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

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

Effects of home-based physical exercise programs on cognition in older adults: an integrative review / Efeitos de programas de exercícios físicos domiciliares na cognição de idosos: uma revisão integrativa

This study sought to review randomized clinical trials of home-based physical exercises and their effects on cognition in older adults. An integrative review was carried out after searching the PubMed, Google Scholar, MEDLINE, LILACS, SciELO, and PEDro databases. The risk of bias of the included randomized controlled trials was assessed using the PEDro Scale. Fourteen studies were included, with an average PEDro score of 6.1±1.7 (range, 3 to 9) points. Overall, the studies found that interventions consisting of home-based physical exercise programs, whether strength training alone or combined with aerobic and balance exercises, performed three times a week in 60-minute sessions for a minimum duration of 8 weeks, contribute to cognitive performance in older adults, with particular impact on executive function. We conclude that home-based physical exercises constitute a strategy to minimize the negative implications associated with cognitive impairment in older adults

Este estudo buscou revisar ensaios clínicos randomizados com exercícios físicos domiciliares e seus efeitos na cognição de idosos. Foi feita uma revisão integrativa com seleção nas bases de dados PubMed, Google Scholar, MEDLINE, LILACS, SciELO e PEDro. A avaliação do risco de viés dos ensaios clínicos randomizados incluídos foi feita usando a Escala PEDro. Catorze estudos foram incluídos, cuja pontuação dos artigos na escala PEDro foi em média de 6,1±1,7 pontos, com a pontuação total variando de 3 a 9. De forma geral, os estudos apontaram que a intervenção com programas de exercícios domiciliares de treino de força isolado ou combinado com exercícios aeróbio e de equilíbrio, realizado três vezes na semana com 60 minutos por sessão e duração mínima de oito semanas, contribui para o desempenho cognitivo de idosos, especialmente sobre a função executiva. Concluiu-se que exercícios domiciliares se apresentam como uma estratégia para minimizar as consequências negativas associadas ao déficit cognitivo em idosos

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

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

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

Affective response of postmenopausal women to resistance training on stable and unstable surfaces: a randomized cross-over study / Respostas afetivas de mulheres pós-menopausadas submetidas ao treinamento com pesos em superfície estável e instável: um estudo cross-over randomizado

Objective: To compare the affective response of postmenopausal women who undergo 6 weeks of resistance training on stable and unstable surfaces. Methods: This randomized counterbalanced cross-over study carried included 14 postmenopausal women (55 [SD, 3] years; height 1.55 [SD, 0.03] m; body mass 78.70 [SD, 12.00] kg; and body mass index 32.80 [SD, 4.90] kg/m²), who underwent 6 weeks of resistance training on stable and unstable surfaces. The participants were initially allocated to 1 experimental condition (stable or unstable) in a randomized counterbalanced manner. The intervention consisted of 8 exercises in 3 series of 8-10 repetitions, with intervals of 60-90 seconds, for 3 weeks. After the first 3-week protocol, they were switched to the other experimental condition for another 3 weeks. To evaluate affective response, the Hardy and Rejeski Sensation Scale was applied weekly at the end of each exercise and again at the end of the 6 weeks. Results: Affective response was similar to the general affect observed at the end of the sessions (stable surface: 5.00 [3.00]; unstable surface: 5.00 [1.00]; p = 0.114), except for the bridge exercise (stable surface: 3.00 [2.00]; unstable surface: 4.00 [2.00]; p = 0.048]). Conclusions: The affective response of these women was not affected by training on unstable surfaces, except for the bridge exercise, in which the unstable surface increased affective response

