Etiologia e fisiopatologia da fibromialgia / Etiology and pathophysiology of fibromyalgia

A fibromialgia é uma condição crônica de etiologia desconhecida e desvinculada de marcadores laboratoriais específicos para diagnóstico, devido à pobre caracterização da etiopatogenia. Em geral, as alterações comuns à fibromialgia também são observadas em outras condições de dor crônica, tornando a patogênese controversa entre diferentes condições patológicas. A etiologia desconhecida dificulta o diagnóstico e, consequentemente, repercute em um tratamento não tão eficaz de pacientes com fibromialgia. A restauração de desordens sistêmicas confere amplo espectro de possibilidades terapêuticas com potencial de orientar profissionais a estabelecer metas e métodos de avaliação. Diante disso, essa revisão narrativa se volta para debater hipóteses etiológicas e fisiopatológicas no desenvolvimento da fibromialgia.

Fibromyalgia is a chronic condition of unknown etiology unrelated to specific laboratory markers for diagnosis because of poor etiopathogenesis. In general, the changes common to fibromyalgia are also seen in other chronic pain conditions, making the pathogenesis controversial among different pathological conditions. The unknown etiology makes the diagnosis difficult and consequently has repercussions on a not so effective treatment of patients with fibromyalgia. The restoration of systemic disorders provides a wide spectrum of therapeutic possibilities with the potential to guide professionals in establishing goals and evaluation methods. Therefore, this narrative review discusses the etiological and pathophysiological hypotheses involved in the development of fibromyalgia.

Effects of Creatine Supplementation on the Myostatin Pathway and Myosin Heavy Chain Isoforms in Different Skeletal Muscles of Resistance-Trained Rats.

Creatine has been used to maximize resistance training effects on skeletal muscles, including muscle hypertrophy and fiber type changes. This study aimed to evaluate the impact of creatine supplementation on the myostatin pathway and myosin heavy chain (MyHC) isoforms in the slow- and fast-twitch muscles of resistance-trained rats. Twenty-eight male Wistar rats were divided into four groups: a sedentary control (Cc), sedentary creatine supplementation (Cr), resistance training (Tc), and resistance training combined with creatine supplementation (Tcr). Cc and Tc received standard commercial chow; Cr and Tcr received a 2% creatine-supplemented diet. Tc and Tcr performed a resistance training protocol on a ladder for 12 weeks. Morphology, MyHC isoforms, myostatin, follistatin, and ActRIIB protein expressions were analyzed in soleus and white gastrocnemius portion samples. The results were analyzed using two-way ANOVA and Tukey's test. Tc and Tcr exhibited higher performance than their control counterparts. Resistance training increased the ratio between muscle and body weight, the cross-sectional area, as well as the interstitial collagen fraction. Resistance training alone increased MyHC IIx and follistatin while reducing myostatin (p < 0.001) and ActRIIB (p = 0.040) expressions in the gastrocnemius. Resistance training induced skeletal muscle hypertrophy and interstitial remodeling, which are more evident in the gastrocnemius muscle. The effects were not impacted by creatine supplementation.

Effectiveness of aquatic exercise in the treatment of inflammatory arthritis: systematic review.

Spondyloarthritis and rheumatoid arthritis are classified as inflammatory arthritis and represent a significant source of pain and disability. Non-pharmacological intervention with physical exercise is among the therapeutic approaches most used by health professionals. This study aimed to investigate the effectiveness of aquatic exercise in the treatment of inflammatory arthritis. The review was registered on the PROSPERO (CRD42020189602). The databases (PubMed, PEDro, Web of Science, and SciELO) were searched for studies involving adults with inflammatory arthritis and subjected to rehabilitation with aquatic exercise compared to any other control group, from the year 2010 to March 2022. Pain, disease activity, and physical function were regarded as primary outcomes. Two reviewers completed the eligibility screening and data extraction, and disagreements were resolved by a third reviewer. The methodological quality was assessed using the PEDro scale. A total of 5254 studies were identified, and nine articles were included, totalling 604 participants. Regarding pain, two studies showed that aquatic exercise was superior to home exercise. One study showed that disease activity was significantly improved in the aquatic group compared to the land-based exercise and the control groups (no exercise). Two studies reported that therapy containing aquatic exercise was able to improve physical function. Overall, the studies included in this review indicate that aquatic exercise is effective in treating pain, disease activity, and physical function in individuals with inflammatory arthritis. However, further studies carrying stronger evidence should be conducted to determine whether the treatment with aquatic exercise is superior to other types of therapies.

Cardiovascular health indicators in soccer exercise during adolescence: systematic review.

