Carla Silva-Batista

Resistance Training with Instability for Patients with Parkinson’s Disease

PURPOSE This randomized controlled trial compared the effects of resistance training (RT) and RT with instability (RTI) on the timed up and go test (TUG), on-medication Unified Parkinsons Disease Rating Scale part III motor subscale score (UPDRS-III), Montreal Cognitive Assessment (MoCA) score, Parkinsons Disease Questionnaire (PDQ-39) score, and muscle strength in the leg press exercise (one-repetition maximum) of patients with Parkinsons disease (PD). METHODS Thirty-nine patients with moderate to severe PD were randomly assigned to a nonexercising control group (C), RT group, and RTI group. The RT and RTI groups performed progressive RT twice a week for 12 wk. However, only the RTI group used high motor complexity exercises (i.e., progressive RT with unstable devices), for example, half squat exercise on the BOSU® device. The primary outcome was mobility (TUG). The secondary outcomes were on-medication motor signs (UPDRS-III), cognitive impairment (MoCA), quality of life (PDQ-39), and muscle strength (one-repetition maximum). RESULTS There were no differences between RTI and RT groups for any of the outcomes at posttraining (P > 0.05). However, there were differences between RTI and C groups in the TUG, MoCA, and muscle strength values at posttraining (P < 0.05). Only the RTI group improved the TUG (-1.9 s), UPDRS-III score (-4.5 score), MoCA score (6.0 score), and PDQ-39 score (-5.2 score) from pre- to posttraining (P < 0.001). Muscle strength improved for both training groups (P < 0.001). No adverse events were reported during the trial. CONCLUSIONS Both training protocols improved muscle strength, but only RTI improved the mobility, motor signs, cognitive impairment, and quality of life, likely because of the usage of high motor complexity exercises. Thus, RTI may be recommended as an innovative adjunct therapeutic intervention for patients with PD.

Associations Between Fitness Tests and the International Physical Activity Questionnaire—short Form in Healthy Men

Abstract Silva-Batista, C, Urso, RP, Lima Silva, AE, and Bertuzzi, R. Associations between fitness tests and the international physical activity questionnaire—short form in healthy men. J Strength Cond Res 27(12): 3481–3487, 2013—The objective of this study was to evaluate the relationship between the components of health-related fitness (flexibility, muscular strength and endurance, and cardiorespiratory) with the outcomes of short version of International Physical Activity Questionnaire (IPAQ-SF). Four hundred eight healthy men (aged 21–43 years) answered the IPAQ-SF and performed the following tests: sit-and-reach, hand grip dynamometer, sit-ups and push-ups, and 20-m shuttle run test. The weekly energy expenditure expressed in metabolic equivalent task minutes per week (METs min·wk−1) from all IPAQ-SF categories showed a significant association with the flexibility (p < 0.05) and the cardiorespiratory fitness (p < 0.05). The METs min·wk−1 of vigorous-intensity physical activity (PA) and total PA score were significantly correlated with upper-body muscular endurance (p < 0.05). In addition, 44% (n = 176) of the subjects presented high PA level and showed greater flexibility, upper-body muscular endurance, and cardiorespiratory fitness than subjects who presented moderate and low PA levels (p < 0.05). In conclusion, IPAQ-SFs outcomes reflect not only the association with the cardiorespiratory fitness but also the flexibility and the upper-body muscular endurance.

Efeito da familiarização na estabilização dos valores de 1RM para homens e mulheres

The purpose of this study was to determine the number of familiarization sessions for stabilizing the load of one repetition maximum (1RM) tests on the squat exercise in men and women. Eight men (25 ± 4 years) and eight women (20 ± 1 years) underwent five experimental sessions. ANOVA and Bland-Altman plotting were used to compare the 1RM load between the sessions (p<0.05). The stabilization of load occurred at the fourth session for men and at the third session for women, with significantly increased in relative and absolute strength from the first to the fourth (17kg and 19%) and from the first to the third (9kg and 14%) session, respectively. However, relative strength did not differ significantly between genders. According to our results, individuals not experienced with strength training can reach high reliability in the 1RM test in the squat exercise, after performing three or four familiarizations sessions.