Objetivo: Comparar as respostas afetivas de mulheres pós-menopausadas submetidas a seis semanas de treinamento com pesos realizado em superfície estável e instável. Metodologia: Trata-se de um estudo cross-over, randomizado e contrabalanceado realizado com 14 mulheres pós-menopausadas (55 ± 3 anos; estatura de 1,55 ± 0,03 m; massa corporal 78,70 ± 12,00 kg; e índice de massa corporal de 32,80 ± 4,90 kg/m²) submetidas a seis semanas de treinamento com pesos em superfície estável e instável. As participantes foram alocadas, inicialmente, numa das condições experimentais de forma randomizada e contrabalanceada. A intervenção foi composta por oito exercícios em três séries de oito a dez repetições, com intervalos entre 60 e 90 segundos, durante três semanas. Para avaliação das respostas afetivas, foi aplicada a Escala de Sensação de Hardy e Rejeski ao fim da última série de cada exercício e ao final das sessões, durante as seis semanas. Resultados: As respostas afetivas foram similares para o afeto geral observado ao final das sessões [Superfície estável: 5,00 (3,00); Superfície instável: 5,00 (1,00); p = 0,114], mas não para o exercício de ponte [Superfície estável: 3,00 (2,00); Superfície instável: 4,00 (2,00); p = 0,048)]. Conclusões: Conclui-se que as respostas afetivas de mulheres pós-menopausadas, observadas ao final da sessão, não foram afetas pela instabilidade. Contudo, as sensações de prazer, no exercício de ponte, foram maiores com a inserção da instabilidade

Função cognitiva em Idosos Saudáveis: análise secundária de um estudo randomizado controlado comparando exercícios domiciliares com supervisão virtual versus por mensagens / Cognitive function in healthy elderly: secondary analysis of a randomized controlled trial comparing home-based exercises with virtual vs. message supervision

O estudo objetivou comparar diferentes estratégias de supervisão durante 12 semanas de um programa de exercícios domiciliares sobre a função cognitiva de idosos saudáveis. Foi realizado um ensaio clínico, no qual participaram idosos comunitários de ambos os sexos, que foram divididos em dois grupos com diferentes estratégias de supervisão: supervisionado virtualmente por videoconferências durante todas as sessões de treino, ou supervisionado por mensagens de texto. A intervenção para ambos os grupos consistiu em um programa ofertado por meio de vídeos-aula, com frequência de três sessões semanais e duração de 12 semanas. Os desfechos foram avaliados remotamente por videoconferência. Para avaliar a cognição global foi utilizado o Montreal Cognitive Assessment (MoCA) e para o controle inibitório o Stroop test. Foi feita uma análise inferencial, com intenção de tratar, de modelos mistos por simetria composta, considerando intervalos de confiança (IC) a 95% e um nível de significância de 5%. Trinta e oito participantes foram randomizados e alocados em um dos grupos (81,6% mulheres, média de idade de 68,39 ± 6,48 anos, massa corporal média de 69,82 ± 12,15 kg, altura média de 1,59 ± 0,06 m, índice de massa corporal médio de 27,82 ± 4,88 kg/m²; e 94,7% com mais de 12 anos de estudo). Não houve diferenças estatisticamente entre os grupos (p>0,05) e não foram observados efeitos ao longo do tempo nas comparações intra-grupos (p>0,05). Concluiu-se que a supervisão utilizada neste estudo não promove ganhos cognitivos adicionais ao programa de exercícios domiciliares supervisionado por mensagens de texto em idosos saudáveis.

The study aimed to compare different supervision strategies during 12 weeks of a home exercise program on the cognitive function of healthy older adults. A clinical trial was conducted in which community-dwelling older adults of both genders participated. They were divided into two groups with different supervision strategies: those virtually supervised by videoconferences during all training sessions or those supervised by text messages. The intervention for both groups consisted of a program offered through video lessons, with a frequency of three weekly sessions and a duration of 12 weeks. Outcomes were assessed remotely via videoconference. The Montreal Cognitive Assessment (MoCA) was used to assess global cognition, and the Stroop test was used for inhibitory control. An intention-to-treat inferential analysis of mixed models by compound symmetry was performed, considering 95% confidence intervals (CI) and a significance level of 5%. Thirty-eight participants were randomized and allocated to one of the groups (81.6% women, mean age 68.39 ± 6.48 years, mean body mass 69.82 ± 12.15 kg, mean height 1.59 ± 0.06 m, mean body mass index of 27.82 ± 4.88 kg/m²; and 94.7% with more than 12 years of study). There were no statistically significant differences between groups (p>0.05), and no effects over time were observed in intra-group comparisons (p>0.05). It was concluded that both supervision methods used in this study did not provide additional cognitive gains to the home exercise program in healthy older adults.

