Ana Claudia de Souza Fortaleza

Dual task interference on postural sway, postural transitions and gait in people with Parkinson's disease and freezing of gait

Freezing of gait (FoG) is associated with less automatic gait and more impaired cognition, balance and postural transitions compared to people with PD who do not have FoG. However, it is unknown whether dual-task cost during postural sway, postural transitions (such as gait initiation and turning), and gait are more in subjects with Parkinsons disease (PD) who have freezing of gait (FoG+) compared to those who do not have FoG (FoG-). Here, we hypothesized that the effects of a cognitive dual task on postural sway, postural transitions and gait would be larger in FoG+ than FoG-. Thirty FoG- and 24 FoG+ performed an Instrumented Stand and Walk test in OFF medication state, with and without a secondary cognitive task (serial subtraction by 3s). Measures of postural sway, gait initiation, turning, and walking were extracted using body-worn inertial sensors. FoG+ showed significantly larger dual task cost than FoG- for several gait metrics, but not during postural sway or postural transitions. During walking, FoG+ exhibited a larger dual task cost than FoG- resulting in shorter stride length and slower stride velocity. During standing, FoG+ showed a larger postural sway compared to FoG- and during gait initiation, FoG+, but not FoG-, showed a longer first step duration during the dual-task condition compared to single-task condition (interaction effect, p=0.04). During turning, both groups showed a slower turn peak speed in the dual-task condition compared to single task condition. These findings partly support our hypothesis that dual task cost on walking is greater in FoG+ than FoG-.

Combined Training (Aerobic Plus Strength) Potentiates a Reduction in Body Fat but Demonstrates No Difference on the Lipid Profile in Postmenopausal Women When Compared With Aerobic Training With a Similar Training Load

Abstract Rossi, FE, Fortaleza, ACS, Neves, LM, Buonani, C, Picolo, MR, Diniz, TA, Kalva-Filho, CA, Papoti, M, Lira, FS, and Freitas Junior, IF. Combined training (aerobic plus strength) potentiates a reduction in body fat but demonstrates no difference on the lipid profile in postmenopausal women when compared with aerobic training with a similar training load. J Strength Cond Res 30(1): 226–234, 2016—The aim of this study was to verify the effects of aerobic and combined training on the body composition and lipid profile of obese postmenopausal women and to analyze which of these models is more effective after equalizing the training load. Sixty-five postmenopausal women (age = 61.0 ± 6.3 years) were divided into 3 groups: aerobic training (AT, n = 15), combined training (CT [strength + aerobic], n = 32), and control group (CG, n = 18). Their body composition upper body fat (TF), fat mass (FM), percentage of FM, and fat-free mass (FFM) were estimated by dual-energy x-ray absorptiometry. The lipid profile, total cholesterol, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein cholesterol were assessed. There was a statistically significant difference in the TF (AT = −4.4%, CT = −4.4%, and CG = 1.0%, p = 0.001) and FFM (AT = 1.7%, CT = 2.6%, and CG = −1.4%, p = 0.0001) between the experimental and the control groups. Regarding the percentage of body fat, there was a statistically significant difference only between the CT and CG groups (AT = −2.8%, CT = −3.9%, and CG = 0.31%; p = 0.004). When training loads were equalized, the aerobic and combined training decreased core fat and increased FFM, but only the combined training potentiated a reduction in percentage of body fat in obese postmenopausal women after the training program. High-density lipoprotein-c levels increased in the combined group, and the chol/HDL ratio (atherogenic index) decreased in the aerobic group; however, there were no significant differences between the intervention programs. Taken together, both the exercise training programs were effective for improving body composition and inducing an antiatherogenic status.

Efeito de um programa de treinamento funcional de curta duração sobre a composição corporal de mulheres na pós-menopausa

