Innovative Design and Development of Personalized Ankle-Foot Orthoses for Survivors of Stroke With Equinovarus Foot: Protocol for a Feasibility and Comparative Trial.

BACKGROUND: Ankle-foot orthoses (AFOs) are vital in gait rehabilitation for patients with stroke. However, many conventional AFO designs may not offer the required precision for optimized patient outcomes. With the advent of 3D scanning and printing technology, there is potential for more individualized AFO solutions, aiming to enhance the rehabilitative process. OBJECTIVE: This nonrandomized trial seeks to introduce and validate a novel system for AFO design tailored to patients with stroke. By leveraging the capabilities of 3D scanning and bespoke software solutions, the aim is to produce orthoses that might surpass conventional designs in terms of biomechanical effectiveness and patient satisfaction. METHODS: A distinctive 3D scanner, complemented by specialized software, will be developed to accurately capture the biomechanical data of leg movements during gait in patients with stroke. The acquired data will subsequently guide the creation of patient-specific AFO designs. These personalized orthoses will be provided to participants, and their efficacy will be compared with traditional AFO models. The qualitative dimensions of this experience will be evaluated using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST) assessment tool. Feedback from health care professionals and the participants will be considered throughout the trial to ensure a rounded understanding of the system's implications. RESULTS: Spatial-temporal parameters will be statistically compared using paired t tests to determine significant differences between walking with the personalized orthosis, the existing orthosis, and barefoot conditions. Significant differences will be identified based on P values, with P<.05 indicating statistical significance. The Statistical Parametric Mapping method will be applied to graphically compare kinematic and kinetic data across the entire gait cycle. QUEST responses will undergo statistical analysis to evaluate patient satisfaction, with scores ranging from 1 (not satisfied) to 5 (very satisfied). Satisfaction scores will be presented as mean and SD values. Significant variations in satisfaction levels between the personalized and existing orthosis will be assessed using a Wilcoxon signed rank test. The anticipation is that the AFOs crafted through this innovative system will either match or outperform existing orthoses in use, with higher patient satisfaction rates. CONCLUSIONS: Embracing the synergy of technology and biomechanics may hold the key to revolutionizing orthotic design, with the potential to set new standards in patient-centered orthotic solutions. However, as with all innovations, a balanced approach, considering both the technological possibilities and individual patient needs, will be paramount to achieving optimal outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52365.

A Review on 3D Scanners Studies for Producing Customized Orthoses.

When a limb suffers a fracture, rupture, or dislocation, it is traditionally immobilized with plaster. This may induce discomfort in the patient, as well as excessive itching and sweating, which creates the growth of bacteria, leading to an unhygienic environment and difficulty in keeping the injury clean during treatment. Furthermore, if the plaster remains for a long period, it may cause lesions in the joints and ligaments. To overcome all of these disadvantages, orthoses have emerged as important medical devices to help patients in rehabilitation, as well as for self-care of deficiencies in clinics and daily life. Traditionally, these devices are produced manually, which is a time-consuming and error-prone method. From another point of view, it is possible to use imageology (X-ray or computed tomography) to scan the human body; a process that may help orthoses manufacturing but which induces radiation to the patient. To overcome this great disadvantage, several types of 3D scanners, without any kind of radiation, have emerged. This article describes the use of various types of scanners capable of digitizing the human body to produce custom orthoses. Studies have shown that photogrammetry is the most used and most suitable 3D scanner for the acquisition of the human body in 3D. With this evolution of technology, it is possible to decrease the scanning time and it will be possible to introduce this technology into clinical environment.

A pilot study on fear and risk of fall: The impact of an 8-month multicomponent exercise program in community-dwelling aged adults / Un estudio piloto sobre el miedo y el riesgo de caída: el impacto de un programa de ejercicios de componentes múltiples de 8 meses en adultos mayores que viven en la comunidad / Um estudo piloto sobre medo e risco de queda: o impacto de um programa de exercício multicomponente de 8 meses em adultos idosos residentes na comunidade

