Effects of 12-Weeks of Home-Based Exercise Training on Physical and Cognitive Function of Older Adults: Randomized Trial Comparing Virtual Versus Minimal Supervision in the Context of the Covid-19 Pandemic in Brazil.

Background: We investigated the effects of a 12-week home-based exercise program delivered with virtual or minimal supervision on the physical and cognitive function of community-dwelling older adults in the context of the COVID-19 pandemic in Brazil. Methods: The study was registered on the Brazilian Registry of Clinical Trials platform (code: RBR-8qby2wt). Thirty-eight older adults (81% female and 68±7 years old), non-disabled, and without cognitive impairment or dementia, were randomly assigned to a 12-week home-based exercise program: 1) virtual supervision (classes remotely delivered through video conference by trained staff), or 2) minimal supervision (once-weekly contact to touch base through standardized text messages). The participants initially performed two sets of 10 repetitions three times a week, with a 60-second interval. The volume and complexity of the exercises were progressively increased. (e.g., the number of sets increased to 3 and later to 4). At baseline and follow-up, we collected remote measurements of physical function (muscle strength and power, functional muscular fitness) and cognition (processing speed, inhibitory control, verbal fluency). Results: Participants in the minimal supervision home-based exercise group significantly improved the Stroop test (-1.6 sec, 95% CI = -3.20; -0.09). No significant between-group differences were observed for physical and cognitive outcomes. Conclusion: A home-based exercise program delivered with virtual or minimal supervision can produce similar effects, and may help to maintain physical and cognitive capabilities among healthy, high-functioning older adults who experienced mobility restrictions due to the COVID-19 pandemic in Brazil.

Treinamento de força com e sem instabilidade não melhora os níveis gerais de capacidade intrínseca em idosos com queixas cognitivas / Resistance training with and without instability does not improve overall levels of intrinsic capacity in older adults with cognitive complaints

INTRODUÇÃO: Capacidade intrínseca (CI) é um construto que engloba capacidades físicas e mentais para o autocuidado e envelhecimento saudável. A compreensão do papel potencial do treinamento resistido, com e sem instabilidade, para promover o CI precisa ser esclarecida. OBJETIVO: Avaliar o impacto do treinamento de força sobre os níveis de capacidade intrínseca em idosos com queixas cognitivas. MÉTODOS: Idosos com queixas cognitivas (n=67) foram aleatoriamente designados para 12 semanas de TF tradicional (n=23), TF com dispositivos de instabilidade (TFI) (n=22) ou controle (n=22). Ambos os grupos de treinamento realizaram três séries de 10- 15 repetições. O grupo TFI realizou exercícios utilizando dispositivos de instabilidade. O grupo controle recebeu aulas semanais de educação em saúde. Os domínios da CI foram de mobilidade e velocidade da marcha (locomotora), função global e executiva (cognitivo), força de preensão e teste de caminhada de seis minutos (vitalidade), e sintomas depressivos e autoeficácia (psicológicos) por meio de escores-z compostos. Calculamos os níveis globais de CI pela soma de cada pontuação composta. RESULTADOS: Diferença significativa intragrupo nos níveis gerais de CI (∆TFI = +1.69, ∆TF = +1.30) e seus respectivos domínios (Locomoção: ∆TFI = +2.32, ∆TF = +3.21; Cognição: ∆TFI = +2.31; Vitalidade: ∆TFI = +1.23, ∆TF = +1.42; e Psicológico: ∆TFI = -0.65, ∆TF = -0.62). Contudo, não houve diferenças entre os grupos. Análise de sensibilidade mesclando os grupos de treinamento revelou diferença significativa para o domínio locomotor após 12 semanas (+1.97, p=0.045). CONCLUSÃO: Treinamento de força com e sem dispositivos de instabilidade não melhorou os níveis de CI em idosos com queixas cognitivas.

INTRODUCTION: Intrinsic capacity (IC) is a construct that encompasses physical and mental capacities important for self-care and healthy aging. Understanding the potential role of resistance training with and without instability to promote IC needs to be clarified. OBJECTIVE: To assess the impact of resistance training on intrinsic capacity levels in older adults with cognitive complaints. METHODS: Older adults with cognitive complaints (n=67) were randomly assigned to either 12 weeks of traditional RE (n=23), RE with instability devices (REI) (n=22), or control (n=22). Both training groups performed three sets of 10-15 repetitions. REI group performed each exercise using instability devices. The control group received weekly health education classes. IC domains were analyzed using mobility and gait velocity (locomotor), global and executive functioning (cognitive), grip strength and six-minute walking test (vitality), and depressive symptoms and self-efficacy (psychological) through z-composite scores. We computed global levels of IC by the sum of each composite score. RESULTS: A significant within-group difference (improvement) in overall levels of IC (∆REI = +1.69, ∆RE = +1.30) and all their domains (Locomotion: ∆REI = +2.32, ∆RE = +3.21; Cognition: ∆REI = +2.31; Vitality: ∆REI = +1.23, ∆RE = +1.42; and Psychological: ∆REI = -0.65, ∆RE = -0.62). However, no between-group differences were observed at the completion of the trial. Sensitivity analysis merging training groups revealed a between-group difference for the locomotor domain (+1.97, p=0.045). CONCLUSION: Resistance training with and without instability devices did not improve IC levels among older adults with cognitive complaints.