This review analyzed the studies that evaluated cardiovascular health indicators (blood pressure, waist circumference, heart rate, glucose index and lipid blood) in recreational soccer players during adolescence, and identify possible associated factors. The search was performed in the electronic databases (PubMED, SciELO, LILACS, Scopus, SPORTDiscus and Web of Science). Inclusion criteria were: population composed of children and/or adolescents (10-19 years or average age up to 19 years); studies adolescents engaged in recreational soccer regularly and observational studies with cross-sectional or longitudinal design. The process of analysis of studies involved reading titles, abstracts and full texts. After these phases, seven articles were eligible. Regarding the design, all studies were cross-sectional. Of the total studies included, five presented moderate methodological quality values and two presented low methodological quality values, according to National Heart, Lung, and Blood Institute instrument. The most cardiovascular health indicators used in recreational soccer players during adolescence was waist circumference; three studies analyzed heart rate, two evaluated blood pressure, one analyzed insulin resistance and none of the included studies analyzed lipid profile. Factors associated were analyzed in four studies, being that sedentary time and body mass index (BMI) present association with at least one indicator of cardiovascular health.

Intermittent Fasting Attenuates Exercise Training-Induced Cardiac Remodeling. / Dieta Intermitente Atenua a Remodelação Cardíaca Causada pelo Exercício Físico.

BACKGROUND: The effects of non-pharmacological interventions such as calorie restriction and exercise training on health and prevention of cardiovascular diseases have been investigated in clinical and experimental studies. OBJECTIVE: To analyze the influence of intermittent fasting and exercise training on functional fitness, glycemia and cardiac remodeling. METHODS: Wistar rats (n=60) were randomly divided into four groups: control, exercise training (ET), intermittent fasting (IF) and exercise training plus intermittent fasting (ETI). Over 12 weeks, control and ET animals were fed daily a standard commercial diet ad libitum , while IF and ETI animals were fed every other day. In addition, the ET and ETI groups were submitted to a running protocol on a treadmill. After this period, functional fitness, nutritional parameters and blood glucose levels were analyzed. In addition to heart morphology, myocardial protein expression of extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) was assessed by Western-blot. The results were analyzed using two-way ANOVA and Student-Newman-Keuls test. The level of significance considered was 5%. RESULTS: Exercise training increased functional fitness in the ET and ETI groups and promoted cardiac fibrosis. The combination of intermittent fasting and exercise training resulted in a smaller area under the blood glucose curve and reduced cardiomyocyte cross-sectional area and interstitial collagen fraction in the ETI group compared to ET. ERK and JNK expression levels were similar among groups (p>0.05). CONCLUSIONS: Intermittent fasting is associated with improved glucose tolerance and attenuates cardiac remodeling induced by exercise training (Arq Bras Cardiol. 2020; 115(2):184-193).

FUNDAMENTO: A influência de intervenções não farmacológicas como restrição calórica e exercício físico sobre a saúde e prevenção de enfermidades cardíacas tem sido documentada em estudos clínicos e experimentais. OBJETIVO: Analisar a influência da combinação entre dieta intermitente e exercício físico sobre a capacidade funcional, metabolismo glicêmico e remodelação cardíaca. MÉTODOS: Foram utilizados 60 ratos Wistar machos distribuídos em quatro grupos: Controle (C), Exercício Físico (EF), Dieta Intermitente (DI) e Exercício Físico e Dieta Intermitente (EDI). Durante 12 semanas, enquanto C e EF foram tratados diariamente com dieta comercial padrão ad libitum, DI e EDI receberam dieta similar em dias alternados com dias de jejum. Os grupos EF e EDI foram submetidos a protocolo de corrida em esteira rolante. Posteriormente, foram analisadas capacidade funcional, comportamento nutricional e metabolismo glicêmico. Além da morfologia do coração, a expressão proteica das proteínas extracellular signal-regulated kinase (ERK) e c-Jun N-terminal kinase (JNK) no coração foi avaliada por Western-blot. A análise dos resultados foi feita por meio de Two-Way ANOVA e teste de Student-Newman-Keuls. O nível de significância considerado foi de 5%. RESULTADOS: O exercício físico aumentou a capacidade funcional nos grupos EF e EDI, e acarretou fibrose cardíaca. A combinação entre dieta intermitente e exercício físico resultou em menor área sob a curva de glicemia e menores medidas de área e interstício cardíaco no EDI em relação ao EF. A expressão de proteínas ERK e JNK foi similar entre os grupos (p>0,05). CONCLUSÕES: Dieta intermitente se associa com melhor tolerância glicêmica e atenua o processo de remodelação cardíaca decorrente do exercício físico. (Arq Bras Cardiol. 2020; 115(2):184-193).