OBJETIVO: Avaliar o efeito de 8 semanas de treinamento funcional sobre a composicao corporal de mulheres na pos-menopausa.METODOS: Participaram do estudo 38 mulheres menopausadas, distribuidas em dois grupos: Grupo Treino (GT) e Grupo Controle (GC). As participantes do GT (n=21) realizaram, por um periodo de 8 semanas, um programa de exercicios fisicos, com frequencia de 3 vezes por semana, em dias nao consecutivos, e duracao de 90 minutos por sessao. Pelo mesmo periodo, as mulheres do GC (n=17) nao realizaram nenhum tipo de atividade fisica sistematizada. Todas as participantes foram avaliadas no momento inicial da pesquisa e apos 8 semanas. As avaliacoes foram conduzidas pelos mesmos avaliadores treinados. A analise da composicao corporal foi realizada no equipamento de absortiometria de raios X de dupla energia (DEXA) que permite estimar a composicao corporal no todo e por segmento. As participantes do GT realizaram um programa de exercicios fisicos funcionais, 3 dias da semana (nao consecutivos), com sessoes compostas por 11 estacoes de exercicios desenvolvidas em formato de circuito. Os exercicios realizados tinham como proposta o desenvolvimento das capacidades forca, agilidade, coordenacao e propriocepcao, e eram seguidos de exercicio aerobio (caminhada). Depois de constatada normalidade dos dados verificada pelo teste Shapiro-Wilk (p<0,05), procedeu-se ao teste t de Student para amostras independentes para verificacao de possiveis diferencas em variaveis de composicao corporal e antropometricas entre grupos nos dois momentos da intervencao (pre e pos-teste). Todas as analises foram realizadas com o software SPSS, v. 17.0 (SPSS Inc., Chicago, IL, USA) com valor de significância estabelecido em 5%.RESULTADOS: No momento inicial nenhuma diferenca significante foi observada entre as variaveis de composicao corporal, antropometricas e idade, indicando homogeneidade dos grupos. Apos 8 semanas de treinamento, foram observadas diferencas significativas entre o GT e o GC quanto a gordura de tronco - GC=0,2±0,7 e GT=-0,4±0,5, gordura corporal total (kg) - GC=0,2±1,3 e GT=-0,7±0,8 e no peso total - GC=0,4±1,4 e GT =-0,6±1,1. A variavel percentual de gordura total apresentou reducao nos valores absolutos, porem sem significância, GC=0,1±1,5 e GT=-0,8±1,5.CONCLUSAO: O treinamento funcional no formato de circuito pode ser usado como estrategia para alteracao da composicao corporal de mulheres na pos-menopausa, em especial na reducao do tecido adiposo. Trata-se de um modelo que promove elevada aderencia dos seus participantes, sugerindo ser uma proposta atrativa para a faixa etaria investigada.

Relationship between moderate-to-vigorous physical activity, abdominal fat and immunometabolic markers in postmenopausal women.

OBJECTS To assess the burden of levels of physical activity, non-esterified fatty acids (NEFA), triacylglycerol and abdominal fat on the immunometabolic profile of postmenopausal women. STUDY DESIGN Forty-nine postmenopausal women [mean age 59.43 (standard deviation 5.61) years] who did not undertake regular physical exercise participated in this study. Body composition was assessed using dual-energy X-ray absorptiometry, and levels of NEFA, tumour necrosis factor-α, adiponectin, insulin and triacylglycerol were assessed using fasting blood samples. The level of physical activity was assessed using an accelerometer (Actigraph GTX3x), and reported as counts/min, time spent undertaking sedentary activities and time spent undertaking moderate-to-vigorous physical activity (MVPA). The following conditions were considered to be risk factors: (i) sedentary lifestyle (<150min of MVPA per week); (ii) high level (above median) of abdominal fat; and (iii) hypertriacylglycerolaemia (<150mg/dl of triacylglycerol). RESULTS In comparison with active women, sedentary women had higher levels of body fat (%) (p=0.041) and NEFA (p=0.064). Women with higher levels of abdominal fat had impaired insulin resistance (HOMA-IR) (p=0.016) and spent more time undertaking sedentary activities (p=0.043). Moreover, the women with two risk factors or more had high levels of NEFA and HOMA-IR (p<0.05), as well as an eight-fold higher risk of a high level of NEFA, independent of age (p<0.05). No significant relationship was found between levels of physical activity, abdominal fat, tumour necrosis factor-α and adiponectin (p>0.05). CONCLUSION Postmenopausal women with a combination of hypertriacylglycerolaemia, a high level of abdominal fat and a sedentary lifestyle are more likely to have metabolic disturbances.