Videoconference assessment of functional and cognitive measures in Brazilian older adults: a reliability and feasibility study / Uso de videoconferência para a avaliação de medidas funcionais e cognitivas de idosos brasileiros: um estudo de confiabilidade e viabilidade

OBJECTIVE: We aimed to determine the feasibility and reliability of videoconference assessment of functional and cognitive status among older adults in the context of the COVID-19 pandemic. METHODS: Thirty community-dwelling older adults (86.70% women) with a mean age of 69.77 (SD = 6.60) years who were physically independent and had no signs of cognitive impairment were included in the sample. An independent and experienced researcher assessed functional (chair rise test, chair stand test, sitting and rising test) and cognitive (Montreal Cognitive Assessment, parts A and B of the Trail Making Test, the Stroop test, the verbal fluency test) performance in real-time on the Google Meet platform on 2 non-consecutive days. The reliability of the measures was analyzed using the intraclass correlation coefficient (ICC), a paired t-test, or Wilcoxon and Bland-Altman analysis. The feasibility of the assessment was investigated using a standardized 14-item questionnaire. RESULTS: All functional performance measures showed excellent intra-rater reliability, with ICCs from 0.90 (95%CI 0.78 ­ 0.95) for the sitting and rising test to 0.98 (95%CI 0.96 ­ 0.99) for the chair rise test. Our analysis also showed mixed levels of reliability across measures, including good ICC (ranging from 0.79 ­ 0.91) for the Montreal Cognitive Assessment, part B of the Trail Making Test, and the congruent and neutral trials in the Stroop test, but poor-to-moderate ICC (ranging from 0.42 ­ 0.58) for the other cognitive assessments. In general, the participants reported good feasibility for the assessment format. CONCLUSION: In healthy and highly educated older adults, videoconferencing is a feasible method of determining functional and cognitive performance. Functional measures showed excellent reliability indexes, whereas cognitive data should be interpreted carefully, since the reliability varied from poor to moderate. (AU)

OBJETIVO: Nosso objetivo foi determinar a viabilidade e confiabilidade de medidas funcionais e cognitivas por meio de uma videoconferência baseada na web entre idosos no contexto da pandemia de COVID-19. METODOLOGIA: Trinta idosos [idade = 69,77 (desvio padrão ­ DP = 6,60) anos; 86,70% mulheres], que vivem de forma independente na comunidade (independente fisicamente e sem sinais de comprometimento cognitivo) participaram do estudo. Um avaliador independente e experiente entregou, em tempo real, avaliações funcionais (Chair Rise Test ­ CRT, Chair Stand Test, Sitting and Rising Test ­ SRT) e cognitivas (MoCA, Teste de Trilhas A e B, Stroop Test e Fluência Verbal) por meio da Plataforma Google Meet em dois dias não consecutivos. A confiabilidade das medidas foi analisada pelo Coeficiente de Correlação Intraclasse (CCI), teste t pareado ou análise de Wilcoxon e Bland-Altman. A viabilidade da avaliação foi examinada com o uso de um questionário padronizado de 14 itens. RESULTADOS: Todas as medidas de desempenho funcional demonstraram excelente confiabilidade intra-avaliador [CCI variando de 0,90 (intervalo de confiança ­ IC95% 0,78 ­ 0,95) para SRT e 0,98 (IC95% 0,96 ­ 0,99) para CRT]. Além disso, nossa análise mostrou níveis mistos de confiabilidade entre as medidas, enquanto o MoCA, Teste de Trilhas B e as fases Interferência e Leitura do Stroop Test tiveram excelente CCI (variando de 0,79 a 0,91) e as outras avaliações cognitivas com CCI ruim a moderado (variando de 0,42 a 0,58). Em geral, os participantes demonstraram boa viabilidade com o formato das avaliações. CONCLUSÃO: Em idosos saudáveis e com alta escolaridade, a videoconferência baseada na web é uma alternativa viável para determinar o desempenho funcional e medidas cognitivas. As medidas funcionais apresentaram excelentes índices de confiabilidade, enquanto os dados cognitivos devem ser interpretados com cautela, visto que atingiram índices de confiabilidade de ruim a moderado. (AU)

Changes in Physical Functioning and Fall-Related Factors in Older Adults Due to COVID-19 Social Isolation.

Background: Social isolation has been one of the main measures for the prevention of COVID-19. It's possible that, in addition to the natural aging-related deficits, social isolation has accelerated the decline of the different components of physical and mental capacity in older adults. This study aimed to compare the functional capacity and concern about falling in older adults before and during COVID-19 social isolation. Method: This observational longitudinal study was carried out with 45 community dwelling older adults (mean age 65.6 ± 4.6 years, 88.8% women). Functional capacity and concerns about falling assessments were carried out before the COVID-19 pandemic, and between the 16th and 18th week of social isolation. All testes were face-to-face, except the second FES-I assessment, which took place via telephone call in order to minimize a prolonged person-to-person contact. Muscle strength, muscle power, functional mobility, functional muscle fitness, upper and lower body flexibility, dynamic balance, and Efficacy Scale were assessments. Results: Regarding functional capacity, there was 14% decline in muscle strength (p<.001), 7% in power (p=.001), 11% in functional mobility (p=.001), 20% in functional muscle fitness (p=.001), and 60% in upper body flexibility (p=.001) and 33% lower body flexibility (p=.003). The dynamic balance and the concern about falling showed no statistically significant differences. Conclusion: Thus, it can be concluded that there was a decline in older adults' functional capacity during COVID-19 social isolation.