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

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

Association between screen time exposure, anxiety, and sleep quality in adolescents / Asociación entre el tiempo de exposición a la pantalla, la ansiedad y la calidad del sueño en adolescentes

Abstract Introduction The increase in sedentary screen time can negatively affect the quality of sleep, impacting the performance of daily activities. Objective To analyze the association between sedentary screen time and sleep quality, regardless of the symptoms of anxiety in adolescents of both genders. Method Cross-sectional study integrating school-based epidemiological research with a representative sample (n = 666) of high school students (14 to 19 years old) in public schools in the municipality of Caruaru-PE. The translated versions into Portuguese of the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HAD) were applied to analyze sleep quality and anxiety, respectively. Binary logistic regression was used to analyze the association, considering sleep quality as an outcome. Results There was a positive, statistically significant (p< .001) correlation between sleep quality and symptoms of anxiety (r = .393). A significant association regarding the association between screen time and sleep quality was noted only in those adolescents classified as being possible or probable anxiety cases and only in exposure to the computer (OR = 2.337; 95% CI [1.01, 5.43]) and video games (OR = 8.083; 95% CI [2.0, 32.8]) after adjusting for gender, age, and school shift. Discussion and conclusion Increased interaction with the screen and higher levels of anxiety can be more harmful to sleep in adolescents. Exposure to screen time, specifically those which have a greater interaction such as video games and computers, can have a negative impact on sleep quality, but only in adolescents with a higher risk of anxiety.

Resumen Introducción Un elevado tiempo de exposición de pantalla puede afectar tanto la calidad del sueño como las actividades diarias. Objetivo Analizar la asociación entre el tiempo de pantalla sedentario y la calidad del sueño, independientemente de los síntomas de ansiedad en adolescentes de ambos sexos. Método Estudio transversal que integra la investigación epidemiológica escolar con una muestra representativa (n = 666) de estudiantes (14 a 19 años) de escuelas públicas de Caruaru-PE. Las versiones traducidas al portugués del Índice de Calidad del Sueño de Pittsburgh (PSQI) y la Escala de Ansiedad y Depresión Hospitalaria (HAD) se aplicaron para analizar la calidad del sueño y la ansiedad. Se utilizó regresión logística binaria para analizar la asociación, considerando como resultado la calidad del sueño. Resultados Hubo una correlación positiva y estadísticamente significativa (p< .001) entre la calidad del sueño y los síntomas de ansiedad (r = .393). Una asociación significativa en cuanto a la asociación entre el tiempo de pantalla y la calidad del sueño se observó sólo en adolescentes clasificados como casos posibles o probables de ansiedad y sólo en la exposición al ordenador (OR = 2.337; IC 95% [1.01, 5.43]) y videojuegos (OR = 8.083; 95% IC [2.0, 32.8]) después de los ajustes. Discusión y conclusión Una mayor interacción con la pantalla y altos niveles de ansiedad pueden ser perjudiciales para el sueño. La exposición al tiempo de pantalla, específicamente aquellos con mayor interacción, como los videojuegos y las computadoras, puede afectar negativamente la calidad del sueño, pero sólo en adolescentes con mayor riesgo de ansiedad.

Activation of upper limb muscles in subjects with scapular dyskinesis during bench-press and dumbbell fly on stable and unstable surfaces.

