Influencia de la terapia de movimiento inducido por restricción en hemiparesia infantil con habilidad manual moderada de 2 a 16 años: revisión sistemática / Influence of constraint-induced movement therapy on childhood hemiparesis with moderate manual dexterity at 16 years of age: a systematic review

INTRODUCCIÓN: El déficit de uso de la extremidad superior afectada, así como la calidad del movimiento, influyen en la ejecución de un agarre funcional (acción de agarrar-liberar un objeto) y, por tanto, reducen las posibilidades de ejecución de las actividades cotidianas del niño diagnosticado de hemiplejía infantil. La habilidad manual (movimientos de los dedos, agarre global y distal, manipulación, movimiento preciso, fluido) podría ser un factor que determine si la ejecución de terapia de movimiento inducido por restricción favorece el incremento de la funcionalidad de la extremidad superior afectada. OBJETIVO: Estudiar la influencia de la terapia de movimiento inducido por restricción en la funcionalidad de la extremidad superior afectada en hemiplejía infantil con una habilidad manual moderada de 2 a 16 años. PACIENTES Y MÉTODOS: Se realizó una búsqueda bibliográfica de los trabajos publicados entre 2014 y 2019 en las bases de datos PubMed, PEDro y The Cochrane Library. RESULTADOS: Tras aplicar los criterios de inclusión y exclusión, se obtuvieron siete estudios, de un total de 203, para ser analizados, en los que se compara la terapia de movimiento inducido por restricción con otras intervenciones. CONCLUSIONES: La comparativa de resultados resulta compleja debido a la falta de unanimidad en la aplicación de dosis y herramientas de evaluación del segmento afectado. La terapia de movimiento inducido por restricción aplicada de manera exclusiva permite mayores beneficios en la funcionalidad en cuanto a destreza manipulativa de la extremidad superior afectada en hemiplejía infantil con habilidad manual moderada que la terapia convencional u otras terapias

INTRODUCTION: The deficit of use on the upper limb affects, as well as the quality of movement, influences the execution of a functional grasp (action of grasping-releasing an object) and therefore, reduces the possibilities of execution of the child’s daily activities diagnosed with infantile hemiplegia. Manual ability (finger movements, global and distal grasp, handling, precise movement, fluid...) could be a factor that determines whether the execution of constraint induced movement therapy favors the increase in functionality of the upper limb affected. AIM: To study the constraint induced movement therapy influence on the functionality of the affected upper limb in infantile hemiplegia with moderate manual ability from 2 to 16 years of age. PATIENTS AND METHODS: A bibliographic search of the works published between 2014 and 2019 was performed in the PubMed, PEDro and The Cochrane Library databases. RESULTS: After applying the inclusion/exclusion criteria, seven studies were obtained from a total of 203 to be analyzed, comparing constraint induced movement therapy with other interventions. CONCLUSIONS: The results comparison is complex due to the lack of unanimity in the doses application and evaluation tools of the affected segment. The exclusive application of constraint induced movement therapy allows greater benefits in functionality, at the level of manual ability on affected upper limb in infantile hemiplegia with moderate manual ability than conventional therapy or other therapies

Children with Hemiparesis Arm and Movement Project (CHAMP): protocol for a multisite comparative efficacy trial of paediatric constraint-induced movement therapy (CIMT) testing effects of dosage and type of constraint for children with hemiparetic cerebral palsy.

INTRODUCTION: The Children with Hemiparesis Arm and Movement Project (CHAMP) addresses two pressing issues concerning paediatric constraint-induced movement therapy (CIMT): effects of two dosages and two types of constraint on functional outcomes. Systematic reviews conclude that CIMT is one of the most efficacious treatments, but wide variations in treatment protocols, outcome measures and patient characteristics have prevented conclusions about potential effects of dosage levels and constraint methods. METHODS AND ANALYSIS: CHAMP is a multisite comparative efficacy randomised controlled trial of 135 children (2-8 years) with hemiparetic cerebral palsy. The 2×2 factorial design tests two dosage levels-60 hours (3.0 hours/day, 5 days/week × 4 weeks) and 30 hours (2.5 hours/day, 3 days/week × 4 weeks) and two constraint conditions-full-arm, full-time cast and part-time splint, plus usual and customary (UCT) controls, yielding five groups: (1) 60 hours CIMT+full-time cast, (2) 60 hours CIMT+part-time splint, (3) 30 hours CIMT+full-time cast, (4) 30 hours CIMT+part-time splint and (5) UCT. Trained therapists deliver the standardised ACQUIREc protocol for CIMT. Blinded assessments at baseline, end of treatment, and 6 and 12 months post treatment include the Assisting Hand Assessment, and subscales from the Peabody Developmental Motor Scales-2 and modified Quality of Upper Extremity Skills Test. Parents complete the Pediatric Motor Activity Log and Pediatric Evaluation of Disability Inventory. A new Fidelity of Implementation Rehabilitation Measure monitors treatment delivery. Data analyses involve repeated-measures multivariate analysis of co-variance controlling for selected baseline variables. ETHICS AND DISSEMINATION: Ethics boards at site universities approved the study protocol. To promote equipoise, parents of UCT controls are offered ACQUIREc after 6 months. A Data Safety and Monitoring Committee reviews results regularly, including measures of child and family stress. We will disseminate CHAMP results via peer-reviewed publications and presentations to professional and advocacy organisations. TRIAL REGISTRATION NUMBER: NCT01895660; Pre-results.