Additional Functional Performance Gains After 24-Week Unstable Strength Training With Cognitive Training in Community-Dwelling Healthy Older Adults: A Randomized Trial.

The authors investigated the effects of unstable strength training (UST) without or with cognitive training (C+UST) on functional performance in community-dwelling older adults. A total of 50 participants were randomly assigned (1:1) to either 24 weeks of thrice-weekly UST (n = 25) or C+UST (n = 25). All participants performed moderate-intensity strength exercises using unstable surfaces, and C+UST participants simultaneously received cognitive training in addition to UST. Primary outcomes included measures of functional performance: single- and dual-task timed up and go tests. Secondary outcomes included dynamic balance, mobility, handgrip strength, flexibility, quality of life, and concern about falling. The authors observed similar improvements on functional performance through the interventions. The C+UST group experienced additional gains at completion (single-task timed up and go: -0.90 s, 95% confidence interval [-2.38, -0.03]; dual-task timed up and go: -4.80 s, 95% confidence interval [-8.65, -0.95]) compared with the UST group. Moreover, significant differences were observed in mobility (sitting-rising test: -1.34, 95% confidence interval [-2.00, -0.20]) at 24 weeks. Both exercise modes improved single-task functional performance, while adding cognitive-training-optimized dual-task functional performance gains.

Associação entre preocupação com quedas e sintomas depressivos em idosos com comprometimento cognitivo: um estudo transversal / Association between concern about falling and depression symptoms in cognitively impaired older adults: a cross-sectional study

Preocupações com quedas e sintomatologia depressiva são fatores de risco de queda bem conhecidos em idosos. No entanto, se ambos os fatores estão inter-relacionados, não está totalmente elucidado entre os indivíduos com problemas cognitivos. Para iluminar este campo, analisamos a associação entre a preocupação com quedas e sintomas depressivos em idosos com déficits cognitivos. Este estudo transversal foi composto por 67 idosos da comunidade, com deficiência cognitiva (idade: 71 ± 5 anos; sexo: 78% feminino). Avaliamos suas preocupações sobre quedas (independentes) e sintomas de depressão (desfecho) usando a Falls Efficacy Scale - International (FESI) e a versão curta da Geriatric Depression Scale (GDS-15), respectivamente. As covariáveis incluíram idade, sexo, escolaridade, histórico de quedas, função física (Short-Physical Performance Battery) e função cognitiva (versão brasileira do Montreal Cognitive Assessment). Modelos de regressão linear foram realizados para examinar a relação independente entre os escores FESI e GDS. Todas as análises foram calculadas usando o STATA e a significância foi estabelecida em P <0,05. Os participantes com sintomas depressivos mais elevados (GDS ≥ 5 pontos) apresentaram uma pontuação significativamente menor no FESI (diferença média: -5,3 pontos; IC 95% = -9,9 a -0,7; p = 0,02). O modelo de regressão mostrou associação entre FESI e GDS-15 após ajuste para fatores de confusão (ß = 0,08; IC 95% = 0,02; 0,14), sugerindo que maiores preocupações com quedas estão associadas a maiores sintomas depressivos. A preocupação com quedas está associada a sintomas depressivos entre idosos com comprometimento cognitivo, independentemente da função física geral, cognição global e histórico de quedas.

Concerns about falling and depressive symptomatology are well-known fall-risk factors in older people. However, whether both factors are inter-related it is not fully elucidated among individuals with cognitive issues. To shed light in this field, we analyzed the association between the concerns about falling and depressive symptoms in older adults with cognitive impairments. This cross-sectional study was composed of 67 community-dwelling cognitively impaired older adults(age: 71±5 years; sex: 78% female). We assessed their concerns about falling (independent) and depression symptoms (outcome) using the Falls Efficacy Scale - International (FESI) and the short-version of Geriatric Depression Scale (GDS-15), respectively. Covariates included age, sex, education, fall history, physical (Short-Physical Performance Battery), and cognitive function (Brazilian version of Montreal Cognitive Assessment). Linear regression models were performed in order to examine the independent relationship between FESI and GDS scores. All analyses were computed using STATA and significance was set at P<0.05. Participants with higher depressive symptoms (GDS ≥ 5 points) showed a significantly poor score on FESI (Mean difference: -5.3 points; 95%CI = -9.9 to -0.7; p=0.02). The regression model showed an association between the FESI and GDS-15 after adjustment for confounders (ß=0.08; 95% CI= 0.02; 0.14), suggesting that higher concerns about falling are associated with higher depressive symptoms. Concerns about falling are associated with depressive symptoms among cognitively impaired older adults independently of overall physical function, global cognition, and fall history.

