Cardiorespiratory abnormalities in ICU survivors of COVID-19 with postacute sequelae of SARS-CoV-2 infection are unrelated to invasive mechanical ventilation.

Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) often leads to exertional intolerance and reduced exercise capacity, particularly in individuals previously admitted to an intensive care unit (ICU). However, the impact of invasive mechanical ventilation (IMV) on PASC-associated cardiorespiratory abnormalities during exercise remains poorly understood. This single-center, cross-sectional study aimed to gather knowledge on this topic. Fifty-two patients with PASC recruited ∼6 mo after ICU discharge were clustered based on their need for IMV (PASC + IMV, n = 27) or noninvasive support therapy (PASC + NIS, n = 25). Patients underwent pulmonary function and cardiopulmonary exercise testing (CPX) and were compared with a reference group (CONTROL, n = 19) comprising individuals of both sexes with similar age, comorbidities, and physical activity levels but without a history of COVID-19 illness. Individuals with PASC, irrespective of support therapy, presented with higher rates of cardiorespiratory abnormalities than CONTROL, especially dysfunctional breathing patterns, dynamic hyperinflation, reduced oxygen uptake and oxygen pulse, and blunted heart rate recovery (all P < 0.05). Only the rate of abnormal oxygen pulse was greater among PASC + IMV group than PASC + NIS group (P = 0.05). Mean estimates for all CPX variables were comparable between PASC + IMV and PASC + NIS groups (all P > 0.05). These findings indicate significant involvement of both central and peripheral factors, leading to exertional intolerance in individuals with PASC previously admitted to the ICU, regardless of their need for IMV.NEW & NOTEWORTHY We found cardiorespiratory abnormalities in ICU survivors of severe-to-critical COVID-19 with PASC to be independent of IMV need. Overall, both group of patients experienced dysfunctional breathing patterns, dynamic hyperinflation, lower oxygen uptake and oxygen pulse, and blunted heart rate responses to CPX. PASC seems to impact exertional tolerance and exercise capacity due to ventilatory inefficiency, impaired aerobic metabolism, and potential systolic and autonomic dysfunction, all of these irrespective of support therapy during ICU stay.

The utility of cardiopulmonary exercise testing in athletes and physically active individuals with or without persistent symptoms after COVID-19

INTRODUCTION: Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms. METHODS: Participants' assessment included medical history and physical examination, cardiac troponin T, resting electrocardiogram, spirometry and CPET. Persistent symptoms were defined as fatigue, dyspnea, chest pain, dizziness, tachycardia, and exertional intolerance persisting >2 months after COVID-19 diagnosis. RESULTS: A total of 46 participants were included; sixteen (34.8%) were asymptomatic and thirty participants (65.2%) reported persistent symptoms, with fatigue and dyspnea being the most reported ones (43.5 and 28.1%). There were a higher proportion of symptomatic participants with abnormal data for slope of pulmonary ventilation to carbon dioxide production (VE/VCO2 slope; p<0.001), end-tidal carbon dioxide pressure at rest (PETCO2 rest; p=0.007), PETCO2 max (p=0.009), and dysfunctional breathing (p=0.023) vs. asymptomatic ones. Rates of abnormalities in other CPET variables were comparable between asymptomatic and symptomatic participants. When assessing only elite and highly trained athletes, differences in the rate of abnormal findings between asymptomatic and symptomatic participants were no longer statistically significant, except for expiratory air flow-to-percent of tidal volume ratio (EFL/VT) (more frequent among asymptomatic participants) and dysfunctional breathing (p=0.008). DISCUSSION: A considerable proportion of consecutive athletes and physically active individuals presented with abnormalities on CPET after COVID-19, even those who had had no persistent cardiorespiratory symptomatology. However, the lack of control parameters (e.g., pre-infection data) or reference values for athletic populations preclude stablishing the causality between COVID-19 infection and CPET abnormalities as well as the clinical significance of these findings.

Performing moderate to severe activity is safe and tolerable for healthy youth while wearing a cloth facemask.