Este estudio tuvo como objetivo examinar el impacto del efecto de un programa de ejercicio de componentes múltiples de 8 meses en adultos mayores que viven en la comunidad. Utilizamos una estrategia inclusiva para examinar la viabilidad de un programa de ejercicio de tres veces por semana. Tener más de 60 años, la capacidad de pararse y caminar con o sin equipo de asistencia, ser físicamente inactivo, autorización médica y vivir en la comunidad fueron todos los criterios de elegibilidad. Se utilizaron la prueba Timed-up and Go y la Berg Balance Scale para examinar el riesgo de caídas. Se utilizó la Fall-Efficacy Scale International para examinar el miedo a las caídas. El programa de ejercicio basado en la comunidad involucró a treinta y cinco participantes, la edad promedio fue de 67.54 años (SD = 3.81) y el 71% eran mujeres. Las tasas de asistencia variaron de 76% a 100% en promedio. Hubo una tendencia significativa hacia una mejora clínicamente importante en el timed-up and go test (t = 4.66; p < .001; d = 0.20), escala de equilibrio de Berg (t = -11.20; p < .001; d = 1.47) y escala internacional de eficacia contra caídas (t = 5.81; p < .001; d = 0.88). Este estudio ha proporcionado evidencia preliminar de que un programa de ejercicio de bajo costo basado en la comunidad de 8 meses puede ser efectivo para mejorar la agilidad, el equilibrio y disminuir el miedo a caerse en las personas mayores. (AU)

The objective of this study was to investigate the impact of an 8-month multicomponent exercise program in community-dwelling older adults. A comprehensive approach was employed to assess the feasibility and effectiveness of a thrice-weekly exercise intervention. Aged over 60 years, the capacity to stand and walk with or without assistive equipment, being physically inactive, medical clearance, and living in the community were all eligibility criteria. The Timed-up and Go test and Berg Balance Scale were used to examine risk of falling. The Fall-Efficacy Scale International was used to examine the fear of falling. The community-based exercise program involved thirty-five participants, the average age was 67.54 years (SD = 3.81) and 71% were female. At-tendance rates ranged from 76% to 100% on average. There was a significant trend toward a clinically important improvement in the timed-up and go test (t = 4.66; p < .001; d = 0.20), berg balance scale (t = -11.20; p < .001; d = 1.47) and fall-efficacy scale international (t = 5.81; p < .001; d = 0.88). This study has provided preliminary evidence that an 8-month community-based low-cost exercise program may be effective in improving agility, balance, and decreasing fear of falling in older people. (AU)

Este estudo teve como objetivo examinar o impacto do efeito de um programa de exercício multicomponente de 8 meses em idosos residentes na comunidade. Usamos uma estratégia inclusiva para examinar a viabilidade de um programa de exercícios três vezes por semana. Idade acima de 60 anos, capacidade de ficar em pé e andar com ou sem equipamento auxiliar, ser inativo fisicamente, ter autorização médica e morar na comunidade foram todos os critériosde elegibilidade. O teste Timed-up and Go e a Escala de Equilíbrio de Berg foram usados para examinar o risco de queda. A Fall-Efficacy Scale International foi utilizada para examinar o medo de cair. O programa de exercícios comunitários envolveu trinta e cinco participantes, a idade média foi de 67,54 anos (DP = 3.81) e 71% eram do sexo feminino. As taxas de adesão variaram de 76% a 100%, em média. Houve uma tendência significativa para uma melhora clinicamente importante no timed-up and go test (t = 4.66;p < .001; d = 0.20), escala de equilíbrio de Berg (t = -11.20; p < .001; d = 1.47) e escala de eficácia de queda internacional (t = 5.81; p < 0.001; d = 0.88). Este estudo forneceu evidências preliminares de que um programa de exercícios de baixo custobaseado na comunidade de 8 meses pode ser eficaz para melhorar a agilidade, o equilíbrio e diminuir o medo de cair em idosos. (AU)

Using Psychometric Testing Procedures for Scale Validity, Reliability, and Invariance Analysis: The PRETIE-Q Portuguese Version.

This study investigated the psychometric nature of preference for and tolerance of exercise intensity in physical activity. It initially re-examined the Preference for and Tolerance of the Intensity of Exercise Questionnaire (PRETIE-Q) among Portuguese exercisers, looking at its applicability to different exercise activities and exercise experiences. Then, to investigate the applicability of the measure in different groups, its invariance was examined. The sample consisted of 1117 participants (528 male, 589 female) aged 18-81 years old (Mage = 36.81, SD = 11.89). All participants reported at baseline that they were exercising, on average, 3.93 days (SD = 1.36) per week. The exploratory structural equation modeling (ESEM) displayed the best fit. The ESEM did show invariance when tested for multigroup analysis. The conclusion of this research is that the ESEM demonstrated the best fit, displaying invariance in multigroup analysis. Furthermore, when assessing preference and tolerance in various exercise modalities, the PRETIE-Q should be primarily used as a multidimensional instrument due to the differential recognition of preference and tolerance in seemingly similar physical activity circumstances, highlighting the importance of employing context-verified measures to evaluate exercise-intensity preference and tolerance based on sample characteristics or real-time context.