Association between physical functioning with cognition among community-dwelling older adults: a cross-sectional study / Associação entre função física e cognição em idosos da comunidade: estudo transversal

OBJECTIVE: Declines in physical and cognitive functioning often co-exist through aging. Gait-related parameters have been related to cognitive function, although it is unclear whether other measures of physical functioning are similarly related to cognition. Here, we analyzed the relationship between physical functioning with cognition in older adults. METHODS: In total, baseline data of 116 dementia-free older adults recruited from two separated clinical trials (RCT) were included (M age = 69 years, SD = 6; 71% women). We quantified cognitive functioning using the Montreal Cognitive Assessment (MoCA) and executive functioning tasks (Digit Span Forward minus Backward and verbal fluency ­ FAS and animal naming). Physical function measures included gait speed, Short-physical Performance Battery (SPPB), five-times Sit-to-Stand Test, the Timed Up and Go (TUG) test, the Six-minute Walk Test (6MWT), and lower extremity muscle strength. We used multiple linear regression analyses to explore the association between cognitive measures and each measure of physical functioning, adjusting for age, sex, education, and RCT. Regression coeficients (b), standard error (SE) and 95% confidence intervals (CI) were used to summarize main results. RESULTS: We observed a positive association between muscle strength and the MoCA (b = 0.84, SE = 0.40, 95%CI 0.05­1.64) after controlling for covariates. Significant associations were also found between the five-times-sit-to-stand test (b = -0.63, SE = 0.26, 95%CI -1.15­-0.12), TUG (b = -1.13, SE = 0.57, 95%CI -2.26­-0.01), 6MWT (b = 0.04, SE = 0.02, 95%CI 0.01­0.07), and lower extremity muscle strength (b = 1.92, SE = 0.93, 95%CI 0.09­3.77) with the FAS verbal fluency test, and between the TUG (b = -0.62, SE = 0.24, 95%CI -1.11­-0.14) with animal naming. CONCLUSION: In community-dwelling older adults, higher levels of muscle strength, dynamic balance and cardiorespiratory fitness were positively related with global cognition and executive control measures.

Effects of Resistance Exercise with Instability on Cognitive Function (REI Study): A Proof-Of-Concept Randomized Controlled Trial in Older Adults with Cognitive Complaints.

BACKGROUND: Activities which simultaneously challenge both physical and cognitive function are promising strategies for promoting cognitive function. OBJECTIVE: To examine the effects of resistance exercise with instability and traditional resistance exercise compared with a health education control on cognitive function in older adults with cognitive complaints. METHODS: Sixty-seven participants were randomized to either 12 weeks of thrice-weekly resistance exercise (RE = 23), RE with instability (REI = 22), or a weekly health education control (CON = 22). At each training session, RE and REI participants performed seven exercises for three sets and 10-15 repetitions. REI participants performed each exercise using instability devices. The primary outcome was a composite score of global cognitive function. Secondary outcomes included composite scores for cognitive sub-domains and physical function. RESULTS: Most participants were women (REI: 77%; RE = 78%; CON = 77%; mean age of 71 years), and did not need transport to the intervention site. At completion, compared with CON, REI and RE did not significantly improve on global cognition or each cognitive sub-domain. Both exercise groups improved on the timed up and go (REI - CON: -1.6 s, 95% CI: [-2.6, -0.5]; RE - CON: -1.4 s, 95% CI: [-2.4, -0.5) and 1-RM (REI - CON: 24 kg, 95% CI: [11, 36]; RE - CON: 25 kg, 95% CI: [12, 37]). An exploratory contrast showed that compared with RE, REI promote greater gains on global cognition (2.20, 95% CI: [0.10, 4.31]) and memory (1.34; 95% CI: [0.15, 2.54]). CONCLUSION: REI did not substantially improve cognitive function but did promote physical function among older adults with cognitive complaints. However, compared with RE, REI improved global cognition and memory.

Improving cognitive and physical function through 12-weeks of resistance training in older adults: Randomized controlled trial.

We performed a randomized, controlled trial to analyse the effects of resistance training (RT) on cognitive and physical function among older adults. Fifty participants (mean age 67 years, ~60% woman) were randomly assigned to an RT program or a control group. Participants allocated to RT performed three sets of 10-15RM in nine exercises, three times per week, for 12-weeks. Control group did not perform any exercise. Variables included cognitive (global and executive function) and physical function (gait, mobility and strength) outcomes. At completion of the intervention, RT was shown to have significantly mitigated the drop in selective attention and conflict resolution performance (Stroop test: -494.6; 95%CI: -883.1; -106.1) and promoted a significant improvement in working memory (digit span forward: -0.6; 95%CI: -1.0; -0.1 and forward minus backward: -0.9; 95% CI: -1.6; -0.2) and verbal fluency (animal naming: +1.4, 95%CI 0.3, 2.5). No significant between-group differences were observed for other cognitive outcomes. Regarding physical function, at completion of the intervention, the RT group demonstrated improved fast-pace gait performance (-0.3; 95% CI: -0.6; -0.0) and 1-RM (+21.4 kg; 95%CI: 16.6; 26.2). No significant between-group differences were observed for other mobility-related outcomes. In conclusion, RT improves cognitive and physical function of older adults.

