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.

Comparative Exergy and Environmental Assessment of the Residual Biomass Gasification Routes for Hydrogen and Ammonia Production.

The need to reduce the dependency of chemicals on fossil fuels has recently motivated the adoption of renewable energies in those sectors. In addition, due to a growing population, the treatment and disposition of residual biomass from agricultural processes, such as sugar cane and orange bagasse, or even from human waste, such as sewage sludge, will be a challenge for the next generation. These residual biomasses can be an attractive alternative for the production of environmentally friendly fuels and make the economy more circular and efficient. However, these raw materials have been hitherto widely used as fuel for boilers or disposed of in sanitary landfills, losing their capacity to generate other by-products in addition to contributing to the emissions of gases that promote global warming. For this reason, this work analyzes and optimizes the biomass-based routes of biochemical production (namely, hydrogen and ammonia) using the gasification of residual biomasses. Moreover, the capture of biogenic CO2 aims to reduce the environmental burden, leading to negative emissions in the overall energy system. In this context, the chemical plants were designed, modeled, and simulated using Aspen plus™ software. The energy integration and optimization were performed using the OSMOSE Lua Platform. The exergy destruction, exergy efficiency, and general balance of the CO2 emissions were evaluated. As a result, the irreversibility generated by the gasification unit has a relevant influence on the exergy efficiency of the entire plant. On the other hand, an overall negative emission balance of -5.95 kgCO2/kgH2 in the hydrogen production route and -1.615 kgCO2/kgNH3 in the ammonia production route can be achieved, thus removing from the atmosphere 0.901 tCO2/tbiomass and 1.096 tCO2/tbiomass, respectively.

Efeitos da crioterapia por imersão sobre o desempenho sensório-motor de esportistas após protocolo de fadiga muscular / Efectos de la crioterapia de inmersión sobre el rendimiento sensoriomotor en deportistas después de unprotocolo de fatiga muscular / Effects of cold-water immersion on sensorimotor performance of sportsmen after muscle fatigue protocol

Objetivo: O objetivo deste trabalho foi avaliar os efeitos da crioterapia por imersão (CI) sobre o desempenho sensório-motor de esportistas apósprotocolo para indução de fadiga muscular localizada. Método: O presente estudo teve caráter experimental e delineamento prospectivo e teve participação de 36 esportistas universitários que foram divididosem três grupos: grupo recuperação passiva (RP), grupo crioterapia por imersão a 5°C (CI5°) e grupo crioterapia por imersão a 10°C (CI10°). Todos osgrupos foram submetidos a protocolo de fadiga de membro inferior dominante em cadeira extensora. Posteriormente, o RP foi mantido em repouso,enquanto os demais grupos foram submetidos à imersão em água gelada a 5°C e 10°C, respectivamente, durante 10 minutos. Para avaliação dodesempenho sensório-motor, foi utilizado o teste de equilíbrio (YBT), que foi realizado antes e no decorrer de 120 minutos após indução de fadiga. Resultados: Embora os resultados absolutos tenham sido similares entre os grupos, em termos relativos (%), o CI5° mostrou menor desempenhosensório-motor do que RP, o que foi mais acentuado no membro não-dominante. Todos os grupos obtiveram maior desempenho no YBT após 120minutos de recuperação, quando comparado aos primeiros momentos de análise. Conclusão: Em conclusão, o protocolo de CI de 5°C durante 10 minutos aplicado após indução de fadiga neuromuscular resultou em menor desempenhosensório-motor no YBT, em comparação com o método de RP.(AU)

