Anselmo de Athayde Costa e Silva

Physical Activity and Improved Diastolic Function in Spinal Cord-Injured Subjects.

PURPOSE Subjects with spinal cord injury (SCI) have been reported to present impaired left ventricular (LV) diastolic function in comparison with able-bodied (AB) ones. The present study investigated the effect of regular physical activity on the cardiac structure and function of SCI subjects. METHODS Fifty-eight SCI men (29 sedentary [SCI-S] and 29 athletes [SCI-A]) and 29 AB men were cross-sectionally evaluated by clinical, laboratory, hemodynamic, and echocardiographic analysis. All enrolled subjects were normotensive, nondiabetic, nonsmoker, and normolipemic, and the studied groups presented similar age and body mass index. RESULTS SCI-S presented similar LV structural and systolic parameters but higher E/Em (8.0 ± 0.5) and lower Em/Am (1.18 ± 0.09) ratios than SCI-A and AB (E/Em = 6.4 ± 0.3 and 5.9 ± 0.3, respectively; Em/Am = 1.57 ± 0.12 and 1.63 ± 0.08, respectively; all P < 0.05 compared with SCI-S). Analysis of SCI individuals according to injury level revealed that tetraplegic athletes had similar features compared with sedentary tetraplegic subjects, except for higher Em (10.9 ± 0.6 vs 8.6 ± 0.7 cm s, P < 0.05) and lower E/Em ratio (6.3 ± 0.4 vs 8.8 ± 0.8, P < 0.05), whereas paraplegic athletes had similar features compared with sedentary paraplegic individuals, except for higher LV end-diastolic diameter (49.4 ± 1.4 vs 45.0 ± 1.0 mm, P < 0.05) and Em/Am ratio (1.69 ± 0.20 vs 1.19 ± 0.08, P < 0.05) and lower LV relative wall thickness (0.330 ± 0.012 vs 0.369 ± 0.010, P < 0.05) and heart rate (67.1 ± 4.2 vs 81.9 ± 2.8 bpm, P < 0.05). CONCLUSION Regular physical activity is associated with improved LV diastolic function in SCI subjects and might exert distinct cardiac structural effects in tetraplegic and paraplegic subjects.

Physical activity is associated with improved subclinical atherosclerosis in spinal cord injury subjects independent of variation in traditional risk factors.

injury subjects independent of variation in traditional risk factors☆ Jose R. Matos-Souza , Anselmo A. Silva , Luis F. Campos , Debora Goulart , Roberto Schreiber , Guilherme de Rossi , Jose A. Pio-Magalhaes , Mauricio Etchebehere , Jose I. Gorla , Alberto Cliquet Jr. , Wilson Nadruz Jr. a,⁎ a Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil b School of Physical Education, State University of Campinas, Campinas, SP, Brazil c Department of Orthopaedics, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil d Department of Electrical Engineering, University of Sao Paulo (USP), Sao Carlos, SP, Brazil

Sports injuries in Paralympic track and field athletes with visual impairment

PURPOSE The aims of this study were to determine the epidemiology, nature, and pattern of sports injuries in Brazilian Paralympic track and field athletes with visual impairment and to assess differences between visual classes and sex. METHODS Forty visually impaired elite Paralympic athletes participated in this study (28 males and 12 females). All athletes competed in International Paralympic competitions between 2004 and 2008. According to the visual classification, 14 athletes were T/F11, 15 were T/F12, and 11 were T/F13. A standardized report form was used to collect injury data during five competitions. RESULTS Thirty-one athletes reported 77 sports injuries, with a prevalence of 78%, a clinical incidence of 1.93 injuries per athlete, and an incidence rate of 0.39 injuries per athlete per competition. Overuse injuries accounted for 82% and traumatic injuries 18% (P < 0.05). Small variations in the prevalence and clinical incidence of injury between sexes and visual classes were observed, but these were not statistically different (P > 0.05). The highest distribution of injury was in the lower limbs (87%), followed by spine (12%) and upper limbs (1%). The body regions most affected were the thighs (33.8%), lower legs (16.9%), and knees (9.1%). The most frequent diagnoses were spasms (26%), tendinopathies (23.4%), and strains (13%). CONCLUSIONS Elite visually impaired track and field Paralympic athletes present a pattern of overuse injuries predominantly affecting the lower limbs, particularly the thighs, lower legs, and knees. These injuries are associated with tendinopathies, muscle spasms, and strains. There were no apparent differences in injury characteristics between visual classes or sex.

Oxidized low-density lipoprotein, matrix-metalloproteinase-8 and carotid atherosclerosis in spinal cord injured subjects.