OBJECTIVE: To investigate if a cloth facemask could affect physiological and perceptual responses to exercise at distinct exercise intensities in healthy young individuals. METHODS: Nine participants (sex, female/male: 6/3; age: 13±1 years; VO2peak: 44.5±5.5 mL/kg/min) underwent a progressive square-wave test at four intensities: (1) 80% of ventilatory anaerobic threshold (VAT), (2) VAT, and (3) 40% between VAT and [Formula: see text] wearing a triple-layered cloth facemask or not. Participants then completed a final stage to exhaustion at a running speed equivalent to the maximum achieved during the cardio-respiratory exercise test (Peak). Physiological, metabolic, and perceptual measures were measured. RESULTS: Mask did not affect spirometry (forced vital capacity, peak expiratory flow, forced expiratory volume; all p≥0.27), respiratory (inspiratory capacity, end-expiratory volume [EELV] to functional vital capacity ratio, EELV, respiratory frequency [Rf], tidal volume [VT], Rf/VT, end-tidal carbo dioxide pressure, ventilatory equivalent to carbon dioxide ratio; all p≥0.196), hemodynamic (heart rate, systolic and diastolic blood pressure; all p>0.41), ratings of perceived exertion (p = 0.04) or metabolic measures (lactate; p = 0.78) at rest or at any exercise intensity. CONCLUSIONS: This study shows that performing moderate to severe activity is safe and tolerable for healthy youth while wearing a cloth facemask. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04887714.

A Cloth Facemask Causes No Major Respiratory or Cardiovascular Perturbations During Moderate to Heavy Exercise.

PURPOSE: Investigate whether a cloth facemask could affect physiological and perceptual responses to exercise at distinct exercise intensities in untrained individuals. METHODS: Healthy participants (n = 35; 17 men, age 30 [4] y, and 18 women, age 28 [5] y) underwent a progressive square wave test at 4 intensities: (1) 80% of ventilatory anaerobic threshold; (2) ventilatory anaerobic threshold; (3) respiratory compensation point; and (4) exercise peak (Peak) to exhaustion, 5-minute stages, with or without a triple-layered cloth facemask (Mask or No-Mask). Several physiological and perceptual measures were analyzed. RESULTS: Mask reduced inspiratory capacity at all exercise intensities (P < .0001). Mask reduced respiratory frequency (P = .001) at Peak (-8.3 breaths·min-1; 95% confidence interval [CI], -5.8 to -10.8), respiratory compensation point (-6.9 breaths·min-1; 95% CI, -4.6 to -9.2), and ventilatory anaerobic threshold (-6.5 breaths·min-1; 95% CI, -4.1 to -8.8), but not at Baseline or 80% of ventilatory anaerobic threshold. Mask reduced tidal volume (P < .0001) only at respiratory compensation point (-0.5 L; 95% CI, -0.3 to -0.6) and Peak (-0.8 L; 95% CI, -0.6 to -0.9). Shallow breathing index was increased with Mask only at Peak (11.3; 95% CI, 7.5 to 15.1). Mask did not change HR, lactate, ratings of perceived exertion, blood pressure, or oxygen saturation. CONCLUSIONS: A cloth facemask reduced time to exhaustion but had no major impact on cardiorespiratory parameters and had a slight but clinically meaningless impact on respiratory variables at higher intensities. Moderate to heavy activity is safe and tolerable for healthy individuals while wearing a cloth facemask. CLINICALTRIALS: gov: NCT04887714.

A cloth facemask increased ratings of perceived exertion and reduced affect, without affecting sprint or muscular performance.

