Armèle Dornelas de Andrade

Effects of muscle strength and aerobic training on basal serum levels of IGF-1 and cortisol in elderly women

The aim of this study was to compare the effects of muscle strength and aerobic training on the basal serum levels of IGF-1 and cortisol in elderly women. The subjects were divided in three groups as follows. 1. Strength training group (SG) submitted to the weight training called 1-repetition maximum test (1-RM, 75-85%). This group contained 12 subjects of mean age=66.08+/-3.37 years; and body mass index (BMI)=26.0+/-3.72kg/m(2). (2) Aerobic training group (AG) submitted to aquatic exercise; they were 13 subjects of the mean age=68.69+/-4.70 years; and BMI=29.19+/-2.96kg/m(2). (3) A control group (CG) of 10 subjects, of mean age=68.80+/-5.41 years; BMI=29.70+/-2.82kg/m2. The training periods were 12 weeks, Fasting blood was analyzed to measure IGF-1 and basal cortisol levels (by chemiluminescence method), both at the beginning and the end of the intervention. Students t-test revealed increased IGF-1 in the SG (p<0.05) compared to the other two groups. Repeated-measure ANOVA showed also elevated IGF-1 (p<0.05) in the SG compared to the other groups (AG and CG). There were no differences in cortisol levels. In conclusion, high-intensity training caused changes in IGF-1. This suggests that strength training may provoke anabolic effects in elderly individuals.

Reversal of Bronchial Obstruction with Bi-level Positive Airway Pressure and Nebulization in Patients with Acute Asthma

Jet nebulization (JN) and non-invasive mechanical ventilation (NIMV) through bi-level pressure is commonly used in emergency and intensive care of patients experiencing an acute exacerbation of asthma. However, a scientific basis for effect of JN coupled with NIMV is unclear. Objective. To evaluate the effect of jet nebulization administered during spontaneous breathing with that of nebulization with NIV at two levels of inspiratory and expiratory pressures resistance in patients experiencing an acute asthmatic episode. Methods. A prospective, randomized controlled study of 36 patients with severe asthma (forced expiratory volume in 1 second [FEV1] less than 60% of predicted) selected with a sample of patients who presented to the emergency department. Subjects were randomized into three groups: control group (nebulization with the use of an unpressured mask), experimental group 1 (nebulization and non-invasive positive pressure with inspiratory positive airway pressure [IPAP] = 15 cm H2O, and expiratory positive airway pressure [EPAP] = 5 cm H2O), and experimental group 2 (nebulization and non-invasive positive pressure with IPAP = 15 cm H2O and EPAP = 10 cm H2O). Bronchodilators were administered with JN for all groups. Dependent measures were recorded before and after 30 minutes of each intervention and included respiratory rate (RR), heart rate (HR), oxygen saturation (SpO2), peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and forced expiratory flow between 25 and 75% (FEF25 − 75). Results. The group E2 showed an increase of the peak expiratory flow (PEF), forced vital capacity (FVC), FEV1 (p < 0.03) and F25 − 75% (p < 0.000) when compared before and 30 minutes after JN+NIMV. In group E1 the PFE (p < 0.000) reached a significant increase after JN+ NIMV. RR decreased before and after treatment in group E1 only (p = 0.04). Conclusion. Nebulization coupled with NIV in patients with acute asthma has the potential to reduce bronchial obstruction and symptoms secondary to augmented PEF compared with nebulization during spontaneous breathing. In reversing bronchial obstruction, this combination appears to be more efficacious when a low pressure delta is used in combination with a high positive pressure at the end of expiration.

Noninvasive Ventilation Coupled With Nebulization During Asthma Crises: A Randomized Controlled Trial