Dieta Intermitente Atenua a Remodelação Cardíaca Causada pelo Exercício Físico / Intermittent Fasting Attenuates Exercise Training-Induced Cardiac Remodeling

Resumo Fundamento A influência de intervenções não farmacológicas como restrição calórica e exercício físico sobre a saúde e prevenção de enfermidades cardíacas tem sido documentada em estudos clínicos e experimentais. Objetivo Analisar a influência da combinação entre dieta intermitente e exercício físico sobre a capacidade funcional, metabolismo glicêmico e remodelação cardíaca. Métodos Foram utilizados 60 ratos Wistar machos distribuídos em quatro grupos: Controle (C), Exercício Físico (EF), Dieta Intermitente (DI) e Exercício Físico e Dieta Intermitente (EDI). Durante 12 semanas, enquanto C e EF foram tratados diariamente com dieta comercial padrão ad libitum, DI e EDI receberam dieta similar em dias alternados com dias de jejum. Os grupos EF e EDI foram submetidos a protocolo de corrida em esteira rolante. Posteriormente, foram analisadas capacidade funcional, comportamento nutricional e metabolismo glicêmico. Além da morfologia do coração, a expressão proteica das proteínas extracellular signal-regulated kinase (ERK) e c-Jun N-terminal kinase (JNK) no coração foi avaliada por Western-blot. A análise dos resultados foi feita por meio de Two-Way ANOVA e teste de Student-Newman-Keuls. O nível de significância considerado foi de 5%. Resultados O exercício físico aumentou a capacidade funcional nos grupos EF e EDI, e acarretou fibrose cardíaca. A combinação entre dieta intermitente e exercício físico resultou em menor área sob a curva de glicemia e menores medidas de área e interstício cardíaco no EDI em relação ao EF. A expressão de proteínas ERK e JNK foi similar entre os grupos (p>0,05). Conclusões Dieta intermitente se associa com melhor tolerância glicêmica e atenua o processo de remodelação cardíaca decorrente do exercício físico. (Arq Bras Cardiol. 2020; 115(2):184-193)

Abstract Background The effects of non-pharmacological interventions such as calorie restriction and exercise training on health and prevention of cardiovascular diseases have been investigated in clinical and experimental studies. Objective To analyze the influence of intermittent fasting and exercise training on functional fitness, glycemia and cardiac remodeling. Methods Wistar rats (n=60) were randomly divided into four groups: control, exercise training (ET), intermittent fasting (IF) and exercise training plus intermittent fasting (ETI). Over 12 weeks, control and ET animals were fed daily a standard commercial diet ad libitum , while IF and ETI animals were fed every other day. In addition, the ET and ETI groups were submitted to a running protocol on a treadmill. After this period, functional fitness, nutritional parameters and blood glucose levels were analyzed. In addition to heart morphology, myocardial protein expression of extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) was assessed by Western-blot. The results were analyzed using two-way ANOVA and Student-Newman-Keuls test. The level of significance considered was 5%. Results Exercise training increased functional fitness in the ET and ETI groups and promoted cardiac fibrosis. The combination of intermittent fasting and exercise training resulted in a smaller area under the blood glucose curve and reduced cardiomyocyte cross-sectional area and interstitial collagen fraction in the ETI group compared to ET. ERK and JNK expression levels were similar among groups (p>0.05). Conclusions Intermittent fasting is associated with improved glucose tolerance and attenuates cardiac remodeling induced by exercise training (Arq Bras Cardiol. 2020; 115(2):184-193)

Bloqueio de Receptores AT1 Melhora o Desempenho Funcional Miocárdico na Obesidade / AT1Receptor Blockade Improves Myocardial Functional Performance in Obesity

Resumo Fundamento A obesidade tem sido associada com ativação crônica do sistema renina-angiotensina-aldosterona e importantes alterações no desempenho cardíaco. Objetivo Avaliar a influência do bloqueio de receptores de angiotensina-II do tipo 1 (AT1) sobre a morfologia e desempenho cardíaco de ratos obesos por dieta Métodos Ratos Wistar (n=48) foram submetidos a dieta controle (2,9 kcal/g) ou hiperlipídica (3,6 kcal/g) durante 20 semanas. Após a 16ª semana, foram distribuídos em quatro grupos: Controle (CO), Obeso (OB), Controle Losartan (CL) e Obeso Losartan (OL). CL e OL receberam losartan (30 mg/kg/dia) na água durante quatro semanas. Posteriormente, foram analisadas composição corporal, pressão arterial sistólica (PAS) e ecocardiograma. A função de músculos papilares foi avaliada em situação basal com concentração de cálcio ([Ca2+]o) de 2,50 mM e após manobras inotrópicas: potencial pós-pausa (PPP), elevação da [Ca2+]o e durante estimulação beta-adrenérgica com isoproterenol. A análise dos resultados foi feita por meio de Two-Way ANOVA e teste de comparações apropriado. O nível de significância considerado foi de 5%. Resultados Embora a alteração da PAS não tenha se mantido ao final do experimento, a obesidade se associou com hipertrofia cardíaca e maior velocidade de encurtamento da parede posterior do ventrículo esquerdo.No estudo de músculos papilares em condição basal, CL mostrou menor velocidade máxima de variação negativa da tensão desenvolvida (-dT/dt) do que CO. O PPP de 60s promoveu menor -dT/dt e pico de tensão desenvolvida (TD) em OB e CL, comparados ao CO, e maior variação relativa de TD e velocidade máxima de variação positiva (+dT/dt) no OL em relação a CL e OB. Sob 1,5, 2,0 e 2,5mM de [Ca2+]o, o grupo OL exibiu maior -dT/dt do que CL. Conclusão Losartan melhora a função miocárdica de ratos com obesidade induzida por dieta. (Arq Bras Cardiol. 2020; 115(1):17-28)

