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

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

Brazil before and during COVID-19 pandemic: Impact on the practice and habits of physical exercise.

INTRODUCTION: The goal of this study was to investigate the practice and habits of physical exercise impact due to COVID-19 social isolation before and during the outbreak in Brazil and its mains macro-regions, which have social and economic disparities. METHODS: This is an observational cross-sectional study through an online questionnaire survey. A self-administered survey (PEF-COVID19) was applied in the Brazilian general population, age ≥ 18 years. T-test for independent samples and Chi-square tests were used to compare Brazil and different macro-regions, p˂0.05. RESULTS: 1,977 participants filled the survey and 1,845 were included; 80% of the included ones were in social isolation. In general, the self-related physical exercise practice before and during the COVID-19 pandemic and exercise characteristics were highly affected by the pandemic (p˂0.05). Sedentary behavior increased significantly (14.9 vs. 29.8%) and between the active ones, the frequency of PEx per week and duration of the PEx practice decreased significantly. The motivation to exercise also changed considering performance and health before and during the pandemic, respectively (10 vs. 5.6% and 72.4 vs. 79.1%). Also, the sample started to exercise less in the night and more in the afternoon, respectively (33.7 vs. 25.3% and 19.1 vs. 31.5%). CONCLUSIONS: The COVID-19 pandemic highly influenced the physical exercise practice and habits (frequency, duration, motivation, period to exercise) in Brazil and its main macro-regions. These results can be used to create measures, as home-based exercise programs, to avoid the harm of sedentary behaviors and mental health impact during and after the pandemic.

Motivação de idosos com doença de Parkinson submetidos ao treino funcional, exercício aeróbico e exergame / Motivation of elderly with Parkinson's disease submitted to functional training, aerobic exercise and exergame

Recomenda-se que pacientes com doença de Parkinson (DP) realizem exercícios físicos durante toda a vida. O exercício deve retardar a progressão da doença e motivar o paciente. Objetivo: Verificar e comparar a motivação de idosos com DP submetidos ao treinamento funcional, exercício em bicicleta estacionária e com o exergame. Método: Ensaio clínico randomizado foi desenvolvido em um centro de referência. O grupo 1 (G1) foi formado por participantes que realizaram treinamento funcional, o grupo 2 (G2) foi tratado em bicicleta estacionária e o grupo 3 (G3) foi submetido ao exergame Xbox 360 com sensor Kinect. Ao final dos treinamentos, foi realizada uma entrevista para avaliar a motivação dos participantes em relação às intervenções as quais foram submetidos. Para cada pergunta existiam quatro opções de respostas: não estava motivado, estava pouco motivado, estava motivado e estava muito motivado. As variáveis foram sumarizadas em mediana e intervalo interquartil e em frequências absolutas e relativas. O teste de Chi-quadrado de Pearson foi usado na inferência estatística. O nível de significância adotado foi de 5% (p<0,05). Participaram do estudo 53 idosos com DP. Resultados: Muitos participantes relataram que o exercício (G1: 72%, G2: 53%, G3: 44%) e o fisioterapeuta (G1: 83%, G2: 76%, G3: 94%) foram muito motivadores. Apenas dois participantes do G2 classificaram o exercício como não motivador. No entanto, nenhuma diferença significativa foi encontrada entre os três grupos. Conclusão: Os indivíduos idosos com DP consideraram o treinamento funcional, o exercício em bicicleta e o exergame como modalidades motivadoras de treinamento.

It is recommended that patients with Parkinsons disease (PD) perform physical exercise throughout their lives. Exercise should slow disease progression and motivate the patient. Objective: Verify and compare the motivation of elderly with PD submitted to functional training, stationary bicycle exercise and exergame. Method: A randomized clinical trial was developed at a referral center. Group 1 (G1) performed functional training, group 2 (G2) trained with stationary bicycle and group 3 (G3) played on Xbox 360 with Kinect sensor. At the end of training, an interview was conducted by a single non-blind investigator to evaluate patient motivation about therapeutic exercise programs they were submitted to. For each question there were four answers options: I was not motivated, I was not very motivated, I was motivated and I was very motivated. The variables were summarized in median and interquartile range and in absolute and relative frequencies. The Pearson Chi-square test was used for statistical inference. The level of significance was 5% (p <0.05). Fifty-three older people with PD have participated. Results: Many participants have reported that exercise (G1: 72%, G2: 53%, G3: 44%) and the physiotherapist (G1: 83%, G2: 76%, G3: 94%) were very motivating. Only two participants of G2 rated exercise as not very motivating. However, no significant difference was found between the three groups. Conclusion: Older individuals with PD considered functional training, bicycle exercise and exergame as motivating modalities of physical exercise.