We determined the effects of wearing a cloth facemask on exercise performance and subjective responses during training of track and field athletes. Track and field athletes (n = 10, sprinters and long jumpers) performed two training sessions with and without a three-layered antiviral cloth facemask. The training session simulated the specific demands of the sport, consisting of five 30-m sprints, interspersed with passive 4-min intervals. Countermovement jump performance was assessed pre- and post-sprints, and ratings of perceived exertion (RPE) and affect were collected throughout. There was no evidence of condition*time interactions for sprint time (P = 0.21) or acceleration (P = 0.47). There was weak evidence of a condition effect on RPE (P = 0.05), though no condition*time interaction (P = 0.35). There was moderate evidence of a condition*time interaction for affect (P = 0.02), with lower ratings following sprints 3, 4 and 5 when using the mask. These findings suggest that wearing a mask may negatively impact subjective feelings of training without necessarily harming sprint performance.

Acute and post-acute COVID-19 presentations in athletes: a systematic review and meta-analysis.

OBJECTIVE: To describe acute/postacute COVID-19 presentations in athletes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: The search was conducted in four databases (MEDLINE, EMBASE, SCOPUS, SPORTDiscus) and restricted to studies published from 2019 to 6 January 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were required to (1) include professional, amateur or collegiate/university athletes with COVID-19; (2) present data on acute/postacute COVID-19 symptoms and (3) have an observational design. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools. RESULTS: 43 studies with 11 518 athletes were included. For acute presentation, the pooled event rates for asymptomatic and severe COVID-19 were 25.5% (95% CI: 21.1% to 30.5%) and 1.3% (95% CI: 0.7% to 2.3%), respectively. For postacute presentations, the pooled estimate of persistent symptoms was 8.3% (95% CI: 3.8% to 17.0%). Pooled estimate for myocardial involvement was 5.0% (95% CI: 2.5% to 9.8%) in athletes undergoing any cardiac testing, and 2.5% (95% CI: 1.0% to 5.8%) in athletes undergoing MRI, although clinical symptoms were not characterised. None of the studies with a control group (eg, non-infected athletes) could confirm a causal relationship between COVID-19 and myocardial involvement. CONCLUSION: This broad characterisation of COVID-19 presentations in athletes indicates that ~94% exhibited mild or no acute symptoms. The available evidence did not confirm a causal relationship between COVID-19 and myocardial involvement. A small proportion of athletes experienced persistent symptoms while recovering from infection, which were mostly mild in nature, but could affect return-to-play decisions and timing.

Poor muscle strength and function in physically inactive childhood-onset systemic lupus erythematosus despite very mild disease / Redução na força muscular e capacidade funcional em pacientes fisicamente inativos com lúpus eritematoso sistêmico de início juvenil, apesar de doença muito leve

ABSTRACT Objective: To compare muscle strength (i.e. lower- and upper-body strength) and function between physically inactive childhood-onset systemic lupus erythematosus patients (C-SLE) and healthy controls (CTRL). Methods: This was a cross-sectional study and the sample consisted of 19 C-SLE (age between 9 and 18 years) and 15 CTRL matched by age, sex, body mass index (BMI), and physical activity levels (assessed by accelerometry). Lower- and upper-body strength was assessed by the one-repetition-maximum (1-RM) test. Isometric strength was assessed through a handgrip dynamometer. Muscle function was evaluated by the timed-stands test (TST) and the timed-up-and-go test (TUG). Results: When compared with CTRL, C-SLE showed lower leg-press and bench-press 1-RM (p = 0.026 and p = 0.008, respectively), and a tendency toward lower handgrip strength (p = 0.052). C-SLE showed lower TST scores (p = 0.036) and a tendency toward higher TUG scores (p = 0.070) when compared with CTRL. Conclusion: Physically inactive C-SLE patients with very mild disease showed reduced muscle strength and functionality when compared with healthy controls matched by physical activity levels. These findings suggest C-SLE patients may greatly suffer from a physically inactive lifestyle than healthy controls do. Moreover, some sub-clinical “residual” effect of the disease or its pharmacological treatment seems to affect C-SLE patients even with a well-controlled disease.

