Heart rate recovery in asthmastic children and adolescents after clinical field test.

BACKGROUND: Inflammation caused by chronic lung disease in childhood may lead to delayed heart rate recovery (HRR) however, there is lack of evidence on HRR in this population. The aim was to assess HRR after functional capacity testing in asthmatic children and adolescents and to compare with severity and disease control. METHOD: This was a study secondary to a randomized control trial. The modified shuttle test (MST) was performed to assess functional capacity and HRR. This is an externally cadenced test in which the distance walked is the outcome. HRR was assessed after MST and was defined as HR at exercise peak minus HR in the second minute after the end of exercise. Asthma control was assessed by the Asthma Control Test (ACT). Data normality was tested by Shapiro Wilk and the comparison between groups was made by Student's t test or Mann Whitney test for numerical variables, and by Chi-square test for categorical variables. Statistical significance was considered when p < 0.05. SPSS version 20 was used in the analyzes. RESULTS: The sample included 77 patients diagnosed with asthma (asthma group - AG) who were regularly treated for asthma. Control group (CG) consisted of 44 volunteers considered healthy, matched in age and gender to AG. The median age of CG was 12 (10-14) years and in AG 11 (9-13 years) being classified as mild to moderate asthmatic, and 57% of the sample had controlled asthma by ACT. Distance walked in the CG was 952 ± 286 m and AG 799 ± 313 m, p = 0.001. HRR was more efficient in CG (79 ± 15 bpm) compared to AG (69 ± 12 bpm), p = 0.001. The mild (69 ± 12 beats) and severe (72 ± 15 beats) AG presented worse HRR compared to control group (79 ± 15 bpm), p < 0.05. CONCLUSIONS: Asthmatic children and adolescents have delayed HRR after modified Shuttle test compared to their peers, suggesting that asthma leads to autonomic nervous system imbalance. TRIAL REGISTRATION: Registered in Clinical Trials under number NCT02383069 and approved by the Universidade Nove de Julho - UNINOVE Research Ethics Committee, protocol number 738192/2014.

Effectiveness of Physical Therapy Interventions in Children with Brachial Plexus Birth Injury: A Systematic Review.

AIM: To systematically review the effectiveness of physical therapy interventions in infants, children and adolescents with brachial plexus birth injury (BPBI). METHODS: Systematic review of randomized controlled trials including patients under 18 years old with BPBI was conducted on Medline, Cochrane, Embase, Amed and Pedro databases. Methodological quality was assessed by the PEDro score and quality of evidence by the GRADE system. The primary outcomes measured were range of motion, muscle strength and bone mineral density. RESULTS: Seven studies were included, two in infant and 5 in children, of 932 title and abstracts screened. The interventions, characteristics of the participants and outcomes were diverse. The largest effect was found when other intervention was combined with conventional physical therapy in the primary outcomes, with low quality of evidence. CONCLUSION: Physical therapy interventions alone or in combination with other treatment modalities are effective in improving short-term disabilities in children with BPBI.

Measurement properties of the six-minute pegboard and ring test (6PBRT) in healthy adolescents.

OBJECTIVES: To investigate the cardiorespiratory responses to the 6-min pegboard and ring test (6PBRT) and to assess its reproducibility in healthy adolescents. METHODS: It was a cross-sectional study with 52 healthy adolescents (11-18 years old of both genders). The 6PBRT was performed twice on two different days by the same examiner. Intra-rater reliability, percentage of the minimal difference chance (MDC%) and agreement of the number of moving rings were analyzed. Also, cardiopulmonary parameters were collected before and after tests. RESULTS: Intraclass correlation coefficient (ICC) for the number of rings moved was 0.87 (95%CI 0.69-0.93). The mean number of moved rings during the second test was higher. The MDC% with a 95 % confidence interval was greater than acceptable values. Bland-Altman analysis did not show agreement between measurements (bias = 30.1); with upper and lower limits of agreement of -67.8 to 127.9, respectively. There was a significant increase in dyspnea, fatigue and HR values at the end of the tests (p < 0.0001). In both tests, participants reached HR equivalent to 48 % of the maximum predicted. CONCLUSION: Together, the results suggest that the 6PBRT is not a reliable measure for a population of healthy adolescents, which indicates the necessity to perform more than one test. The 6PBRT is suggested to be a submaximal test for this population.