Efeitos da realidade virtual na função muscular em mulheres com incontinência urinária: relatos de caso / Effects of virtual reality exposure therapy in muscle function in women with urinary incontinence: case series

INTRODUÇÃO: A incontinência urinária (IU) é um dos mais constrangedores e estressantes sintomas urinários e a principal disfunção do assoalho pélvico. O tratamento através da realidade virtual tem o objetivo de aumentar a adesão das pacientes ao tratamento de forma lúdica e não invasiva, promovendo a capacidade de contração dos MAP durante as atividades físicas, com potenciais reflexos na melhora da incontinência. OBJETIVOS: Avaliar a função muscular do assoalho pélvico e perda de urina de mulheres incontinentes tratadas por meio de um protocolo específico de terapia por exposição à realidade virtual. MÉTODOS: Relato de casos, composto 02 casos de mulheres com diagnóstico médico de IU. Tratadas com realidade virtual através dos jogos do Nintendo Wii Fit PlusTM por 12 sessões de 50 minutos cada, três vezes por semana. Cada sessão compreendeu de 20 minutos de momento educativo, com orientações das ações durante os jogos e treinamento prévio para a contração dos músculos transverso do abdome e assoalho pélvico, seguido de 30 minutos de intervenção com o jogo. O protocolo foi dividido em duas fases de seis sessões cada de acordo com a dificuldade dos jogos, priorizando inicialmente aqueles que exploravam movimentos da pelve no plano frontal (Lotus FocusTM, Penguin SlideTM e Soccer HeadingTM) e, com a evolução, os que permitiam movimentos pélvicos mais globalizados (Penguin SlideTM, Table TiltTM e Balance BubbleTM). A função muscular do assoalho pélvico e a perda urinária foram avaliadas, respectivamente, através do Esquema PERFECT e do pad test de 1 hora, sendo os resultados sumarizados de forma descritiva em tabelas do Excel. RESULTADOS: Melhora da perda urinária através do pad test de 1 hora e da função muscular através da palpação digital associada ao Esquema PERFECT das participantes com incontinência urinária após intervenção. CONCLUSÃO: O tratamento dos MAP através da realidade virtual demonstrou-se efetivo na melhora da perda urinária e da função muscular do assoalho pélvico nas participantes deste estudo, porém fazem-se necessárias ensaios clínicos para comprovar sua eficácia. [AU]

INTRODUCTION: Urinary incontinence is one of the most embarrassing and stressful urinary symptoms and the main pelvic floor dysfunction. The treatment through virtual reality aims to increase the adherence of patients to treatment in a playful, non-invasive, promoting PFM contraction capacity during physical activities, with potential impacts on the improvement of this incontinence. OBJECTIVES: To evaluate the muscle function and loss of urine of the pelvic floor of women incontinent treated with a specific protocol of virtual reality exposure therapy. METHODS: Case report, composed of 02 cases of women with medical diagnosis of UI. Handled with virtual reality through Nintendo Wii Fit Plus ™ games for 12 50-minute sessions each, three times a week. Each session consisted of twenty minutes of educational time, with orientation of the actions during the games and previous training for the contraction of the transverse abdomen and pelvic floor muscles, followed by thirty minutes of intervention with the game. The protocol was divided into two phases of six sessions each according to the difficulty of the games, initially prioritizing those who explored movements of the pelvis in the frontal plane (Lotus FocusTM, Penguin SlideTM and Soccer HeadingTM) and, with evolution, those that allowed global movements (Penguin SlideTM, Table TiltTM and Balance BubbleTM). The pelvic floor muscle function and urinary loss were evaluated, respectively, through the PERFECT scheme and the pad test one hour and the results were descriptive summarized in Excel tables. RESULTS: Improved urinary loss through the pad test one hour and improve muscle function by digital palpation associated with the PERFECT scheme of the participants with urinary incontinence after intervention. CONCLUSION: The treatment of PFM through virtual reality proved to be effective in improving urinary loss and PF muscle function in this study, but clinical trials are required to prove their efficacy. [AU]

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

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

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

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

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

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

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

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

A auditoria e o enfermeiro como ferramentas de aperfeiçoamento do SUS / Audit and the nurse as tools for enhancing the unified health system in Brazil / Auditoría y el enfermero como herramientas de mejoramiento del SUS

A auditoria no Sistema Único de Saúde (SUS) surgiu com a proposta demonitorar e verificar o cumprimento dos princípios básicos do SUS. O objetivo deste estudo é compreender o funcionamento do processo de auditoria nos três níveis de gestão, além de entender o papel do enfermeiro auditor. Trata-se de uma revisão de literatura constituídapor artigos científicos nacionais, relatórios, portarias, decretos e leis disponíveis em sites governamentais publicados a partir de 1993, ano de criação do Sistema Nacional de Auditoria (SNA). Conclui-se que, conhecidos os mecanismos de avaliação do Sistema, pode-sedtrabalhar para aperfeiçoar o SUS e melhorar o atendimento aos usuários.

The audit in the Unified Health System (SUS) emerged with the proposalto monitor and verify the compliance with the basic principles of the SUS. The aim of this study is to understand the functioning of the audit process at the three levels of management, understanding the role of the nurse auditor as well. This is a literature review that comprises national scientific articles, reports, ordinances, decrees and laws, available at the government sites that were created from 1993, the year of the implementation of the SUS national auditing system. It can be concluded from this study that once the mechanisms for evaluating the systemare recognized, work can be done to enhance the SUS and to improve customer service.

La auditoría en el Sistema Único de Salud (SUS) surgió como una propuesta para monitorear y verificar el cumplimiento de los principios básicos del SUS. El objetivo de este estudio es comprender el funcionamiento del proceso de auditoría en los tres nivelesde gestión, además de entender el rol del auditor enfermero. Es una revisión de la literatura constituida por artículos científicos nacionales, informes, ordenanzas, decretos y leyes, disponibles en los sitios del gobierno, publicados a partir de 1993, año de creación del Sistema Nacional de Auditoría (SNA). Se concluye que, una vez conocidos los mecanismos para evaluar el sistema, se puede trabajar para mejorar el SUS y la atención a los usuarios.