Influence of the order of aerobic and resistance exercise on hemodynamic responses and arterial stiffness in young normotensive individuals.

AIMS: To investigate the effects of a combination of aerobic and resistance exercises and the inverse sequence on the hemodynamic parameters and indicators of arterial stiffness in healthy young adult subjects. METHODS: Fifteen subjects were randomized in a crossover procedure according to two experimental conditions: combined aerobic exercise (30 min of treadmill running, 75-80% - peak VO2) followed by resistance exercise (5 exercises, 3 sets - 10 RM) (AR) or vice versa (RA). Data of the hemodynamic parameters and arterial stiffness were obtained at baseline and after exercise (post-10, post-20, and post-30 min). Two-way ANOVA for repeated measurements was performed with the Newman-Keuls post-hoc. The significance level adopted was p < 0.05. RESULTS: The results of the two-way ANOVA for repeated measures were not statistically significant for brachial and central systolic and diastolic blood pressure, respectively, or arterial stiffness indicators: reflected wave indicators and pulse wave velocity (P > 0.05). Statistically significant interactions were observed before and after the exercise sessions for heart rate and rate pressure product (P = < 0.001). CONCLUSION: The performance order of aerobic exercise followed by resistance exercise (AR) and the reverse order (RA) present similar changes in blood pressure (BP) and arterial stiffness. However, resistance exercise before aerobic exercise promotes increases in heart rate and rate product pressure.

Efficacy of a behavior change program on cardiovascular parameters in patients with hypertension: a randomized controlled trial.

OBJECTIVE: To investigate the efficacy of a behavior change program named Vida Ativa Melhorando a Saúde on cardiovascular parameters in hypertensive patients. METHODS: Ninety hypertensive patients aged over 40 years were randomly allocated to one of two groups: Vida Ativa Melhorando a Saúde or Control (n=45 respectively). Patients in the Vida Ativa Melhorando a Saúde group took part in a behavior change program aimed to encourage changes in physical activity levels and eating habits, according to the Social Cognitive Theory. The program consisted of 90-minute weekly group meetings conducted by a physical therapist and a dietitian. One chapter of the educational material (workbook) provided was discussed per meeting. Participants in the Control Group attended a single educative lecture on lifestyle changes. Brachial and central blood pressure, arterial stiffness and endothelial function parameters were measured pre- and post-intervention. RESULTS: Vida Ativa Melhorando a Saúde led to reduction of brachial (131.3±15.8mmHg to 125.1±17.3mmHg; p<0.01) and central (123.6±16.3mmHg to 119.0±20.6mmHg; p=0.02) systolic and brachial diastolic (123.6±16.3mmHg to 119.0±20.6mmHg; p<0.01) blood pressure values, and improvement of post-occlusive reactive hyperemia (from 5.7±2.5mL·100mL-1 to 6.5±2.1mL·100mL-1 tissue·min-1; p=0.04). No changes in body composition, heart rate and arterial stiffness parameters were detected in both groups (p>0.05). CONCLUSION: Vida Ativa Melhorando a Saúde program improved blood pressure and microvascular reactivity in hypertensive patients. Trial registration: ClinicalTrials.gov: NCT02257268.

Efficacy of a behavior change program on cardiovascular parameters in patients with hypertension: a randomized controlled trial / Eficácia de um programa de mudança de comportamento sobre parâmetros cardiovasculares em pacientes com hipertensão arterial sistêmica: ensaio clínico controlado randomizado

ABSTRACT Objective To investigate the efficacy of a behavior change program named Vida Ativa Melhorando a Saúde on cardiovascular parameters in hypertensive patients. Methods Ninety hypertensive patients aged over 40 years were randomly allocated to one of two groups: Vida Ativa Melhorando a Saúde or Control (n=45 respectively). Patients in the Vida Ativa Melhorando a Saúde group took part in a behavior change program aimed to encourage changes in physical activity levels and eating habits, according to the Social Cognitive Theory. The program consisted of 90-minute weekly group meetings conducted by a physical therapist and a dietitian. One chapter of the educational material (workbook) provided was discussed per meeting. Participants in the Control Group attended a single educative lecture on lifestyle changes. Brachial and central blood pressure, arterial stiffness and endothelial function parameters were measured pre- and post-intervention. Results Vida Ativa Melhorando a Saúde led to reduction of brachial (131.3±15.8mmHg to 125.1±17.3mmHg; p<0.01) and central (123.6±16.3mmHg to 119.0±20.6mmHg; p=0.02) systolic and brachial diastolic (123.6±16.3mmHg to 119.0±20.6mmHg; p<0.01) blood pressure values, and improvement of post-occlusive reactive hyperemia (from 5.7±2.5mL·100mL−1 to 6.5±2.1mL·100mL−1 tissue·min−1; p=0.04). No changes in body composition, heart rate and arterial stiffness parameters were detected in both groups (p>0.05). Conclusion Vida Ativa Melhorando a Saúde program improved blood pressure and microvascular reactivity in hypertensive patients. Trial registration: ClinicalTrials.gov: NCT02257268