Whole body vibration in the static modified push-up position in untrained healthy women stimulates neuromuscular system potentiating increased handgrip myogenic response.

OBJECTIVE: To investigate the acute effect of whole-body vibration (WBV) on handgrip strength (HS) and electromyographic activity of the flexor digitorum superficialis muscle of healthy women in the static push-up position. METHODS: Twenty-eight women received four experimental tests in a randomized order: A) Control - rest in seating position with feet on the floor and hands in the supine position on the lower limbs. There was no vibration stimulus; B) Placebo - push-up position with their hands on the vibratory platform that remained disconnected, but with a sonorous stimulus mimicking the vibration; C) Low vibration and D) High vibration - push-up position with their hands on the vibratory platform using one of the vibratory stimulus intensity: low vibration: 25 Hz/2 mm/49.30 m s-2; or high vibration: 45 Hz/2 mm/159.73 m s-2. Participants remained 5 min in each situation. HS and electromyography (EMG) were performed at baseline and after all four experimental tests. The index of neural efficiency (i.e. the ratio between EMG and HS) was also calculated to determine the efficiency of muscle contraction. Statistical analysis was performed by ANOVA two-way design mixed test with Tukey's post hoc test, being considered significant p < 0.05. RESULTS: High vibration increased HS compared with all the other experimental tests (p = 0.0006, F = 6.03). There was a reduction of EMG activity of the flexor digitorum superficialis muscle only after high vibration (p = 0.0135, F = 6.22), which was accompanied by lower values of the index of neural efficiency after intervention (between-group difference, p = 0.0002, F = 0.674). CONCLUSION: WBV in the push-up position has an acute positive effect on HS accompanied by a lower index of neural efficiency, providing a better efficiency of muscle contraction.

Current evidence does not support whole body vibration in clinical practice in children and adolescents with disabilities: a systematic review of randomized controlled trial.

BACKGROUND: Whole body vibration has been used alone or combined with other interventions in rehabilitation of children and adolescents with disabilities; however, there is limited evidence to support this approach. OBJECTIVES: To review the strength, quality, and conclusiveness of evidence supporting the use of whole body vibration in children and adolescents with disabilities. METHODS: Electronic database search included Medline, AMED, Embase, Cochrane, SportDiscus, CINAHL and PEDro from the inception to June 2018. Studies investigating the effects of whole body vibration, alone or combined with other interventions, compared to minimal intervention or other interventions were included. The outcomes measured were: body structure and function (lean body mass, bone mineral density, knee muscle strength and overall stability) and activity and participation (gait speed, walking distance, gross motor function, self-care and mobility). RESULTS: Fifteen randomized trials involving 403 participants were included. Methodological quality of eligible trials was moderate (mean of 5.5 points on the 10-point PEDro scale). Overall, whole body vibration was no better than minimal intervention. In all comparisons where additional effect of whole body vibration was better than other interventions, the effect size ranged from low to high in the trials, but ranged from very-low to low quality at short and medium-term follow-up. Sensitivity analysis for health condition and low-quality studies showed impact on trunk bone mineral density of additional effect of whole body vibration at medium-term compared to other interventions. CONCLUSION: The low to very-low quality of evidence suggests caution in recommending the use of this approach. New studies could change the findings of this review. PROSPERO registration: CRD42017060704.

High-intensity interval training improves cerebellar antioxidant capacity without affecting cognitive functions in rats.

High-intensity interval training (HIIT) is associated with better physical performance, but there is limited information about the effects of HIIT on redox state of cerebellar tissue, cerebral cortex, and cognition. The aim of this study was to evaluate the effects of HIIT on redox state parameters in cerebellar tissue, cerebral cortex, and cognitive function of Wistar rats. Forty-three young male Wistar rats were housed under controlled environmental conditions with food, and water ad libitum. Animals were assigned to HIIT or Non-trained groups. HIIT protocol was performed during six weeks. Speed was determined through the assesstment of the maximum oxygen consumption (VO2max). HIIT consisted of short bouts (1 min) running on a treadmill at 10° inclination (85-100% of VO2max) with 2 min of active recovery (60% of VO2max, without inclination). Non-trained group was daily exposed to a disconnected treadmill for the same amount of time as HITT group. Both groups were submitted to the open field, and novel object recognition tasks after six weeks. Malondialdehyde concentration (MDA), superoxide dismutase (SOD) activity, and non-enzymatic antioxidant capacity (FRAP) were quantified to determine the redox state. HIIT presented increased levels of MDA, SOD, and FRAP (p < 0.05) in the cerebellar tissue, but no differences were seen in cerebral cortex. These results indicated an improved antioxidant capacity, despite increased MDA levels in the cerebellar tissue. Both groups did not present impairment in locomotor activity, development of anxious behavior or cognitive decline. HIIT enhanced the antioxidant defenses on cerebellar tissue with no deleterious effects on rats' cognition.

