Danielle Aparecida Gomes Pereira

Effects of Physical Exercise on Plasma Levels of Brain-Derived Neurotrophic Factor and Depressive Symptoms in Elderly Women—A Randomized Clinical Trial

OBJECTIVES To investigate the effect of 2 standardized exercise programs, muscle strength exercises (SE) and aerobic exercises (AE), on the plasma levels of brain-derived neurotrophic factor (BDNF) and depressive symptoms in 451 elderly women. DESIGN A randomized controlled trial. SETTING Belo Horizonte/MG-Brazil. PARTICIPANTS Community-dwelling older women (N=451; age, 65-89y). INTERVENTION The participants were divided into 2 groups: SE and AE. Both protocols lasted 10 weeks, and 30 sessions (1-h sessions) in total were performed 3 times a week under the direct supervision of physical therapists. MAIN OUTCOME MEASURES Plasma levels of BDNF (enzyme-linked immunosorbent assay) and depressive symptoms (Geriatric Depression Scale). RESULTS There was a significant difference for BDNF plasma levels between the SE and AE groups (P=.009). Post hoc analysis revealed a pre-post intervention difference in BDNF levels only for the SE group (P=.008). A statistically significant difference was found for the pre- and postintervention Geriatric Depression Scale scores in both groups (P=.001), showing that the effects of both exercise protocols were comparable regarding depressive symptoms (P=.185). CONCLUSIONS The present findings have demonstrated the positive effect of muscle strengthening and aerobic intervention on depressive symptoms in community-dwelling elderly women. Interestingly, only SE significantly increased the plasma levels of BDNF in our sample. The positive effects of physical exercise on depressive symptoms in the elderly were not mediated by BDNF.

The reliability of walking tests in people with claudication.

Teixeira da Cunha-Filho I, Gomes Pereira DA, Borges de Carvalho AM, Campedeli L, Soares M, de Sousa Freitas J: The reliability of walking tests in people with claudication. Am J Phys Med Rehabil 2007;86:574–582. Objective:To contrast the reliability of the 6-min walking test (6MW) with that of the shuttle walking test (SWT) in patients with intermittent claudication attributable to peripheral obstructive arterial disease (POAD), and to examine the relationships of the walking tests, medical outcomes, and hemodynamic variables. Design:Twenty-three patients were randomly assigned to perform both walking tests on two different occasions. Total distance walked (DW), time of pain onset (PO), and time of limiting claudicating symptom (TLS) were analyzed. Results:The reliability coefficients (ICC) generated with the 6MW for DW, PO, and TLS were 0.84, 0.81, and 0.63, respectively, and the coefficients of variation (CV) across trials were 18, 31.8, and 20.3%, respectively. With the SWT, the ICCs were 0.95, 0.72, and 0.90 for each variable, respectively, whereas the CV was 10.9% for DW, 26.8% for PO, and 9.1% for TLS. There was a significant correlation between DW and double product with the SWT (r = 0.51, P = 0.01), but there was no correlation with the 6MW. Conclusion:Both the 6MW and the SWT are reliable walking tests for claudicant patients. However, the reliability coefficients obtained with the SWT are higher, the measurements are less variable, and there were better associations between this walking test and hemodynamic variables.

Adherence of older women with strength training and aerobic exercise

Background Participation of older people in a program of regular exercise is an effective strategy to minimize the physical decline associated with age. The purpose of this study was to assess adherence rates in older women enrolled in two different exercise programs (one aerobic exercise and one strength training) and identify any associated clinical or functional factors. Methods This was an exploratory observational study in a sample of 231 elderly women of mean age 70.5 years. We used a structured questionnaire with standardized tests to evaluate the relevant clinical and functional measures. A specific adherence questionnaire was developed by the researchers to determine motivators and barriers to exercise adherence. Results The adherence rate was 49.70% in the aerobic exercise group and 56.20% in the strength training group. Multiple logistic regression models for motivation were significant (P=0.003) for the muscle strengthening group (R2=0.310) and also significant (P=0.008) for the aerobic exercise group (R2=0.154). A third regression model for barriers to exercise was significant (P=0.003) only for the muscle strengthening group (R2=0.236). The present study shows no direct relationship between worsening health status and poor adherence. Conclusion Factors related to adherence with exercise in the elderly are multifactorial.