Testing the Associations between Coping, Mental Health, and Satisfaction with Life in Portuguese Workers.

The present study aimed to explore the relationships between coping strategies, symptoms of depression, anxiety, and stress, and satisfaction with life among Portuguese workers. A sample of 402 participants (207 male, 195 female), ranging in age from 18 to 70 years (M = 32.90, SD = 11.75), was included in the study. Participants reported varying levels of work experience, ranging from 1 to 45 years (M = 10.62, SD = 4.07). The sample encompassed diverse occupations, including arts and design (n = 28), engineering (n = 23), marketing (n = 27), administration (n = 50), transportation and logistics (n = 57), clerks (n = 63), lawyers (n = 21), factory workers (n = 20), accountant and finance (n = 41), journalism (n = 27), health care (n = 29), and others (n = 16). To examine the associations between each determinant and satisfaction with life, hierarchical multiple regression analyses were conducted. Two models were tested, with predictors entered in blocks based on theoretical and empirical considerations. The second model accounted for 52.4% of the variance in satisfaction with life (F (14, 384) = 3.884, p < 0.001, R2 = 0.27, adjusted R2 = 0.24). Depressive symptoms and stress consistently exhibited a significant association (p < 0.05) with satisfaction with life across all tested models. In terms of coping mechanisms, instrumental support reinterpretation, disengagement, and humor demonstrated a significant association with satisfaction with life (p < 0.05). The findings suggest that employing adaptive coping strategies may help mitigate symptoms of mental distress and enhance satisfaction with life. By understanding the relationships between coping strategies, mental health symptoms, and satisfaction with life, interventions can be developed to promote well-being and improve overall quality of life among Portuguese workers.

Effects of Muscle Strength, Agility, and Fear of Falling on Risk of Falling in Older Adults.

Falls are a major public health problem among older adults because they lead to premature mortality, loss of autonomy, and increased dependence on others. However, these associations have not been explored using procedures that analyze the sequential effects between risk factors of falling. The present study aimed to examine the effects of muscle strength, agility, and fear of falling on risk of falling using path analysis in community-dwelling older adults. In total, 49 elderly (female = 33, male = 16) participants aged between 65 and 76 years (M = 68.38 years; SD = 6.22) were included for analysis. Muscle strength, agility, fear of falling, and risk of falling were assessed using validated instruments for the older adult population. The proposed model shows that muscle strength was negatively associated with agility. Consequently, agility was negatively associated with fear of falling. The same trend appeared between fear of falling and risk of falling. The effect sizes were between small and medium for agility (R2 = 0.16), fear of falling, (R2 = 0.29), and risk of falling (R2 = 0.03). The main finding of the present study was that muscle strength was significantly correlated with agility, which, in turn, predicted fear of falling. Consequently, lower scores for fear of falling explained lower risk of falling in community-dwelling older adults. While muscle strength is a crucial component of physical fitness, only with adequate levels of agility can older adults possess the efficacy and ability to perform daily tasks.

“RespirArFundo”: Um programa de promoção de exercício físico em professores e funcionários em contexto escolar -Estudo quantitativo e qualitativo / “RespirArFundo”: Un programa para promover el ejercicio físico en profesores y personal en un contexto escolar -Estudio cuantitativo y cualitativo / “RespirArFundo”: A program to promote physical exercise for teachers and employees in the school context -Quantitative and qualitative study

O projeto RespirArFundo, através de uma metodologia mista quantitativa e qualitativa teve como objetivo avaliar o efeito de um programa de intervenção (22 “sessões teórico-práticas”), com realização de diferentes tipos de atividades, para melhorar os níveis de aptidão física, bem-estar e qualidade de vida (QdV) em professores e funcionários de uma escola secundária da região centro de Portugal. Pretendeu-se ainda avaliar os níveis de satisfação dos participantes com o projeto e identificar as principais barreiras e facilitadores à sua participação. A fase de intervenção deste projeto decorreu entre janeiro e junho de 2021. A amostra foi constituída por 26 profissionais da escola (19 professores e 7 funcionários não docentes), sendo na sua maioria (92.3%) do sexo feminino (53.7 ± 5.0 anos). Para a avaliação da aptidão física foram utilizados os testes “levantar e sentar da cadeira”, “levantar, percorrer 2.44m e sentar” e o “teste de preensão manual”. Para a avaliação do bem-estar recorreu-se às escalas PANAS, SWLS e SVS enquanto o WHOQOL-Bref foi utilizado para a avaliação da QdV. Foi ainda realizado um grupo focal. Apóso programa, verificou-se que os participantes melhoraram no teste “levantar e sentar na cadeira” (η2=0.51), em relação ao momento inicial. Para além disso, os participantes revelaram níveis elevados de satisfação com o programa e percecionaram a existência de benefícios físicos e de bem-estar associados ao projeto, adotando hábitos saudáveis. A importância do projeto foi reconhecida pela Direção da escola, tendo sido atribuídas horas específicas para que o projeto continuassea funcionar nos seguintes anos letivos. (AU)