BACKGROUND: Scapular dyskinesis has been associated with shoulder dysfunctions, and changes in electromyographic (EMG) activity have been reported during the execution of some exercises. OBJECTIVE: To compare upper limb muscles EMG of asymptomatic subjects with and without scapular dyskinesis during bench-press and dumbbell fly exercise performed on different surface stability conditions. METHODS: Twenty-eight physically active men were allocated into two groups: Control group (n= 14) and Dyskinesis group (n= 14). The participants performed six repetitions lasting three seconds of the bench press and dumbbell fly exercises with 50% of one-repetition maximum (1RM) on a bench and a Swiss ball. The EMG activity of the pectoralis major, serratus anterior, upper and lower trapezius, anterior deltoid, biceps and triceps muscles were recorded. RESULTS: No differences were found between groups, regardless of exercise or surface type. Inserting the unstable surface in the supine exercise promoted a slight increase in upper trapezius EMG activity for the control [4.32 (95% CI: 1.04 to 7.60)] and dyskinesis [3.30 (95% CI: 0.34 to 6.27)] groups. CONCLUSIONS: There is no difference in upper limb muscle EMG activity between subjects with and without scapular dyskinesis. In addition, inserting unstable surfaces did not modify EMG activity.

Correlation between concern about falling and functional muscle fitness in community-dwelling elderly / Correlação entre preocupação em cair e aptidão muscular funcional em idosos comunitários

Abstract Introduction: To establish a correlation between concern about falling and a more comprehensive functional parameter, functional muscle fitness, a variable that encompasses functional components such as balance, muscle strength, power, flexibility and motor coordination in an integrated way. Functional muscle fitness is measured using the sitting-rising (from the floor) test (SRT), a simple, safe, fast and ecological test. Objective: The aim of our study was to determine the correlation between concern about falling and functional muscle fitness in the elderly. Methods: A cross-sectional observational study was conducted. The sample consisted of 53 elderly people of both sexes (86.8% women; 65.6 ± 4.7 years old; body mass index 28.5 ± 3.8 kg/m2), who were assessed for concern about falling (through Falls Efficacy Scale International, FES-I-Brazil) and functional muscle fitness (through SRT). Correlation analysis was performed using the Spearman test. For all analyses, a significance level of 5% (p < 0.05) was established. Results: Concern about falling showed a negative correlation with functional muscle fitness (rho =-0.229; p = 0.015). Conclusion: Elderly people with lower levels of functional muscle fitness have a higher level of concern about falling.

Resumo Introdução: Com o intuito de estabelecer uma correlação entre a preocupação em cair e um parâmetro funcional mais abrangente, a aptidão muscular funcional, variável que engloba componentes funcionais como equilíbrio, força, potência muscular, flexibilidade e coordenação motora de forma integrada, surge como uma alternativa. A aptidão muscular funcional é mensurada por meio do teste de sentar e levantar do chão (TSL), um teste simples, seguro, rápido e ecológico. Objetivo: A pesquisa teve como objetivo verificar a correlação entre a preocupação em cair e a aptidão muscular funcional de idosos. Métodos: Trata-se de um estudo com delineamento observacional do tipo transversal correlacional. A amostra foi composta por 53 idosos de ambos os sexos (86,8% mulheres; 65,6 ± 4,7 anos; índice de massa corporal 28,5 ± 3,8 kg/m2), avaliados quanto à preocupação em cair (através da Escala Internacional de Eficácia de Quedas Brasil - FES-I-Brasil) e à aptidão muscular funcional (através do TSL). A análise de correlação foi realizada pelo teste de Spearman. Para todas as análises foi estabelecido um nível de significância de 5% (p < 0,05). Resultados: A preocupação em cair apresentou correlação negativa com aptidão muscular funcional (rho =-0,229; p = 0,015). Conclusão: Idosos com menores índices de aptidão muscular funcional apresentam maior nível de preocupação em cair.

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

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

Static Stretching Intensity Does Not Influence Acute Range of Motion, Passive Torque, and Muscle Architecture.