OBJECTIVE Previous reports have indicated that subjects with chronic spinal cord injury (SCI) exhibit increased cardiovascular risk compared to able-bodied individuals. This study investigated the relationship between plasmatic oxidized low-density lipoprotein (OxLDL), matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) levels and vascular remodeling in SCI subjects and the role of physical activity in this regard. METHODS We studied 42 men with chronic (≥2 years) SCI [18 sedentary (S-SCI) and 24 physically active (PA-SCI)] and 16 able-bodied men by clinical, anthropometric, laboratory, and carotid intima-media thickness (IMT) analysis. All enrolled subjects were normotensive, non-diabetics, non-smokers and normolipemic. Plasmatic OxLDL, MMP-2, MMP-8, MMP-9, TIMP-1 and TIMP-2 levels were determined by enzyme-linked immunosorbent assay. RESULTS Carotid IMT, IMT/diameter ratio and OxLDL levels of PA-SCI and able-bodied subjects were statistically similar. Conversely, S-SCI subjects exhibited higher IMT, IMT/diameter ratio and OxLDL levels compared to PA-SCI (p < 0.01, p < 0.001 and p = 0.01, respectively) and able-bodied (p < 0.001 for all) individuals. Results of bivariate correlation analysis including all injured subjects showed that carotid IMT and IMT/diameter ratio only correlated with OxLDL, MMP-8 and MMP-8/TIMP-1 ratio. Further stepwise regression analysis adjusted for the presence or not of physical activity and age showed that OxLDL was associated with carotid IMT and IMT/diameter ratio, while MMP-8 was associated with IMT/diameter ratio in SCI individuals. CONCLUSIONS Plasmatic OxLDL and MMP-8 levels are associated with carotid atherosclerosis and there is an interaction among physical inactivity, atherosclerosis and OxLDL in SCI individuals.

Aspectos das lesões esportivas em atletas com deficiência visual

Most research on sport injuries in disabled athletes uses a cross-disability (physical and sensorial) design and merges different sport modalities in the same study. This procedure creates difficulties in interpreting the results, since different disabilities and modalities may cause different injury conditions. The purpose of this study was to analyze the sports injuries frequency in visually impaired athletes, to identify the site of the injury, its mechanism, and the main injuries that occur to these athletes as well as to verify if the visual class relates to the sports injury frequency. The subjects were male and female visually impaired athletes, members of the Brazilian team of athletics, soccer 5, goalball, judo, and swimming, who played in international competitions between 2004 and 2008. Data was collected using the Brazilian Paralympic Committee and the Brazilian Confederation of Sports for the Blind medical form, which included the following information: name, age, modality, competition, visual classification (B1, B2, B3), injury type, location of injury, and diagnosis. A total of 131 athletes participated in this study: 42 female, 89 male amongst which 61 were B1, 46 B2, and 24 B3. From this total, 102 athletes reported 288 sports injuries; 2.82 injuries per athlete. Female athletes presented more injuries than male athletes; however, this difference did not show statistical significance. Regarding visual classification, B1 athletes got more injuries than B2 athletes, and these more than B3 athletes; statistically significant difference was found only between B1 and B3 group. As one group, athletes presented similar values between accident and overuse injuries. Concerning body segment, lower limbs showed more injuries, followed by upper limbs, spine, head, and trunk. Twenty-one diagnoses were reported, being tendinopathies, contractures, and contusions the most frequent.

Validação da bateria "Beck" de testes de habilidades para atletas brasileiros de "rugby" em cadeira de rodas

The Wheelchair Rugby is a sport practiced by subjects with tetraplegia or tetra-equivalence, since 2005 in Brazil, where there are approximately 10 teams in business. The motricity evaluation is a means of training control that allows achieve real progress in planning. The BECK battery of skills tests (ball handling, precision passing, blocking, speed and long distance passing) to wheelchair rugby athletes was developed in the U.S.A. by Yilla & Sherrill (1998).The aim of this study was to examine the criteria of scientific authenticity of the battery to the Brazilian athletes population. The results of two assessments with the battery (test and retest) with 11 athletes (mean age 27.59 ± 5.37 years, length of lesion 8.19 ± 3.83 years), were recorded by three assessors , which allowed the analysis of objectivity, reliability and internal consistency. We used ANOVA for analysis of objectivity and linear correlation and t test for analysis of reliability and consistency. No differences were found between results from different raters (p values ranging from 0.45 to 1.00) and the values of intraclass correlation coefficient found (range r 0.78 to 0.99 p < 0.00) indicate that the battery is consistent and reliable. The results of this study indicate that the criteria of scientific authenticity to the battery are satisfied and battery can be considered a valid tool for motricity evaluation of wheelchair rugby brazilian players.

Impact of Wheelchair Rugby on Body Composition of Subjects With Tetraplegia: A Pilot Study.

