Treinamento muscular respiratório em idosos: estudo de revisão / Respiratory muscle training in older adults: review article

OBJECTIVE: Respiratory muscle training has been considered one of the main strategies to alleviate sarcopenia in older adults. Therefore, the present study aimed to verify which respiratory muscle training protocols are most used in this population and their main benefits described in the literature. METHODS: A literature search was performed in the electronic databases PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SciELO). For this, we used the terms: respiratory muscle training, older adults, and muscle weakness. A total of 80 articles were studied, of which only 8 met the inclusion criteria of this study, whose methodology, variables studied, and outcome were analyzed. RESULTS: Among the 8 articles analyzed, we can observe an important diversity of the studied protocols; and all articles showed the most varied gains possible with respiratory muscle training. CONCLUSION: The protocols used in the various studies depend directly on the objective to be achieved with respiratory muscle training; and the main outcomes were improvements in strength, lung function, physical fitness level, quality of life, inflammatory markers and glucose intake.

OBJETIVO: O treinamento muscular respiratório vem sendo considerado uma das principais estratégias para amenizar a sarcopenia em idosos, portanto, o presente estudo teve por objetivo verificar quais protocolos de treinamento muscular respiratório são mais utilizados em idosos e os seus principais benefícios encontrados na literatura. MÉTODOS: Foi realizada pesquisa bibliográfica nas bases de dados eletrônicas PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO). Para tanto, foram utilizados os termos: treinamento muscular respiratório, idosos e fraqueza muscular. Foi estudado um total de 80 artigos, dos quais apenas 8 preencheram os critérios de inclusão deste estudo, cuja metodologia, variáveis estudadas e desfecho foram analisados. RESULTADOS: Dos oito artigos analisados, podemos observar uma importante diversidade dos protocolos estudados; e em todos os artigos foram encontrados ganhos dos mais variados possíveis com o treinamento muscular respiratório. CONCLUSÃO: Os protocolos utilizados nos diversos estudos dependem diretamente do objetivo a ser alcançado com o treinamento muscular respiratório; e os principais desfechos foram a melhora na força, na função pulmonar, no nível de aptidão física, na qualidade de vida, em marcadores inflamatórios e no consumo da glicose.

Funcionalidade e qualidade de vida em indivíduos com linfedema unilateral em membro inferior: um estudo transversal / Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study

O linfedema de membros inferiores é uma doença crônica decorrente de dano no sistema linfático que influencia a mobilidade, a funcionalidade e a qualidade de vida dos indivíduos. Questionários e o teste físico são métodos bastante práticos, de fácil aplicação e baixo custo, que fornecem dados importantes para a avaliação desses pacientes. Objetivos Avaliar a influência do linfedema unilateral de membro inferior na funcionalidade e na qualidade de vida, correlacionando três ferramentas de avaliação. Métodos Estudo descritivo com 25 indivíduos com linfedema unilateral em membro inferior, de ambos os sexos. Foi avaliada a perimetria e foram aplicados The Medical Outcome Study Short Form-36 Health Survey (SF-36) para avaliação da qualidade de vida, Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) para estudo das habilidades físicas, mentais e sociais relacionadas ao linfedema e o Timed Up and Go (TUG) para avaliação da funcionalidade. Resultados Houve a presença de linfedema em todo o membro inferior dos participantes. Os domínios mais prejudicados pelo linfedema foram os aspectos físicos (25,0 ± 31,4) e emocionais (36,0 ± 42,9) no SF-36 e o domínio mobilidade (6,0 ± 2,6) no Lymph-ICF-LL. O TUG foi realizado em 9,88 ± 1,98 s. Houve correlação entre o TUG e os questionários e entre os dois questionários utilizados. Conclusões Indivíduos com linfedema unilateral em membro inferior apresentam um impacto negativo na qualidade de vida e na funcionalidade avaliadas através de questionários, que correlacionam entre si. Não foi encontrada alteração no TUG, mas houve correlação entre ele e os questionários utilizados

Lymphedema of the lower limbs is a chronic disease caused by damage to the lymphatic system that influences people's mobility, functionality, and quality of life. Questionnaires and physical test are very practical, easy to apply, and low cost methods that provide important data for evaluation of these patients. Objectives To evaluate the influence of unilateral lower limb lymphedema on functionality and quality of life, correlating 3 assessment tools. Methods This was a descriptive study investigating 25 patients of both sexes with unilateral lymphedema in a lower limb. Limb volume was assessed using circumferential tape measurements, the Medical Outcomes Study Short Form-36 Health Survey (SF-36) was used to assess quality of life, the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) was used to assess physical, mental, and social skills related to lymphedema, and the Timed Up and Go (TUG) test was used for functional assessment. Results Lymphedema was present throughout the affected lower limb of participants. The domains most affected by lymphedema were physical aspects (25.0 ± 31.4) and emotional aspects (36.0 ± 42.9) from the SF-36 and the mobility domain (6.0 ± 2.6) from the Lymph -ICF-LL. Patients performed the TUG in 9.88 ± 1.98 seconds. The TUG was correlated with the questionnaires and the questionnaires were correlated with each other. Conclusions People with unilateral lower limb lymphedema exhibited negative impacts on quality of life and functionality, as evaluated by questionnaires, which were correlated with each other. TUG performance was within normal limits, but results correlated with the questionnaires used

