 40 idosos da comunidade, divididos em dois grupos: G1, idosos com diabetes tipo 2 e G2, idosos sem diabetes, sendo os grupos semelhantes quanto ao gênero, idade e índice de massa corporal. A mobilidade funcional e o risco de quedas foram avaliados pelo Timed Up and Go (TUG e TUGcognitivo), e a função executiva, pelo teste de fluência verbal (categoria animal). RESULTADOS: Os diabéticos apresentaram pior desempenho no teste de fluência verbal (G1:14,9±4,5; G2:17,7±5,6; p=0,031). Uma diferença estatisticamente significativa foi observada entre os grupos em relação à mobilidade funcional, sendo que o G1 apresentou pior desempenho no TUG (G1:10,5±1,8s; G2:8,9±1,9s; p=0,01) e noTUGcognitivo (G1:13,9±3,2s; G2:10,9±2,3s; p=0,004). Uma correlação siginificativa foi observada entre o TUGcognitivo e o teste de fluência verbal apenas no G1 (G1: Spearman's rho = -0,535; p=0,015; G2: Spearman's rho = -0,250; p=0,288). CONCLUSÕES: Os diabéticos apresentaram um pior desempenho nos testes de mobilidade funcional e de fluência verbal que os idosos sem a doença, sugerindo um maior risco de quedas para idosos diabéticos. A inclusão desses parâmetros de avaliação para diabéticos na prática clinica da fisioterapia é fundamental para preservar a funcionalidade e evitar quedas.

BACKGROUND: Elderly diabetics tend to show cognitive deficits related to more complex processes such as the executive function, which can lead to a greater risk of falls. OBJECTIVES: The aims of this study were to compare the functional mobility, the risk of falls and the executive function among elderly with and without type 2 diabetes, and to check the correlation between these variables. METHODS: Forty community elderly participated in the study and were divided into two groups: G1 elderly with type 2 diabetes and G2 elderly without diabetes, being the variables age, body mass index and gender similar between the groups. The functional mobility and the risk of falls were assessed by the "Timed Up and Go" test (TUG and cognitive TUG) and the executive function was assessed by the Verbal Fluency Test (VFT) (animal category). RESULTS: Elderly with diabetes showed worse performance in the verbal fluency test (G1:14.9±4.5; G2:17.7±5.6; p=0.031). A statistically between-group difference was observed regarding the functional mobility; being the G1 presenting worse performance in TUG (G1:10.5±1.8sec; G2:8.9±1.9sec; p=0.01) and cognitive TUG (G1:13.9±3.2sec; G2:10.9±2.3sec; p=0.004) tests. A significant correlation was observed between the cognitive TUG and VFT only in G1 (G1: Spearman's rho = -0.535; p=0.015; G2: Spearman's rho =-0.250; p=0.288). CONCLUSIONS: Diabetics presented worse performance in the functional mobility and in the verbal fluency test than non-diabetics elderly that suggests a greater risk of falls for the elderly with diabetes. The inclusion of these evaluation parameters for diabetics on the physical therapy clinical practice is crucial in order to maintain the functionality and to prevent falls.

The effects of a muscle resistance program on the functional capacity, knee extensor muscle strength and plasma levels of IL-6 and TNF-alpha in pre-frail elderly women: a randomized crossover clinical trial--a study protocol.

BACKGROUND: With the increase in the elderly population, a growing number of chronic degenerative diseases and a greater dependency on caregivers have been observed. Elderly persons in states of frailty remain more susceptible to significant health complications. There is evidence of an inverse relationship between plasma levels of inflammatory mediators and levels of functionality and muscle strength, suggesting that muscle-strengthening measures can aid in inflammatory conditions. The purpose of this study will be verified the effect of a muscle-strengthening program with load during a ten-week period in pre-frail elderly women with attention to the following outcomes: (1) plasma levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha), (2) functional capacity and (3) knee extensor muscle strength. METHODS/DESIGN: The study design is a randomized crossover clinical trial evaluating 26 elderly women (regardless of their race and/or social condition) who are community residents, older than 65, and classified as pre-frail according to the criteria previously described by Fried et al. (2004). All subjects will be assessed using the Timed up and go and 10-Meter Walk Test functional tests. The plasma levels of IL-6 and TNF-alpha will be assessed by ELISA (enzyme-linked immunosorbent assay) with high sensitivity kits (QuantikineHS, R&D Systems Minneapolis, MN, U.S.). Knee extensor muscle strength will be assessed using the Byodex System 3 Pro(R) isokinetic dynamometer at angular speeds of 60 and 180 degrees/s. The intervention will consist of strengthening exercises of the lower extremities at 50 to 70% of 1RM (maximal resistance) three times per week for ten weeks. The volunteers will be randomized into two groups: group E, the intervention group, and group C, the control group that did not initiate any new activities during the initial study period (ten weeks). After the initial period, group C will begin the intervention and group E will maintain everyday activities without exercising. At the end of the total study period, all volunteers will be reassessed. DISCUSSION: To demonstrate and discuss possible influences of load-bearing exercises on the modification of plasma levels of IL-6 and TNF-alpha and in the functional performance of pre-frail elderly women. TRIAL REGISTRATION: ISRCTN62824599.

Functional mobility and executive function in elderly diabetics and non-diabetics.

BACKGROUND: Elderly diabetics tend to show cognitive deficits related to more complex processes such as the executive function, which can lead to a greater risk of falls. OBJECTIVES: The aims of this study were to compare the functional mobility, the risk of falls and the executive function among elderly with and without type 2 diabetes, and to check the correlation between these variables. METHODS: Forty community elderly participated in the study and were divided into two groups: G1 elderly with type 2 diabetes and G2 elderly without diabetes, being the variables age, body mass index and gender similar between the groups. The functional mobility and the risk of falls were assessed by the "Timed Up and Go" test (TUG and cognitive TUG) and the executive function was assessed by the Verbal Fluency Test (VFT) (animal category). RESULTS: Elderly with diabetes showed worse performance in the verbal fluency test (G1:14.9 ± 4.5; G2:17.7 ± 5.6; p = 0.031). A statistically between-group difference was observed regarding the functional mobility; being the G1 presenting worse performance in TUG (G1:10.5 ± 1.8 sec; G2:8.9 ± 1.9 sec; p = 0.01) and cognitive TUG (G1:13.9 ± 3.2 sec; G2:10.9 ± 2.3 sec; p = 0.004) tests. A significant correlation was observed between the cognitive TUG and VFT only in G1 (G1: Spearman's rho = -0.535; p = 0.015; G2: Spearman's rho =-0.250; p = 0.288). CONCLUSIONS: Diabetics presented worse performance in the functional mobility and in the verbal fluency test than non-diabetics elderly that suggests a greater risk of falls for the elderly with diabetes. The inclusion of these evaluation parameters for diabetics on the physical therapy clinical practice is crucial in order to maintain the functionality and to prevent falls.