Gordura corporal total e do tronco e o desempenho da marcha em mulheres na menopausa

OBJETIVO: Verificar a relacao entre gordura corporal total e de tronco com o desempenho da marcha em mulheres na menopausa.METODOS: Trinta e nove mulheres na menopausa, com idade de 50 anos ou mais, foram avaliadas. As avaliacoes foram: peso e estatura para calculo do indice de massa corporal (IMC), composicao corporal pela tecnica de Dual-Energy X-ray Absorptiometry (DEXA) e marcha utilizando um baropodometro. As variaveis de composicao corporal utilizadas foram gordura corporal total, percentual de gordura corporal e gordura de tronco, enquanto as variaveis da marcha foram porcentagem de tempo de duplo apoio e de apoio simples e velocidade. As mulheres foram divididas de acordo com a mediana em dois grupos para cada variavel da composicao corporal: menos e mais gordura corporal, menos e mais percentual de gordura e menos e mais gordura de tronco. Para comparar as variaveis de marcha nesses grupos, foi utilizado o teste de Mann-Whitney. Para avaliar as possiveis relacoes entre as variaveis de composicao corporal e marcha, o teste de correlacao de Spearman foi utilizado. Todas as analises foram realizadas com nivel de significância de 5%.RESULTADOS: O grupo com mais gordura de tronco, quando comparado com o grupo com menos gordura de tronco, apresentou maiores valores de duplo apoio (p=0,007) e menores valores de apoio simples (0,03). Foram encontradas correlacoes significativas e positivas entre gordura de tronco e duplo apoio (R=0,40) e negativas entre gordura de tronco e apoio simples (R=-0,32).CONCLUSAO: Mulheres na menopausa que apresentam maiores quantidade de gordura no tronco tendem a apresentar desempenho prejudicado na marcha.

Diabetic peripheral neuropathy in ankles and feet: muscle strength and plantar pressure

This study aims to evaluate and correlate the vascular, sensory and motor components related to the plantar surface in individuals with diabetic peripheral neuropathy. 68 patients were categorized into two groups: 28 in the neuropathic group and 40 in the control group. In each patient, we assessed: circulation and peripheral perfusion of the lower limbs; somatosensory sensitivity; ankle muscle strength; and pressure on the plantar surface in static, dynamic and gait states. We used the Mann–Whitney test and analysis of variance (ANOVA and MANOVA) for comparison between groups, and performed Pearson and Spearman linear correlations amongst the variables (P < 0.05). The somatosensory sensitivity, peripheral circulation and ankle muscle strength were reduced in the neuropathic group. In full peak plantar pressures, no differences were seen between groups, but differences did appear when the foot surface was divided into regions (forefoot, midfoot and hindfoot). In the static condition, the plantar surface area was greater in the neuropathic group. In the dynamic state, peak pressures in the neuropathic group, were higher in the forefoot and lower in the hindfoot, as well as lower in the hindfoot during gait. There were positive or negative correlations between the sensitivity deficit, dorsal ankle flexor strength, plantar surface area, and peak pressure by plantar region. The sensitivity deficit contributed to the increased plantar surface area.

Changes in HDL-c concentrations after 16 weeks of combined training in postmenopausal women: characteristics of positive and negative responders

This study aimed to investigate the individual characteristics of body composition and metabolic profile that could explain interindividual variation in high-density lipoprotein cholesterol (HDL-c) concentrations in response to 16 weeks of combined strength plus aerobic (combined) training in postmenopausal women. The participants were divided into tertiles based on percentage of changes in HDL-c concentrations after combined training. Only women in the upper tertile (positive responders: Δ > 10.4%; n = 19) and lower tertile (negative responders: Δ < -1.4%; n = 19) were considered for analyses. The total body fat (BF), trunk fat (TF), android fat (AF), gynoid fat, and lean body mass were estimated by dual-energy X-ray absorptiometry. The metabolic profile - glucose, triacylglycerol, total cholesterol, HDL-c, low-density lipoprotein cholesterol, and very-low-density lipoprotein (VLDL) - were assessed. After 16 weeks, both positive and negative responders presented similar improvement in body composition, such as a decrease in percentage and kilograms of BF, TF, and AF, and increase in lean body mass (p value for time < 0.05). As expected, there was an effect of time and also a significant interaction (time vs. group) (p value < 0.001) in the improvement of HDL-c, with higher values for positive responders. Regarding metabolic profile, there were significant interactions (time vs. group) for triacylglycerol (p value = 0.032) and VLDL (p value = 0.027) concentrations, with lower values for positive responders. Our results suggests there is heterogeneity in combined training-induced HDL-c changes in postmenopausal women, and the positive responders were those who presented more pronounced decreases in triacylglycerol and VLDL concentrations.