Daily Well-Being Benefits of Physical Activity in Older Adults: Does Time or Type Matter?

Purpose of the Study: There is little debate that maintaining some level of physical activity in later life conveys positive benefits both physically and psychologically. What is less understood is the extent to which the type of activity or the length of time spent doing it matters when it comes to these benefits on the daily level. Here, we investigated (a) whether the presence of daily purposeful exercise (Exercise) or non-exercise physical activity (Activity) is sufficient for experiencing day-level benefits, or if time spent matters, and (b) whether there are differential well-being benefits of Exercise and Activity on the daily level. Design and Methods: Older adults (N = 127; aged 60-95, Mage = 79.4) filled out surveys for 14 days, reporting daily Exercise and Activity behaviors as well as Positive and Negative Affect (PA/NA), Perceived Stress (PS), Perceived Health (PH), and Sleep Quality (SQ). Results: Multilevel regression models showed that for purposeful exercise, more time spent was beneficial for PA, NA, and PH, but for PS, only the presence of exercise was important (time did not matter). For non-exercise activity, time did not have as great an influence as presence-doing any form of activity was beneficial for both PA and SQ. Exercise and Activity had largely independent (additive) effects. Implications: Results reveal that both purposeful exercise and non-exercise activity convey independent daily well-being benefits, and that for some aspects of daily well-being, duration does matter. Findings can be applied in the development of physical activity education or engagement programs for older adults.

Guía básica de detección del sedentarismo y recomendaciones de actividad física en atención primaria / Basic guidelines for detecting sedentarism and recommendations for physical activity in primary care

La detección del sedentarismo en adultos mediante instrumentos sencillos y útiles es un objetivo primordial tanto en salud pública como en el ámbito clínico, ya que este factor de riesgo es una de las causas más importantes de enfermedad no transmisible en el mundo y es muy prevalente en las sociedades desarrolladas como la española. Se describen 2 instrumentos validados, sencillos y útiles para detectar y/o manejar el sedentarismo en adultos: a) el cuestionario internacional de actividad física en su versión corta, y b) el podómetro, para cuantificar el número de pasos realizados en un día. Aumentar los niveles de actividad física es importante para la prevención primaria de algunas enfermedades crónicas (cardiopatía coronaria, diabetes tipo 2, osteoporosis, cáncer de colon) y para mejorar la calidad de vida. El personal sanitario debe conocer el grado de motivación y la disponibilidad del paciente y su familia para el cambio de conducta hacia la actividad física. Las actividades físicas de intensidad moderada no presentan prácticamente ninguna contraindicación y los riesgos son muy escasos

The detection of physical inactivity in adults, using simple and useful tools is primary objective in both public health and in clinical settings, since this risk factor is one of the major causes of non-communicable disease in the world, and is very prevalent in developed societies such as in Spain. Two validated instruments are described that are simple and useful for detecting and/or monitoring physical inactivity in adults: (i) the international physical activity questionnaire in its short version, and (ii) the pedometer to measure the number of steps taken in a day. Increased levels of physical activity are important for the primary prevention of some chronic diseases (coronary heart disease, type 2 diabetes, osteoporosis, colon cancer) and to improve the quality of life. Medical personnel must determine the motivation level and the availability of patients and their families to change their behavior towards physical activity. Moderate-intensity physical activities have hardly any contraindications and the risks are few

Reducción de marcadores de disfunción endotelial mediante ejercicio en adultos sedentarios con lesión medular crónica / Reduction of exercise-mediated endothelial dysfunction markers in sedentary adults with chronic spinal cord injury