Optoelectronic plethysmography: Intra-rater and inter-rater reliability in healthy subjects

Optoelectronic plethysmography (OEP) has been used to measure changes in chest wall volume and its compartments. However, literature lacks research on its reliability. The purpose of this study was to evaluate the intra-rater and inter-rater reliability of OEP. Thirty-two healthy subjects were evaluated at rest and during submaximal exercise on a cycle ergometer. The following variables were assessed: chest wall volume (VCW); percentage contribution of the pulmonary rib cage (V(rcp)%), abdominal rib cage (V(rca)%), rib cage (V(rc)%) and abdomen (Vab%); chest wall end-expiratory volume (Vee(cw)); chest wall end-inspiratory volume (Vei(cw)); ratio of inspiratory time to total time of the respiratory cycle (Ti/T(tot)); respiratory rate (f) and mean inspiratory flow (V(cw)/Ti). Intraclass correlation coefficient (ICC) and coefficient of variation of Method Error (CV(ME)) were used to evaluate reliability. Results showed ICC values higher than 0.75 and CV(ME) values less than 10% for most variables at rest and during exercise indicating that OEP is a reliable instrument to assess chest wall volumes at rest and during exercise in healthy subjects.

TNF-α, IL6, and IL10 polymorphisms and the effect of physical exercise on inflammatory parameters and physical performance in elderly women.

High levels of inflammatory mediators are associated with reduced physical capabilities and muscle function in the elderly. Single nucleotide polymorphisms (SNPs) may affect the expression and synthesis of these molecules, thus influencing the intensity of the inflammatory response and susceptibility to certain diseases. Physical exercise may attenuate age-related chronic inflammation and improve physical performance. This study evaluated the interaction between the SNP rs1800629 in TNF-α, rs1800795 in IL6, and rs1800896 in IL10 and the effect of physical exercise on physical performance and inflammation in elderly women. There was a significant interaction between rs1800629 and the effect of exercise on physical performance and between the combined 3-SNP genotype and changes in physical performance in response to exercise. These SNPs did not influence the effect of exercise on inflammatory parameters. Elderly women with a combination of genotypes associated with an anti-inflammatory profile (low TNF-α and IL-6 production, high IL-10 production) showed better physical performance independent of exercise modality, evidence of an interactive influence of genetic and environmental factors on improving physical performance in elderly women.

Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Background The Duke Activity Status Index (DASI) assesses the functional capacity of patients with cardiovascular disease (CVD), but there is no Portuguese version validated for CVD. Objectives To translate and adapt cross-culturally the DASI for the Portuguese-Brazil language, and to verify its psychometric properties in the assessment of functional capacity of patients with CVD. Methods The DASI was translated into Portuguese, then checked by back-translation into English and evaluated by an expert committee. The pre-test version was first evaluated in 30 subjects. The psychometric properties and correlation with exercise testing was performed in a second group of 67 subjects. An exploratory factor analyses was performed in all 97 subjects to verify the construct validity of the DASI. Results The intraclass correlation coefficient for test-retest reliability was 0.87 and for the inter-rater reliability was 0.84. Cronbachs α for internal consistency was 0.93. The concurrent validity was verified by significant positive correlations of DASI scores with the VO2max (r = 0.51, p < 0.001). The factor analysis yielded two factors, which explained 54% of the total variance, with factor 1 accounting for 40% of the variance. Application of the DASI required between one and three and a half minutes per patient. Conclusions The Brazilian version of the DASI appears to be a valid, reliable, fast and easy to administer tool to assess functional capacity among patients with CVD.

Relação entre força muscular e capacidade funcional em pacientes com doença arterial obstrutiva periférica: um estudo piloto

CONTEXTO: As informacoes sobre o grau de correlacao entre forca muscular e capacidade funcional em pacientes com doenca arterial obstrutiva periferica (DAOP) sao inconsistentes, alem de nem sempre apresentarem protocolos que relacionem apropriadamente medidas de forca muscular com desempenho. OBJETIVO: Estabelecer o nivel de correlacao entre forca muscular e capacidade funcional em pacientes fisicamente ativos com DAOP. METODOS: Doze pacientes com diagnostico da doenca e presenca de claudicacao intermitente participaram do estudo. Todos realizaram testes de forca muscular e de caminhada. Grau de correlacao entre forca muscular e capacidade funcional foi avaliado pela correlacao de Pearson. RESULTADOS: Dos 12 voluntarios incluidos, 10 eram do sexo masculino e 2 do sexo feminino. Os participantes tinham media de idade de 63 ± 11 anos. Houve alta correlacao (r = 0,872; p = 0,0001) entre distância percorrida no teste de deslocamento bidirecional progressivo (TDBP) e carga alcancada no teste de resistencia maxima. Nao se observou correlacao entre distância percorrida no TDBP e tempo gasto para realizacao das cinco flexoes plantares no teste de ponta de pe. CONCLUSAO: O desempenho funcional em um grupo de pacientes com DAOP, em sua maioria fisicamente ativos, foi fortemente correlacionado com forca muscular de extensores de joelho, mas nao com desempenho observado funcionalmente pelo teste de ponta de pe. Futuros estudos sao necessarios para avaliar se forca muscular de flexores plantares, mensurada de forma especifica e isolada, correlaciona-se com funcao em pacientes com a doenca.

