Effects of three physical exercise modalities on respiratory function of older adults with Parkinson's disease: A randomized clinical trial.

INTRODUCTION: Deficits in respiratory function of patients with Parkinson's disease contribute to aspiration pneumonia, one of the main causes of mortality in this population. The aim of this study was to evaluate the effects of functional training, bicycle exercise, and exergaming on respiratory function of elderly with Parkinson's disease. METHODS: A randomized clinical trial with single blinding was conducted in a public reference outpatient clinic for the elderly. The participants were randomly assigned to three groups. Group 1 was submitted to functional training (n = 18); group 2 performed bicycle exercise (n = 20), and group 3 trained with Kinect Adventures exergames (n = 20). The sessions performed lasted 8 weeks with a frequency of three 50-min sessions per week. The primary outcome was the forced expiratory volume in the first second; and the secondary outcomes were forced vital capacity, peak expiratory flow, and maximum inspiratory and expiratory pressures. RESULTS: The interventions performed did not improve the forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow. However, group 2 improved (p = 0.03) maximum expiratory pressure (from 65.5cmH2O to 73.1cmH2O) (effect size 0.47), and group 3 increased (p = 0.03) maximum inspiratory pressure (from -61.3cmH2O to -71.6cmH2O) (effect size 0.53). CONCLUSIONS: No effect was found on lung volume, forced respiratory flow and capacity of the participants with Parkinson's disease submitted to three different modalities of motor training. However, bicycle exercise and exergaming have improved expiratory and inspiratory muscle strength, respectively. NCT02622737.

Disfunções sexuais em mulheres jovens universitárias: estudo transversal / Sexual dysfunctions in young university women: a cross-sectional study

OBJETIVO: Verificar a frequência e os fatores associados à disfunção sexual em mulheres jovens universitárias. MÉTODOS: Trata-se de um estudo descritivo analítico de corte transversal. Participaram deste estudo 111 mulheres, estudantes, heterossexuais do curso de fisioterapia da Universidade Federal da Bahia. Cada participante respondeu a dois questionários autoaplicáveis "Investigação de fatores associados" e "Quociente sexual ­ versão feminina", entre os meses de setembro e outubro de 2019. RESULTADOS: Foi encontrado nesta população prevalência de 8% de disfunção sexual. O sintoma de esforço evacuatório esteve associado a pior desempenho/satisfação sexual pelo score total do QS-F (p=0,03), e quando avaliado por agrupamento de questões, foi encontrada associação entre esforço evacuatório e pior excitação (p=0,01), esforço evacuatório e mais dor (p=0,04); urgência urinária e mais dor (p=0,04); violência e pior excitação (p=0,05) e violência e menos satisfação/orgasmo (p=0,02). CONCLUSÃO: Os resultados sugerem que há baixa prevalência de disfunção sexual na população estudada, mas há associação entre sintomas de disfunções do assoalho pélvico e disfunções sexuais em mulheres jovens.

OBJECTIVE: To estimate the prevalence of sexual dysfunction in young college women. METHODS: This is a descriptive-analytical cross-sectional study. A total of 111 heterosexual women students of the physiotherapy course from the Universidade Federal da Bahia participated in this study. Each participant answered two self-administered questionnaires, "Investigation of associated factors" and "Sex ratio - female version" between September and October 2019. RESULTS: A prevalence of 8% of sexual dysfunction was found in this population. The symptom of evacuatory effort was associated with worse performance / sexual satisfaction by the total SQ-F score (p=0.03), and when assessed by a grouping of questions, an association was found between evacuatory effort and worse arousal (p=0.01), evacuatory effort, and pain (p=0.04); urinary urgency and pain (p=0.04); violence and arousal (p=0.05); and violence and less satisfaction/orgasm (p=0.02). CONCLUSION: The results suggest a low prevalence of sexual dysfunction in the studied population, but there is an association between symptoms of pelvic floor dysfunction and sexual dysfunction in young women.

Functional capacity of elderly with lower-limb amputation after prosthesis rehabilitation: a longitudinal study.