Weekly time spent in the standing position is independently related to a better quality of life in postmenopausal women

OBJECTIVES To analyze the relationship between standing, sitting and reclining behaviors and quality of life in postmenopausal women. STUDY DESIGN Cross-sectional study composed of forty postmenopausal women (aged 59.58±5.32) who do not practice regular physical exercise. Body composition was measured using Dual-energy X-ray absorptiometry and quality of life by the Short Form 36 Health Survey (SF-36). Physical activity level was assessed using an accelerometer (Actigraph GTX3x) and is reported as minutes per week of moderate-to-vigorous physical activity (MVPA). Inclinometer analysis was also measured using this accelerometer model and reported as a weekly percentage of time spent standing, sitting and reclining. All analyses were performed using SPSS 17.0 software with the significance level set at 5%. RESULTS The percentage of time in the standing position was lower among women with poor quality of life (p<0.05). Adjusted analysis (age, years since menopause, percentage of fat mass, MVPA and occupation status) was used to evaluate the relationship between quality of life and accelerometer inclinometer measures. The relationship between time standing and general health status (β=0.353; 95%CI=0.017; 0.377), social function (β=0.429; 95%CI=0.060; 0.396) and overall score (β=0.336; 95%CI=0.015; 0.442) were statistically significant. The relationship between the reclining position and both overall score (β=-0.320; 95%CI=-0.492; 0.006) and emotional aspects (β=-0.337; 95%CI=-0.191; 0.001) showed a tendency to present statistical significance. CONCLUSION In summary, our results suggest that postmenopausal women who spend more time in the standing position have a better overall quality of life regardless of confounders.

Is dynamometry able to infer the risk of muscle mass loss in patients with COPD

Introduction Sarcopenia is characterized by a progressive and generalized decrease of strength and muscle mass. Muscle mass loss is prevalent in patients with chronic obstructive pulmonary disease (COPD) as a result of both the disease and aging. Some methods have been proposed to assess body composition (and therefore identify muscle mass loss) in this population. Despite the high accuracy of some methods, they require sophisticated and costly equipment. Aim The purpose of this study was to infer the occurrence of muscle mass loss measured by a sophisticated method (dual energy X-ray absorptiometry [DEXA]) using a more simple and affordable equipment (dynamometer). Methods Fifty-seven stable subjects with COPD were evaluated for anthropometric characteristics, lung function, functional exercise capacity, body composition, and peripheral muscle strength. A binary logistic regression model verified whether knee-extension strength (measured by dynamometry) could infer muscle mass loss (from DEXA). Results Patients with decreased knee-extension strength were 5.93 times more likely to have muscle mass loss, regardless of sex, disease stage, and functional exercise capacity (P=0.045). Conclusion Knee-extension dynamometry was able to infer muscle mass loss in patients with COPD.

Parkinson’s disease does not alter automatic visual-motor coupling in postural control

This study examined the coupling between visual information and body sway in patients with Parkinsons disease (PD) compared with healthy controls. Postural control performance was compared between 14 patients with PD (age: 69.6 ± 8.8 years - stages 1-3 of the Hoehn and Yahr scale) and 14 healthy control participants (age: 68.6 ± 3.0 years). Participants stood upright in a moving room that remained motionless or continuously oscillated in the anterior-posterior direction. Ten trials were performed in the following conditions: no movement of the room (1 trial) and with the room moving at frequencies of 0.1, 0.17, and 0.5 Hz (3 trials each frequency). Body sway and moving room displacement were recorded. The results indicated that patients with PD displayed larger body sway magnitude in the stationary room condition. Body sway of patients with PD was induced by visual manipulation in all three visual stimulus frequencies, but body sway of patients with PD was less coherent compared to that of the control participants. However, no difference was observed in the visual-body sway coupling structure. These results indicate that patients with PD can unconsciously couple body sway to visual information in order to control postural sway in a similar manner to healthy participants with intact visual-motor coupling for posture control. However, this coupling is marked by greater variability, indicating that people with PD have a motor system with greater inherent noise leading to a more varied behavior.