CONTEXT: Although stretching exercises are commonly used in clinical and athletic practice, there is a lack of evidence regarding the methodological variables that guide the prescription of stretching programs, such as intensity. OBJECTIVE: To investigate the acute effects of different stretching intensities on the range of motion (ROM), passive torque, and muscle architecture. DESIGN: Two-group pretest-posttest design. SETTING: Laboratory. PARTICIPANTS: Twenty untrained men were allocated into the low- or high-intensity group. MAIN OUTCOME MEASURES: Subjects were evaluated for initial (ROMinitial) and maximum (ROMmax) discomfort angle, stiffness, viscoelastic stress relaxation, muscle fascicle length, and pennation angle. RESULTS: The ROM assessments showed significant changes, in both groups, in the preintervention and postintervention measures both for the ROMinitial (P < .01) and ROMmax angle (P = .02). There were no significant differences for stiffness and viscoelastic stress relaxation variables. The pennation angle and muscle fascicle length were different between the groups, but there was no significant interaction. CONCLUSION: Performing stretching exercises at high or low intensity acutely promotes similar gains in flexibility, that is, there are short-term/immediate gains in ROM but does not modify passive torque and muscle architecture.

Effects of a 12-Week Chronic Stretch Training Program at Different Intensities on Joint and Muscle Mechanical Responses: A Randomized Clinical Trial.

CONTEXT: Stretching intensity is an important variable that can be manipulated with flexibility training. However, there is a lack of evidence regarding this variable and its prescription in stretching programs. OBJECTIVE: To investigate the effects of 12 weeks of knee flexor static stretching at different intensities on joint and muscle mechanical properties. DESIGN: A randomized clinical trial. SETTING: Laboratory. PARTICIPANTS: A total of 14 untrained men were allocated into the low- or high-intensity group. MAIN OUTCOME MEASURES: Assessments were performed before, at 6 week, and after intervention (12 wk) for biceps femoris long head architecture (resting fascicle length and angle), knee maximal range of motion (ROM) at the beginning and maximal discomfort angle, knee maximal tolerated passive torque, joint passive stiffness, viscoelastic stress relaxation, knee passive torque at a given angle, and affective responses to training. RESULTS: No significant differences were observed between groups for any variable. ROM at the beginning and maximal discomfort angle increased at 6 and 12 weeks, respectively. ROM significantly increased with the initial angle of discomfort (P < .001, effect size = 1.38) over the pretest measures by 13.4% and 14.6% at the 6- and 12-week assessments, respectively, and significantly improved with the maximal discomfort angle (P < .001, effect size = 1.25) by 15.6% and 18.8% from the pretest to the 6- and 12-week assessments, respectively. No significant effects were seen for muscle architecture and affective responses. Initial viscoelastic relaxation for the low-intensity group was lower than ending viscoelastic relaxation. CONCLUSION: These results suggest that stretching with either low or high discomfort intensities are effective in increasing joint maximal ROM, and that does not impact on ROM, stiffness, fascicle angle and length, or affective response differences.

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

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

Cardiovascular responses after isometric handgrip exercise at different intensities in healthy men / Respostas cardiovasculares após exercício isométrico com handgrip em diferentes intensidades em homens saudáveis

ABSTRACT The 30% maximal voluntary contraction protocol for isometric handgrip exercise is widely used to improve the cardiovascular system. However, it is unknown whether intensity modulation affects these responses. Objective: To analyze acute cardiovascular responses after isometric handgrip exercise performed at different intensities. Twenty-three healthy men participated in this cross-over study. The volunteers performed three experimental sessions: 4x2 minutes of contraction at 30% (S30) MVC and 4x2 minutes of contraction at 50% (S50) MVC, besides control (CS). Blood pressure (BP) as well as time (SDNN, RMSSD and PNN50) and frequency (LF, HF and LF/HF) domain heart rate variability parameters were obtained before and after sessions. None of the experimental sessions promoted statistically significant changes in systolic and diastolic BP (p> 0.05 for all). After S50, there was a smaller increase in SDNN five minutes after the exercise (S50: +5±6, S30: +20±5, SC: +10±2 ms, p <0.05) and higher LF/HF after 20 minutes (S50: +1.59±0.80, S30: -0.49±0.49, SC: +0.39±0.49, p <0.05) compared to the other sessions. In conclusion, BP responses to isometric handgrip exercise are similar between intensities; however, the most intense exercise promoted a greater increase in sympathetic modulation and decrease in parasympathetic modulation after exercise.