OBJECTIVES: Elderly amputees are a specific clientele because of the interaction of this disease with the ageing process. The objective of this study was to determine the impact of prosthesis rehabilitation on the functional capacity of elderly with lower-limb amputation (LLA) in short and long time. MATERIALS AND METHODS: A quasi-experimental study was developed. The sample consisted of 29 elderly with LLA who finished the prosthesis rehabilitation programme. Gait capacity was evaluated by Functional Ambulation Classification Scale (FAC), ability to perform basic activities of daily living (ADL) was evaluated by Barthel Index (BI) and Pfeffer Questionnaire was used to evaluate the capacity to execute instrumental ADL. Statistical inference was done by t-test, t-student test and chi-squared test. The significance level was fixed at 5% (p < 0.05). RESULTS: In the transtibial group (n = 15) no difference (p = 0.108) was found between BI score before amputation and after 3 months of follow up. The transfemoral group (n = 14) improved significantly (p = 0.045) the FAC before starting and after 3 months of discharge from ambulatory rehabilitation. Both groups increased the time of prosthesis use during the day after 3 months of follow up. However, no group has achieved FAC and Pfeffer Questionnaire pre-amputation performance. CONCLUSION: Although elderly with LLA improved functional capacity after 3 months of a prosthesis rehabilitation programme, they did not achieve their pre-amputation functionality.Implications for rehabilitationLower-limb amputation causes a significant socioeconomic impact and decreases functional capacity, autonomy and quality of life. Elderly people with a lower-limb amputation impose a heavy burden on health resources, requiring extensive rehabilitation and long term care. The specific presentation of elderly persons with lower-limb amputation, with multiple physical, psychological, cognitive, and social comorbidities, imposes unique challenges to ongoing care. The potential bias from the inclusion of younger patients into a study with an elderly population with lower-limb amputation supports the need for independent investigation.In our study we verified that although elderly with transfemoral or transtibial amputation have improved their functional independence after lower-limb prosthesis rehabilitation, they could not achieve their functional capacity before amputation. This improvement especially occurred for the basic activities of daily living, however elderly patients with transfemoral amputations presented greater difficulty in improving functional capacity.These results support that being able to better select elderly by their mobility potential and environmental barriers, is an important goal for future research to aim toward those who will achieve and maintain prosthetic walking or those who could better focus on regaining nonprosthetic mobility.

Patient's satisfaction with a lower limb prosthesis: a longitudinal study / Satisfação de pacientes com prótese de membro inferior: um estudo longitudinal / Satisfacción de pacientes con protésis de miembro inferior: un estudio longitudinal

ABSTRACT This is a descriptive longitudinal study that aimed to verify prosthesis satisfaction of older adults with lower-limb amputation (LLA). In total, This study was composed of 34 older adults with LLA participated of this study. Participant's satisfaction about the lower-limb prosthesis (LLP), the discomforts, and the embarrassment when use it were evaluated through an interview composed of five questions. The occurrence of falls and the independence in prosthesis management were also evaluated. All variables were collected at the last week of ambulatory rehabilitation discharge and after one and three months. A descriptive and inferential statistical analysis was performed. The level of significance was set at 5% (p <0.05). In total, 80% of participants with transtibial amputation and 78.6% of participants with transfemoral amputation were satisfied with the LLP after three months. Tight prosthesis, walking pain, the embarrassment of using LLP, and the occurrence of falls decreased over time. The independence in prosthesis handling did not change significantly after three months. Participants that used manual locking knee (p=0.040) and/or Solid-Ankle Cushion Heel foot (p=0.017) were more satisfied with LLP. The occurrence of falls reduced (p=0.039) after transfemoral participants started to use the prosthesis. Participant's satisfaction with the LLP was high and did not change significantly over time.

RESUMO O objetivo do estudo foi verificar a satisfação de indivíduos amputados com a prótese de membro inferior (PMI). Trata-se de um estudo longitudinal descritivo. Participaram 34 idosos com amputação de membro inferior (AMI). A satisfação dos participantes com a PMI, os desconfortos e a vergonha de usá-la foram avaliados por meio de uma entrevista composta por 5 perguntas. A ocorrência de quedas e a independência no manuseio da prótese também foram avaliadas. Todas as variáveis foram coletadas na última semana de alta da reabilitação ambulatorial e após 1 e 3 meses. Foi realizada análise estatística descritiva e inferencial. O nível de significância foi estabelecido em 5% (p<0,05). Oitenta por cento dos participantes com amputação transtibial e 78,6% dos participantes com amputação transfemoral estavam satisfeitos com a PMI após três meses de seguimento. A prótese apertada, a dor ao caminhar, a vergonha de usar a PMI e a ocorrência de quedas diminuíram com o tempo. A independência no manuseio da prótese não mudou significativamente após três meses. Os participantes que utilizaram o joelho com trava manual (p=0,040) e/ou o pé com calcanhar sólido (SACH) (p=0,017) estavam mais satisfeitos com a PMI após alta da reabilitação. A ocorrência de quedas diminuiu (p=0,039) nos transfemorais após iniciarem o uso da PMI. A satisfação dos idosos participantes com relação a sua PMI foi alta e não mudou significativamente ao longo do tempo.