RESUMO Objetivo Analisar a eficácia do programa de mudança de comportamento Vida Ativa Melhorando a Saúde sobre parâmetros cardiovasculares em pacientes hipertensos. Métodos Noventa pacientes hipertensos ≥40 anos foram aleatoriamente randomizados em dois grupos: Vida Ativa Melhorando a Saúde (n=45) e Controle (n=45). O Grupo Vida Ativa Melhorando a Saúde participou de um programa de mudança de comportamento que objetiva motivar mudanças na atividade física e nos hábitos alimentares, de acordo com a teoria sociocognitiva. O programa foi conduzido em grupos, durante 12 semanas consecutivas, em encontros semanais (~90 minutos), conduzidos por um profissional de edução física e um nutricionista. Um capítulo do material didático era discutido em cada um desses encontros. O Grupo Controle participou de uma única palestra educativa sobre mudanças de estilo de vida. Medidas de pressão arterial braquial e central, rigidez arterial, e de função endotelial foram realizadas nos momentos pré e pós-intervenção. Resultados O Grupo Vida Ativa Melhorando a Saúde reduziu a pressão arterial sistólica braquial (de 131,3±15,8mmHg a 125,1±17,3mmHg; p<0,01) e central (de 123,6±16,3mmHg a 119,0±20,6mmHg; p=0,02) e a pressão arterial diastólica braquial (123,6±16,3mmHg a 119,0±20,6mmHg; p<0,01) e apresentou melhora na hiperemia reativa pós-oclusão (de 5,7±2,5mL·100mL−1a 6,5±2,1mL·100mL−1tecido·min−1; p=0,04). Não houve modificação na composição corporal, na frequência cardíaca e nem nos parâmetros de rigidez arterial em ambos os grupos (p>0,05). Conclusão O Programa Vida Ativa Melhorando a Saúde melhorou a pressão arterial e a reatividade microvascular em pacientes hipertensos. Registro do estudo: ClinicalTrials.gov: NCT02257268

Does the stretching intensity matter when targeting a range of motion gains? a randomized trial

Abstract Aims: To verify the effects of flexibility training conducted at different intensities in young adults. Methods: Twenty-one (21) young adults of both genders with no history of surgery, fracture, and/or rheumatic diseases in the lower limbs and hip, were randomly assigned to low intensity (LI) or high intensity (HI) stretching groups. Two researchers were assigned to evaluate the active knee extension range of motion (ROM) of the volunteers and two other researchers were responsible for the training program. The training consisted of a single exercise for the hamstring muscles (biceps femoris, semimembranosus, semitendinosus). Each session consisted of three repetitions of passive static stretching, maintained for the 60s each, with 30s interval between them, and performed three times a week for four weeks. The stretching intensity was based on the Numerical Verbal Scale, the LI group maintained the intensity between 1 and 2, while the HI group between 9 and 10. Three ROM evaluations were performed pre-intervention, after the 6th session and at the end of the 12th session. Results: No difference was observed between the groups that underwent either high- or low-intensity programs. Both groups achieved gains in flexibility after four weeks of training. Conclusions: The study demonstrated that both high- and low-intensity stretching exercises are effective for ROM and there were no differences between them. Therefore, the intensity can be defined by the preference of the therapist or patient.

Effect of 24-week strength training on unstable surfaces on mobility, balance, and concern about falling in older adults.

OBJECTIVE: To evaluate the effects of 24 weeks of strength training on stable (ST) and unstable surfaces (UST) on the functional mobility, balance, and concern about falling in healthy older adults, younger than 70. DESIGN: A single-center randomized clinical trial. PARTICIPANTS: Sixty-four older adults (58 females and 6 males; 68 years) were randomized into control, ST, or UST groups. INTERVENTIONS: Both ST and UST intervention groups received a core muscle, upper, and lower limb moderate-intensity strength exercises using stable and unstable surfaces. The classes were performed three times per week over a 24-week period. The control group did not receive any type of active intervention. MEASUREMENTS: The primary outcome measures were the dynamic balance (Berg Balance Scale (BBS)) and functional mobility (timed up and go (TUG) test). The secondary outcomes included the sitting and rising test (SRT) and Falls Efficacy Scale-International (FESI) scores. RESULTS: There was a significant improvement in balance performance (BBS = +4 points) after 24 weeks of both ST (+1.22; 95% CI, -0.19 to 2.63) and UST (+2.26; 95% CI, 0.83-3.70) compared with the control group. Additionally, compared with the control, only UST experienced functional mobility gains (TUG = -2.44; 95% CI, -4.41 to -0.48; SRT = +1.12; 95% CI, 0.08-2.17) and decreased concern about falling (FESI = -4.41; 95% CI, -9.30 to -0.27). CONCLUSION: Long-term ST with and without unstable devices was effective to improve dynamic balance in older adults. Furthermore, the effects of UST were extended to functional mobility gains and reduced concern about falling.

Factors Associated to Arterial Stiffness in Patients With Symptomatic Peripheral Artery Disease.