Effects of Concurrent Strength and Endurance Training on Genes Related to Myostatin Signaling Pathway and Muscle Fiber Responses

Abstract De Souza, EO, Tricoli, V, Aoki, MS, Roschel, H, Brum PC, Bacurau, AVN, Silva-Batista, C, Wilson, JM, Neves, M Jr, Soares, AG, Ugrinowitsch, C. Effects of concurrent strength and endurance training on genes related to myostatin signaling pathway and muscle fiber responses. J Strength Cond Res 28(11): 3220–3228, 2014—Concurrent training (CT) seems to impair training-induced muscle hypertrophy. This study compared the effects of CT, strength training (ST) and interval training (IT) on the muscle fiber cross-sectional area (CSA) response, and on the expression of selected genes involved in the myostatin (MSTN) signaling mRNA levels. Thirty-seven physically active men were randomly divided into 4 groups: CT (n = 11), ST (n = 11), IT (n = 8), and control group (C) (n = 7) and underwent an 8-week training period. Vastus lateralis biopsy muscle samples were obtained at baseline and 48 hours after the last training session. Muscle fiber CSA, selected genes expression, and maximum dynamic ST (1 repetition maximum) were evaluated before and after training. Type IIa and type I muscle fiber CSA increased from pre- to posttest only in the ST group (17.08 and 17.9%, respectively). The SMAD-7 gene expression significantly increased at the posttest in the ST (53.9%) and CT groups (39.3%). The MSTN and its regulatory genes ActIIb, FLST-3, FOXO-3a, and GASP-1 mRNA levels remained unchanged across time and groups. One repetition maximum increased from pre- to posttest in both the ST and CT groups (ST = 18.5%; CT = 17.6%). Our findings are suggestive that MSTN and their regulatory genes at transcript level cannot differentiate muscle fiber CSA responses between CT and ST regimens in humans.

The effects of different intensities and durations of the general warm-up on leg press 1RM.

Abstract Barroso, R, Silva-Batista, C, Tricoli, V, Roschel, H, and Ugrinowitsch, C. The effects of different intensities and durations of the general warm-up on leg press 1RM. J Strength Cond Res 27(4): 1009–1013, 2013—The precision of maximum strength assessments (1 repetition maximum; 1RM) is important to evaluate the functional capacity and to prescribe and monitor the training load. Several factors can affect the precision of 1RM tests, including the warm-up procedure. General and specific warm-up routines are recommended to enhance performance. The effects of a specific warm-up have already been acknowledged in improving performance. However, the effects of a general warm-up (GWU) are unclear but seem to depend on its ability to increase muscle temperature while avoiding fatigue. Furthermore, temperature elevation is dependent on both the duration and the intensity of the activity, which may eventually affect 1RM performance. The objective of this study was to investigate the effect of different intensities and durations of GWU on 1RM performance. Sixteen strength-trained men were tested for 1RM leg press after 4 GWU conditions after specific warm-up: short duration and low intensity (SDLI; i.e., 5 minutes at 40% V[Combining Dot Above]O2max), long duration and low intensity (LDLI; i.e., 15 minutes at 40% V[Combining Dot Above]O2max), short duration and moderate intensity (SDMI; i.e., 5 minutes at 70% V[Combining Dot Above]O2max), long duration and moderate intensity (LDMI; i.e., 15 minutes at 70% V[Combining Dot Above]O2max), and the control (CTRL) no-GWU condition. Leg press 1RM values were higher (on average 3%) when subjects performed LDLI (367.8 ± 70.1 kg; p = 0.01), compared with the other 4 conditions. After the LDMI condition, 1RM values were lower (on average −4%) than in the other 4 conditions (345.6 ± 70.5 kg; p = 0.01). There were no differences between SDMI, SDLI, and CTRL (359.4 ± 69.2 kg, 359.1 ± 69.3 kg, and 359.4 ± 70.4 kg, respectively; p = 0.99). According to our results, long-duration low-intensity general warm-up seems be appropriately to improve 1RM performance in strength-trained individuals.

