Antonio Carlos da Silva

Progressive resistance training in patients with shoulder impingement syndrome: A randomized controlled trial

OBJECTIVE To assess pain, function, quality of life, and muscle strength in patients with shoulder impingement syndrome who participated in muscle strengthening exercises. METHODS A total of 60 patients diagnosed with shoulder impingement syndrome were selected from the clinics of the Federal University of São Paulo and randomly distributed into experimental and control groups. Patients were evaluated regarding pain, function, quality of life, muscle strength, and the number of antiinflammatory drugs and analgesics taken. Patients then participated in the progressive resistance training program for the musculature of the shoulder, which was held twice a week for 2 months, while the control group remained on a waiting list. RESULTS Sixty patients were randomly allocated to the experimental group (21 women and 9 men, mean age 56.3 years) and control group (25 women and 5 men, mean age 54.8 years). Patients from the experimental group showed an improvement from 4.2 cm to 2.4 cm on a 10-cm visual analog scale (P < 0.001) regarding pain at rest and from 7.4 cm to 5.2 cm (P < 0.001) regarding pain during movement. Function went from 44.0 to 33.2 (P < 0.007) using the Disabilities of the Arm, Shoulder, and Hand assessment and domains from the Short Form 36. There was a statistically significant difference in improvement in pain and function between patients in the experimental group and those in the control group (P < 0.05). CONCLUSION The progressive resistance training program for the musculature of the shoulder in patients with shoulder impingement syndrome was effective in reducing pain and improving function and quality of life.

Incidence of periodic leg movements and of the restless legs syndrome during sleep following acute physical activity in spinal cord injury subjects.

The purpose of the present study was to evaluate sleep patterns and complaints, and Periodic Limb Movement (PLM) and the Restless Legs Syndrome (RLS) in subjects with complete spinal cord injury. Volunteers were submitted to two polysomnograms (Oxford Medilog SAC system - EEG, EMG, EOC): (1) basal night, when the volunteer arrived at the Sleep Center, and (2) after a maximal physical test (Cybex Met 300/increase of 12,5 watts/2 min until exhaustion). Eleven volunteers with complete spinal cord injury between T7-T12 were evaluated. Data were analyzed by the paired Students t test (total sleeping time) and by the Wilcoxon matched paired test (change of sleep stages, number of awakenings during sleep, latency to REM sleep and leg movements - PLM + RLS). Comparison of sleep recordings from the night before with that from the night after (12 h) practice of physical activity, showed a significant reduction in all of the sleep parameters. The results indicate that physical activity improves the sleep patterns of spinal cord injured volunteers. In particular, we noticed that PLM and RLS after physical activity were inhibited during sleep.

Mild Stunting Is Associated with Higher Susceptibility to the Effects of High Fat Diets: Studies in a Shantytown Population in São Paulo, Brazil

Previous studies by our group and others have suggested that nutritional stunting may increase the risk of obesity. To investigate mechanisms that could explain a link between stunting and obesity, a 22-mo follow-up study was conducted in two groups of shantytowns school girls (7-11 y old) in São Paulo, Brazil. One group (n = 15) had mild stunting (defined using a cutoff of -1.4 Z-scores of height-for-age) but normal weight-for-height; the control group (n = 15) had normal weight and height. Similar energy intake, dietary macronutrient composition and energy expenditure were observed in the two groups. Both groups showed comparable levels of IGF-1 that were below the normal range. A significant and positive association between baseline IGF-1 and the change in height-for-age during follow-up was found in all subjects combined (P = 0.044). A significant association was found between the baseline percentage of dietary energy supplied by fat and the gain in weight-for-height during follow-up in girls with mild stunting (P = 0.048), but not in the nonstunted control girls (P = 0.245); however, the slopes of these relationships were not significantly different. This study raises the question of whether a diet high in fat may increase the susceptibility to excess body fat gain in children who are mildly stunted. Further studies are need to explore this issue and to examine the possible etiological role of low levels of IGF-1.

Physical Activity and Epilepsy Proven and Predicted Benefits

Epilepsy is a common disease found in 2% of the population, affecting people from all ages. Unfortunately, persons with epilepsy have previously been discouraged from participation in physical activity and sports for fear of inducing seizures or increasing seizure frequency. Despite a shift in medical recommendations toward encouraging rather than restricting participation, the stigma remains and persons with epilepsy continue to be less active than the general population. For this purpose, clinical and experimental studies have analysed the effect of physical exercise on epilepsy. Although there are rare cases of exercise-induced seizures, studies have shown that physical activity can decrease seizure frequency, as well as lead to improved cardiovascular and psychological health in people with epilepsy. The majority of physical activities or sports are safe for people with epilepsy to participate in with special attention to adequate seizure control, close monitoring of medications, and preparation of family or trainers. The evidence shows that patients with good seizure control can participate in both contact and non-contact sports without harmfully affecting seizure frequency. This article reviews the risks and benefits of physical activity in people with epilepsy, discusses sports in which persons with epilepsy may participate, and describes the positive effect of physical exercise in experimental models of epilepsy.