The project RespirArFundo, through a mixed method (quantitative and qualitative), aimed to assess the effect of an intervention program (22 theoretical-practical sessions). It carried out different types of activities to improve physical fitness levels, well-being,and quality of life (QoL) in teachers and employees of a higher school in the centre region of Portugal. It was also intended to assess the satisfaction levels of the participants that participated in the project as well as to identify the main barriers and facilitators to their participation. The intervention phase of this project took place between January and June 2021. The sample consisted of 26 school professionals (19 teachers and 7 employees). The majority was female (92.3%) with a mean age of 53.7 (± 5.0 years old). In order to assess physical fitness we used the following tests “chair stand”, “8-Ft Up-&-Go” and “hand grip”. For the assessment of well-being, the PANAS, SWLS and SVS scales were used, while the WHOQOL-Bref was used to assess QoL. A focusgroup was also performed. After the program, it was found that participants improved on the test “chair stand” (η2=0.51), in relation to the initial moment. Moreover, participants revealed high levels of satisfaction with the program and perceived the existence of physical and well-being benefits associated with the project, adopting healthy habits. The importance of the project was recognized by the school's management, and specific hours were assigned so that the project continues to function in the following academic years. (AU)

El proyecto RespirArFundo, a través de una metodología mixta cuantitativa y cualitativa, tuvo como objetivo evaluar el efecto de un programa de intervención (22 "sesiones teórico-prácticas"), con diferentes tipos de actividades, para mejorar los niveles de aptitud física, el bienestar y la calidad de vida (CdV) en profesores y empleados de una escuela secundaria en la región central de Portugal. También queríamos evaluar el grado de satisfacción de los participantes con el proyecto e identificar los principales obstáculos y facilitadores de su participación. La fase de intervención de este proyecto tuvo lugar entre enero y junio de 2021. La muestra estaba compuesta por 26 profesionales (19 profesores y 7 personal no docente), siendo la mayoría (92.3%) mujeres (53.7 ± 5.0 años). Para la evaluación de la aptitud física se utilizaron las pruebas "levantarse y sentarse de una silla", "levantarse, caminar 2.44 m y sentarse" y la " fuerza de prensiónmanual ". Se utilizaron las escalas PANAS, SWLS y SVS para evaluar el bienestar, mientras que el WHOQOL-Bref se utilizó para evaluar la CdV. También se realizó un grupo de discusión. Tras el programa, se comprobó que los participantes mejoraron en la prueba "levantarse y sentarse en una silla” (η2=0.51). Además, los participantes revelaron altos niveles de satisfacción con el programa y percibieron la existencia de beneficios físicos y de bienestar asociados al proyecto, adoptando hábitos saludables. La dirección de la escuela reconoció la importancia del proyecto y le asignó horas específicas para que continuara en los años siguientes.

The impact of an exercise intervention using low-cost equipment on functional fitness in the community-dwelling older adults: A pilot study.

Exercise interventions have shown significant improvements in the older adult population regarding functional and cognitive capacity. However, much research has applied exercise protocols that are expensive both for research and participation. Thus, high investments that are made are currently not ecologically efficient. The aim of the study was to determine whether the impact of a 20-week multicomponent exercise intervention using low-cost material could improve physical fitness in community-dwelling older adults. We tested the feasibility of this three times per week exercise protocol using an inclusive approach. Eligibility criteria included age ≥65 years, the ability to stand and walk with or without assistive devices, being physically inactive; medical clearance, and living in the community. Outcomes were muscle resistance measured using the chair-stand test for lower limbs, cardiorespiratory capacity measured using the 6-min walk test, and agility and balance using the Timed-up and Go test. Flexibility was measured using the chair sit and reach for lower limbs and the back scratch for upper limbs using the dominant leg and arm, respectively. Hand grip strength was measured using a dynamometer. Thirty participants (n = 30) were recruited and included in the intention-to-treat analysis. The mean age of participants was 70 years (±3.62 years), 100% were Caucasians, and 50% were female. There was a significant trend toward a clinically important improvement in the chair-stand (t = -5.23; p < 0.001; d = 0.36), arm curl (t = -5.21; p < 0.001; d = 0.74), 6-min walk test (t = -4.69; p = <0.001; d = 0.77), timed-up and go test (t = 8.788; p < 0.001; d = 1.18), and hand grip strength (t = 2.846; p = 0.009; d = 0.23). There were also differences in the back scratch (t = 2.243; p = 0.035; d = 0.29) and chair sit and reach test (t = -3.380; p < 0.001; d = 0.15). This pilot study has provided preliminary evidence that a 20-week community-based low-cost exercise program may be effective in improving overall functional fitness in older people. The pilot trial has provided the necessary data to design future randomized-controlled trials that can be implemented in the community in an ecological feasible manner.