Fundamento y objetivo: La morbimortalidad cardiovascular se ha incrementado entre las personas con lesión medular crónica (LMC). Se planteó como objetivo determinar el efecto del ejercicio sobre marcadores de disfunción endotelial en adultos sedentarios con LMC. Método: Estudio prospectivo aleatorizado en 17 adultos varones con LMC a nivel o debajo de T5. Nueve de ellos realizaron un programa supervisado de ejercicios en ergómetro de manivela a intensidad moderada (12 semanas, 3 sesiones/semana). Se determinaron mediante enzimoinmunoanálisis los valores plasmáticos de endotelina-1, fracción soluble de la molécula de adhesión celular vascular tipo-1, y fracción soluble de la molécula de adhesión intercelular tipo-1 (sICAM-1), antes y después del programa de ejercicio. La capacidad aeróbica y el porcentaje de masa grasa también fueron evaluados. Resultados: Tras completar el programa de entrenamiento, tanto en el estudio comparativo como en el estudio antes-después, se observó una disminución significativa de los valores de endotelina-1 y fracción soluble de la molécula de adhesión intercelular tipo-1. Asimismo, se observó una mejora estadísticamente significativa de la capacidad aeróbica y la composición corporal. Conclusión: El ejercicio mejoró la disfunción endotelial en varones adultos con LMC (AU)

Background and objective: Recent studies have found increased markers of endothelial activation in men with chronic spinal cord injury. This study was conducted to determine the effects of arm-cranking exercise on endothelial dysfunction in male adults with chronic SCI. Method: A prospective randomized study of 17 sedentary adult males with chronic SCI at or under T5 level. Nine performed a supervised exercise program at a moderate intensity (arm-cranking: 12 weeks, 3 sessions/week). Plasma levels of endothelin-1, soluble intercellular adhesion molecule type 1 (sICAM-1), and soluble vascular adhesion molecule type 1 (sVCAM-1) were assessed by ELISA. Outcome measurements also included physical fitness and total body fat mass percentage. Results: We observed both in the randomized and in the before-after studies a significant reduction of the levels of endothelin-1 and sICAM-1. Furthermore, significant improvements of both physical fitness and body composition were also found. Conclusion: Arm-cranking exercise improved endothelial dysfunction in adult males with chronic SCI. Long-term studies are still required to determine whether the correction of endothelial dysfunction improves the clinical outcomes of adults with chronic SCI (AU)

Patrones de descanso, actividades físico-deportivas extraescolares y rendimiento académico en niños y niñas de primaria / Night-rest patterns, extracurricular sports activities and academic achievement in primary education students / Padrões de descanso, actividades físico-desportivas extra-escolares e rendimento académico em rapazes e rapa-rigas no 1º ciclo

The aim of this paper was to study the connection between students’ rest patterns (appropriate and inappropriate), accumulated hours of extracurricular physical and sports activities, and the academic results of primary school students. The sample includes 573 primary school students from Barcelona and the Balearic Islands (54.62% boys and 45.38% girls). An ad hoc questionnaire gathering both quantitative and qualitative data regarding sociodemographic and psychoeducational questions concerning rest patterns and extracurricular activities was completed by the parents. The study shows that the best academic marks were found as a result of both proper rest patterns and moderate after school exercise (2 to 5 hours a week). The study further reveals that the worst school grades were obtained in cases of inadequate rest patterns combined with a high number of hours of extracurricular sports activities (more than 5 hours a week)

El objetivo del trabajo consiste en estudiar si existe una relación entre patrones de descanso (adecuados e inadecuados), realización de determinado número de horas de actividades físico-deportivas extraescolares, y rendimiento académico en una muestra de 573 alumnos de primaria (54.62% niños y 45.38% niñas) de las provincias de Barcelona e Illes Balears. Un cuestionario con preguntas concernientes a aspectos sociodemográficos y preguntas específicas sobre evaluación cuantitativa y cualitativa del sueño y registro cuantitativo de las actividades extraescolares fue administrado a los padres de los alumnos. Los mejores resultados se observan como consecuencia de unos patrones de descanso adecuados y una práctica moderada del ejercicio físico (entre 2 y 5 horas a la semana). Asimismo, las peores notas escolares se obtienen cuando a unos patrones de descanso inadecuados, se une un elevado número de horas de actividades físico-deportivas extraescolares (más de 5 horas a la semana)

objectivo do trabalho consiste em estudar se existe uma relação entre padrões de descanso (adequados e inadequados), realização de umdeterminado número de horas de actividades físico-deportivas extra-escolares e o rendimento académico numa amostra de 573 alunos do primeiro ciclo (54.62 rapazes e 45.38% raparigas)das províncias de Barcelona e das Ilhas Baleares. Um questionário com perguntas relativas a aspectos sociodemográficos e perguntas específicas sobrea avaliação qualitativa e quantitativa do sono e registo quantitativo das actividades extra-escolares foi administrado aos pais dos alunos. Os melhores re-sultados são observados como consequência dos padrões de descanso adequados e uma prática moderada do exercício (entre 2 e 5 horas por semana).Adicionalmente, as piores notas escolares foram obtidas quando aos padrões de descanso inadequados se junta um elevado número de actividades fí-sico-deportivas extra-escolares (mais de 5 horas por semana)