Objetivo: El objetivo de este trabajo es evaluar los efectos de la crioterapia (CI) por inmersión sobre el rendimiento sensoriomotor de deportistas tras unprotocolo de inducción de fatiga muscular localizada.Método: El presente estudio tuvo un carácter experimental y diseño prospectivo y contó con la participación de 36 deportistas universitarios que sedividieron en tres grupos: grupo de recuperación pasiva (PR), grupo de crioterapia a 5°C (IC5°) y grupo de crioterapia a 10°C (IC10°). Todos los grupos sesometieron a un protocolo de fatiga de miembros inferiores dominante en una silla de extensión. Posteriormente, la PR se mantuvo en reposo, mientrasque los otros grupos se sumergieron en agua helada a 5°C y 10°C, respectivamente, durante 10 minutos. Para evaluar el desempeño sensoriomotor seutilizó la prueba de equilibrio (YBT), que se realizó antes y durante 120 minutos después de la inducción de fatiga.Resultados: Aunque los resultados absolutos eran similares entre grupos, en términos relativos (%), el IC5° mostró un menor rendimiento sensoriomotorque el PR, que se acentuó más en la extremidad no dominante. Todos los grupos lograron un mayor rendimiento en los YBT 120 minutos de recuperación,en comparación con los primeros momentos de análisis.Conclusión: En conclusión, el protocolo de CI de 5°C durante 10 minutos aplicado después de la inducción de fatiga neuromuscular resultó en un menorrendimiento sensoriomotor en YBT, en comparación con el método de recuperación pasiva.(AU)

Objective: The objective of this investigation was to evaluate the effects of cold-water immersion (CWI) on the sensorimotor performance of youngathletes in response to local muscle fatigue.Method: The present study had prospective experimental design and involved 36 university sportsmen who were divided into three groups: passiverecovery group (PR), cryotherapy group at 5°C (CI5°) and cryotherapy group at 10°C (CI10°). All groups were submitted to a dominant lower limb fatigueprotocol in an extension chair. Subsequently, the PR was kept at rest, while the other groups were immersed in cold-water at 5°C and 10°C, respectively,for 10 minutes. To assess sensorimotor performance, the Y balance test (YBT) was used, which was performed before and during 120 minutes afterfatigue induction.Results: Although the absolute results had been similar among groups, in relative terms (%), the CI5° showed less sensorimotor performance than PR,which was more accentuated in the non-dominant limb. All groups achieved greater performance in the YBT after 120 minutes of recovery, whencompared to the first moments of analysis (p<0.05).Conclusion: In conclusion, postexercise CWI to 5°C for 10 minutes resulted lower sensorimotor performance in YBT, compared to the PR method.(AU)

Analysis of high-intensity interval training on bone mineral density in an experimental model of type 2 diabetes.

PURPOSE: To analyze the effect of high-intensity interval training (HIIT) on bone mineral density (BMD) in a model of type 2 diabetes mellitus. METHODS: Thirty-two male, adult, 12-week-old rats (Rattus norvegicus), of the Wistar lineage, were used. The animals induced to the experimental model received a high fat diet for 10 days and, after that period, intraperitoneal injection of streptozotocin (40 mg·kg-1), dissolved in 20 mmol·L-1 sodium citrate solution (pH = 4.5). The experimental group of diabetes was formed by the animals that, 48 h after the injection of streptozotocin, had fasting blood glucose > 250 mg·dL-1). The animals were randomly divided into four groups with eight animals each: HIIT experimental diabetes; HIIT control; sedentary experimental diabetes and sedentary control. The animals in the HIIT group performed an aerobic exercise protocol on a treadmill inclined at an angle of 15° to the horizontal, with interspersed intensity. Five weekly sessions, lasting 49 min each, were held for 6 weeks. The analysis of cortical bone density (CBD) and BMD were performed by X-ray images using the In-Vivo Xtreme II/Bruker system. RESULTS: For CBD and BMD, when comparing diabetes and control groups, a significant difference was seen between groups in relation to HIIT (p = 0.007). Animals submitted and not submitted to HIIT in the same group showed a significant difference between groups in relation to diabetes (p < 0.001). CONCLUSIONS: The HIIT experimental diabetes group had increased CBD and BMD in comparison with the sedentary experimental diabetes group.

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.

Efficacy of Different Cold-Water Immersion Temperatures on Neuromotor Performance in Young Athletes.