Tokyo 2020: A Sociodemographic and Psychosocial Characterization of the Portuguese Paralympic Team.

The importance of practicing sports and its impact on the quality of life of people with disabilities is fundamental. Characterizing subjective well-being, resilience, and social influence in the practice of adapted sports, namely in those who participate in elite sport in Portugal, is truly important to support a set of initiatives to promote higher levels of practice. Thus, this study describes the Portuguese delegation at the Tokyo 2020 Paralympic Games through sociodemographic and psychosocial (positive and negative affect, life satisfaction, resilience, and social support) variables. The study involved 31 of the 33 athletes of the Portuguese Paralympic team aged between 15 and 58 years (34.45 ± 11.7 years), with 21 men and 10 women. Individual-level sociodemographic data gave us a clear insight into the reality of adapted sport in Portugal. The high values of life satisfaction, high positive affect and low negative affect, as well as high levels of resilience and social support seem to be important variables for these athletes. The data from the present study highlighted the importance of understanding the characteristics of Paralympic athletes, in order to better understand the reality of Paralympic sport in Portugal.

A Review of Additive Manufacturing Studies for Producing Customized Ankle-Foot Orthoses.

Ankle-foot orthoses (AFO) are prescribed to improve the patient's quality of life. Supporting weak muscles or restraining spastic muscles leads to smoother and more stable locomotion. Commonly, AFO are made using thermoplastic vacuum forming, which requires a long time for production and has limited design options. Additive manufacturing (AM) can solve this problem, leading to a faster and cheaper solution. This review aimed to investigate what is the state-of-art using AM for AFO. Evaluating the used manufacturing processes, customization steps, mechanical properties, and biomechanical features in humans would provide significant insights for further research. The database searches combined AM and AFO with no year or publication type restrictions. Studies must have examined outcomes on human participants with the orthoses built by AM. Other types of orthotic devices or different manufacturing techniques were excluded. Nineteen studies met the inclusion criteria. As stated by having all studies conducted in the last nine years, this is a very recent domain. Different AM processes have been used, with the majority relying on Fused Deposition Modeling. Overall, the manuscripts' quality is deficient, which is critical to promoting further studies with higher samples. Except for one paper, AM-printed AFO was comparable or superior to the thermoplastic vacuum forming AFO in mechanical tests, kinematics, kinetics, and participant feedback.

Quantification of swimmers' ability to apply force in the water: the potential role of two new variables during tethered swimming.

This study aimed 1) to examine variables that may quantify the ability to apply force in the water and 2) to test their relationship with free swimming performance. Sixteen regional-level swimmers participated in this study. Average (Favg) and maximum (Fmax) forces were measured for 30 s arm stroke tethered swimming in a flume at zero and 1.389 m/s water flow speeds. The maximum and average force's relative changes (ΔFmax and ΔFavg, respectively) were calculated between tethered swimming at zero and 1.389 m/s water flow speeds. Free swimming speeds were obtained from 25, 50, and 100 m front crawl trials, and were correlated with ΔFmax and ΔFavg. A negative correlation was found between ΔFmax and 25, 50 and 100 m speeds (r = -0.84, r = -0.74, r = -0.55; p < 0.05, respectively) and ΔFavg correlated negatively with 25 and 50 m speeds (r = -0.63, r = -0.54; p < 0.05, respectively), but it did not correlate with 100 m swimming speed. The relative change in force could be used to quantify the ability to apply force in the water. This could aid coaches to understand if changes in swimmers' ability to apply force in the water contribute to improvements in performance.

The Contribution of Exercise in Telemedicine Monitoring in Reducing the Modifiable Factors of Hypertension-A Multidisciplinary Approach.