RESUMEN El objetivo de este estudio fue verificar si las personas mayores que tienen amputadas un miembro estaban satisfechas con la prótesis de miembro inferior (PMI). Se ha realizado un estudio longitudinal descriptivo. Han participado 34 personas mayores con PMI. La satisfacción de los participantes con la PMI, las molestias y la vergüenza de usarla han sido evaluadas a través de una entrevista con 5 preguntas. Las caídas y la independencia en el manejo de la prótesis también han sido evaluadas. Todas las variables fueron recolectadas en la última semana de alta de rehabilitación en el ambulatorio y después de 1 y 3 meses. Se ha realizado análisis estadístico, descriptivo y de inferencia. El nivel de significancia establecido fue del 5% (p<0,05). Un ochenta por ciento de los participantes con amputación transtibial y el 78,6% con amputación transfemoral estaban satisfechos con la PMI después de tres meses de seguimiento. La prótesis apretada, el dolor al caminar, la vergüenza de usarla y las caídas han disminuido con el tiempo. La independencia con el manejo de la prótesis no ha cambiado significativamente después de tres meses. Los participantes que han utilizado la rodilla con traba manual (p=0,040) y/o el pie con tobillo sólido (SACH) (p=0,017) estaban más satisfechos con la PMI tras la rehabilitación. Las caídas han disminuido (p=0,039) en los transfemorales después de empezar a usar la PMI. Los adultos mayores estaban muy satisfechos con la PMI y no han cambiado de opinión a lo largo del tempo.

Prevalence of falls in frail elderly users of ambulatory assistive devices: a comparative study.

Aim: The aim of this study was to verify the prevalence of falls in frail users of ambulatory assistive devices (AAD) and compare with controls.Materials and methods: Nineteen frail elderly users of AAD (G1) and 31 non-users (G2) participated in the study. The occurrence of falls, at the last 6 months, was collected by an interview with the patient and the caregiver. Cognitive status was assessed by the Mini Mental State Examination, functional capacity by the Pfeffer's Questionnaire and Modified Barthel's Index, the frail level by a functional stratification and the risk of falls by the Timed Up and Go (TUG) test. T-Student test was used to compare independent variables. The significance level was set at 5%.Results: Both groups G1 and G2 were homogeneous in relation to the functional and sociodemographic variables. G1 reported more falls in the last 6 months, but most of the participants did not use AAD at the time of the fall. Transferences were the main reason for falls in G1 and stumble in the street in G2.Conclusion: Elderly users of AAD fall out when they are not using the walk device.IMPLICATIONS FOR REHABILITATIONFalling is the second leading cause of death from unintentional injuries in the world. Fall prevention programmes prescribe ambulatory assistive devices, such as walking sticks, crutches and walkers device and walking training with a physiotherapist to provide independence, safety, satisfaction, adherence and psychosocial benefits. However, studies have showed a higher prevalence of falls in frail elderly users of ambulatory-assistive devices.In our study, we verified if users of the ambulatory-assistive devices were using it at the moment of the fall. We found that frail elderly fall down when they are not using the walk device during their activities of day living. Thus, education strategies should be developed to encourage the use of ambulatory-assistive devices by the frail elderly previously evaluated by physiotherapists. Prevalence of falls in this population could reduce if frail elderly users of ambulatory assistive devices really use it during the activities of daily living.

Análise da mobilidade toracoabdominal de idosos com doença de parkinson, submetidos ao treinamento funcional, bicicleta estacionária e exergame: um ensaio clínico randomizado / Analysis of the thoracoabdominal mobility of elderly parkinson's disease that have done stationary bicycle, functional training and exergaming: a randomized controlled trial

Introdução: idosos com doença de Parkinson (DP) apresentam mobilidade toracoabdominal reduzida, o que os predispõe a complicações respiratórias, como a pneumonia aspirativa. Objetivo: avaliar a mobilidade toracoabdominal em idosos com doença de Parkinson, antes e após realizarem treino funcional, bicicleta estacionária e exergame. Metodologia: 58 idosos foram randomizados em três grupos: um que realizou treino funcional (GF) n=18, outro que fez bicicleta estacionária (GB) n=20 e o terceiro que realizou o exergame (GE) n=20. A mobilidade foi mensurada pela cirtometria, por avaliador cego, em três níveis: axilar, xifoideano e umbilical, antes e após as intervenções. Resultados: não foram encontradas diferenças estatisticamente significativas no coeficiente de amplitude nos níveis axilar e xifoide e umbilical nos três grupos. No nível umbilical, entretanto, houve um discreto acréscimo, comparando antes e após as intervenções GF de 2,1(4,52) cm para 3,1(4,27) cm; GB de 1,1(3,16) cm para 1,7(4,68) cm e GE de 0,5 (3,29) cm para 1,0 (3,68) cm. Conclusão: os três programas de exercícios propostos não foram eficazes na melhora da mobilidade torácica no nível axilar e xifoide e parecem provocar uma pequena melhora na mobilidade abdominal, no contexto respiratório.