Abstract Background Obesity has been associated with chronic activation of the renin-angiotensin-aldosterone system and with significant changes in cardiac performance. Objective To assess the impact of a blockade of angiotensin-II receptor type 1 (AT1receptor) on morphology and on myocardial functional performance in rats with high-fat diet- induced obesity. Methods Wistar rats (n=48) were submitted to control (2.9 kcal/g) or high-fat (3.6 kcal/g) diet for 20 weeks. After the 16thweek they were divided into four groups: Control (CO), Obese (OB), Control Losartan (CL) and Obese Losartan (OL). CL and OL received losartan (30 mg/kg/day) in drinking water for four weeks. Subsequently, body composition, systolic blood pressure (SBP) and echocardiographic variables were analyzed. Papillary muscle function was assessed at baseline with 2.50 mM calcium concentration ([Ca2+]o) and after inotropic maneuvers: post-pause potentiation (PPP), [Ca2+]oelevation, and during beta-adrenergic stimulation with isoproterenol. Analysis of the results was performed by the Two-Way ANOVA and by the appropriate comparison test. The level of significance was set at 5%. Results Although SBP change had been not maintained at the end of the experiment, obesity was associated with cardiac hypertrophy and with increased left ventricle posterior wall shortening velocity. In the study of papillary muscles in basal condition, CL showed lower developed tension maximum negative variation velocity (-dT/dt) than CO. The 60s PPP promoted lower -dT/dt and maximum developed tension (DT) in OB and CL compared with CO, and higher relative DT variation and maximum positive variation velocity (+dT/dt) in OL compared with CL and OB. Under 1.5, 2.0, and 2.5mM [Ca2+]o, the OL group showed higher -dT/dt than CL. Conclusion Losartan improves myocardial function in high-fat diet-induced obesity. (Arq Bras Cardiol. 2020;115(1):17-28)

AT1Receptor Blockade Improves Myocardial Functional Performance in Obesity. / Bloqueio de Receptores AT1 Melhora o Desempenho Funcional Miocárdico na Obesidade.

Background Obesity has been associated with chronic activation of the renin-angiotensin-aldosterone system and with significant changes in cardiac performance. Objective To assess the impact of a blockade of angiotensin-II receptor type 1 (AT1receptor) on morphology and on myocardial functional performance in rats with high-fat diet- induced obesity. Methods Wistar rats (n=48) were submitted to control (2.9 kcal/g) or high-fat (3.6 kcal/g) diet for 20 weeks. After the 16thweek they were divided into four groups: Control (CO), Obese (OB), Control Losartan (CL) and Obese Losartan (OL). CL and OL received losartan (30 mg/kg/day) in drinking water for four weeks. Subsequently, body composition, systolic blood pressure (SBP) and echocardiographic variables were analyzed. Papillary muscle function was assessed at baseline with 2.50 mM calcium concentration ([Ca2+]o) and after inotropic maneuvers: post-pause potentiation (PPP), [Ca2+]oelevation, and during beta-adrenergic stimulation with isoproterenol. Analysis of the results was performed by the Two-Way ANOVA and by the appropriate comparison test. The level of significance was set at 5%. Results Although SBP change had been not maintained at the end of the experiment, obesity was associated with cardiac hypertrophy and with increased left ventricle posterior wall shortening velocity. In the study of papillary muscles in basal condition, CL showed lower developed tension maximum negative variation velocity (-dT/dt) than CO. The 60s PPP promoted lower -dT/dt and maximum developed tension (DT) in OB and CL compared with CO, and higher relative DT variation and maximum positive variation velocity (+dT/dt) in OL compared with CL and OB. Under 1.5, 2.0, and 2.5mM [Ca2+]o, the OL group showed higher -dT/dt than CL. Conclusion Losartan improves myocardial function in high-fat diet-induced obesity. (Arq Bras Cardiol. 2020;115(1):17-28).

Influência da reabilitação física sobre aspectos funcionais em indivíduos submetidos à artroplastia total de quadril: uma revisão sistemática / Influence of physical rehabilitation on functional aspects in individuals submitted to total hip arthroplasty: a systematic review

Resumo Objetivo: Avaliar, por meio de revisão sistemática, a influência do tratamento fisioterapêutico sobre a funcionalidade, amplitude de movimento articular e força muscular em pacientes submetidos à artroplastia total de quadril devido à osteoartrite. Métodos: A busca sistemática de ensaios clínicos randomizados e não randomizados foi conduzida utilizando os bancos de dados eletrônicos PubMed, Web of Science, PEDro, Cochrane, Clinical Trials e SciELO, com base nas estratégias de pesquisa recomendadas pelos itens de relatórios preferenciais para análises sistemáticas e metanálises (PRISMA). Resultados: Em geral, protocolos supervisionados por fisioterapeutas associados à realização de exercícios ativos da musculatura periarticular do quadril e de extensores de joelho têm propiciado importante prognóstico físico e funcional. Exercícios resistidos (dinâmicos e isométricos) de alta intensidade são mais eficazes para a funcionalidade. Para a força muscular e Amplitude de movimento (ADM), exercícios dinâmicos com 3 a 5 séries de 8 a 12 repetições com baixa e alta intensidade promoveram ganhos mais expressivos em relação a outras modalidades terapêuticas. Conclusões: As técnicas e os protocolos utilizados pela fisioterapia para o tratamento da ATQ são variados e possuem importante eficácia clínica comprovada na literatura.