The aim of this review was to explore the contribution of physical activity and exercise in the control and reduction of modifiable factors of arterial hypertension in telemedicine programs, assuming a multidisciplinary perspective. Searches were carried out following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses), and the research question defined using the PICOS approach (Population, Intervention, Comparator, Outcomes, Study design). The search strategy applied the following terms: blood pressure OR hypertension AND exercise OR physical activity AND telemedicine. The initial search identified 2190 records, but only 19 studies were considered eligible after checking for the inclusion and exclusion criteria. The following training variables were generally included: heart rate and heart rate reserve, respiratory rate, rate of perceived exertion and oxygen consumption, but no resistance training variables were found. The significant improvements on blood pressure parameters of participants diagnosed with hypertension tended to be transient. The exercise prescription was commonly based on general instructions and recommendations for exercise and hypertension. On the other hand, most of the studies including patients in cardiac rehabilitation programs used a personalized training program based on a baseline assessment, particularly following a cardiopulmonary exercise test. The inclusion of exercise professionals in multidisciplinary teams could provide a more person-oriented approach and the long-term maintenance of a healthy lifestyle.

A Review on Aging, Sarcopenia, Falls, and Resistance Training in Community-Dwelling Older Adults.

As aging continues to grow in our society, sarcopenia and associated fall risk is considered a public health problem since falling is the third cause of chronic disability. Falls are negatively related to functionality and independence and positively associated with morbidity and mortality. The cost of treatment of secondary injuries related to falls is high. For example, one in ten fall incidents leads to bone fractures and several other comorbidities. As demonstrated by several experimental studies, adopting a more active lifestyle is critical for reducing the number of fall episodes and their consequences. Therefore, it is essential to debate the proven physical exercise methods to reduce falls and fall-related effects. Since muscle mass, muscle strength, bone density, and cartilage function may play significant roles in daily activities, resistance training may positively and significantly affect the elderly. This narrative review aimed to examine current evidence on existing resistance training using resistance machines and bodyweight or low-cost equipment for the elderly and how they are related to falls and fall-related consequences. We provide theoretical links between aging, sarcopenia, and falls linking to resistance training and offer practical suggestions to exercise professionals seeking to promote regular physical exercise to promote quality of life in this population. Exercise programs focusing on strength may significantly influence muscle mass and muscle strength, minimizing functional decline and risk of falling. Resistance training programs should be customized to each elderly according to age, sex, and other fundamental and individual aspects. This narrative review provides evidence to support recommendations for practical resistance training in the elderly related to intensity and volume. A properly designed resistance training program with adequate instructions and technique is safe for the elderly. It should include an individualized approach based on existing equipment (i.e., body weight, resistance machines). Existing literature shows that exercise performance towards 2-3 sets of 1-2 exercises per major muscle group, performing 5-8 repetitions or achieving intensities of 50-80% of 1RM, 2-3 times per week should be recommended, followed by training principles such as periodization and progression. Bearing this in mind, health and exercise professionals should combine efforts focusing on efficient strategies to reduce falls among the elderly and promote higher experiences of well-being at advanced stages in life.

A randomized controlled preclinical trial on 3 interposal temporomandibular joint disc implants: TEMPOJIMS-Phase 2.

The effort to develop an effective and safe temporomandibular joint (TMJ) disc substitute has been one of the mainstreams of tissue engineering. Biodegradable customized scaffolds could approach safety and effectiveness to regenerate a new autologous disc, rather than using non-biodegradable materials. However, it is still technically challenging to mimic the biomechanical properties of the native disc with biodegradable polymers. In this study, new 3D tailored TMJ disc implants were developed: (1) Poly(glycerol sebacate) (PGS) scaffold reinforced with electrospun Poly(εcaprolactone) (PCL) fibers on the outer surface (PGS+PCL); (2) PCL and polyethylene glycol diacrylate (PEGDA) (PCL+PEGDA); and (3) PCL. The TMJ implants were tested in a randomized preclinical trial, conducted in 24 black Merino sheep TMJ, perfoming bilateral interventions. Histologic, imaging, and kinematics analysis was performed. No statistical changes were observed between the PGS+PCL disc and the control group. The PCL+PEGDA and PCL groups were associated with statistical changes in histology (p = 0.004 for articular cartilage mid-layer; p = 0.019 for structure changes and p = 0.017 for cell shape changes), imaging (p = 0.027 for global appreciation) and dangerous material fragmentation was observed. No biomaterial particles were observed in the multi-organ analysis in the different groups. The sheep confirmed to be a relevant animal model for TMJ disc surgery and regenerative approaches. The PCL and PCL+PEGDA discs presented a higher risk to increase degenerative changes, due to material fragmentation. None of the tested discs regenerate a new autologous disc, however, PGS+PCL was safe, demonstrated rapid resorption, and was capable to prevent condyle degenerative changes.