RESUMO Objetivo: Comparar a força muscular (ou seja, a força muscular dos membros superiores e inferiores) e a capacidade funcional de pacientes fisicamente inativos com lúpus eritematoso sistêmico de início juvenil (LESJ) com controles saudáveis (CTRL). Métodos: Estudo transversal cuja amostra foi composta por 19 pacientes com LESJ (entre 9 e 18 anos) e 15 CTRL pareados por idade, sexo, índice de massa corporal (IMC) e nível de atividade física (avaliada através do uso de acelerômetros). A força dos membros superiores e inferiores foi avaliada pelo teste de uma repetição máxima (1-RM). A força isométrica foi avaliada através do uso de um dinamômetro. A capacidade funcional foi avaliada pelo Timed-stands test (TST) e Timed-up-and-go test (TUG). Resultados: Quando comparados com os CTRL, os pacientes com LESJ apresentaram menor força em 1-RM no Leg press e supino (p = 0,026 e p = 0,008, respectivamente) e uma tendência a menor força de preensão manual (p = 0,052). Os pacientes com LESJ apresentaram menores escores no TST (p = 0,036) e uma tendência a maior pontuação no TUG (p = 0,070), quando comparados com o grupo CTRL. Conclusão Pacientes com LESJ, fisicamente inativos, com doença muito leve mostraram redução na força muscular e capacidade funcional quando comparados com controles saudáveis pareados por níveis de atividade física. Esses achados sugerem que pacientes com LESJ podem apresentar mais efeitos deletérios por manter um estilo de vida fisicamente inativo do que controles saudáveis. Além disso, alguns efeitos “residuais” subclínicos da doença ou do tratamento farmacológico parecem afetar pacientes com LESJ, mesmo com uma doença bem controlada.

GLUT4 translocation is not impaired after acute exercise in skeletal muscle of women with obesity and polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to examine the effects of acute exercise on insulin signaling in skeletal muscle of women with polycystic ovary syndrome (PCOS) and controls (CTRL). METHODS: Fifteen women with obesity and PCOS and 12 body mass index-matched CTRL participated in this study. Subjects performed a 40-min single bout of exercise. Muscle biopsies were performed before and 60 min after exercise. Selected proteins were assessed by Western blotting. RESULTS: CTRL, but not PCOS, showed a significant increase in PI3-k p85 and AS160 Thr 642 after a single bout of exercise (P = 0.018 and P = 0.018, respectively). Only PCOS showed an increase in Akt Thr 308 and AMPK phosphorylation after exercise (P = 0.018 and P = 0.018, respectively). Total GLUT4 expression was comparable between groups (P > 0.05). GLUT4 translocation tended to be significantly higher in both groups after exercise (PCOS: P = 0.093; CTRL: P = 0.091), with no significant difference between them (P > 0.05). CONCLUSIONS: A single bout of exercise elicited similar GLUT4 translocation in skeletal muscle of PCOS and CTRL, despite a slightly differential pattern of protein phosphorylation. The absence of impairment in GLUT4 translocation suggests that PCOS patients with obesity and insulin resistance may benefit from exercise training.

Effects of Aerobic Training on Cognition and Brain Glucose Metabolism in Subjects with Mild Cognitive Impairment.

BACKGROUND: Aerobic training (AT) is a promising intervention for mild cognitive impairment (MCI). OBJECTIVE: To evaluate the effects of AT on cognition and regional brain glucose metabolism (rBGM) in MCI patients. METHODS: Subjects performed a twice-a-week, moderate intensity, AT program for 24 weeks. Assessment with ADAS-cog, a comprehensive neuropsychological battery, and evaluation of rBGM with positron emission tomography with 18F-fluorodeoxyglucose ([18F]FDG-PET) were performed before and after the intervention. Aerobic capacity was compared using the maximal oxygen consumption VO2max (mL/Kg/min). [18F]FDG-PET data were analyzed on a voxel-by-voxel basis with SPM8 software. RESULTS: Forty subjects were included, with a mean (M) age of 70.3 (5.4) years and an initial Mini-Mental State Exam score of 27.4 (1.7). Comparisons using paired t-tests revealed improvements in the ADAS-cog (M difference: -2.7 (3.7), p <  0.001) and VO2max scores (M difference: 1.8 (2.0) mL/kg/min, p <  0.001). Brain metabolic analysis revealed a bilateral decrease in the rBGM of the dorsal anterior cingulate cortex, pFWE = 0.04. This rBGM decrease was negatively correlated with improvement in a visuospatial function/attentional test (rho =-0.31, p = 0.04). Several other brain areas also showed increases or decreases in rBGM. Of note, there was an increase in the retrosplenial cortex, an important node of the default mode network, that was negatively correlated with the metabolic decrease in the dorsal anterior cingulate cortex (r =-0.51, p = 0.001). CONCLUSION: AT improved cognition and changed rBGM in areas related to cognition in subjects with MCI.