Pectoralis Major Muscle Rupture in Athletes A Prospective Study

Background In the past 20 years, there has been an increase in the incidence of upper extremity tendinous injuries, especially in sports including strong physical activity, such as in weight lifting, as well as with the concurrent use of anabolic steroids. Today, there are more than 200 cases describing rupture of the pectoralis major muscle in athletes. Hypothesis Surgical treatment will have a better outcome than nonsurgical treatment in total rupture of the pectoralis major muscle in athletes. Study Design Cohort study; Level of evidence, 2. Methods Twenty athletes with pectoralis major muscle (PMM) rupture were studied; 10 had surgical treatment, and the other 10 were treated nonoperatively. The mean age was 32.27 years (range, 27-47 years); all of them were men. The average follow-up was 36 months (range, 48-72 months). Injuries were diagnosed by history, physical examination, and subsidiary tests. Functional evaluation and isokinetic evaluation were performed on all 20 patients. Results The clinical evaluation revealed 70% (n = 7) excellent, 20% good (n = 2), and 10% poor (n = 1) outcomes for the cases treated with surgery and 20% good (n = 2), 50% fair (n = 5), and 40% poor (n = 4) outcomes for the cases treated nonsurgically. The isokinetic evaluation at 60-deg/s speed showed a decrease in strength of 53.8% in the nonsurgical group and 13.7% for the surgical group. Conclusion Total PMM rupture in athletes showed a better functional result after surgical treatment than after nonsurgical treatment.

Evaluation of physical activity habits in patients with posttraumatic stress disorder.

OBJECTIVE In this study, we present data from a survey that aimed to assess the physical activity habits of adult Brazilian patients with Posttraumatic Stress Disorder. METHOD Fifty male and female patients with Posttraumatic Stress Disorder participated in this study. The mean age at onset was 37±12 years, and the mean time between diagnosis and follow-up was 3.6±4.2 years. RESULTS Substantial changes in physical activity habits were observed following the onset of PTSD. While more than half of the patients participated in physical activities prior to Posttraumatic Stress Disorder onset, there was a significant reduction in their participation afterwards. The justifications for stopping physical activities or sport participation were lack of time and lack of motivation. DISCUSSION Several studies have shown that physical exercise decreases reverts symptoms of psychiatric disorders such as depression, anxiety and social isolation. We could therefore hypothesize that patients with Posttraumatic Stress Disorder who exercise should experience the same benefits. CONCLUSION Our findings demonstrated that patients with Posttraumatic Stress Disorder have low levels of participation in sports or physical activities.

Effect of aerobic training on ventilatory muscle endurance of spinal cord injured men

The functional consequences of ventilatory muscle impairment of spinal cord injured (SCI) subjects has been evaluated through spirometric and maximal respiratory pressure tests. Nevertheless, underlying functional abnormalities may be evident only under dynamic conditions, such as with a ventilatory muscle endurance test (VME). In order to evaluate the VME of thoracic SCI men and the effect of physical training on it we evaluated 12 SCI subjects (Group I) and 12 able-bodied controls (Group II). The subjects were submitted to clinical evaluation, spirometry, maximum voluntary ventilation in 12 s (MVV-12sec) and a test of VME–the highest time of sustained ventilation at 70% of the maximum voluntary ventilation in isocapnic conditions (MVV-70% time). Gr. II was evaluated before and after an arm cranking aerobic training program (30 min/session, three times/week, 6 weeks) with training target heart rate corresponding to ventilatory anaerobic threshold. On the initial evaluation, Gr. I subjects presented a significantly reduced forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and MVV-12 sec when compared to controls (P<0.05). Also, the VME was severely reduced in Group I (median, ranges; 1.15, 0.61–12.22) when compared to Group II (14.60, 1.20–15.00)–P<0.001. When Gr. I subjects were separated by the level of lesion, the VME was lower in high injured (T1–T7) than intermediate (T8–T10) and low injured patients (T11–T12)–P<0.05. After aerobic training, Group I subjects incremented significantly the FVC (P<0.05) and the VME (P<0.001), so that MVV-70% time values post-training were not different from the initial values of the Gr. II. In conclusion, (i) the VME of thoracic SCI men was severely reduced when compared to able-bodied controls; (ii) a 6-weeks arm cranking aerobic training program was efficient to normalize the VME of SCI subjects.