Introduction: elderly with Parkinson's disease (PD), have reduced thoracoabdominal mobility, which predisposes to respiratory complications such as aspiration pneumonia. Objective: to assess thoracoabdominal mobility in elderly with PD before and after performing functional training, stationary bike and exergaming. Methodology: fifty eight (58) elderly people were randomized into three groups: functional training (GF) n = 18, stationary bike (GB) n = 20 and exergaming (GE) n = 20. Mobility was measured by cirtometry, by blind assessor, in three levels: axillary, xiphoid and umbilical; before and after the interventions. Results: no statistically significant differences were found in the amplitude coefficient at axillary and xiphoid and umbilical levels in the three groups. At the umbilical level, however, there was a slight increase comparing before and after GF interventions from 2.1 (4.52) cm to 3.1 (4.27) cm; GB of 1.1 (3.16) cm to 1.7 (4.68) cm and GE of 0.5 (3.29) cm to 1.0 (3.68) cm. Conclusion: the three exercise programs proposed were not effective in improving axillary and xiphoid thoracic mobility and appear to cause a slight improvement in abdominal mobility in the respiratory context.

Condições de saúde e trabalho entre cuidadores de idosos frágeis / Health and work conditions between caregivers of elderly

INTRODUÇÃO: A presença de problemas físicos e de saúde contribuem para que os idosos se tornem dependentes do auxílio de cuidadores para a realização das atividades básicas e instrumentais da vida diária. OBJETIVO: Avaliar as condições de saúde e de trabalho de cuidadores de idosos frágeis usuários do Centro de Referência Estadual de Atenção à Saúde do Idoso (CREASI). MÉTODOS: Estudo observacional de corte transversal realizado no CREASI. Participaram do estudo 41 cuidadores. Foram coletadas informações sobre os aspectos sociodemográficos, atividade de cuidador, saúde do cuidador, sobrecarga doméstica e foi avaliada a frequência de dores musculoesqueléticas através do questionário Nórdico dos Sintomas Musculoesqueléticos (NMQ). RESULTADOS: A maioria dos participantes eram mulheres, filhas/os, informais, com idade 48,8 (±14,5) anos, 44% dos participantes possuíam ensino médio completo, 95,1% estavam satisfeitos com a atividade de cuidar do idoso e 87,8% não possuíam curso de capacitação. A alta sobrecarga doméstica foi observada em 51,2% dos cuidadores e 50% possuíam doenças crônicas degenerativas. De acordo com o NMQ, 46,34% relataram dor lombar e 26,83% dor na coluna dorsal. CONCLUSÃO: Foi possível observar um excesso de atividades realizadas pelo cuidador que quando acumuladas causam sobrecargas físicas e sintomas dolorosos pelo corpo, o que pode comprometer a atividade do cuidado e a saúde do cuidador. Assim, a formação em cuidador de idoso pode ser uma alternativa para evitar riscos a sua saúde como a do idoso cuidado. [AU]

INTRODUCTION: With the appearance of physical and health problems, the elderly become dependent, needing the help of caregivers in carrying out the basic daily activities. Objective: To evaluate the health and working conditions among caregivers of fragile elderly in the State Reference Center for Health Care of the Elderly (CREASI). METHODS: Observational cross-sectional study performed at CREASI. It was 41 caregivers were analyzed regarding sociodemographic aspects, caregiver activity, caregiver health, domestic overload and the frequency of musculoskeletal pain was evaluated by the Nordic questionnaire on musculoskeletal symptoms (NMQ). RESULTS: Most caregivers were female, daughters, informal, with a age of 48,8 (±14,5) yeares. Regarding education, 43.9% had completed high school, 95.1% were satisfied with the activity of caring and 87.8% did not have a training course. The high domestic overload was observed in 51.2% of caregivers and 50% had chronic degenerative diseases. According to the NMQ, 46.34% had low back pain, followed by 26.83% with pain in the dorsol column. CONCLUSION: It was possible to notice excess activities carried out by the caregiver who, when they accumulate, cause physical overloads and generate painful symptoms through the body, which may compromise the care and health of the caregiver. Thus, caregiver training would be beneficial in avoiding risks to the health of both the caregiver and the elderly. [AU]

Equilíbrio corporal, mobilidade e força muscular respiratória de idosas praticantes do método Pilates / Body balance, mobility and respiratory muscle strength in elderly women practitioners of the method Pilates