Prescripción de ejercicio físico en la depresión por parte de Médicos de Familia. Factores involucrados / Prescrição de exercício físico na depressao por parte de médicos de família. factores envolvidos / Exercise prescription for depression by general practitioners, factors involved

El problema del sedentarismo es acuciante en sociedades desarrolladas y sus consecuencias para la salud de la población constituyen uno de los principales problemas de salud pública actuales. La depresión es un motivo de consulta muy habitual en las consultas de atención primaria de países occidentales. Se ha planteado la prescripción de ejercicio físico como una estrategia antidepresiva útil en depresiones leves-moderadas, con frecuencia de forma complementaria a los tratamientos de primera elección. Sin embargo, los médicos de atención primaria no siempre lo prescriben y se desconoce de qué depende que lo hagan. Contribuir a aclarar esta cuestión es el objetivo del presente trabajo. Nuestra hipótesis era que el grado de prescripción depende de sus opiniones y experiencia sobre el tratamiento de la depresión.Se trata de un estudio descriptivo transversal en el que participaron 13 centros de salud. Utilizamos el cuestionario Depression Questionaire Attitude para valorar la actitud de los médicos hacia la depresión, y recogimos otras variables relacionadas con la importancia que otorgaban al ejercicio físico y a otros aspectos del estilo de vida en la salud física y mental. Los resultados confirman que la actitud de los médicos frente a la depresión influye en su disposición a recomendar ejercicio físico. Además, los médicos de atención primaria con menos años de práctica profesional valoran más el papel del ejercicio físico en la salud, tanto en la depresión como en otras patologías médicas. También se observa una correlación entre la importancia que se da al ejercicio físico en la salud y la que se da a otros factores ligados al estilo de vida, especialmente la dieta. Se concluye que aunque la utilidad de recomendar ejercicio físico en la depresión va acercándose al mismo nivel de importancia que en otros problemas de salud, su empleo por parte de los médicos de atención primaria es muy mejorable. Por ello, es importante insistir en la necesidad de ofrecer apoyo y programas de formación continuada a los médicos de atención primaria para ayudarles en este propósito (AU)

A sedentary lifestyle is an urgent problem in developed societies and its consequences are one of the main current problems in public health. Depression is a common reason to attend primary care in Western countries. In many cases of low and mild depression, exercise is recommended as a complement to the main therapy: Psychotherapy and/or pharmacotherapy. Nevertheless, general practitioners do not always recommend exercise to depressive patients and it is unknown why they do not. The main aim of our study was to clarify how the degree of prescribing exercise relies on a general practitioner’s opinion and experience in depression treatment. A cross-sectional design was undertaken in 13 public health centers. The Depression Attitude Questionnaire (DAQ) was used to evaluate general practitioners’ attitude towards depression; other variables related to the importance accorded to physical exercise; and other lifestyle aspects of physical and mental health. Our results show that general practitioners’ attitude towards depression influence their willingness to recommend exercise. Moreover, less experienced general practitioners (in years) tend to appreciate the importance of exercise in health, not only in depression. A positive relationship was found between importance of exercise and importance accorded to other factors linked to lifestyle, especially diet. Although recommendation of exercise in depression is similar to other medical conditions, its prescription may be improved. Hence, it is important to point out the need for education programs for general practitioners, in order to improve their capacity to deal with their task (AU)