Maximal aerobic power and leg muscle mass and strength related to age in non-athletic males and females

Abstract To investigate the relationships between the age-associated decline in peak oxygen uptake (peak V˙O2), leg muscle mass (LMM) and leg strength (LS) under the modulating effect of gender and level of physical activity (LPA, as assessed by questionnaire), we evaluated 71 sedentary subjects [males(M):females(F), 34:37], aged 20–80 years. Peak V˙O2 at maximum cycle ergometry was related to LMM (dual energy X-ray absorptiometry) and LS (isokinetic dynamometry) using both standard (y · x−1) and power function ratios (allometry). Absolute values of all variables were higher in males and declined with age (P < 0.01). Differences between the genders disappeared after peak V˙O2·LS−1.46 (M) or −1.62 (F) adjustment but remained significant between peak V˙O2·LMM-−0.51 (M) or −0.45 (F) and LS·LMM-−0.91 (M) or −1.10 (F) corrected values. Allometric correction of peak V˙O2 and LS by LMM slowed their age-related declines; the flattening effect however, was more evident in the females. Interestingly, while no age-related decrement in peak V˙O2·LS−1 was found, power function ratio values also declined with age, and at a slower rate in females. These findings are consistent with those obtained following a multiple regression analysis using LPA as an independent covariate (P < 0.01). We conclude that using adequate scaling methods and controlling by LPA: (1) no gender differences are observed in peak V˙O2 adjusted for LS, (2) loss of LS and LMM are important determinants of the age-associated reduction in physical fitness in both genders but (3) age per se has an LS- and LMM-independent influence on the functional decline, although this intrinsic effect of senescence is less pronounced in females.

Isokinetic hamstrings-to-quadriceps peak torque ratio: The influence of sport modality, gender, and angular velocity

Abstract The purpose of this study was to determine differences in hamstrings-to-quadriceps (H/Q) peak torque ratios evaluated at different angular velocities between men and women who participate in judo, handball or soccer. A total of 166 athletes, including 58 judokas (26 females and 32 males), 39 handball players (22 females and 17 males), and 69 soccer players (17 females and 52 males), were evaluated using an isokinetic dynamometer. The H/Q isokinetic peak torque ratios were calculated at angular velocities of 1.05 rad · s−1 and 5.23 rad · s−1. In the analysis by gender, female soccer players produced lower H/Q peak torque ratios at 1.05 rad · s−1 than males involved in the same sport. However, when H/Q peak torque ratio was assessed at 5.23 rad · s−1, there were no significant differences between the sexes. In the analysis by sport, there were no differences among females at 1.05 rad · s−1. In contrast, male soccer players had significantly higher H/Q peak torque ratios than judokas (66 ± 12% vs. 57 ± 14%, respectively). Female handball players produced significantly lower peak torque ratios at 5.23 rad · s−1 than judokas or soccer players, whereas males presented no ratio differences among sports At 5.23 rad · s−1. In the analysis by velocity, womens muscular ratios assessed at 1.05 rad · s−1 were significantly lower than at 5.23 rad · s−1 for all sports; among men, only judokas presented lower ratios at 1.05 rad · s−1 than at 5.23 rad · s−1. The present results suggest that sport modality and angular velocity influence the isokinetic strength profiles of men and women.

Shoulder functional ratio in elite junior tennis players

OBJECTIVE To evaluate shoulder rotation strength and compare the functional ratio between shoulders of elite junior tennis players. DESIGN This cross-sectional study evaluated muscular rotation performance of 40 junior tennis players (26 male and 14 female) with an isokinetic dynamometer. MAIN OUTCOME MEASURES Strength variables of external (ER) and internal rotators (IR) in concentric and eccentric modes were considered. For the peak torque functional ratio, the eccentric strength of the ER and the concentric strength of the IR were calculated. RESULTS All variables related to IR were significantly higher on the dominant compared to the non-dominant side in males and females (p<0.05), but only boys exhibited this dominance effect in ER (p<0.05 and p<0.001). Regarding functional ratios, they were significantly lower for the dominant shoulder (p<0.001) and below 1.00 for both groups, indicating that the eccentric strength of the ER was not greater than the concentric strength of the IR. CONCLUSION Elite junior tennis players without shoulder injury have shoulder rotation muscle strength imbalances that alter the normal functional ratio between rotator cuff muscles. Although these differences do not seem to affect the athletic performance, detection and prevention with exercise programs at an early age are recommended.