Effects of Progressive Resistance Training on Cardiovascular Autonomic Regulation in Patients With Parkinson Disease: A Randomized Controlled Trial

OBJECTIVE To evaluate the effects of a progressive resistance training (RT) on cardiac autonomic modulation and on cardiovascular responses to autonomic stress tests in patients with Parkinson disease (PD). DESIGN Randomized clinical trial. SETTING The Brazil Parkinson Association. PARTICIPANTS Patients (N=30) with PD (modified Hoehn & Yahr stages 2-3) were randomly divided into 2 groups: a progressive RT group (PD training [PDT] group) and a control group (PD control [PDC] group). In addition, a group of paired healthy control (HC) subjects without PD was evaluated. INTERVENTIONS The PDT group performed 5 resistance exercises, 2 to 4 sets, 12 to 6 repetitions maximum per set. Individuals in the PDC group maintained their usual lifestyle. MAIN OUTCOME MEASURES The PDT and PDC groups were evaluated before and after 12 weeks. The HC group was evaluated once. Autonomic function was assessed by spectral analysis of heart rate variability and cardiovascular responses to autonomic stress tests (deep breathing, Valsalva maneuver, orthostatic stress). RESULTS Compared with baseline, the normalized low-frequency component of heart rate variability decreased significantly after 12 weeks in the PDT group only (PDT: 61±17 normalized units [nu] vs 47±20nu; PDC: 60±14nu vs 63±10nu; interaction P<.05). A similar result was observed for systolic blood pressure fall during orthostatic stress that also was reduced only in the PDT group (PDT: -14±11mmHg vs -6±10mmHg; PDC: -12±10mmHg vs -11±10mmHg; interaction P<.05). In addition, after 12 weeks, these parameters in the PDT group achieved values similar to those in the HC group. CONCLUSIONS In patients with PD, progressive RT improved cardiovascular autonomic dysfunction.

Blood flow restriction increases metabolic stress but decreases muscle activation during high-load resistance exercise: Blood Flow Restriction Training

Introduction: We investigated differences in metabolic stress (lactate) and muscle activation (electromyography; EMG) when high‐load resistance exercise (HL) is compared with a condition in which blood flow restriction (BFR) is applied during the exercise or during the rest interval. Methods: Twelve participants performed HL with BFR during the intervals (BFR‐I), during the set (BFR‐S), and without BFR. Each condition consisted of 3 sets of 8 repetitions with knee extension at 70% of 1‐repetition maximum. Lactate and root mean square (RMS) from the surface EMG of the vastus lateralis were calculated. Results: Lactate increased in all protocols but was higher with BFR‐I than with BFR‐S and HL. RMS decreased under all conditions, with a larger effect size in BFR‐I (1.47) than in BFR‐S (0.66) and HL (0.59). Discussion: BFR‐I increases lactate, possibly as a result of reduced restoration of ATP. Muscle activation seems to be impacted by mechanical stress but may be reduced by metabolic stress. Muscle Nerve 57: 107–111, 2018

Instability Resistance Training Improves Neuromuscular Outcome in Parkinson's Disease

Purpose This study compared the effects of resistance training (RT) and RT with instability (RTI) on neuromuscular and total training volume (TTV) outcomes obtained as part of the Instability Resistance Training Trial in Parkinsons disease. It also used a linear multiple regression (forward stepwise method) to identify the contribution of neuromuscular outcomes to previously published improvements in the timed-up-and-go test and the Unified Parkinsons Disease Rating Scale, motor subscale score. Methods Thirty-nine patients with moderate to severe Parkinsons disease were randomly assigned to three groups: control (C), RT, and RTI. RT and RTI groups performed resistance exercises twice a week for 12 wk, and only the RTI group used unstable devices to perform resistance exercises. The following neuromuscular outcomes were assessed: quadriceps muscle cross-sectional area, root mean square and mean spike frequency of electromyographic signal, peak torque, rate of torque development, and half relaxation time of the knee extensors and plantarflexors during maximum ballistic voluntary isometric contractions. TTV was calculated for lower limb exercises. Results From pre- to posttraining, RTI improved all of the neuromuscular outcomes (P < 0.05) except half relaxation time of the knee extensors (P = 0.068), despite the lower TTV than RT (P < 0.05). RTI was more effective than RT in increasing the root mean square values of vastus medialis, mean spike frequency of gastrocnemius medialis, and rate of torque development of plantarflexors (P < 0.05). Stepwise regression identified the changes in mean spike frequency of gastrocnemius medialis as the best predictor of improvements in timed-up-and-go test (R2 = 0.58, P = 0.002) and on-medication Unified Parkinsons Disease Rating Scale, motor subscale scores (R2 = 0.40, P = 0.020). Conclusion RTI optimizes neuromuscular adaptations, which partially explains mobility and motor sign improvements in patients with Parkinsons disease.