Cold-Water-Immersion (CWI) has been frequently used to accelerate muscle recovery and to improve performance after fatigue onset. In the present study, the aim was to investigate the effects of different CWI temperatures on neuromuscular activity on quadriceps after acute fatigue protocol. Thirty-six young athletes (16.9 ± 1.4 years-old; 72.1 ± 13.8 kg; 178.4 ± 7.2 cm) were divided into three groups: passive recovery group (PRG); CWI at 5 °C group (5G); and CWI at 10 °C group (10G). All participants performed a fatigue exercise protocol; afterwards, PRG performed a passive recovery (rest), while 5G and 10G were submitted to CWI by means of 5 °C and 10 °C temperatures during 10 min, respectively. Fatigue protocol was performed by knee extension at 40% of isometric peak force from maximal isometric voluntary contraction. Electromyography was used to evaluate neuromuscular performance. The passive recovery and CWI at 5 °C were associated with normalized isometric force and quadriceps activation amplitude from 15 until 120 min after exercise-induced fatigue (F = 7.169, p < 0.001). CWI at 5 °C and 10 °C showed higher muscle activation (F = 6.850, p < 0.001) and lower median frequency (MF) than passive recovery after 15 and 30 min of fatigue (F = 5.386, p < 0.001). For neuromuscular efficiency (NME) recovery, while PRG normalized NME values after 15 min, 5G and 10G exhibited these responses after 60 and 30 min (F = 4.330, p < 0.01), respectively. Passive recovery and CWI at 5 °C and 10 °C revealed similar effects in terms of recovery of muscle strength and NME, but ice interventions resulted in higher quadriceps activation recovery.

Analysis of high-intensity interval training on bone mineral density in an experimental model of type 2 diabetes

Purpose: To analyze the effect of high-intensity interval training (HIIT) on bone mineral density (BMD) in a model of type 2 diabetes mellitus. Methods: Thirty-two male, adult, 12-week-old rats (Rattus norvegicus), of the Wistar lineage, were used. The animals induced to the experimental model received a high fat diet for 10 days and, after that period, intraperitoneal injection of streptozotocin (40 mg·kg­1), dissolved in 20 mmol·L­1 sodium citrate solution (pH = 4.5). The experimental group of diabetes was formed by the animals that, 48 h after the injection of streptozotocin, had fasting blood glucose > 250 mg·dL­1). The animals were randomly divided into four groups with eight animals each: HIIT experimental diabetes; HIIT control; sedentary experimental diabetes and sedentary control. The animals in the HIIT group performed an aerobic exercise protocol on a treadmill inclined at an angle of 15° to the horizontal, with interspersed intensity. Five weekly sessions, lasting 49 min each, were held for 6 weeks. The analysis of cortical bone density (CBD) and BMD were performed by X-ray images using the In-Vivo Xtreme II/Bruker system. Results: For CBD and BMD, when comparing diabetes and control groups, a significant difference was seen between groups in relation to HIIT (p = 0.007). Animals submitted and not submitted to HIIT in the same group showed a significant difference between groups in relation to diabetes (p < 0.001). Conclusions: The HIIT experimental diabetes group had increased CBD and BMD in comparison with the sedentary experimental diabetes group.

Prevalência e fatores associados às lesões esportivas em jovens jogadores de futebol