Abstract Objective: by performing a systematic review, the present study aimed to evaluate the influence of physical rehabilitation on functionality, range of motion and musculoskeletal strength in patients submitted to total hip arthroplasty due to osteoarthritis. Methods: a systematic search for randomized and non-randomized controlled trials was conducted using the PubMed, Web of Science, PEDro, Cochrane, Clinical Trials and SciELO electronic databases, using the search strategies recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: in general, protocols supervised by physiotherapists associated with performing active exercises of the hip periarticular muscles and knee extensors have provided effective functional prognosis. High intensity resistance exercises (dynamic and isometric) are more effective in improving functionality. Dynamic exercises with three to five sets of eight to twelve low and high intensity repetitions promoted more pronounced increases in muscle strength and range of motion than other therapeutic modalities. Conclusions: the techniques and protocols used for physical therapy treatment after THA are wide-ranging and their clinical efficacy is demonstrated in literature.

Epidemiological profile of soccer-related injuries in a state Brazilian championship: An observational study of 2014-15 season.

BACKGROUND: Soccer related injuries are often reported in studies, but epidemiological research on this theme is rare in Brazil, Furthermore, the conditions in which athletes have returned to sports practice, namely, either symptomatic or asymptomatic, have been neglected in research. OBJECTIVES: The aim of this study was to describe the epidemiological features of injuries among professional Brazilian soccer players in relation to location, type, mechanism, severity, recurrence, treatment and, lastly, symptoms in return to sport. STUDY DESIGN: Descriptive and cross-sectional, observational study. STUDY CENTER: School of Physical Therapy of the University of Mato Grosso do Sul, Brazil. METHODS: 116 male professional athletes of teams from a Brazilian state championship were interviewed and information about injuries was recorded using a retrospective reported morbidity questionnaire. Data were analyzed in mean ±â€¯SD for physical characteristics and sports practice history in absolute and relative frequencies (chi-square test with Bonferroni's correction) for characterization of soccer injuries in terms of type, location, severity, recurrence and symptoms in return to sport. RESULTS: The numbers of injuries per athlete and per injured athlete were 0.92 and 1.43 respectively. The injuries of muscle-tendon unit and the joint types localized on lower limbs constituted the most important clinical occurrences with significant difference both in relation to other types (p < 0.05). Moderate and severe injuries were the most frequent occurrences. In relation to mechanisms for each type of injury, body contact was at least three times more responsible for injury cases. This type of mechanism was associated with a significantly greater impairment of joint structures. Concerning occurrence and recurrence of cases, the number of recurrent injuries of the muscle-tendon unit reached about 7.5% of the first-time injuries, while the number of joint recurrent injuries integrated almost 40% of the first-time cases. Significant differences between first-time injuries and recurrent injuries were found only for muscle-tendon and joint structures (p < 0.05), while significant differences among the type of injuries within each type of occurrence (first-time or recurrent injuries) were also found between muscle-tendon and joint injuries (p < 0.05). In relation to athletes with symptoms, in return to sport, 77.6% of them were treated for their injuries but more than half of them returned with symptoms still present when compared to those who returned without any symptoms. Among athletes who did not receive treatment, a lower percentage (58.3%) returned to the sport with symptoms still present. Significant associations between treatment and symptomatology were not found.

Cardiovascular effects of a strength test (1rm) in prehypertensive subjects / Efeitos cardiovasculares de um teste de força (1rm) em sujeitos pré-hipertensos / Efectos cardiovasculares de un test de fuerza (1rm) en sujetos pre-hipertensos