Spondyloptosis in athlete.

The adolescent athletes are at greater risk of low back pain and structural spine injuries. Spondylolysis is responsible for the majority of back pain cases in young athletes, rarely occurring in adults. We report a case of a 13-year-old judo female athlete, who came to our service with 5 months of progressive low back pain during training which was initially attributed to mechanical causes, without any further investigation by imaging methods. At admission, the patient had lumbar deformity, antalgic posture and bilaterally positive unipodalic lumbar hyperextension maneuver. After a research which showed spondyloptosis, the patient underwent surgery. In this article, we discuss, based on this case report, the diagnostic approach to low back pain in young athletes, since the complaint of chronic back pain can be a marker of a structural lesion that may be permanent and bring irreversible functional loss.

Espondiloptose em atleta / Spondyloptosis in athlete

Os atletas adolescentes estão sob maior risco de lombalgia e lesões estruturais da coluna. A espondilólise é responsável pela maioria das lombalgias em jovens esportistas e raramente ocorre em adultos. Relatamos o caso de uma paciente de 13 anos, atleta de judô, que chegou a nosso serviço com quadro de cinco meses de lombalgia progressiva durante os treinos, sendo inicialmente atribuída a causas mecânicas, sem que houvesse uma investigação mais detalhada por métodos de imagem. Na admissão já apresentava deformidade lombar, postura antálgica e manobra de hiperextensão lombar em unipodálico positiva bilateralmente. Realizou-se investigação, que evidenciou espondiloptose, sendo, então, submetida a tratamento cirúrgico. Com base neste relato de caso, discutimos a abordagem diagnóstica de lombalgia em atletas jovens, uma vez que a queixa de lombalgia crônica pode ser marcador de uma lesão estrutural, a qual pode ser definitiva e trazer perda funcional irreversível.

The adolescent athletes are at greater risk of low back pain and structural spine injuries. Spondylolysis is responsible for the majority of back pain cases in young athletes, rarely occurring in adults. We report a case of a 13-year-old judo female athlete, who came to our service with 5 months of progressive low back pain during training which was initially attributed to mechanical causes, without any further investigation by imaging methods. At admission, the patient had lumbar deformity, antalgic posture and bilaterally positive unipodalic lumbar hyperextension maneuver. After a research which showed spondyloptosis, the patient underwent surgery. In this article, we discuss, based on this case report, the diagnostic approach to low back pain in young athletes, since the complaint of chronic back pain can be a marker of a structural lesion that may be permanent and bring irreversible functional loss.

Efeito da suplementação de creatina, associada ou não ao treinamento de força, sobre a peroxidação lipídica em mulheres idosas / Effects of creatine supplementation associated or not with strength training upon lipid peroxidation in elderly women