RESUMO O protocolo com 30% da contração voluntária máxima do exercício isométrico com handgrip é amplamente utilizada para melhoria do sistema cardiovascular. Todavia, é desconhecido se a modulação da intensidade afetam essas respostas. Objetivou analisar as respostas cardiovasculares agudas após exercício isométrico com handgrip realizado em diferentes intensidades. Fizeram parte deste estudo cross-over 23 homens saudáveis. Os voluntários realizaram três sessões experimentais: 4x2 minutos de contração a 30% (S30) e 4x2 minutos de contração a 50% (S50) da contração voluntária máxima e controle (SC). A pressão arterial (PA) e os parâmetros da variabilidade da frequência cardíaca do domínio do tempo (SDNN, RMSSD e PNN50) e da frequência (LF, HF e LF/HF) foram obtidos antes e após as sessões. Nenhuma das sessões experimentais promoveram alterações estatisticamente significantes na PA sistólica e diastólica (p>0,05 para todos). Após a S50, houve menor aumento do SDNN nos cinco minutos pós-exercício (S50:+5±6; S30:+20±5;SC:+10±2 ms, p<0,05) e maior aumento do LF/HF após 20 minutos (S50:+1,59±0,80;S30:-0,49±0,49;SC:+0,39±0,49, p<0,05) comparado as demais sessões. Conclui-se que as respostas da PA ao exercício isométrico de handgrip são similares entre as intensidade, no entanto, o exercício mais intenso promoveu maior aumento da modulação simpática e redução da modulação parassimpática após exercício.

Activity of periscapular muscles and its correlation with external oblique during push-up: Does scapular dyskinesis change the electromyographic response?

Scapular dyskinesis is the term used to describe changes in the positioning or movement of the scapula. Such dysfunction is associated with changes in the activation of the scapular muscles. However, the influence of the axial muscles on the scapular muscles activity of subjects with scapular dyskinesis is unknown. This study aimed to compare the electromyography (EMG) activity of periscapular muscles and its correlation with the external oblique muscle during the execution of push-up performed in different surfaces, in volunteers with and without scapular dyskinesis. Thirty-six men, divided in two groups (control and dyskinesis), performed push-up on stable and unstable surface. The EMG activity of serratus anterior (SA_5th and SA_7th fibers), upper (UT) and lower (LT) trapezius, external oblique (EO) was recorded during execution of each task condition. Statistical analyzes were performed using two way ANOVA repeated measures and Pearson correlation. It was observed effect of interaction between factors, being evidenced increased activity of UT, SA_7th and OE for the control group and decreased activity of SA_5th, SA_7th and EO for dyskinesis group during execution of push-up on unstable surface. In both groups positive correlations (r > 0.47) were observed between EMG activity of SA and EO. In the exercises tested, there seems to be an anatomical and functional relationship between the SA and EO muscles. The use of the unstable surface promotes increased neuromuscular demand, but the neuromuscular strategies appear to differ between groups.

Diferentes ordens dos exercícios durante o método circuito não alteram as respostas hemodinâmicas / Different orders of exercises during the circuit method does not alter the hemodynamic responses

Introdução: O efeito da ordem dos exercícios no Treinamento Circuito (TC) sobre variáveis hemodinâmicas é inconclusivo. Objetivo: Avaliar o efeito de diferentes ordens de execução nas respostas hemodinâmicas agudas no TC. Métodos: Onze homens foram recrutados. As sessões de treinamento foram compostas pela seguinte sequência: Sequência A: multiarticulares/monoarticulares; Sequência B: monoarticulares/multiarticulares, realizados a 60% de 1-RM com intervalo de um minuto. Ambos circuitos foram compostos por três passagens com oito estações. Os desfechos foram: pressão arterial sistólica (PAS), diastólica (PAD), frequência cardíaca (FC) e duplo produto (DP). Para comparações utilizou-se ANOVA two-way medidas repetidas considerando p<0.05. Resultados: Os valores da FC foram significativamente mais altos durante e após o exercício em comparação ao momento pré (p<0,001), aumento do DP (p< 0,001) e diminuição da PAS (p<0,001) após os treinos, independente da ordem dos exercícios. Conclusão: O método de TC é eficiente em promover o efeito hipotensor pós-exercício independente da ordem de execução.