Functional performance and plasma cytokine levels in elderly women with and without low back pain

BACKGROUND AND OBJECTIVES Low back pain (LBP) is a complaint of great importance among the elderly due to its significant impact on function. LBP could contribute to changes in the regulatory process of inflammatory mediators observed in elders. The aim of this study was to compare plasma levels of interleukin(IL)-6, soluble tumor necrosis factor receptor 1(sTNF-R1), and functionality among 3 groups of elderly women: GI, with LBP; GII, without LBP but reports of other pain; and GIII, without any reported pain. MATERIAL AND METHOD This was an observational study of a subsample of the international Back Complaints in the Elders cohort study. IL-6 and sTNF-R1 were measured using the enzyme-linked immunosorbent assay. Functionality was assessed using the Timed Up and Go, gait speed and Roland Morris Disability Questionnaire; and pain, using the numerical pain scale. RESULTS Two hundred and thirteen women aged 71.35 ± 4.76 years were included. GI presented the highest sTNF-R1 levels (p=0.016), worst TUG performance (p< 0.001) and slowest gait speed (p< 0.01) compared to GII and GIII, which were similar (p > 0.05). No difference was found between the IL-6 plasma levels in any of the groups. CONCLUSION Elderly women with LBP had the highest sTNF-R1 plasma levels and the worst functional performance compared to elderly women with reports of other pain (not LBP) or no pain.

Correlação entre o índice tornozelo-braço antes e após teste de deslocamento bidirecional progressivo

BACKGROUND: Patients with peripheral occlusive artery disease (POAD) show changes in blood flow that may impair their walking ability. However, variability between inferential measurements of blood flow and walking performance is still high. OBJECTIVE: To correlate the ankle-brachial index (ABI) before and after performing the shuttle walk test (SWT). METHODS: Twenty-one patients with claudication due to POAD had their ABI values registered before and after walking based on a progressive external controlled speed walking protocol. RESULTS: Distance (261.07±160.63 m), time (292.30±122.61 seconds) and speed (1.23±0.34 m/s) obtained at claudication onset and when the limiting walking symptom started (369.52±157.97 m, 377.71±104.60 seconds, 1.46±0.29 m/s, respectively) were registered. Mean ABI before and after the SWT was 0.66±0.14 and 0.42±0.19, respectively. There was no substantial correlation between ABI pre- and post-walking and the variables obtained with the SWT (distance, time and speed). CONCLUSION: Time, speed and distance for claudication onset and walking limiting symptom during a progressive speed walking protocol are independent of inferential blood flow measurements obtained by ABI before and after exercise.

Heel-rise test in the assessment of individuals with peripheral arterial occlusive disease.

Introduction The Heel-Rise Test (HRT) is a clinical instrument relevant to vascular rehabilitation that has been proposed to assess the function of the triceps surae muscle. To use HRT in the assessment of individuals with peripheral arterial occlusive disease (PAOD), its ability to detect differences in the functional performance of patients with PAOD must be verified. Aim To verify whether the test is sensitive in differentiating between individuals with PAOD with distinct functional capacities. Materials and methods A transversal study in which individuals with PAOD were assessed using the HRT, the Walking Impairment Questionnaire (WIQ), and the Shuttle Walk Test. The following variables were analyzed: number of plantar flexions performed in the HRT (time in seconds) and velocity (plantar flexions per second) when performing plantar flexions up to the point of volunteer fatigue, maximum distance walked in the Shuttle Walk Test, and scores obtained in each WIQ domain. Results Twenty-five individuals (14 male) were included in the study, with a mean age of 63.36 ± 9.83 years. The variables number of plantar flexions and time to perform the HRT were sensitive enough to differentiate between distinct functional capacities in individuals with PAOD (P = 0.003 and P = 0.009, respectively). However, this result was not found for the variable of velocity in the HRT. The number of plantar flexions in the HRT was sensitive enough to differentiate individuals of extreme classes on the WIQ domain, stairs (P = 0.008). Conclusion The HRT can be applied in clinical practice as a valid assessment of the distinct function capacities of individuals with PAOD.