O objetivo desse trabalho foi avaliar o efeito da suplementação de creatina associada ou não ao treinamento de força sobre a peroxidação lipídica em mulheres idosas. Foi conduzido um estudo clínico, randomizado, duplo-cego e controlado por placebo, no qual mulheres idosas foram randomizadas para compor quatro grupos: 1) suplementação com placebo (PL; n = 10); 2) suplementação com creatina (CR; n = 10); 3) suplementação com placebo associado ao treinamento de força (PL+TR; n = 6); e 4) suplementação com creatina associado ao treinamento de força (CR+TR; n = 8). Antes (PRE) e após 24 semanas (POS) de intervenção, foram coletadas amostras de sangue para posterior análise das concentrações plasmáticas de hidroperóxidos lipídicos por espectrofotometria. Nenhuma diferença estatística foi observada na concentração de hidroperóxidos lipídicos entre os grupos (PL: PRE = 48,7 ± 36,9; POS = 29,3 ± 18,8; delta = -13,0 ± 26,8; CR: PRE = 51,0 ± 46,0; POS = 54,2 ± 51,6; delta = -8,6 ± 30,2; PL+TR: PRE = 33,0 ± 11,2; POS = 47,3 ± 31,6; Δ = 14,3 ± 39,2; CR+TR: PRE = 18,5 ± 10,1; POS = 28,1 ± 17,9; delta = 9,7 ± 16,4 pmol.mg-1 de proteína total; p = 0,17). A suplementação de creatina associada ou não ao treinamento de força não afetou a peroxidação lipídica, um importante marcador de estresse oxidativo no plasma, em mulheres idosas.

The aim of this study was to evaluate the effects of creatine supplementation associated or not with strength training upon lipid peroxidation in older women. This was a clinical, randomized, double-blind, placebo-controlled trial. Older women were randomly allocated into four groups: 1) placebo supplementation (PL, n = 10), 2) creatine supplementation (CR; n = 10), 3) placebo supplementation associated with strength training (PL + RT, n = 6) and 4) creatine supplementation associated with strength training (CR + RT, n = 8). Before (PRE) and after 24 weeks (POST), blood samples were collected to measure lipid hydroperoxides concentration by spectrophotometry. No statistical difference was observed on the lipid hydroperoxides concentration between groups (PL: PRE = 48.7 ± 36.9; POST = 29.3 ± 18.8; Δ = -13.0 ± 26.8; CR : PRE = 51.0 ± 46.0; POST = 54.2 ± 51.6; Δ = -8.6 ± 30.2; + PL TR: PRE = 33.0 ± 11.2; POST = 47.3 ± 31.6, Δ = 14.3 ± 39.2; CR + TR: PRE = 18.5 ± 10.1; POST = 28.1 ± 17.9, Δ = 9.7 ± 16.4 pmol.mg-1 of total protein, p = 0.17). Creatine supplementation associated or not with strength training did not affect the lipid peroxidation, an important plasmatic marker of oxidative stress, in elderly women.

Efeitos terapêuticos do treinamento físico em pacientes com doenças reumatológicas pediátricas / Therapeutic effects of exercise training in patients with pediatric rheumatic diseases

Ao longo das últimas décadas, o papel do exercício em doenças reumatológicas tem sido bastante explorado. Sabe-se, atualmente, que a prática de atividade física promove inúmeros benefícios ao paciente com osteoporose, osteoartrite, lúpus eritematoso sistêmico, esclerose sistêmica, miopatias idiopáticas inflamatórias, fibromialgia e artrite reumatoide. Dessa forma, o exercício físico tem sido considerado ferramenta valiosa no tratamento do paciente reumático. Os efeitos terapêuticos do treinamento físico em doenças reumatológicas pediátricas também têm sido alvos recentes de investigação. Em conjunto, os estudos têm revelado grande potencial terapêutico do exercício para pacientes com artrite idiopática juvenil, lúpus eritematoso sistêmico juvenil, dermatomiosite juvenil, fibromialgia juvenil e outras causas de dor crônica. Esta revisão narrativa tem como objetivos familiarizar o reumatologista pediátrico ao campo da ciência do exercício, discutir os potenciais benefícios do exercício físico na reumatologia pediátrica, com ênfase nas perspectivas desse promissor campo de atuação clínica e científica, e apresentar modelos práticos de exame de pré-participação e contraindicações ao exercício físico.