Higher Physical Activity Levels May Help Buffer the Negative Psychological Consequences of Coronavirus Disease 2019 Pandemic.

This study explored the associations between physical activity (PA) anxiety levels, and the perception of satisfaction of basic psychological needs (BPN), during Coronavirus Disease 2019 (COVID-19) lockdown. Thus, 1,404 participants (977 women, 426 men, and one respondent preferred not to answer) ranging from 18 to 89 years old (36.4 ± 11.7 year-old) completed a questionnaire in the period between 1st and 15th April 2021. The survey included sociodemographic data and the following validated instruments: the International Physical Activity Questionnaire (IPAQ), the Basic Need General Satisfaction Scale and the State-Trait Anxiety Inventory. The Kruskal-Wallis test was performed to examine variation in anxiety levels and BPN satisfaction according to PA category (low, moderate, and high). Spearman's Rho correlations coefficients were used to determine the association between anxiety levels and psychological needs. Individuals presenting a higher level of PA revealed lower levels of anxiety-state (H = 20.14; p < 0.01). Differences between elements from different levels of PA were found for the autonomy (H = 23.52; p < 0.001), competence (H = 18.89; p < 0.001), and relatedness (H = 24.42; p < 0.001) psychological needs, suggesting that those who feel their BPN as more satisfied have higher levels of PA. The study found statistically significant correlations between anxiety-state and the satisfaction of the needs for autonomy (p = 0.01; r = -0.46), competence (p = 0.01; r = -0.40), and relatedness (p = 0.01; r = -0.21). These findings support the importance that PA has in the anxiety levels during social isolation, emphasizing the importance of multidisciplinary teams in an individual-based approach.

The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Post-exercise (i.e., cool-down) stretching is commonly prescribed for improving recovery of strength and range of motion (ROM) and diminishing delayed onset muscular soreness (DOMS) after physical exertion. However, the question remains if post-exercise stretching is better for recovery than other post-exercise modalities. Objective: To provide a systematic review and meta-analysis of supervised randomized-controlled trials (RCTs) on the effects of post-exercise stretching on short-term (≤1 h after exercise) and delayed (e.g., ≥24 h) recovery makers (i.e., DOMS, strength, ROM) in comparison with passive recovery or alternative recovery methods (e.g., low-intensity cycling). Methods: This systematic review followed PRISMA guidelines (PROSPERO CRD42020222091). RCTs published in any language or date were eligible, according to P.I.C.O.S. criteria. Searches were performed in eight databases. Risk of bias was assessed using Cochrane RoB 2. Meta-analyses used the inverse variance random-effects model. GRADE was used to assess the methodological quality of the studies. Results: From 17,050 records retrieved, 11 RCTs were included for qualitative analyses and 10 for meta-analysis (n = 229 participants; 17-38 years, mostly males). The exercise protocols varied between studies (e.g., cycling, strength training). Post-exercise stretching included static stretching, passive stretching, and proprioceptive neuromuscular facilitation. Passive recovery (i.e., rest) was used as comparator in eight studies, with additional recovery protocols including low intensity cycling or running, massage, and cold-water immersion. Risk of bias was high in ~70% of the studies. Between-group comparisons showed no effect of post-exercise stretching on strength recovery (ES = -0.08; 95% CI = -0.54-0.39; p = 0.750; I 2 = 0.0%; Egger's test p = 0.531) when compared to passive recovery. In addition, no effect of post-exercise stretching on 24, 48, or 72-h post-exercise DOMS was noted when compared to passive recovery (ES = -0.09 to -0.24; 95% CI = -0.70-0.28; p = 0.187-629; I 2 = 0.0%; Egger's test p = 0.165-0.880). Conclusion: There wasn't sufficient statistical evidence to reject the null hypothesis that stretching and passive recovery have equivalent influence on recovery. Data is scarce, heterogeneous, and confidence in cumulative evidence is very low. Future research should address the limitations highlighted in our review, to allow for more informed recommendations. For now, evidence-based recommendations on whether post-exercise stretching should be applied for the purposes of recovery should be avoided, as the (insufficient) data that is available does not support related claims. Systematic Review Registration: PROSPERO, identifier: CRD42020222091.