Introdução: O Método Pilates é baseado em movimentos do corpo inteiro, respiração, concentração, centralização, precisão e ritmo. Não está claro se a prática desta atividade é superior à manutenção de um estilo de vida ativo. Objetivo: Comparar o equilíbrio corporal, a mobilidade e a força muscular respiratória de mulheres idosas praticantes do Método Pilates e idosas ativas. Métodos: Estudo transversal analítico em 22 idosas, sendo 11 praticantes do Método Pilates (PMP) e 11 idosas ativas (IA). As participantes foram classificadas pelo Perfil de Atividade Humana (PAH) e avaliadas por Timed up and Go (TUG), Escala de Equilíbrio de Berg (EEB) e manovacuometria. Resultados: A idade da amostra foi de 69,36 ± 9,49 anos. A média no TUG das PMP foi de 8,06 ± 4,29 segundos, e das IA de 8,28 ± 2,82 (p>0,05). Na EEB, a média do escore pelas PMP foi 54,63 ± 1,91 e pelas IA foi 52,90 ± 4,01 (p>0,05). Quanto à avaliação da força muscular respiratória, também não houve diferença significativa entre os grupos, mas houve diferença nas IA ao comparar os valores reais (PiMáx = 59,00 cmH2O e PeMáx = 54,00 cmH2O), com os preditivos (PiMáx = 77,12 cmH2O e PeMáx = 74,18 cmH2O), com p<0,05. Conclusão: Manter-se fisicamente ativa ou praticar o Método Pilates parece ter o mesmo efeito sobre o equilíbrio corporal e a mobilidade de mulheres idosas, principalmente entre os 60 e 65 anos. No entanto, idosas que praticam Pilates parecem manter a força muscular respiratória mais adequada à sua idade. (AU)

Introduction: The Pilates Method is based on whole body movements, breathing, concentration, centering, precision and rhythm. It is not clear whether the practice of this activity is superior to maintain an active lifestyle. Objective: To compare the body balance, mobility and respiratory muscle strength of elderly women practicing the Pilates Method and active elderly women. Methods: An analytical cross-sectional study was carried out on 22 elderly women, including 11 Pilates Method Practitioners (PMP) and 11 Active Elderly (AE) women. Participants were classified by the Human Activity Profile (HAP) and evaluated by Timed up and Go (TUG), Berg Balance Scale (BBS) and manovacuometry. Results: The sample was 69.36 ± 9.49 years old. The TUG mean of the PMPs was 8.06 ± 4.29 seconds, and of the AE was 8.28 ± 2.82 (p> 0.05). In BBS, the mean of the PMP score was 54.63 ± 1.91 and the AE was 52.90 ± 4.01 (p> 0.05). Regarding the evaluation of respiratory muscle strength, there was also no significant difference between the groups, but there was a difference in AE when comparing the actual values (PiMax = 59.00 cmH2O and PeMax = 54.00 cmH2O), with the predictive values (PiMax = 77 , 12 cmH 2 O and Pemax = 74.18 cmH 2 O), with p <0.05. Conclusion: Staying physically active or practicing the Pilates Method seems to have the same effect on the body balance and mobility of older women, especially between 60 and 65 years. However, elderly women who practice Pilates seem to maintain respiratory muscle strength more appropriate to their age. (AU)

The Effects of Functional Training, Bicycle Exercise, and Exergaming on Walking Capacity of Elderly Patients With Parkinson Disease: A Pilot Randomized Controlled Single-blinded Trial.

OBJECTIVES: To compare the effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly with Parkinson disease (PD). DESIGN: A pilot randomized, controlled, single-blinded trial. SETTING: A state reference health care center for elderly, a public reference outpatient clinic for the elderly. PARTICIPANTS: Elderly individuals (≥60 years of age; N=62) with idiopathic PD (stage 2 to 3 of modified Hoehn and Yahr staging scale) according to the London Brain Bank. INTERVENTION: The participants were randomly assigned to three groups. Group 1 (G1) participated in functional training (n=22); group 2 (G2) performed bicycle exercise (n=20), and group 3 (G3) trained with Kinect Adventures (Microsoft, Redmond, WA) exergames (n=20). MAIN OUTCOME MEASURES: The primary outcome measure was the 6-minute walk test (6MWT); secondary outcome measures were the 10-m walk test (10MWT), sitting-rising test (SRT), body mass index, Parkinson Disease Questionnaire-39, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and 15-item Geriatric Depression Scale. RESULTS: All groups showed significant improvements in 6MWT (G1 P=.008; G2 P=.001; G3 P=.005), SRT (G1 P<.001; G2 P=.001; G3 P=.003), and WHODAS 2.0 (G1 P=.018; G2 P=.019; G3 P=.041). Only G3 improved gait speed in 10MWT (P=.11). G1 (P=.014) and G3 (P=.004) improved quality of life. No difference was found between groups. CONCLUSIONS: Eight weeks of exergaming can improve the walking capacity of elderly patients with PD. Exergame training had similar outcomes compared with functional training and bicycle exercise. The three physical exercise modalities presented significant improvements on walking capacity, ability to stand up and sit, and functionality of the participants.