ABSTRACT Introduction: Physical exercise promotes positive physiological adaptations, reducing the risk of developing cardiovascular diseases and promoting greater autonomic control of heart rate and reduction in pressure levels. Objective: To compare the behavior of arterial pressure and autonomic heart rate modulation in the 1-repetition maximum knee extension test, performed on the 45-degree leg press machine in normotensive and prehypertensive subjects. Methods: Twenty-four male volunteers were assessed. Blood pressure (BP) and heart rate variability (HRV) were evaluated at rest, immediately after the maximum load achieved and during the 10, 20, 30 and 40-minute recovery phases. Statistical analyses were obtained using SigmaStat 3.5 software and a level of significance of 5%. Results: Mean and standard deviation were used to identify 12 normotensive patients (N) aged = 25.5 ± 5.7 years; height = 174.3 ± 6.6 cm; BMI = 24.9 ± 2.4; SBP on average = 112.6 ± 5.6 mmHg and 12 prehypertensive (PH) patients aged = 29.8 ± 6.5 years; height = 175.7 ± 6.7 cm; BMI = 27.8 ± 6.5; mean SBP = 131.1 ± 3.2 mmHg. There was a statistical difference in the pNN50 index (%) at rest (PH = 1.13 ± 0.66 and N = 1.58 ± 0.35) and in the LF/HF index, also at rest (PH = 0.18 ± 0.29 and N = −0.18 ± 0.36). Conclusion: The one-repetition maximum (1RM) test did not promote cardiovascular risk in the prehypertensive group during its execution, with double product results lower than 30,000 mmHg.bpm, demonstrating lower cardiac overload. Moreover, HRV exhibited similarity in sympathetic-vagal behavior, in the time/frequency domain, between the groups. Level of Evidence III; Study Case-control.

RESUMO Introdução: O exercício físico promove adaptações fisiológicas de caráter positivo, diminuindo os riscos de desenvolvimento de doenças cardiovasculares, além de promover um maior controle autonômico da frequência cardíaca e redução nos níveis pressóricos. Objetivo: Comparar o comportamento da pressão arterial e da modulação autonômica da frequência cardíaca no teste de uma repetição máxima de extensão de joelhos, realizado no aparelho de Leg press 45° em sujeitos normotensos e pré-hipertensos. Métodos: Foram avaliados 24 voluntários do sexo masculino. Foi feita a avaliação da pressão arterial (PA) e da variabilidade da frequência cardíaca (VFC) no momento de repouso, imediatamente após a carga máxima alcançada e durante as fases de 10, 20, 30 e 40 minutos de recuperação. As análises estatísticas foram obtidas através do software SigmaStat 3.5 e nível de significância igual a 5%. Resultados: A média e o desvio padrão foram utilizados para identificação de 12 normotensos (N) com idade = 25,5 ± 5,7 anos; altura = 174,3 ± 6,6 cm; IMC = 24,9 ± 2,4; PAS em média = 112,6 ± 5,6 mmHg e 12 pré-hipertensos (PH) com idade = 29,8 ± 6,5 anos; altura = 175,7 ± 6,7 cm; IMC = 27,8 ± 6,5; PAS em média = 131,1 ± 3,2 mmHg. Houve diferença estatística no índice pNN50 (%) no momento repouso (PH = 1,13 ± 0,66 e N =1,58 ± 0,35) e no índice LF/HF igualmente no momento repouso (PH = 0,18 ± 0,29 e N = −0,18 ± 0,36). Conclusão: O teste de uma repetição máxima (1RM) não promoveu risco cardiovascular no grupo pré-hipertenso durante sua execução, com resultados de duplo produto menor que 30.000 mmHg.bpm, demonstrando menor sobrecarga cardíaca, e a VFC apresentou similaridade no comportamento simpático-vagal no domínio do tempo e frequência entre os grupos. Nível de evidência III; Estudo Caso controle.

RESUMEN Introducción: El ejercicio físico promueve adaptaciones fisiológicas de carácter positivo, disminuyendo los riesgos de desarrollo de enfermedades cardiovasculares, además de promover un mayor control autonómico de la frecuencia cardíaca y reducción en los niveles presóricos. Objetivo: Comparar el comportamiento de la presión arterial y de la modulación autonómica de la frecuencia cardíaca en el test de una repetición máxima de extensión de rodillas, realizado en el aparato de Leg press 45° en sujetos normotensos y pre-hipertensos. Métodos: Fueron evaluados 24 voluntarios del sexo masculino. Fue hecha la evaluación de la presión arterial (PA) y de la variabilidad de la frecuencia cardíaca (VFC) en el momento de reposo, inmediatamente después de la carga máxima alcanzada y durante las fases de 10, 20, 30 y 40 minutos de recuperación. Los análisis estadísticos fueron obtenidos a través del software SigmaStat 3.5 y nivel de significancia igual a 5%. Resultados: El promedio y la desviación estándar fueron utilizados para identificación de 12 normotensos (N) con edad = 25,5 ± 5,7 años; altura = 174,3 ± 6,6 cm; IMC = 24,9 ± 2,4; PAS en promedio = 112,6 ± 5,6 mmHg y 12 pre-hipertensos (PH) con edad = 29,8 ± 6,5 años; altura = 175,7 ± 6,7 cm; IMC = 27,8 ± 6,5; PAS en promedio = 131,1 ± 3,2 mmHg. Hubo diferencia estadística en el índice pNN50 (%) en el momento reposo (PH = 1,13 ± 0,66 y N =1,58 ± 0,35) y en el índice LF/HF igualmente en el momento reposo (PH = 0,18 ± 0,29 y N = −0,18 ± 0,36). Conclusión: El test de una repetición máxima (1RM) no promovió riesgo cardiovascular en el grupo pre-hipertenso durante su ejecución, con resultados de doble producto menor que 30.000 mmHg.bpm, demostrando menor sobrecarga cardíaca, y la VFC presentó similitud en el comportamiento simpático-vagal en el dominio del tiempo y frecuencia entre los grupos. Nivel de evidencia III; Estudio Caso control.