The effect of inspiratory muscle training on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults: a randomized controlled trial / O efeito do treinamento muscular inspiratório em idosos sobre a qualidade de vida, resposta imune, força muscular inspiratória e de membros inferiores: um ensaio clínico randomizado

Abstract Objective: To evaluate the impact of inspiratory muscle training (IMT) on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults. Method: A randomized clinical trial was conducted with 30 institutionalized older adults. They were allocated into two groups: the IMT group (n=15), which underwent IMT with PowerBreathe Classic, using a load of 60% of maximal inspiratory pressure (MIP). This was performed using a 30 repetition protocol, three times a week, for six weeks. The second group was the control group (n=15) which did not perform any type of therapeutic intervention. In both groups, MIP, lower limb strength by sit-up test, quality of life by the SF-36 questionnaire and C-reactive protein (CRP) were evaluated. Results: The results demonstrated the homogeneity between the groups regarding the demographic and clinical variables. The IMT group showed an increase in the variation of MIP (9.20±7.36 cmH2O) compared to the control (0.93±8.79 cmH2O). Improvement was also observed in the sitting and standing test (p<0.05) (Tukey Test) in the difference between the values ​​before and after the IMT. In terms of quality of life, two of the eight SF-36 domains were influenced by the IMT, namely: functional capacity and limitations due to physical factors. There were no changes in CRP in either group. Conclusion: IMT improved the inspiratory muscle strength, lower limb strength and quality of life of institutionalized older adults. These findings reinforce the contribution of this therapy to reducing the deleterious effects of aging.

Resumo Objetivo: Avaliar o impacto do treinamento muscular inspiratório (TMI) sobre a qualidade de vida, resposta imune, força muscular inspiratória e de membros inferiores de idosos. Método: Trata-se de um ensaio clínico randomizado, realizado com 30 idosos institucionalizados. Eles foram alocados em dois grupos, Grupo TMI (n=15): TMI com o PowerBreathe Classic, usando carga de 60% da pressão inspiratória máxima (PIM). O TMI foi realizado através de um protocolo de 30 repetições, três vezes por semana, durante seis semanas; e Grupo controle (n=15): não realizavam nenhum tipo de intervenção terapêutica. Em ambos os grupos foram avaliadas a PIM, a força de membros inferiores pelo teste de sentar-levantar, a qualidade de vida pelo questionário SF-36 e a proteína C reativa (PCR). Resultados: Os resultados demonstraram a homogeneidade entre os grupos em relação às variáveis demográficas e clínicas. O grupo TMI apresentou um aumento da variação da PIM (9,20±7,36cmH2O) comparado ao controle (0,93±8,79 cmH2O). Foi observada ainda melhora no teste de sentar e levantar (p<0,05) (teste de Tukey) na diferença entre os valores antes e após o TMI. Em relação à qualidade de vida, dois dos oito domínios do SF-36 sofreram influência do TMI, são eles: capacidade funcional e limitações por aspectos físicos. Não ocorreram mudanças na PCR em nenhum dos grupos. Conclusão: o TMI foi capaz de melhorar a força muscular inspiratória, a força de membros inferiores, e a qualidade de vida de idosos institucionalizados. Estes achados reforçam a contribuição desta terapêutica em reduzir os efeitos deletérios do envelhecimento.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients

OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Post-splenectomy infections in chronic schistosomiasis as a consequence of bacterial translocation

INTRODUCTION : Bacterial translocation is the invasion of indigenous intestinal bacteria through the gut mucosa to normally sterile tissues and internal organs. Schistosomiasis may cause alterations in the immune system and damage to the intestines, portal system and mesenteric lymph nodes. This study investigated bacterial translocation and alterations in the intestinal microbiota and mucosa in schistosomiasis and splenectomized mice. METHODS : Forty female 35-day-old Swiss Webster mice were divided into the following four groups with 10 animals each: schistosomotic (ESF), splenectomized schistosomotic (ESEF), splenectomized (EF) and control (CF). Infection was achieved by introduction of 50 Schistosoma mansoni (SLM) cercariae through the skin. At 125 days after birth, half of the parasitized and unparasitized mice were subjected to splenectomy. Body weights were recorded for one week after splenectomy; then, the mice were euthanized to study bacterial translocation, microbiota composition and intestinal morphometry. RESULTS : We observed significant reductions in the weight increases in the EF, ESF and ESEF groups. There were increases of at least 1,000 CFU of intestinal microbiota bacteria in these groups compared with the CF. The EF, ESF and ESEF mice showed decreases in the heights and areas of villi and the total villus areas (perimeter). We observed frequent co-infections with various bacterial genera. CONCLUSIONS : The ESEF mice showed a higher degree of sepsis. This finding may be associated with a reduction in the immune response associated with the absence of the spleen and a reduction in nutritional absorption strengthened by both of these factors (Schistosoma infection and splenectomy). .