Introduction: The effect of Circuit Training (CT) order's on hemodynamics variables is inconclusive. Objective: To evaluate the effect of different orders of execution in acute hemodynamic responses in the CT. Methods: Eleven men were recruited. Training sessions were composed by the following sequence: sequence A: multi-joint/single-joint; Sequence B: single-joint/multi-joint, performed at 60% of 1-MR with one minute interval. Both circuits were composed of three passes with eight stations. The outcomes were: systolic blood pressure (BPS), diastolic (DPS), heart rate (HR) and double product (DP). For comparisons was used twoway ANOVA repeated measures considering p<0.05. Results: HR values were significantly higher during and after exercise compared to baseline, increase of DP (p< 0,001) and decrease of BPS (p<0,001) after practice, regardless of the order of exercise execution. Conclusion: The CT method is efficient in promoting the hypotensive effect post-exercise regardless of the order of execution.

The number of visits and blood pressure measurements influence the prevalence of high blood pressure in adolescents.

The aim of this study was to analyze the influence of the number of visits and the number of blood pressure (BP) measurements on the prevalence of high blood pressure (HBP) in adolescents. A cross-sectional epidemiologic study with 481 adolescents (14-19 years old) selected using a random cluster sampling strategy. We measured the BP three times in a first visit. Adolescents with HBP performed subsequent visits. The final calculation of BP followed four strategies: the 1st measure, mean of 1st and 2nd measurements, mean of all three measurements, and averaging the 2nd and 3rd measurements. The prevalence of HBP in the first and second visits was 6.4% and 1.9%, and the prevalence of hypertension (after three visits) was 1.7%. The prevalence of HBP varied from 8.6%-18.6% for boys and 4.6%-9.2% for girls, using the average 2nd and 3rd measurements and the 1st measurement, respectively. In all strategies, HBP and hypertension were more prevalent in boys and students attending the nocturnal shift. The number of visits and number of measurements affect the prevalence of HBP and hypertension in adolescents. Thus, clinicians and researchers should consider these aspects when assessing BP in adolescents aged 14-19 years old.

Shoulder Muscle Activation Levels During Exercises With Axial and Rotational Load on Stable and Unstable Surfaces.

This study evaluated the effects of instability on the EMG activity of scapular stabilizing and upper limb muscles during exercises with axial and rotational load. Twenty male volunteers (20.9 ± 1.8 years, 174.1 ± 0.04 cm, 73.17 ± 8.77 kg) experienced in strength training participated in a crossover design. Muscle activation of anterior deltoid (AD), posterior deltoid (PD), pectoralis major (PM), biceps brachii (BB), triceps brachii (TB), upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) were determined on both conditions. Participants performed a single series of 10 repetitions of bench press and fly exercises on stable (bench) and unstable (proprioceptive disc) conditions at 60% of 1-RM. The Friedman test and post hoc Dunn's indicated that the unstable condition showed greater EMG activity for AD (P = .001) and BB (P = .002) on the fly exercise, SA (P = .001) and LT (P = .048) on the bench press, and PM (P ≤ .002) on both exercises. These results show that using an unstable surface in exercises with rotational load provides superior EMG activity of the agonist muscles, while in exercise with axial load, the instability favors EMG activity of the scapular stabilizing muscles.

Electromyographic analysis of the serratus anterior and trapezius muscles during push-ups on stable and unstable bases in subjects with scapular dyskinesis.