BACKGROUND: Despite the clinical improvements attributed to noninvasive ventilation (NIV) during asthma crises, and the well established effects of nebulization, there are few studies on the effects of these interventions together. We hypothesized that nebulization coupled to NIV should raise radio-aerosol pulmonary deposition in asthmatics. The aims of this study were to assess the effects of coupling β-agonist nebulization and NIV during asthma exacerbations on radio-aerosol pulmonary deposition, using scintigraphy and cardiopulmonary parameters, to correlate pulmonary function with radio-aerosol deposition index, radio-aerosol penetration index, and pulmonary clearance. METHODS: In this controlled trial, 21 adults with moderate to severe asthma attack were randomized to a control group (n = 11) or experimental group (NIV + nebulizer group, n = 10). All subjects inhaled bronchodilators for 9 minutes, and after particles were counted with a gamma camera to analyze regions of interest and pulmonary clearance at 0, 15, 30, 45, and 60 min. RESULTS: Breathing frequency (P = < .001) and minute ventilation (P = .01) were reduced, and tidal volume was increased (P = .01) in the NIV + nebulizer group, compared with the control group. The NIV + nebulizer group had improvement from baseline values, compared to the control group in the following parameters: FEV1 46.7 ± 0.5% of predicted vs 29.8 ± 8.9% of predicted, P = .02), FVC (41.2 ± 1.5% of predicted vs 23.2 ± 7.1% of predicted, P = .02), peak expiratory flow (67.3 ± 38.3% of predicted vs 26.9 ± 12.1% of predicted, P = .01), and inspiratory capacity (54.9 ± 28.8% of predicted vs 31.2 ± 9.1% of predicted, P = .01). No differences were observed between groups regarding radio-aerosol deposition index or pulmonary clearance. Negative correlations were found between FEV1, forced expiratory flow during the middle half of the FVC maneuver (FEF25–75%), inspiratory capacity, and radio-aerosol penetration index. CONCLUSIONS: Coupling nebulization and NIV during asthma exacerbation did not improve radio-aerosol pulmonary deposition, but we observed clinical improvement of pulmonary function in these subjects. (ClinicalTrials.gov registration NCT01012050)

The Second Physical Therapy Summit on Global Health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases

Abstract Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n = 32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World CaféTM methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization’s non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.

Valores de referência da pressão inspiratória nasal em indivíduos saudáveis no Brasil: estudo multicêntrico

OBJECTIVE: The objectives of this study were to determine reference values for sniff nasal inspiratory pressure (SNIP) and to propose reference equations for the population of Brazil. METHODS: We evaluated 243 healthy individuals (111 males and 132 females), between 20 and 80 years of age, with an FVC and FEV1/FVC ratio > 80% and > 85% of the predicted value, respectively. All of the subjects underwent respiratory muscle strength tests to determine MIP, MEP, and SNIP. RESULTS: We found that SNIP values were higher in males than in females (p < 0.05) and that SNIP correlated negatively with age, for males (r = -0.29; p < 0.001) and for females (r = -0.33; p < 0.0001). Linear regression also revealed that age influenced the predicted SNIP, for males (R2 = 0.09) and females (R2 = 0.10). We obtained predicted SNIP values that were higher than those obtained for other populations. CONCLUSIONS: We have devised predictive equations for SNIP to be used in adults (20-80 years of age) in Brazil. These equations could help minimize diagnostic discrepancies among individuals.

Effects of hemiplegy on pulmonary function and diaphragmatic dome displacement.

We evaluated the diaphragmatic excursion, volumetric measurement, maximal inspiratory pressure (PI(max)), lung function tests (forced vital capacity-FVC, forced expiratory volume in the first second-FEV1, mean forced expiratory flow between 25 and 75% of the FVC maneuver-FEF(25-75%), peak expiratory flow-PEF and maximal voluntary ventilation-MVV), displacement of the domes diaphragmatics with ultrasonography and inspiratory capacity, the MAS scale (Motor Assessment Scale) in 20 hemiplegic patients volunteers and eight controls. In right-side hemiplegia, movement was 4.97 ± 0.78 cm and 4.20 ± 1.45 cm for the right and left domes of the diaphragm, respectively, whereas these values were 4.42 ± 0.92 cm and 4.66 ± 1.17 cm in left-side hemiplegia. PI(max) was -48.75 ± 27.5 cmH2O in right-side hemiplegic patients and -74.17 ± 13.57 cmH2O in left-side hemiplegic patients. Right-side hemiplegia exhibited greater impairment of the respiratory muscles than left-side hemiplegia due to the physiologic positioning of the domes of the diaphragm which may be compromised for hemiplegia.

Inspiratory muscle endurance testing: Pulmonary ventilation and electromyographic analysis

This study analyzed regional pulmonary ventilation and electromyographic (EMG) activity of the respiratory muscles during an inspiratory muscle endurance (IME) test in 10 young women. Radioaerosol (99mTc-DTPA) was generated using a jet nebulizer connected to a linear inspiratory loading system. The lung scintigraphic analysis showed an increase in the radioaerosol deposition using loads of 20 and 30 cmH(2)O (p<0.01). The vertical gradient showed a larger radioaerosol deposition in the medium third of the lungs during the control period (p<0.001). There were larger amounts of radioaerosol deposition in the medium third when compared with the upper and lower third at 30 cmH(2)O (p<0.001). The horizontal gradient showed a larger deposition in the intermediate and central segments during all phases (p<0.00). Electromyographic activity from the muscles of the lower rib cage increased with loads of 20 and 30 cmH(2)O (p<0.03). There was an increase in deposition of radioaerosol when the load increased (r=0.584, p=0.000 for the left lung and r=0.609, p=0.000 for right lung). These findings suggest that during the IME test, EMG activity in the muscles of the lower rib cage increase during progressive respiratory workloads is associated with a greater radioaerosol deposition in the medium third and intermediate and central segments of the lungs.