Prediction equation of peak oxygen uptake for the modified shuttle test in healthy adolescents / Equação de predição do consumo máximo de oxigênio para o shuttle test modificado em adolescentes saudáveis / Ecuación de predicción del consumo máximo de oxígeno para el shuttle test modificado en adolescentes sanos

ABSTRACT Given the gap in the literature regarding the peak of oxygen consumption (VO2peak) for adolescents of both sexes, this study aimed to propose an equation to predict the VO2peak in healthy adolescents using the Modified Shuttle Test (MST). This is a cross-sectional study with 84 healthy adolescents between 12 and 18 years old, female and male. The MST is an external paced test, in which the speed increases at each minute. Two MST were performed with at least 30 minutes of rest between them. The test with the longest walked distance was considered for analysis. VO2 was directly monitored by an open circuit spirometry. Mean age was 14.67±1.82 and the walked distance was 864.86±263.48m. Variables included in the prediction equation were walked distance and sex, explaining the VO2peak variability of 53% during MST performance. The prediction equation for VO2peak with the MST was: predicted VO2peak=18.274+(0.18×Distance Walked, meters)+(7.733×Sex); R2=0.53 and p<0.0001 (sex: 0 for girls, 1 for boys). This MST equation, proposed to predict VO2peak in healthy adolescents of both sexes, can be used as a reference to assess exercise capacity in healthy adolescents and to investigate cardiopulmonary function in adolescents with reduced functional capacity.

RESUMO Dada a lacuna na literatura quanto à equação de predição do pico de consumo de oxigênio (VO2) para adolescentes de ambos os sexos, o objetivo deste estudo é propor uma equação para predizer o VO2pico em adolescentes saudáveis utilizando o shuttle test modificado (MST). Trata-se de um estudo transversal realizado com 84 adolescentes saudáveis entre 12 e 18 anos, do sexo feminino e masculino. O MST é um teste de campo ditado por um sinal sonoro que indica o aumento da velocidade a cada minuto. Dois MSTs foram realizados com pelo menos 30 minutos de descanso entre eles. O teste com a maior distância percorrida foi o considerado para análise. O VO2 foi monitorado diretamente por uma espirometria de circuito aberto. A média de idade foi de 14,67±1,82 anos, e a de distância percorrida foi de 864,86±263,48m. As variáveis incluídas na equação de predição foram distância percorrida e sexo, que explicaram 53% da variabilidade do VO2pico durante a realização do MST. A equação de referência para o VO2pico previsto com o MST foi VO2pico predito=18,274+(0,18×Distância percorrida, em metros)+(7,733×Sexo); R2=0,53 e p<0,0001 (sexo: 0 para meninas, 1 para meninos). A equação do MST proposta para predizer o VO2pico em adolescentes saudáveis de ambos os sexos pode ser usada como referência para avaliar a capacidade de exercício em adolescentes saudáveis e investigar a função cardiopulmonar em adolescentes com capacidade funcional reduzida.

RESUMEN Dada una laguna en la literatura con respecto a la ecuación para predecir el consumo máximo de oxígeno (VO2) en adolescentes de ambos sexos, el objetivo de este estudio es proponer una ecuación para predecir el VO2máximo en adolescentes sanos usando el shuttle test modificado (MST). Se trata de un estudio transversal, realizado con 84 adolescentes sanos con edades entre 12 y 18 años, de ambos sexos. El MST es una prueba de campo dictada por una señal sonora que indica el aumento de velocidad cada minuto. Se realizaron dos MST con al menos 30 minutos de descanso entre ellos. Para el análisis se consideró la prueba con mayor distancia recorrida. El monitoreo del VO2 fue realizado directamente por espirometría de circuito abierto. La edad media fue de 14,67±1,82 años; y la distancia recorrida, de 864,86±263,48m. Las variables incluidas en la ecuación de predicción fueron la distancia recorrida y el sexo, que explicaron el 53% de la variabilidad del VO2máximo durante la realización del MST. La ecuación de referencia para el VO2máximo predicho con el MST fue VO2máximo previsto=18,274+(0,18×Distancia recorrida, en metros)+(7,733×Sexo); R2=0,53 y p<0,0001 (sexo: 0 para chicas, 1 para chicos). La ecuación MST propuesta para predecir el VO2máximo en adolescentes sanos de ambos sexos puede utilizarse como una referencia para evaluar la capacidad de ejercicio en adolescentes sanos y para investigar la función cardiopulmonar en adolescentes con capacidad funcional reducida.