Over the past decades, the role of exercise training in rheumatic diseases has been largely explored. Currently, physical activity is well known to benefit patients with osteoporosis, osteoarthritis, systemic lupus erythematosus, systemic sclerosis, idiopathic inflammatory myopathy, fibromyalgia and rheumatoid arthritis. Therefore, exercise training has been considered a valuable tool for treating rheumatic patients. The therapeutic effects of exercise training have also been investigated in pediatric rheumatic diseases. Collectively, studies have revealed the therapeutic potential of exercise in juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, juvenile dermatomyositis, juvenile fibromyalgia and other causes of chronic pain. The aim of this review is to familiarize the pediatric rheumatologist with the exercise science field; discuss the potential benefits of exercise training in pediatric rheumatic diseases, emphasize both research and clinical perspectives of this promising field; and propose practical models of pre-participation examinations and contraindications to exercise.

Therapeutic effects of exercise training in patients with pediatric rheumatic diseases.

Over the past decades, the role of exercise training in rheumatic diseases has been largely explored. Currently, physical activity is well known to benefit patients with osteoporosis, osteoarthritis, systemic lupus erythematosus, systemic sclerosis, idiopathic inflammatory myopathy, fibromyalgia and rheumatoid arthritis. Therefore, exercise training has been considered a valuable tool for treating rheumatic patients. The therapeutic effects of exercise training have also been investigated in pediatric rheumatic diseases. Collectively, studies have revealed the therapeutic potential of exercise in juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, juvenile dermatomyositis, juvenile fibromyalgia and other causes of chronic pain. The aim of this review is to familiarize the pediatric rheumatologist with the exercise science field; discuss the potential benefits of exercise training in pediatric rheumatic diseases, emphasize both research and clinical perspectives of this promising field; and propose practical models of pre-participation examinations and contraindications to exercise.

Beneficial effect of creatine supplementation in knee osteoarthritis.

INTRODUCTION: The aim of this study was to investigate the efficacy of creatine (CR) supplementation combined with strengthening exercises in knee osteoarthritis (OA). METHODS: A randomized, double-blind, placebo-controlled trial was performed. Postmenopausal women with knee OA were allocated to receive either CR (20 g·d(-1) for 1 wk and 5 g·d(-1) thereafter) or placebo (PL) and were enrolled in a lower limb resistance training program. They were assessed at baseline (PRE) and after 12 wk (POST). The primary outcome was the physical function as measured by the timed-stands test. Secondary outcomes included lean mass, quality of life, pain, stiffness, and muscle strength. RESULTS: Physical function was significantly improved only in the CR group (P = 0.006). In addition, a significant between-group difference was observed (CR: PRE = 15.7 ± 1.4, POST = 18.1 ± 1.8; PL: PRE = 15.0 ± 1.8, POST = 15.2 ± 1.2; P = 0.004). The CR group also presented improvements in physical function and stiffness subscales as evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (P = 0.005 and P = 0.024, respectively), whereas the PL group did not show any significant changes in these parameters (P > 0.05). In addition, only the CR group presented a significant improvement in lower limb lean mass (P = 0.04) as well as in quality of life (P = 0.01). Both CR and PL groups demonstrated significant reductions in pain (P < 0.05). Similarly, a main effect for time revealed an increase in leg-press one-repetition maximum (P = 0.005) with no significant differences between groups (P = 0.81). CONCLUSIONS: CR supplementation improves physical function, lower limb lean mass, and quality of life in postmenopausal women with knee OA undergoing strengthening exercises.