Could current factors be associated with retrospective sports injuries in Brazilian jiu-jitsu? A cross-sectional study.

BACKGROUND: Brazilian jiu-jitsu is characterized by musculoskeletal disorders and high occurrence of sports injuries. The present study was aimed to analyze some internal factors, as well as to describe occurrence and characteristics of retrospective musculoskeletal injuries in different age groups of Brazilian jiu-jitsu practitioners. METHODS: One hundred ninety-three Brazilian jiu-jitsu practitioners, which were divided into three age groups: Adolescent, Adult, and Master. Besides anthropometric characterization, standard clinical tests were conducted to analyze the global and segmental joint flexibility, lumbar spine range of motion, and handgrip strength. Sports injury occurrence and total physical activity were obtained from an adapted morbidity survey and International Physical Activity Questionnaire - Short Form (IPAQ-SF), respectively. RESULTS: A total of 247 cases of retrospective injuries was registered (1.27 injury/ participant). Occurrence of rectus femoral muscle retraction in the right leg was increased within Master. Adult and Master have exhibited higher occurrence of sports injuries than Adolescent group (p < 0.05). Joint injuries were the most common sports-related injuries by all Brazilian jiu-jitsu practitioners. While female gender and exposure time constituted the most predictive variables for sports injury occurrence in Adolescent, graduation level was more associated with sports injuries occurrence in Adult. CONCLUSIONS: Joint injuries derived from combat demands were the main sports injury in all age categories of Brazilian jiu-jitsu. Master subjects presented a higher occurrence of clinical changes and retrospective musculoskeletal injuries in relation to other age groups. Female gender and exposure time constituted the main predictive factors in adolescent subjects, while graduation category was more directly associated with retrospective injury onset in the Adult group.

Lesões musculoesqueléticas em praticantes de judô / Lesiones músculo-esqueléticas en practicantes de judo / Musculoskeletal injuries in judo practitioners

RESUMO A prática de judô integra situações variadas de contato físico e exigências específicas, tornando-o uma modalidade competitiva e com alto índice de lesões musculoesqueléticas (LME). Este estudo transversal teve por objetivo descrever a epidemiologia de LME e analisar a relação entre diferentes características e a ocorrência de lesão em judocas. A casuística integrou 111 participantes de ambos os sexos. Para tomar informações sobre lesões, utilizou-se um inquérito de morbidade referida. Para análise estatística, foi empregado o teste de Goodman de proporções multinomiais. A relação entre fatores associados com LME foi avaliada por meio de regressão logística. Foram relatados 135 LME, com prevalência de 65% (72 esportistas), totalizando 1,22 LME/atleta. A maioria dos relatos foi constituída por lesões articulares decorrentes de traumas (n=50 casos, 37%), sendo que entorse de tornozelo (25,2%) e luxação de ombro (17,8%) foram os casos com maior frequência. Entre as lesões ósseas, verificou-se maior proporção de casos graves (25 casos; 18,5%). Sexo e carga horária semanal constituíram-se como as principais características preditivas para ocorrência de LME no judô (p<0,001). Conclui-se que as lesões articulares traumáticas em tornozelo e ombro foram as principais LME no judô. Sexo masculino e maior carga horária semanal constituíram-se como as principais características preditivas de lesão entre judocas.

RESUMEN La práctica de judo integra situaciones variadas de contacto físico y exigencias específicas, tornándole una modalidad competitiva y con alto índice de lesiones músculo-esqueléticas (LME). Este estudio transversal tuvo por objectivo describir la epidemiología de LME y analizar la relación entre diferentes características y la aparición de lesión en judocas. La casuística integró 111 participantes de ambos los sexos. Para tomar informaciones sobre lesiones, se utilizó una investigación de morbilidad referida. Para análisis estadística, fue empleada la prueba de Goodman de proporciones multinomiales. La relación entre factores asociados con LME fue evaluada por medio de regresión logística. Fueron relatados 135 LME, con prevalencia de 65% (72 deportistas), totalizando 1,22 LME/atleta. La mayoría de los relatos fue constituida por lesiones articulares derivadas de traumas (n=50 casos, 37%), considerándose que esquince de tobillo (25,2%) y luxación de hombro (17,8%) fueron los casos con mayor frecuencia. Entre las lesiones óseas, se verificó mayor proporción de casos graves (25 casos; 18,5%). Sexo y carga horária semanal se constituyeron como las principales características predictivas para aparición de LME en el judo (p<0,001). Se concluye que las lesiones articulares traumaticas en tobillo y hombro fueron las principales LME en el judo. Sexo masculino y mayor carga horária semanal se constituyeron como las principales características preditivas de lesión entre judocas.