O problema do sedentarismo é premente nas sociedades desenvolvidas e as suas consequências para a saúde da população constituem umdos principais problemas de saúde pública actuais. A depressão é um motivo muito habitual nas consultas de cuidados primários nos países ocidentais.Foi delineada a prescrição de exercício físico como uma estratégia antidepressiva útil em depressões leves-moderadas, de forma complementar aostratamentos de primeira escolha. Contudo, os médicos de cuidados primários nem sempre o prescrevem e desconhece-se o porquê de o fazerem. Contribuirpara clarificar esta questão é o objectivo do presente trabalho. A nossa hipótese era que o grau de prescrição depende das suas opiniões e experiênciasno tratamento da depressão. Trata-se de um estudo descritivo transversal no qual participaram 13 centros de saúde. Utilizámos o questionário DepressionQuestionaire Attitudepara avaliar a atitude dos médicos face à depressão e medimos outras variáveis relacionadas com a importância que atribuíam aoexercício físico e a outros aspectos do estilo de vida na saúde física e mental. Os resultados confirmam que a atitude dos médicos face à depressão influína sua disposição para recomendar exercício físico. Adicionalmente, os médicos de cuidados primários com menos anos de prática profissional valorizammais o papel do exercício físico na saúde, tanto na depressão como noutras patologias médicas. Também se observa uma correlação entre a importânciaque se dá ao exercício físico na saúde e à que se dá a outros factores ligados ao estilo de vida, especialmente à dieta. Conclui-se que apesar da utilidadede recomendar exercício físico na depressão se ir aproximando do nível de importância atribuído a outros problemas de saúde, a sua utilização por partedos médicos de cuidados primários pode ser substancialmente melhorada. Para tal, é importante insistir na necessidade de oferecer apoio e programasde formação continuada aos médicos de cuidados primários para ajudá-los neste propósito

El papel de la carga mental en la planificación del entrenamiento deportivo1 / The role of metnal workload insport training planning / O papel da carga mental no planeamento do treino desportivo

Una de las claves que determinan el éxito del entrenamiento es la alternancia correcta entre esfuerzo y descanso. La acumulación de esfuerzo puede producir fatiga, con el consiguiente deterioro de la capacidad motriz del deportista. Su impacto a largo plazo sobre el organismo depende de la capacidad adaptativa del deportista ante los estímulos que la generaron. El sometimiento a cargas por encima de la capacidad adaptativa del deportista produce un estado de incapacidad funcional conocido con el término “sobreentrenamiento” y caracterizado por la pérdida de rendimiento y alteraciones emocionales (Goodger, Gorely, Lavallee y Harwood, 2007; Gould, 1996; Gould, y Dieffenbach, 2002; Kellmann, 2002). Los estímulos que determinan la carga del entrenamiento son de naturaleza física y mental. Aunque la repercusión de los primeros ha sido ampliamente estudiada, no sucede igual con la de los segundos. Por tanto, nuestro objetivo es (1) revisar el concepto de carga mental, incluyendo elementos de carga cognitiva y emocional; (2) profundizar en las repercusiones de la carga mental y la necesidad de controlarla en el entrenamiento, y (3) proponer aplicaciones para el diseño de tareas por parte del entrenador

One of the keys to achieving success in training is the correct alternation between exertion and rest. Accumulation of load causes fatigue, with a consequent deterioration of an athlete’s motor skills. This impact on the organism depends on the capacity of the athlete to adapt to the stimuli that generated it. Repetitive loads, systematically above the adaptive capacity of the athlete, can produce performance and mode deterioration in the form of dysfunctional overtraining or stalement. (Goodger, Gorely, Lavallee AND Harwood, 2007; Gould, 1996; Gould AND Dieffenbach, 2002; Kellmann, 2002). Loading stimuli can be physical and/or mental. Although the impact of the former has been widely studied, this is not the case with the latter. Therefore, our aim was (1) to review the concept of mental workload, including cognitive and emotional elements, (2) to explore the implications of controlling mental workload for training, and (3) to propose practical applications for designing training tasks

ma das chaves que determinam o êxito do treino é a alternância correcta entre esforço e descanso. A acumulação de esforço pode produzirfadiga, com o consequente deterioramento da capacidade motora do atleta. O seu impacto a longo prazo sobre o organismo depende da capacidade adap-tativa do desportista face aos estímulos que a originam. A exposição a cargas acima da capacidade adaptativa do atleta produz um estado de incapacidadefuncional denominado de “sobretreino” e caracterizado pela perda de rendimento e alterações emocionais (Goodger, Gorely, Lavallee e Harwood, 2007;Gould, 1996; Gould e Dieffenbach, 2002; Kellmann, 2002). Os estímulos que determinam a carga de treino são de natureza física e mental. Embora arepercussão dos primeiros tenha sido amplamente estudada, o mesmo não sucede com os segundos. Como tal, o nosso objectivo é (1) rever o conceitode carga mental, incluindo elementos de carga cognitiva e emocional; (2) aprofundar as repercussões da carga mental e a necessidade de controlá-la notreino, e (3) propor aplicações para o delineamento de tarefas por parte do treinador