Respostas cardiopulmonares durante o exercício de agachamento dinâmico com e sem vibração de corpo inteiro em adolescentes / Cardiopulmonary responses during dynamic squatting exercise with and without wholebody vibration in adolescents

INTRODUÇÃO: A vibração de corpo inteiro (VCI) tem sido amplamente utilizada como recurso terapêutico na reabilitação pediátrica. Porém, as respostas cardiopulmonares ainda são desconhecidas nesta população. OBJETIVOS: Investigar a intensidade do exercício de agachamento dinâmico com e sem VCI em adolescentes saudáveis a fim de caracterizar as respostas cardiorrespiratórias. MATERIAIS E MÉTODOS: Trata-se de um estudo quase experimental. Vinte e cinco adolescentes (14,1 ± 1,7 anos), 10 meninas e 15 meninos, foram submetidos a avaliações do consumo de oxigênio (VO2) e frequência cardíaca (FC) durante um protocolo de agachamento com e sem vibração. Os critérios de inclusão foram idade entre 12 e 18 anos, ambos os sexos, IMC normal. Os critérios de exclusão foram apresentar doenças neurológicas, ortopédicas, respiratórias, cardíacas e endócrinas crônicas ou agudas ou alguma contraindicação autorreferida para VCI (trombose venosa profunda, implantes metálicos, marca-passo, epilepsia, tumores, aneurisma ou arritmia). RESULTADOS: A VCI aumentou significativamente o VO2, FC e a percepção do esforço durante o agachamento quando comparado ao repouso e agachamento sem-VCI. VCI associada ao agachamento atingiu 24,7% do VO2máx e 56% da FCmáx prevista para a idade. Os indivíduos durante a VCI relataram esforço entre ligeiramente cansativo e cansativo em comparação com entre muito fácil e fácil no protocolo Sem-VCI. CONCLUSÃO: O agachamento associado à VCI foi considerado de intensidade leve e foi tolerado por adolescentes saudáveis. Este estudo forneceu resultados válidos desta modalidade de exercício e pode ser utilizado como uma ferramenta para definir o consumo de energia gasto durante a prática deste tipo treinamento.

BACKGROUND: Whole-body vibration (WBV) has been widely used as a therapeutic resource in pediatric rehabilitation. However, the cardiopulmonary responses are still unknown. OBJECTIVE: To investigate the intensity of dynamic squatting exercise with and without WBV in healthy adolescents to characterize cardiorespiratory responses. METHODS: This was a quasi-experimental study. Twentyfive adolescents (14.1 ± 1.7 years), 10 girls and 15 boys, underwent into oxygen consumption (VO2) and heart rate (HR) assessments during a protocol of squatting with and without vibration. Inclusion criteria were age between 12 and 18 years old of both sexes, have normal weight according to BMI. Exclusion criteria were to present chronic or acute, neurological, orthopedic, respiratory, cardiac, and endocrine disease and no self-reported contraindication for WBV (i.e. deep vein thrombosis, metal implants, pacemaker, epilepsy, tumors, arterial aneurysm, or arrhythmia). RESULTS: WBV was able to significantly increase VO2, HR, and perceived exertion during squatting exercise when compared to rest and squatting without-WBV. WBV associated with squatting reached 24.7% of the VO2max and 56% of the HRmax predicted for the age. Subjects during WBV reported a perceived exertion score between somewhat hard and hard compared to between very light and light in the Without-WBV protocol. CONCLUSION: Squatting associated with WBV was considered a light-intensity exercise that can be tolerated by healthy adolescents. This study provided valid results of this training modality and could be used as a tool to define the energy consumption spent in this training modality.