The Relationship Between Anxiety Levels, Sleep, and Physical Activity During COVID-19 Lockdown: An Exploratory Study.

Nowadays and worldwide, the attention is focused on coronavirus disease (COVID-19), and its consequences on mental health are yet to be fully understood. It is important to capture differences in anxiety levels among populations, groups, and the gender-related variation. Therefore, the present study had two main purposes: (1) to characterize the levels of state anxiety and trait anxiety by examining gender-related, sleep-related, and physical activity-related variations in a nonrepresentative sample of the Portuguese population during the first weeks of lockdown; and (2) to explore the possible relationship between trait anxiety and state anxiety and the possible role of gender as a moderator. This cross-sectional study comprised 1,332 Portuguese adults (aged 18-55 years old) recruited online during COVID-19 outbreak measures. Participants answered to sociodemographic data and the Portuguese version of the State-Trait Anxiety Inventory (STAI). Gender differences were found in both state anxiety (p = < 0.001; d = 0.385) and trait anxiety (p = < 0.001; d = 0.467) with females presenting higher values. People reporting doing more physical activity than usual during COVID-19 lockdown presented lower levels of state anxiety (p = < 0.001; d = 0.200). People reporting more satisfaction with the quality of sleep presented lower levels of both state anxiety (p = < 0.001; d = 0.701) and trait anxiety (p = < 0.001; d = 0.899). Variation associated with the physical activity level (low, moderate, and high) was significantly different among groups in both state anxiety (p = < 0.001) and trait anxiety (p = < 0.001). When analyzing in more detail separating the levels of physical activity, participants performing moderate and high physical activity showed lower values of state and trait anxiety compared to participants with low physical activity. Participants performing high physical activity also showed lower values of state anxiety compared to participants performing moderate physical activity. Higher levels of trait anxiety were related to higher levels of state anxiety, but this association was not moderated by gender. Interventions aiming to support people psychologically during this outbreak should consider anxiety as well as gender and possible behavioral changes in sleep and physical activity, for example. Health professionals should not only consider the anxiety related to the situation we are living but also address trait anxiety to help overcome COVID-19 psychological consequences.

Challenges and Innovations in Osteochondral Regeneration: Insights from Biology and Inputs from Bioengineering toward the Optimization of Tissue Engineering Strategies.

Due to the extremely high incidence of lesions and diseases in aging population, it is critical to put all efforts into developing a successful implant for osteochondral tissue regeneration. Many of the patients undergoing surgery present osteochondral fissure extending until the subchondral bone (corresponding to a IV grade according to the conventional radiographic classification by Berndt and Harty). Therefore, strategies for functional tissue regeneration should also aim at healing the subchondral bone and joint interface, besides hyaline cartilage. With the ambition of contributing to solving this problem, several research groups have been working intensively on the development of tailored implants that could promote that complex osteochondral regeneration. These implants may be manufactured through a wide variety of processes and use a wide variety of (bio)materials. This review aimed to examine the state of the art regarding the challenges, advantages, and drawbacks of the current strategies for osteochondral regeneration. One of the most promising approaches relies on the principles of additive manufacturing, where technologies are used that allow for the production of complex 3D structures with a high level of control, intended and predefined geometry, size, and interconnected pores, in a reproducible way. However, not all materials are suitable for these processes, and their features should be examined, targeting a successful regeneration.

Recovery and evaluation of cellulose from agroindustrial residues of corn, grape, pomegranate, strawberry-tree fruit and fava.

Considering the expected increasing demand for cellulose fibers in the near future and that its major source is wood pulp, alternative sources such as vegetable wastes from agricultural activities and agro-food industries are currently being sought to prevent deforestation. In the present study, cellulose was successfully isolated from six agroindustrial residues: corncob, corn husk, grape stalk, pomegranate peel, marc of strawberry-tree fruit and fava pod. Cellulose fibers were characterized by Fourier-transform infrared spectroscopy, thermogravimetric analysis, stereomicroscopy and scanning electron microscopy (SEM). Despite the evident morphological differences among the extracted celluloses, results revealed similar compositional and thermal properties with the wood-derived commercial microcrystalline cellulose used as a control. Trace amounts of lignin or hemicellulose were detected in all cellulose samples, with the exception of corncob cellulose, that exhibited the greatest extraction yield (26%) and morphological similarities to wood-derived microcrystalline cellulose, visible through SEM. Furthermore, corncob cellulose was found to have thermal properties (TOnset of 307.17 °C, TD of 330.31 °C, and ΔH of 306.04 kJ/kg) suitable for biomedical applications.