Using the spirometry to indicate respiratory exercises for elderly with Parkinson's disease / O uso da espirometria na indicação de exercícios respiratórios para idosos com Doença de Parkinson

Abstract Introduction: Respiratory dysfunction is the main cause of death in Parkinson's disease (PD) patients and bronchoaspiration pneumonia is the most common clinical respiratory complication. Objective: To assess respiratory function of elderly with PD in mild to moderate phase of the disease. Methods: A cross-sectional study was carried. Elderly in 2 to 3 PD Hoehn & Yahr stage have participated. A single researcher has evaluated maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), thoracoabdominal amplitude, forced vital capacity (FVC) and expiratory volume in the first second (FEV1). Results: Sixty elderly have participated and their all spirometry and manovacuometry parameters presented significant differences (p < 0.05) comparing with predicted values, except for FVC (p = 0.25). Only umbilical level did not reach normal values on cirtometry parameters. Patients classified as a restrictive disorder presented significant decrease in thoracic expandability. However the participants classified as an obstructive disorder showed significant decrease in expiratory muscle strength and peak expiratory flows. Conclusion: Elderly in mild or moderate phase of PD presented reduction in respiratory parameters. Spirometry showed to be an important tool to evaluate respiratory function and to indicate the modality of respiratory exercise. Our results suggest the indication of thoracic flexibility exercises for patient with PD classified as restrictive disorder and strength exercise of respiratory muscles for those classified as obstructive disorder.

Resumo Introdução: Disfunções respiratórias são as principais causas de morte em pacientes com Doença de Parkinson (DP) e a pneumonia por bronco-aspiração é a complicação respiratória mais comum. Objetivo: Avaliar a função respiratória de idosos com doença de Parkinson (DP) em fase leve a moderada da doença. Métodos: Foi realizado um estudo transversal. Participaram idosos nos estágios 2 a 3 da classificação de Hoehn & Yahr. Um único pesquisador avaliou a pressão inspiratória máxima (PIM), pressão expiratória máxima (PEM), amplitude toracoabdominal, capacidade vital forçada (CVF) e volume expiratório forçado no primeiro segundo (VEF1). Resultados: Sessenta idosos participaram e todos os seus parâmetros de espirometria e manovacuometria apresentaram diferenças significativas (p < 0,05) em comparação com os valores previstos, exceto a CVF (p = 0,25). Somente o nível umbilical não atingiu valores normais nos parâmetros da cirtometria. Pacientes classificados como distúrbios restritivos apresentaram diminuição significativa na capacidade de expansão torácica. No entanto, os participantes classificados como transtornos obstrutivos mostraram diminuição significativa na força muscular expiratória e dos fluxos expiratórios máximos. Conclusão: Os idosos em fase leve ou moderada da DP apresentaram redução nos parâmetros respiratórios. A espirometria mostrou ser uma ferramenta importante para avaliar a função respiratória e para indicar a modalidade do exercício respiratório. Nossos resultados sugerem a indicação de exercícios de flexibilidade torácica para pacientes com DP classificados como distúrbios restritivos e exercícios de força da musculatura respiratória para aqueles classificados como desordem obstrutiva.

The effects of functional training and stationary cycling on respiratory function of elderly with Parkinson disease: a pilot study / Os efeitos do treino funcional e da bicicleta estacionária na função respiratória de idosos com Doença de Parkinson: um estudo piloto

Abstract Introduction: Respiratory function changes in patients with Parkinson's disease (PD) contribute to aspiration pneumonia, the main cause of mortality in PD population. Objective: To compare the effects of functional training and cycle exercise in respiratory function of elderly with PD. Methods: Twenty participants were randomised into two groups. Experimental group (EG) (n = 10) performed cycle exercise and control group (CG) (n = 10) was trained with functional training. A blinded researcher evaluated maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), thoracoabdominal amplitude, forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) before and after interventions. Results: Both groups did not improve significantly respiratory function. Only CG improved significantly FVC (p = 0.01). No differences were found between groups. Conclusion: 8-week exercise programs are not able to improve the respiratory function of elderly in 2 to 3 PD Hoehn & Yahr stage. Both functional training and cycle exercise do not to improve respiratory function in elderly with PD.

Resumo Introdução: Mudanças na função respiratória em pacientes com Doença de Parkinson (DP) contribuem para a pneumonia aspirativa, principal causa de mortalidade nessa população. Objetivo: Comparar os efeitos do treino funcional e do exercício em bicicleta estacionária na função respiratória de idosos com Doença de Parkinson (DP). Métodos: 20 participantes foram randomizados em 2 grupos. O grupo experimental (GE) (n = 10) realizou exercício em bicicleta estacionária e o grupo controle (GC) (n = 10) realizou o treino funcional. Um pesquisador cegado avaliou a pressão inspiratória máxima (PIM), a pressão expiratória máxima (PEM), a amplitude toracoabdominal, a capacidade vital forçada (CVF) e o volume expiratório forçado no primeiro segundo (VEF1) antes e após as intervenções. Resultados: Ambos os grupos não melhoraram significativamente a função respiratória. Apenas o GC melhorou de forma significante a CVF (p = 0.01). Nenhuma diferença foi encontrada entre os grupos. Conclusão: Programas de exercício com duração de 8 semanas não são capazes de melhorar a função respiratória de idosos com DP nos estágios 2 a 3 de Hoehn & Yahr. Ambos grupos que realizaram o treino funcional e exercício em bicicleta estacionária não melhora a função respiratória de idosos com DP.