OBJECTIVE To investigate the longitudinal effects of wheelchair rugby (WR) training on body composition of subjects with tetraplegia. DESIGN Subjects were evaluated at baseline and after WR training. SETTING Faculty of physical education settings. PARTICIPANTS Individuals with tetraplegia (N=13; age, 26.6±6.0y). INTERVENTIONS Four sessions per week of WR training composed by aerobic and anaerobic activities and technical and tactical aspects of WR. The average time of intervention was 8.1±2.5 months. MAIN OUTCOME MEASURES Body composition assessed by dual-energy x-ray absorptiometry. RESULTS After training, fat mass was significantly reduced in the whole body (15,191±4603 vs 13,212±3318 g, P=.016), trunk (7058±2639 vs 5693±1498 g, P=.012), and legs (2847±817 vs 2534±742 g, P=.003). Conversely, increased bone mineral content (183±35 vs 195±32 g, P=.01) and fat-free mass (2991±549 vs 3332±602 g, P=.016) in the arms and reduced bone mineral content in the trunk (553±82 vs 521±86 g, P=.034) were observed after training. Furthermore, no significant correlation between the duration of training and changes in body composition was detected. CONCLUSIONS Regular WR training increased lean mass and bone mineral content in the arms and decreased total body fat mass. Conversely, WR training was associated with decreased bone mineral content in the trunk. These results suggest that regular WR training improves body composition in subjects with tetraplegia.

Matrix metalloproteinases and left ventricular function and structure in spinal cord injured subjects.

Subjects with spinal cord injury (SCI) exhibit impaired left ventricular (LV) diastolic function, which has been reported to be attenuated by regular physical activity. This study investigated the relationship between circulating matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) and echocardiographic parameters in SCI subjects and the role of physical activity in this regard. Forty-two men with SCI [19 sedentary (S-SCI) and 23 physically-active (PA-SCI)] were evaluated by clinical, anthropometric, laboratory, and echocardiographic analysis. Plasmatic pro-MMP-2, MMP-2, MMP-8, pro-MMP-9, MMP-9, TIMP-1 and TIMP-2 levels were determined by enzyme-linked immunosorbent assay and zymography. PA-SCI subjects presented lower pro-MMP-2 and pro-MMP-2/TIMP-2 levels and improved markers of LV diastolic function (lower E/Em and higher Em and E/A values) than S-SCI ones. Bivariate analysis showed that pro-MMP-2 correlated inversely with Em and directly with E/Em, while MMP-9 correlated directly with LV mass index and LV end-diastolic diameter in the whole sample. Following multiple regression analysis, pro-MMP-2, but not physical activity, remained associated with Em, while MMP-9 was associated with LV mass index in the whole sample. These findings suggest differing roles for MMPs in LV structure and function regulation and an interaction among pro-MMP-2, diastolic function and physical activity in SCI subjects.

Impact of Adapted Sports Activities on the Progression of Carotid Atherosclerosis in Subjects With Spinal Cord Injury

OBJECTIVE To determine whether regular performance of adapted sports is associated with long-term changes in carotid atherosclerosis in subjects with spinal cord injury (SCI). DESIGN Prospective observational study. SETTING Academic medical center. PARTICIPANTS Men with chronic (>1y) SCI and no preserved motor function below the injury level were evaluated in 2007 and 2012 (N=17). Nine subjects did not perform physical activity between the studied time points (control group), whereas 8 subjects entered competitive upper-body sports programs (rugby: n=5, basketball: n=1, jiu-jitsu: n=1, and tennis: n=1) after baseline and were regularly training at the time of the second evaluation (sports group). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Clinical, laboratory, hemodynamic, and carotid ultrasonography analysis. RESULTS The studied groups showed no differences in all studied variables at baseline. After 5 years of follow-up, the control group showed increases in heart rate (87.0±3.1 vs 74.7±3.8 beats per minute; P=.004), but the participants had no significant changes in carotid intima-media thickness (IMT) (.65±.05 vs .67±.03mm; P=.73) or IMT/diameter (.118±.007 vs .136±.013; P=.24). In contrast, the sports group showed long-term decreases in carotid IMT (.56±.05 vs .74±.05mm; P=.001) and IMT/diameter (.097±.006 vs .141±.009; P<.001), but the participants did not show any variation in the other studied variables at follow-up. CONCLUSIONS Regular upper-body sports activities are associated with long-term reductions in carotid atherosclerosis in subjects with SCI and might be a potential prevention strategy aiming to reduce cardiovascular risk in this population.

Avaliação da potência aeróbia de praticantes de Rugby em Cadeira de Rodas através de um teste de quadra

The present study aimed to estimate aerobic power in wheelchair athletes with SCI. Other objetive was VO2max levels correlate with the functional classification of athletes and analyze the behavior of the FC before and after testing. The sample consisted of 10 male athletes with SCI and mean age was 29.6 ± 6.5 years. The athletes were tested for race 12 minutes and the heart rate monitor was used. The average VO2max was 18.3±8.1 ml (kg.min)-1, while the mean HRmax was 114.6±25.3bpm. The VO2max values obtained in the study are classified as medium for people with quadriplegia. It was observed that there is a moderate correlation (r = 0.77) between the functional classification and VO2max among athletes practicing WR and finally, was observed low values of HR will face a submaximal test, which may be related to decreased activity symphatetic after SCI.