Incidência e fatores de risco de lesões osteomioarticulares em corredores: um estudo de coorte prospectivo / Incidence and risk factors of lower limb injury in runners: a prospective cohort study

A prática de corrida de média e longa distância tem crescido em todo o mundo. Apesar de todos os efeitos benéficos da prática de corrida, tem-se observado uma elevada incidência de lesões, sobretudo em membros inferiores. O mecanismo de lesão relacionada à corrida obedece a um padrão comum a todas as lesões nos diferentes esportes e decorre da sobreposição de dois ou mais fatores. Os objetivos desse estudo foram: 1) relatar prospectivamente a incidência de lesões osteomioarticulares em corredores amadores durante 12 meses de seguimento; e 2) detectar os principais fatores extrínsecos e intrínsecos para as lesões encontradas. Dezoito corredores (13 homens e cinco mulheres) amadores foram selecionados para participarem do estudo. Eles foram submetidos a uma avaliação clínica com exame físico completo e do aparelho locomotor, avaliação nutricional, exames laboratoriais, teste ergométrico, avaliação da densidade mineral óssea e composição corporal e radiografia dos pés no período basal e após um ano de seguimento. Aqueles que apresentaram alguma lesão foram comparados com seus pares que não lesionados, considerando-se as diversas variáveis coletadas. Metade da amostra (50 por cento) apresentou alguma lesão osteomuscular em membros inferiores no período do estudo. Os fatores de risco significantemente associados foram graus de extensão de joelho e flexão plantar diminuídos, frequência cardíaca de repouso menor e velocidade de treino maior. A alta frequência de lesões osteomioartculates nestes corredores de longa distância esteve associada a fatores intrínsecos e extrínsecos. A avaliação clínica deve ser focada nesses parâmetros com intuito de prevenir lesões em corredores.

The practice of middle- and long-distance running has become worldwide popular. Despite the number of benefits associated with this sport, increased incidence of lower limb injury has been observed. The injury mechanisms related to running are similar to those seen in different sports and can be a result of two or more factors. The aims of this study were: 1) to report prospectively the incidence of injuries in non professional runners after a 12-month follow-up; and 2) to determine the main intrinsic and extrinsic factors related to the observed injuries. Eighteen runners (13 males and five females) took part in this study. They were submitted to clinical examination, nutritional and biochemical assessments, VO2max test, bone mineral density and body composition evaluation, and foot radiography at baseline and after one year. The subjects who had injury were compared to those non-injured taken into account the several variables assessed. Fifth percent of the sample presented at least one lower limb injury. The factors significantly associated with the injuries were reduced knee extension and plantar flexion range of motion, lower resting heart rate, and high training speed. The high incidence of injuries observed in this study was associated with intrinsic and extrinsic factors. The clinical assessment should focus on these parameters in order to prevent injuries.

Resistance training with vascular occlusion in inclusion body myositis: a case study.

UNLABELLED: Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy that produces remarkable muscle weakness. Resistance training with vascular occlusion has been shown to improve muscle strength and cross-sectional area in other muscle wasting conditions. PURPOSE: We evaluated the efficacy of a moderate-intensity resistance training program combined with vascular occlusion by examining functional capacity, muscle morphology, and changes in the expression of genes related to muscle protein synthesis and proteolysis in a patient with IBM. METHODS: A 65-yr-old man with IBM resistant to all proposed treatments underwent resistance training with vascular occlusion for 12 wk. Leg press one-repetition maximum; thigh cross-sectional area; balance, mobility, and muscle function; quality of life; and blood markers of inflammation and muscle damage were assessed at baseline and after the 12-wk program. The messenger RNA (mRNA) expression levels of mechanogrowth factor, mammalian target of rapamycin, atrogin-1, and muscle RING finger-1 were also quantified. RESULTS: After the 12-wk training program, the patient's leg press one-repetition maximum, balance and mobility function, and thigh cross-sectional area increased 15.9%, 60%, and 4.7%, respectively. All Short Form-36 Health Survey Questionnaire subscales demonstrated improvements as well, varying from 18% to 600%. mRNA expression of mechanogrowth factor increased 3.97-fold, whereas that of atrogin-1 decreased 0.62-fold. Muscle RING finger-1 and mammalian target of rapamycin mRNA levels were only slightly altered, 1.18- and 1.28-fold, respectively. Importantly, the exercise did not induce disease flare. CONCLUSIONS: We describe a novel, and likely the first, nonpharmacological therapeutic tool that might be able to counteract the muscle atrophy and the declining strength that usually occur in IBM.