Aptidão cardiorrespiratória de idosos saudáveis e com doença de Parkinson: um estudo comparativo / Cardiorespiratory fitness of healthy elderly patients with Parkinson's disease: a comparative study

Fundamento: A expectativa de vida no Brasil aumentou significativamente nas últimas cinco décadas, elevando consideravelmente o número de idosos no país. A idade avançada é um fator de risco para o aparecimento de várias doenças crônicas, que junto com o envelhecimento podem causar alterações orgânicas e funcionais na vida do indivíduo, dentre elas estão as disfunções cardiorrespiratórias. Um exemplo é a Doença de Parkinson (DP), que é neurodegenerativa, atinge células dopaminérgicas da substância negra do mesencéfalo e causa alterações motoras e não motoras no paciente. Objetivo: Comparar o desempenho cardiorrespiratório de idosos saudáveis e com DP. Métodos: Trata-se de um estudo transversal analítico. Constituiu o Grupo Parkinson (GP) idosos com a DP em fase leve a moderada da doença (2,5 e 3 da classificação de Hoehn e Yahr). No Grupo Controle (GC), de comparação, participaram idosos saudáveis não praticantes de exercício físico. Ambos os grupos foram submetidos à avaliação da aptidão cardiorrespiratória através do Teste de caminhada de 6 minutos (TC6M). Resultados: Houve diferença significativa em relação à distância percorrida e a porcentagem da estimada dos grupos, onde o GC obteve maior resultado em ambos (p=0,006) e (p<0,001), respectivamente. Conclusão: Os pacientes com DP participantes do estudo apresentaram uma aptidão cardiorrespiratória significativamente menor quando comparado aos idosos saudáveis da mesma idade. (AU)

Background: life expectancy in Brazil increased significantly in the last five decades, significantly increasing the number of elderly in the country. Advanced age is a risk factor for the onset of several chronic diseases, which along with aging can cause organic and functional changes in the individual's life, among them are the cardiorespiratory disorders. One example is Parkinson's disease (PD) is a neurodegenerative reaches dopaminergic cells in the substantia nigra of the midbrain and causes motor and non-motor abnormalities in the patient. Objective: To compare the cardiorespiratory performance of healthy elderly and PD. Methods: This is an analytical cross-sectional study. Were the Parkinson Group (PG) elderly people with PD in mild to moderate stage of the disease (2.5 and 3 of the Hoehn and Yahr classification). In the control group (CG), comparison, participated healthy elderly non-practicing physical exercise. Both groups were subjected to evaluation of cardiorespiratory fitness through the 6-minute walk test (6MWT). Results: There was significant difference in the distance and the estimated percentage of the groups where the GC had higher results in both groups (p=0,006) and (p<0,001), respectively. Conclusion: Patients with PD study participants had a significantly lower cardiorespiratory fitness when compared to healthy older adults the same age. (AU)

Nintendo Wii training on postural balance and mobility rehabilitation of adults with Parkinson's disease: a systematic review / Treinamento com Nintendo Wii na reabilitação do equilíbrio postural e mobilidade de indivíduos com Doença de Parkinson: uma revisão sistemática

Abstract Introduction: Postural instability affects balance control in Parkinson disease (PD) patients and increases the particular risk of falling compared with healthy older adults. Video games with not immersive virtual reality have been used in neurological disorders rehabilitation process. Objective: To evaluate the effectiveness of the video game console Nintendo Wii (NW) on postural balance and mobility treatment of adults with PD in Hoehn and Yahr stages I to III. Methods: The following databases were searched electronically on MEDLINE, Cochrane Library, PEDro, CAPES Periodic, BIREME, and LILACS databases. The search period for this review was January 2010 to June 2016. The assessment of methodological quality was performed using the PEDro Scale as reference. Results: 12 original studies were selected, but only 3 were randomized controlled trials (RCTs). Conclusion: Some of the studies analysed suggest that NW can provide improvement in balance and mobility of adults with PD. These benefits should be interpreted with caution because of the low methodological quality of the included trials, and the lack of common assessment of treatment effects. There is little evidence to ensure the effectiveness and support the inclusion of the treatment with NW of patients with PD.