ABSTRACT Practice of judo integrates varied situations of physical contact and specific requirements, which makes it a competitive modality with a high rate of musculoskeletal injuries (MSI). This cross-sectional study aimed to describe MSI epidemiology and analyze the relationship among different characteristics and injury occurrence in judo practitioners. Casuistry was formed by 111 participants of both sexes. To gather information about injuries, a morbidity survey was used. For statistical analysis, Goodman's test of multinomial proportions was taken. Relationship among factors associated with MSI was assessed through logistic regression. We reported 135 MSI, with 65% prevalence (72 subjects), totaling 1.22 MSI/athlete. Most reports consisted of joint lesions resulting from trauma (n=50 cases, 37%); ankle sprain (25.2%) and shoulder dislocation (17.8%) were the cases with the highest frequency. Regarding bone lesions, there was higher proportion of serious cases (25 cases; 18.5%). Sex and weekly workload constituted the main predictive characteristics for MSI occurrence in Judo (p<0.001). The conclusion was that joint traumatic lesions on ankle and shoulder were the main MSI in Judo. The male sex and bigger weekly workload constituted the main predictive characteristics for lesion in Judo practitioners (p<0.001).

Incidence of low back pain according to physical activity level in hospital workers / Ocorrência de lombalgia segundo o nível de atividade física em trabalhadores hospitalares

ABSTRACT BACKGROUND AND OBJECTIVES: Hospitals integrate several risks posed by physical, chemical, psychosocial and ergonomic factors, which may be noxious for different healthcare professionals. This study aimed at evaluating the level of physical activity, the presence of musculoskeletal risk factors and the incidence of low back pain among nursing professionals of a hospital Materials and Sterilization Center. METHODS: Sample was made up of 56 individuals of both genders, working for the Associação Beneficente de Campo Grande/MS-Hospital Santa Casa. Participants were divided in two groups: G1 (insufficiently active, n=27) and G2 (sufficiently active, n=29). In addition to the level of physical activity, anthropometric data, incidence of pain and functional incapacity, flexibility and muscle resistance were evaluated. RESULTS: The incidence of low back pain was lower in G2 (13 cases; 44.8%) as compared to G1 (24 cases; 88.9%). Body mass index, pain intensity and functional incapacity index were lower for G2. Time of physical activity was lower in G1. Abdominal muscles resistance was higher in G2. CONCLUSION: In nursing professionals, the level of physical activity influences the presence of low back pain, pain intensity and functional incapacity index.

RESUMO JUSTIFICATIVA E OBJETIVOS: O ambiente hospitalar integra uma série de riscos decorrentes de fatores físicos, químicos, psicossociais e ergonômicos, que podem ser prejudiciais a diferentes profissionais da área de saúde. Este estudo teve por objetivo avaliar o nível de atividade física, a presença de fatores de risco musculoesqueléticos e a ocorrência de lombalgia em profissionais de enfermagem de Centro de Materiais e Esterilização hospitalar. MÉTODOS: A casuística integrou 56 indivíduos de ambos os gêneros, trabalhadores da Associação Beneficente de Campo Grande/MS-Hospital Santa Casa. Os participantes foram alocados em dois grupos: G1 (insuficientemente ativos, n=27) e G2 (suficientemente ativos, n=29). Além do nível de atividade física, foram realizadas análises antropométricas, de ocorrência de dor e incapacidade funcional, flexibilidade e resistência muscular. RESULTADOS: A ocorrência de lombalgia foi menor em G2 (13 casos; 44,8%) que em G1 (24 casos; 88,9%). Índice de massa corporal, intensidade da dor e índice de incapacidade funcional foram menores em G2. O tempo de atividade física foi menor em G1. Resistência dos músculos abdominais foi maior em G2. CONCLUSÃO: Em profissionais de enfermagem, o nível de atividade física influencia a ocorrência de lombalgia, intensidade de dor e índice de incapacidade funcional.

Skeletal muscle aging: influence of oxidative stress and physical exercise.

Skeletal muscle abnormalities are responsible for significant disability in the elderly. Sarcopenia is the main alteration occurring during senescence and a key public health issue as it predicts frailty, poor quality of life, and mortality. Several factors such as reduced physical activity, hormonal changes, insulin resistance, genetic susceptibility, appetite loss, and nutritional deficiencies are involved in the physiopathology of muscle changes. Sarcopenia is characterized by structural, biochemical, molecular and functional muscle changes. An imbalance between anabolic and catabolic intracellular signaling pathways and an increase in oxidative stress both play important roles in muscle abnormalities. Currently, despite the discovery of new targets and development of new drugs, nonpharmacological therapies such as physical exercise and nutritional support are considered the basis for prevention and treatment of age-associated muscle abnormalities. There has been an increase in information on signaling pathways beneficially modulated by exercise; nonetheless, studies are needed to establish the best type, intensity, and frequency of exercise to prevent or treat age-induced skeletal muscle alterations.