The present study was performed to assess the electromyographic activity of the scapular muscles during push-ups on a stable and unstable surface, in subjects with scapular dyskinesis. Muscle activation (upper trapezius [UT]; lower trapezius [LT]; upper serratus anterior [SA_5th]; lower serratus anterior [SA_7th]) and ratios (UT/LT; UT/SA_5th; UT/ SA_7th) levels were determined by surface EMG in 30 asymptomatic men with scapular dyskinesis, during push-up performed on a stable and unstable surface. Multivariate analysis of variance with repeated measures was used for statistical analyses. The unstable surface caused a decrease in the EMG activity of the serratus anterior and an increase in EMG activity of the trapezius (p=0.001). UT/SA_5th and UT/ SA_7th ratios were higher during unstable push-ups (p=0.001). The results suggest that, in individuals with scapular dyskinesis, there is increased EMG activity of the trapezius and decreased EMG activity of the serratus anterior in response to an unstable surface. These results suggest that the performance of the push up exercise on an unstable surface may be more favorable to produce higher levels of trapezius activation and lower levels of serratus anterior activation. However, if the goal of the exercise program is the strengthening of the SA muscle, it is suggested to perform the push up on a stable surface.

Effect of exercise order on the resistance training performance during a circuit training session / Efeito da ordem dos exercícios sobre o desempenho durante uma sessão de treinamento resistido no método circuito

The aim of this study was to compare total work volume, number of repetitions and rate of perceived effort performed in two different sequences of circuit training sessions. Eleven recreationally trained men (24.0 ± 4.8 years, 76.1 ± 8.5 kg, 1.75 ± 0.06 m) performed two different sequences of circuit training sessions. All sessions consisted of eight stations (exercises) of three sets in circuit, performed to volitional fatigue, alternating upper and lower body exercises, with 1-minute rest interval between exercises. Sequence A began with multiple joint exercises and progressed to single joint exercises, whereas sequence B was performed with the opposite exercise order. Number of repetitions and rating of perceived exertion (RPE) were compared by repeated measures multivariate analysis of variance (repeated measures MANOVA). Total work volume (TWV) was compared by paired t-test. There were no differences between exercise order for TWV (p=0.47) and RPE of all exercises (p>0.05). For both sequences, number of repetitions was greater when exercise was performed first (p<0.05). These results indicate that during a circuit training session, exercises order influenced the number of repetition, but did not influence TWV and RPE. These findings may suggest that for those who aim overall muscular gains, similar results will be obtained with single and multiple joint, upper and lower body circuit training exercise orders. Similarly, exercise intensity will be similarly perceived regardless of exercise sequences. For those who aim specific muscle group gains, priority exercises must be performed first.

O objetivo deste estudo foi comparar o Volume Total de Trabalho (VTT), o Número de Repetições (NR), e a Percepção Subjetiva de Esforço (PSE) de duas sequências de exercícios executadas no método circuito. Onze homens treinados recreacionalmente (24.0 ± 4.8 years, 76.1 ± 8.5 kg, 1.75 ± 0.06 m) realizaram duas sequências diferentes de exercícios contra a resistência no método circuito. As sessões foram compostas por três passagens em oito estações (exercícios), executadas até a fadiga, alternados membros superiores e inferiores, com 1 minuto de intervalo entre os exercícios. A sequência A foi iniciada por exercícios multiarticulares e progrediu para exercícios monoarticulares, enquanto a sequência B foi executada na ordem inversa. O NR e a PSE foram comparadas pela MANOVA com medidas repetidas. O VTT foi comparado por meio do teste t pareado. Não houve diferenças significativas entre as ordens de exercícios para o VTT (p=0.47) e PSE (p>0.05). Para ambas as sequências, o NR foi maior quando os exercícios foram realizados no início das sequências (p<0,05). Esses resultados indicaram que a ordem dos exercícios afetou o número de repetições, mas não afetou o VTT e a PSE. Esses achados sugerem que, para aqueles que objetivam ganhos musculares gerais, resultados similares podem ser obtidos com exercícios mono e multiarticulares, para membros superiores e inferiores em diferentes ordens no método circuito. Da mesma forma, a intensidade do exercício será percebida de forma similar independente da sequência. Para aqueles que objetivam ganhos musculares específicos, exercícios prioritários devem ser executados no início da sessão.