BACKGROUND: The aim of this study was to identify the clinical factors associated with arterial stiffness in patients with symptomatic peripheral artery disease. METHODS: In this cross-sectional study, 181 patients (67% men; mean aged 66 ± 9 years) were recruited and had their central arterial stiffness assessed by carotid-femoral pulse wave velocity (cf-PWV). Clinical characteristics are sociodemographic data, body mass index, comorbid conditions, and walking capacity. RESULTS: Multiple linear regression analysis showed that age (b = 0.182, P = 0.032), body mass index (b = 0.254, P = 0.002), and mean blood pressure (b = 0.249, P = 0.021) were positively associated with cf-PWV. CONCLUSIONS: Our results showed that the aging, elevated body mass index, and higher blood pressure are clinical factors associated with increased arterial stiffness in patients with peripheral artery disease.

Reliability of the Closed Kinetic Chain Upper Extremity Stability Test in young adults.

OBJECTIVE: To analyze the reliability indicators of CKCUEST, and to investigate how many sessions are necessary to find a stable score. DESIGN: Reliability study. SETTING: Biomechanics laboratory. PARTICIPANTS: The sample consisted of 36 healthy young adults, of both genders. MAIN OUTCOME MEASURES: The subjects performed four CKCUEST with a minimum interval of three days between evaluations. The number of touches in each execution was counted, and then the average values of the number of rings, normalized score and power were calculated. RESULTS: The CKCUEST presented ICC ranging from 0.77 to 0.92 (mean number of touches), 0.80 to 0.94 (normalized score) and 0.91 to 0.98 (power). The Bland-Altman plots showed the presence of systematic error for all measures, as also confirmed by the ANOVA analysis. The scores increased every session for both genders. The boys' scores stabilized in the third session. However, the girls' scores did not stabilize. CONCLUSION: The CKCUEST presents excellent reliability; however, there is the presence of systematic error between measurements. It is necessary to perform at least three sessions to obtain reliable data for male participants, and the female results were not conclusive.

Effects of Resistance Exercise with Instability on Neurocognitive Functions (REI STUDY): Study Protocol for a Proof-of-Concept Clinical Trial in Older Adults with Subjective Cognitive Complaints

Aim: Resistance exercise (RE) is a widely accepted strategy to counteract the effects of aging and chronic diseases on health-related outcomes. Studies have been suggested that RE improves brain and cognitive health. RE with unstable devices (REI) is a neuromotor complexity strategy with the potential to improve strength, power, and balance in onder adults, however, their effects on neurocognitive function in individuals at risk of cognitive decline are poorly understood. Thus, we describe the REI study protocol, a randomized clinical trial design to assess the effects of 12-weeks of REI and RE on neurocognitive functions in older adults with subjective cognitive complaints. Methods: The sample will consist of individuals (aged 65 or older) with subjective cognitive complaints, who will be randomized in one of three experimental groups: control, RE or REI. Participants of the RE group will receive 12-weeks of progressive resistance training (seven exercises structured into 3 sets of 10-15 repetitions maximum, three times per week). Participants of the REI group will receive the same RE protocol performed on unstable devices that promote progressive instability. The control group received a health education program. The primary outcome is a composite score of neurocognitive functions. Secondary outcomes include each separately neurocognitive domain, functional performance, balance, falls-related parameters, cardiovascular and mood variables. The study results will provide information to design a future and larger preventive trial on populations at risk of cognitive decline and dementia, which is imperative in public health terms. Trial registration: Brazilian registry of clinical trials number RBR-4kqs22.(AU)

Função muscular de membros inferiores e massa muscular em jogadores de futebol / Muscular function of lower limbs and muscular mass in soccer players

Introdução: No futebol a força muscular exerce um papel fundamental nas ações técnicos/táticas realizadas durante uma partida. Objetivo: Investigar a relação entre a função muscular de membros inferiores e a massa muscular total em jogadores. Métodos: Dezesseis jogadores realizaram avaliação isocinética concêntrica na extensão e flexão de joelhos por membro dominante. Foram realizadas avaliações antropométricas e estimativas da massa muscular. Resultados: Foi observado que a massa muscular total apresentou uma relação positiva com o pico de torque (r=0,67, p=0,005; r=0,62, p=0,011), potência (r=0,59, p=0,017; r=0,60, p=0,015) e função global (r= 0,59; p= 0,017; r= 0,60; p= 0,013) na extensão do joelho em ambos os membros e no trabalho total (r=0,63, p=0,009) apenas no membro dominante. Nenhuma relação significante foi encontrada na ação de flexão do joelho. Conclusão: A relação entre a massa muscular total e as variáveis da função muscular podem ser utilizados como indicadores da capacidade de produção de força e assimetrias dos membros inferiores em jogadores.

Introduction: In soccer muscular strength plays a key role in the technical / tactics actions during the game. Objective: To investigate the relationship between lower limb muscle function and total muscle mass in players. Methods: Sixteen players performed concentric isokinetic evaluation on extension and knee flexion by dominant member. Anthropometric evaluations and muscle mass estimates were performed. Results: It was observed that the total muscle mass presented a positive relation with the peak torque (r = 0.67, p = 0.005, r = 0.62, p = 0.011) 0.017, r = 0.60, p = 0.015) and overall function (r = 0.59, p = 0.017, r = 0.60, p = 0.013) on knee extension in both limbs and total work = 0.63, p = 0.009) in the dominant limb only. No significant relationship was found in the knee flexion action. Conclusion: The relationship between total muscle mass and muscle function variables can be used as indicators of strength capacity and functional asymmetries of lower limbs in players.