Resumo Introdução: A instabilidade Postural altera o controle do equilíbrio em pacientes com Doença de Parkinson (DP) e diminui o risco de quedas quando comparado a idosos saudáveis. Vídeo games com realidade virtual não imersiva tem sido utilizados no processo de reabilitação de desordens neurológicas. Objetivo: Avaliar a eficácia do videogame Nintendo Wii (NW) no tratamento do equilíbrio postural e mobilidade de pacientes adultos com DP em estágios I a III da escala de Hoehn & Yahr. Métodos: As seguintes bases de dados foram pesquisadas eletronicamente no período de março e junho 2016: MEDLINE, Biblioteca Cochrane, PEDro, Periódico CAPES, BIREME e bases de dados Lilacs, publicados até 03 de julho de 2016. A avaliação da qualidade metodológica foi realizada utilizando a Escala PEDro como referência. Resultados: 12 estudos originais foram selecionados, mas apenas 3 eram ensaios clínicos randomizados (ECRs). Conclusão: Alguns dos estudos analisados sugerem que o NW pode proporcionar melhora no equilíbrio e na mobilidade de adultos com DP. Estes benefícios devem ser interpretados com cautela por causa da baixa qualidade metodológica dos estudos incluídos e da falta de avaliação comum dos efeitos do tratamento. Há pouca evidência para garantir a eficácia e apoiar a inclusão do tratamento com NW em pacientes com DP.

Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients.

BACKGROUND: The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed. OBJECTIVE: To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients. METHODS: The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl-Meyer scales were used to evaluate the patients. RESULTS: After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl-Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients' performance in a similar manner. CONCLUSION: Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.

The Use of Nintendo Wii in the Rehabilitation of Poststroke Patients: A Systematic Review.

BACKGROUND: To evaluate the effectiveness of the video game console Nintendo Wii (NW) in motor function, balance, and functional independence in the treatment of poststroke patients and to identify which games are commonly used in therapy. METHODS: Randomized controlled trials were researched in MEDLINE, Cochrane Library, PEDro, CAPES Periodic, BIREME, and LILACS databases, covering publications up to March 31, 2014. The assessment of methodological quality was performed using the PEDro Scale as reference. RESULTS: The 5 studies included for analysis showed that NW can provide an improvement of motor function of the individual, but the data are unclear when it comes to the balance and functional independence. CONCLUSIONS: It was concluded that there is little evidence to ensure the effectiveness and support the inclusion of the treatment with NW in patients with sequelae caused by a stroke; however, some of the studies analyzed suggest that NW can provide improvement in motor function.

Perfil funcional, sociodemográfico e epidemiológico de idosos hospitalizados por fratura proximal de fêmur / Functional, social-demographic and epidemiological profile of elderly hospitalized for hip fracture

A fratura proximal de fêmur (FPF) está relacionada a altos índices de morbidade e a grande impacto sobre a capacidade funcional do idoso. O objetivo do estudo foi traçar o perfil funcional de pacientes idosos hospitalizados por FPF, analisando os tipos de fraturas, o mecanismo causal, e as características físicas e funcionais prévias ao evento. Trata-se de um estudo do tipo observacional, quantitativo, de corte transversal, cujos participantes eram pacientes hospitalizados por FPF. Foi utilizada uma Ficha de Registro para coletar os dados sociodemográficos. O grau de independência funcional e a capacidade de marcha prévia à FPF foram avaliados respectivamente pelo Índice de Barthel, o Questionário de Pfeffer e a Classificação Funcional da Marcha Modificada. A amostra foi constituída por 32 idosos com média de idade de 79 (± 9,5) anos e uma predominância do sexo feminino (71,8%), de cor parda (43,8%) e baixa escolaridade. A maioria não morava sozinho e faziam uso de algum medicamento. Os idosos participantes, previamente à fratura, eram independentes para as atividades básicas da vida diária (ABVD), dependentes para as atividades instrumentais da vida diária (AIVD) e não utilizam dispositivos para locomoção. A queda foi a principal causa da FPF, sendo as mais prevalentes a fratura de colo de fêmur (FCF) e a fratura transtrocantérica (FTT). As comorbidades, os medicamentos, os fatores sociodemográficos, o deficit de marcha e a dependência funcional, podem estar associados à ocorrência de FPF em idosos.

The hip fracture (HF) is related to high rates of morbidity and a major impact on the functional capacity of the elderly. The aim of the study was to outline the functional profile of elderly patients hospitalized for HF analyzing kinds of fractures, the causal mechanism and the physical and functional prior to the event. This is an observational study, quantitative, cross-sectional whose participants were patients hospitalized for FPF. A registry file was used to collect sociodemographic data. The degree of functional independence and the ability to walk prior to the HF, respectively were evaluated by the Barthel Index, the Pfeffer questionnaire and the Functional Classification of the March Modified. The sample consisted of 32 elderly people with an average age of 79 (± 9.5) years and a predominance of females (71.8%), mulatto (43.8%) and low education. Most lived alone and did not use any medication. Participants elderly, prior to fracture, were independent for basic activities of daily living (ADL), dependent for instrumental activities of daily living (IADL) and do not use for locomotion devices. Falls were the leading cause of HF, the most prevalent the femoral neck fracture (FNF) and the trochanteric fracture (TF). Comorbidities, medications, sociodemographic factors, gait impairment and functional dependency, they may be associated with occurrence of HF in the elderly.