Resistance training with instability is more effective than resistance training in improving spinal inhibitory mechanisms in Parkinson's disease

This study assessed 1) the effects of 12 wk of resistance training (RT) and resistance training with instability (RTI) on presynaptic inhibition (PSI) and disynaptic reciprocal inhibition (DRI) of patients with Parkinsons disease (PD); 2) the effectiveness of RT and RTI in moving PSI and DRI values of patients toward values of age-matched healthy controls (HC; Z-score analysis); and 3) associations between PSI and DRI changes and clinical outcomes changes previously published. Thirteen patients in RT group, 13 in RTI group, and 11 in a nonexercising control group completed the trial. While RT and RTI groups performed resistance exercises twice a week for 12 wk, only the RTI group used unstable devices. The soleus H reflex was used to evaluate resting PSI and DRI before and after the experimental protocol. The HC (n = 31) was assessed at pretest only. There were significant group × time interactions for PSI (P < 0.0001) and DRI (P < 0.0001). RTI was more effective than RT in increasing the levels of PSI (P = 0.0154) and DRI (P < 0.0001) at posttraining and in moving PSI [confidence interval (CI) 0.1-0.5] and DRI (CI 0.6-1.1) levels to those observed in HC. There was association between DRI and quality of life changes (r = -0.69, P = 0.008) and a strong trend toward association between PSI and postural instability changes (r = 0.60, P = 0.051) after RTI. RTI increased PSI and DRI levels more than RT, reaching the average values of the HC. Thus RTI may cause plastic changes in PSI and DRI pathways that are associated with some PD clinical outcomes. NEW & NOTEWORTHY Patients with Parkinsons disease (PD) have motor dysfunction. Spinal inhibitory mechanisms are important for modulating both supraspinal motor commands and sensory feedback at the spinal level. Resistance training with instability was more effective than resistance training in increasing the levels of presynaptic inhibition and disynaptic reciprocal inhibition of lower limb at rest of the patients with PD, reaching the average values of the healthy controls.

Patients with Parkinson disease present high ambulatory blood pressure variability

Patients with Parkinson disease (PD) present blunted nocturnal blood pressure fall and similar ambulatory blood pressure variability (ABPV) measured by standard deviation (SD) and coefficient of variation (CV) compared with healthy subjects. However, these classical indices of ABPV have limited validity in individuals with circadian blood pressure alterations. New indices, such as the average of daytime and night‐time standard deviation weighted by the duration of the daytime and night‐time intervals (SDdn) and the average real variability (ARV), remove the influence of the daytime and the night‐time periods on ABPV. This study assessed ABPV by SDdn and ARV in PD. Twenty‐one patients with PD (11 men, 66 ± 2 years, stages 2–3 of modified Hoehn & Yahr) and 21 matched controls without Parkinson disease (9 men, 64 ± 1 years old) underwent blood pressure monitoring for 24 h. ABPV was analysed by 24 h, daytime and night‐time SD and CV, and by the SDdn and ARV. Systolic/diastolic 24‐h and night‐time SD and CV were similar between the patients with PD and the controls. The patients with PD presented higher daytime systolic/diastolic CV and SD than the controls (10·4 ± 0·9/12·3 ± 0·8 versus 7·0 ± 0·3/9·9 ± 0·5%, P<0·05; 12·6 ± 1·0/9·1 ± 0·5 versus 8·6 ± 0·4/7·5 ± 0·3 mmHg, P<0·05, respectively) as well as higher systolic/diastolic SDdn (10·9 ± 0·8/8·2 ± 0·5 versus 8·2 ± 0·3/7·1 ± 0·2 mmHg, P<0·05, respectively) and ARV (8·8 ± 0·6/6·9 ± 0·3 versus 7·2 ± 0·2/6·0 ± 0·2 mmHg, P<0·05, respectively). In conclusion, patients with PD have higher ABPV than control subjects as assessed by SDd, CVd, SDdn and AVR.