Introdução: O futebol é a modalidade esportiva mais praticada no mundo com milhões de adeptos, incluindo-se crianças e adolescentes. Objetivo: Analisar a ocorrência de lesões esportivas (LEs) e sua relação com fatores associados às lesões em jovens jogadores de futebol. Método: A casuística foi constituída por 102 jogadores (de 12 a 18 anos de idade) procedentes de dois clubes de futebol. Foram registradas informações sobre treinamento e antropometria e os dados de LEs foram obtidos por meio de inquérito de morbidade referida. Considerando-se a taxa de LEs por participante (2,4 LEs/ indivíduo), foram estabelecidos dois grupos: Grupo 1 (G1, n=61), constituído por voluntários com histórico de até dois casos de LEs, e Grupo 2 (G2, n=41), com participantes com pelo menos três casos de LEs. Resultados: Foram registrados 245 casos de LEs em 81 participantes (prevalência de 79,4%). Trauma foi a principal causa de lesões musculoesqueléticas (56,8%); 74,7% envolveram membros inferiores. Composição corporal e exposição foram diretamente associadas à recorrência de LEs. O G2 mostrou maior massa corporal (G1, 56,7±9,5; G2, 61,6±12,5kg) e maior histórico de prática esportiva (G1, 4,8±2,6; G2, 6,2±2,7 anos) do que o G1. Conclusão: A maioria das LEs teve instalação em membros inferiores devido a trauma. Quanto maior o índice de massa corporal e a exposição a treinos, maior a chance de apresentar três ou mais lesões

Acute effects of different rest intervals between agonist-antagonist paired-sets in the neuromuscular system performance of young adults.

INTRODUCTION: The agonist-antagonist paired-sets (APS) is a resistance training that involves alternating between exercises for agonist/antagonist muscles of a joint, with little or no rest between then. There is evidence that APS is more strenuous than traditional methods, but evidence on the optimal RI between agonist-antagonist actions is unknown. OBJECTIVE: The aim of this study was to compare different rest intervals between agonist-antagonist actions during APS in young adults. METHOD: Fifty healthy men (mean age 23.2 ± 2.8 years; 1.76 ± 0.1m height, 78.03 ± 8.1 kg) were included and performed three different agonist-antagonist paired-sets protocols separated by 72h, consisting of 4 sets of 10 repetitions. The protocols differed in terms of the rest interval between the knee flexion and extension movements: 0s (no rest); 60s and 120s. The rest intervals between exercise sets were standardized at 60s. Total work, peak torque, neuromuscular efficiency, surface EMG amplitude (sEMG, root mean square) and fatigue index obtained by processing of sEMG signal, were compared between rest intervals and exercise sets within each protocol. RESULTS: There were no significant differences between rest intervals for total work, peak torque and neuromuscular efficiency (P > 0.05), but significant differences were found for sEMG and fatigue (P < 0.01), in which the protocol with 60s interval resulted in greater fatigue. CONCLUSION: We showed that peak torque, total work and neuromuscular efficiency were not different between RI. The 60s RI showed a lower sEMG and a greater muscle fatigue. Although there were no significant differences, the NME was higher in the 60s interval.

Effects of Circuit Weight-Interval Training on Physical Fitness, Cardiac Autonomic Control, and Quality of Life in Sedentary Workers.

Sedentary behaviors, those that involve sitting and low levels of energy expenditure, have been associated with several adverse cardiometabolic effects. This study evaluated the chronic effects of a combined circuit weight interval training (CWIT) on physical fitness, quality of life, and heart rate variability (HRV), and compared the effects of CWIT-induced autonomic adaptations on different postures in adult sedentary workers. Twenty-seven sedentary workers (age 36.9 ± 9.2 years old, 13 men and 14 women) were divided into two groups: control, who continued their sedentary behavior, and experimental, who were submitted to a CWIT for 12 weeks, completing two ~40 min sessions per week. Monitoring of 8th, 16th, and 24th sessions revealed a moderate training load during sessions. Participants exhibited an improved aerobic capacity (VO2max, 34.03 ± 5.36 vs. 36.45 ± 6.05 mL/kg/min, p < 0.05) and flexibility (22.6 ± 11.4 vs. 25.3 ± 10.1 cm, p < 0.05) after the training period. In addition, they showed greater quality of life scores. However, the CWIT did not change body composition. Interestingly, more HRV parameters were improved in the seated position. The CWIT used in the current study was associated with improvements in several fitness and quality of life parameters, as well as in cardiac autonomic control of HR in adult sedentary workers. Examination of different body positions when evaluating changes in HRV appears to be a relevant aspect to be considered in further studies. Future randomized controlled trials (RCTs) with larger samples of both sexes should confirm these promising results.

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.