Cutoffs of Short-Term Heart Rate Variability Parameters in Brazilian Adolescents Male.

A low heart rate variability (HRV) has been associated with cardiovascular risk factors in adolescents. However, no cut-off points are known for HRV parameters in this age group, making it difficult to use in clinical practice. Thus, the aims of the current study were to establish cutoffs of HRV parameters and to examine their association with cardiovascular risk in Brazilian adolescents male. For this reason, this cross-sectional study included 1152 adolescent boys (16.6 ± 1.2 years old). HRV measures of time (SD of all RR intervals, root mean square of the squared differences between adjacent normal RR intervals, and the percentage of adjacent intervals over 50 ms), frequency domains [low (LF) and high (HF) frequency], and Poincaré plot (SD1, SD2 and SD1/SD2 ratio) were assessed. Cardiovascular risk was assessed by sum of abdominal obesity, high blood pressure, overweight, and low physical activity level. The proposed cutoffs showed moderate to high sensitivity, specificity, and area under curve values (p < 0.05). HRV frequency parameters were statistically superior when compared to time-domain and Poincaré plot parameters. The binary logistic regression analysis indicated that all proposed HRV cutoffs were independently associated with a clustering of cardiovascular risk factors, with greater magnitude of HF and SD1/SD2 ratio (two or more risk factors: OR = 3.59 and 95% CI 1.76-7.34). In conclusion, proposed HRV cutoffs have moderate to high sensitivity in detecting of the cardiovascular risk factor and HRV frequency-domain were better discriminants of cardiovascular risk than time-domain and Poincaré plot parameters.

Relationship between propulsive force of the arm, body composition and isokinetic muscle strength indicators in surfers / Relação entre a força propulsiva da braçada, composição corporal e indicadores de força muscular isocinética em surfistas

Abstract This study aimed to evaluate the potential relationship between body composition (percentage of fat mass (FM %), fat mass and lean mass), muscle function (i.e., muscles; deltoid side and front, pectoralis major and teres major) and the propulsive force of the arm (PFA). Sixteen competitive surfers (29.1 ± 7.3 years; 1.72 ± 0.06 m; 74.2 ± 1.4 kg) were assessed for height, body mass, body composition (dual-energy-DXA), muscle function and PFA. Pearson correlation analyses were used to verify the relationship between all variables. An inverse correlations were found between PFA and isokinetic parameters to 60o/s: external rotation (peak torque: r = -0.71; p = 0.014; total work: r = -0.75; p = 0.007; power: r = -0.72; p = 0.011) and internal rotation (peak torque: r = -0.61; p = 0.045; total work: r = -0.73; p = 0.010; power: r = -0.61; p = 0.045) and 300o/s: external rotation (peak torque: r = -0.79; p = 0.003; total work: r = -0.84; p<0,001; power: r = -0.81; p = 0.002) and internal rotation (peak torque: r = -0.69; p = 0.017; total work: r = -0.72; p = 0.011; power: r = -0.69; p = 0.017). There was no significant correlation between body composition components and PFA (p>0.05). Although correlations do not imply cause and effect, PFA is not correlated with body composition in surfers and these relationships are inversely related to the parameters of muscle function.

Resumo Objetivou-se avaliar a potencial relação entre a composição corporal (percentual de gordura (% gord.), massa gorda e massa magra), função muscular (i.e., músculos; deltoide anterior, deltoide lateral, peitoral maior e redondo maior) e a força propulsiva da braçada (FPB). Dezesseis surfistas competitivos (29,1 ± 7,3 anos, 1,72 ± 0,06 m, 74,2 ± 1,4 kg) tiveram a altura, massa corporal, composição corporal (dual-energy-DXA), função muscular e FPB avaliados. O coeficiente de correlação de Pearson foi empregado para avaliar a relação entre todas as variáveis. Foram observadas relações inversas entre a FPB e os parâmetros isocinéticos a 60°/s: rotação externa (pico de torque: r = -0,71; p = 0,014; trabalho total: r = -0,75; p = 0,007; potência: r = -0,72; p = 0,011) e rotação interna (pico de torque: r = -0,61; p = 0,045; trabalho total= r = -0,73; p = 0,010; potência: r = -0,61; p = 0,045) e 300o/s: rotação externa (pico de torque: r = -0,79; p = 0,003; trabalho total: r = -0,84; p<0,001; potência: r = -0,81; p = 0,002) e rotação interna (pico de torque: r = -0,69; p = 0,017; trabalho total: r = -0,72; p = 0,011; potencia: r = -0,69; p = 0,017). Não foram observadas correlações significativas entre os componentes da composição corporal e a FPB (p>0,05). Embora as correlações não impliquem em causa e efeito, a FPB não está correlacionada com a composição corporal em surfistas e estas relações são inversas com os parâmetros da função muscular.