Evaluation of lung function and deposition of aerosolized bronchodilators carried by heliox associated with positive expiratory pressure in stable asthmatics: a randomized clinical trial.

While administration of medical aerosols with heliox and positive airway pressure are both used clinically to improve aerosol delivery, few studies have differentiated their separate roles in treatment of asthmatics. The aim of this randomized, double blinded study is to differentiate the effect of heliox and oxygen with and without positive expiratory pressure (PEP), on delivery of radiotagged inhaled bronchodilators on pulmonary function and deposition in asthmatics. 32 patients between 18 and 65 years of age diagnosed with stable moderate to severe asthma were randomly assigned into four groups: (1) Heliox + PEP (n = 6), (2) Oxygen + PEP (n = 6), (3) Heliox (n = 11) and (4) Oxygen without PEP (n = 9). Each group received 1 mg of fenoterol and 2 mg of ipratropium bromide combined with 25 mCi (955 Mbq) of Technetium-99m and 0.9% saline to a total dose volume of 3 mL placed in a Venticis II nebulizer attached to a closed, valved mask with PEP of 0 or 10 cm H2O. Both gas type and PEP level were blinded to the investigators. Images were acquired with a single-head scintillation camera with the longitudinal and transverse division of the right lung as regions of interest (ROIs). While all groups responded to bronchodilators, only group 1 showed increase in FEV1%predicted and IC compared to the other groups (p < 0.04). When evaluating the ROI in the vertical gradient we observed higher deposition in the middle and lower third in groups 1 (p = 0.02) and 2 (p = 0.01) compared to group 3. In the horizontal gradient, a higher deposition in the central region in groups 1 (p = 0.03) and 2 (p = 0.02) compared to group 3 and intermediate region of group 2 compared to group 3. We conclude that aerosol deposition was higher in groups with PEP independent of gas used, while bronchodilator response with Heliox + PEP improved FEV1 % and IC compared to administration with Oxygen, Oxygen with PEP and Heliox alone. Trial registration NCT01268462.

Predictive equations for respiratory muscle strength according to international and Brazilian guidelines

Background: The maximum static respiratory pressures, namely the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), reflect the strength of the respiratory muscles. These measures are simple, non-invasive, and have established diagnostic and prognostic value. This study is the first to examine the maximum respiratory pressures within the Brazilian population according to the recommendations proposed by the American Thoracic Society and European Respiratory Society (ATS/ERS) and the Brazilian Thoracic Association (SBPT). Objective: To establish reference equations, mean values, and lower limits of normality for MIP and MEP for each age group and sex, as recommended by the ATS/ERS and SBPT. Method: We recruited 134 Brazilians living in Belo Horizonte, MG, Brazil, aged 20-89 years, with a normal pulmonary function test and a body mass index within the normal range. We used a digital manometer that operationalized the variable maximum average pressure (MIP/MEP). At least five tests were performed for both MIP and MEP to take into account a possible learning effect. Results: We evaluated 74 women and 60 men. The equations were as follows: MIP=63.27-0.55 (age)+17.96 (gender)+0.58 (weight), r2 of 34% and MEP= - 61.41+2.29 (age) - 0.03(age2)+33.72 (gender)+1.40 (waist), r2 of 49%. Conclusion: In clinical practice, these equations could be used to calculate the predicted values of MIP and MEP for the Brazilian population.

Undertreatment of depressive symptomatology in the elderly living in long stay institutions (LSIs) and in the community in Brazil.

The aim of the present study was to assess the presence of depressive symptomatology among elderly residents in long stay institution (LSI) and in the community of Recife, Brazil. In total, 81 LSI elderly patients (mean age of 75.55 + or - 9.18 years) and 132 elderly (mean age of 73.14 + or - 8.27 years) individuals from the community were evaluated. Depressive symptomatology was assessed by the geriatric depression scale (GDS-15), cognitive status by the mini mental state examination (MMSE) and capacity to perform the activities of daily living (ADL) by the Katz Index. Comorbidities and the use of medication were recorded. The LSI elderly exhibited more depressive symptoms (p < 0.001) and more dependency (p < 0.001). We observed no differences in MMSE (p = 0.058). The elderly in the community displayed more comorbidities and the LSI elderly consumed more medication (p < 0.001 and < 0.001, respectively). According to multivariate analysis (logistic regression), being male, having no spouse and having a low schooling level are risk factors for depressive symptoms. In conclusion, most elderly with depressive symptoms received no medication for depression.