Denilson C. Teixeira

Perfil do nível de atividade física na vida diária de pacientes portadores de DPOC no Brasil

OBJECTIVE: To evaluate characteristics of physical activities in daily life in COPD patients in Brazil, correlating those characteristics with physiological variables. METHODS: Physical activities in daily life were evaluated in 40 COPD patients (18 males; 66 ± 8 years of age; FEV1 = 46 ± 16 % of predicted; body mass index = 27 ± 6 kg/m2) and 30 healthy age- and gender-matched subjects, using a multiaxial accelerometer-based sensor for 12 h/day on two consecutive days. We also assessed maximal and functional exercise capacity, using the incremental exercise test and the six-minute walk test (6MWT), respectively; MIP and MEP; peripheral muscle force, using the one-repetition maximum test and the handgrip test; quality of life, using the Saint Georges Respiratory Questionnaire (SGRQ); functional status, using the London Chest Activity of Daily Living questionnaire; and dyspnea sensation, using the Medical Research Council (MRC) scale. RESULTS: Mean walking time/day was shorter for COPD patients than for the controls (55 ± 33 vs. 80 ± 28 min/day; p = 0.001), as movement intensity was lower (1.9 ± 0.4 vs. 2.3 ± 0.6 m/s2; p = 0.004). The COPD patients also tended to spend more time seated (294 ± 114 vs. 246 ± 122 min/day, p = 0.08). Walking time/day correlated with the 6MWT (r = 0.42; p = 0.007) and maximal workload (r = 0.41; p = 0.009), as well as with age, MRC scale score and SGRQ activity domain score (-0.31 < r < -0.43; p < 0.05 for all). CONCLUSIONS: This sample of Brazilian patients with COPD, although more active than those evaluated in studies conducted in Europe, were less active than were the controls. Walking time/day correlated only moderately with maximal and functional exercise capacity.

Physical activity in daily life in physically independent elderly participating in community-based exercise program

BACKGROUND It is unclear whether participation in exercise programs specifically developed for elderly translates into a more active lifestyle. OBJECTIVES To compare the objectively measured level of physical activity in daily life (PADL) between physically independent elderly who participate or do not participate in community-based exercise programs; and to evaluate which factors are associated with the higher level of PADL in these subjects. METHOD 134 elderly participants in community-based exercise programs (PG) and 104 non-participants (NPG) had their level of PADL measured using pedometers during 7 days. OTHER MEASUREMENTS 6-minute walking test (6MWT), incremental shuttle walking test (ISWT), muscle strength, flexibility and balance. RESULTS The PG had higher 1-week mean daily step count than NPG (8314 [IQR 5971-10060] vs. 6250 [IQR 4346-8207] steps/day, p<0.0001), as well as higher step count in any day of the week. There was a higher proportion of physically active subjects (>8000 steps/day) in PG than in NPG (37% vs. 16%, respectively; p<0.001), as well as the proportion of sedentary subjects (<5000 steps/day) (14% vs. 33%, respectively; p<0.001). Participation in exercise programs, 6MWT and ISWT explained a higher daily steps count (model r(2)=0.56, p<0.0001). CONCLUSIONS In physically independent elderly, a higher level of physical activity in daily life occurs in those who participate in community-based exercise programs, regardless of the weekday and including non-program days. Participation of elderly in community-based exercise programs should be more systematically available and encouraged due to its close link to higher activity levels and better exercise capacity.

Postural balance and physical activity in daily life (PADL) in physically independent older adults with different levels of aerobic exercise capacity

Balance impairs with aging and may cause mobility limitations and functional decline. We aimed to evaluate postural balance and PADL in physically independent older adults with different levels of exercise capacity. One hundred fifty seven physically independent individuals, aged 60 years or older were evaluated. Postural balance assessment was performed during one-legged stance test using a force-platform and maximum exercise capacity with the incremental shuttle walking test (ISWT). PADL was assessed subjectively by the modified Baecke questionnaire and objectively using a pedometer. Based on the performance achieved in the ISWT, according to the percentage of the predicted value, the older adults were separated into 3 groups: low performance group (LP group, ISWT < 80% predicted, n = 32, 19 women), normal performance group (NP group, 80 ≤ ISWT ≤ 100% predicted, n = 30, 22 women) and high performance group (HP group, ISWT > 100% predicted, n = 95, 67 women). The HP group showed better postural balance when compared to LP groups (p < 0.001) and also higher levels of PADL measured with pedometer (p < 0.001). There was a modest correlation (r = 0.45) between exercise capacity and PADL in the LP group and a weak correlation between exercise capacity and balance (r = -28) in the HP group. Physically independent older adults with more preserved exercise capacity have better postural balance and higher levels of PADL in comparison to those older adults who show a poorer condition in terms of exercise capacity.

Relationship between force platform and two functional tests for measuring balance in the elderly

BACKGROUND Clinical and laboratory methods have been developed to assess the different dimensions of postural control with the aim to increase the clinical relevance of decisions about balance deficit. OBJECTIVES The purpose of this study was to correlate the force platform measurements with two functional tests used to evaluate balance in elderly. METHODS A total of 124 physically independent elderly volunteers participated in this study. Subjects performed the following three tests: 1) a traditional functional balance test, named the one-leg standing test, which measures the time in seconds at this position; 2) a functional agility/dynamic balance test, which quantifies the total time in seconds that a subject can stand up from a chair and move as quickly as possible around two cones; and 3) an unipodal balance test on a force platform. RESULTS The one-leg standing test yielded a mean of 12 seconds (SD=9 s), while the mean time observed in the functional agility/dynamic balance test was 26 seconds (SD=6 s). The correlations between the balance parameters of force platform and two functional tests varied between -0.28 and 0.20, which shows a weak association between them. CONCLUSIONS Our results support the idea that these functional tests do not necessarily furnish the same information regarding balance mechanisms as the force platform. This study contributes to the evaluation of balance in elderly and suggests that functional tests should be used with caution especially in regards to the purposes of the research and when conducting clinical assessments of the elderly.

Efeitos de um programa de exercício físico para idosas sobre variáveis neuro-motoras, antropométrica e medo de cair

O objetivo deste estudo foi analisar os efeitos de um programa de 19 meses de exercicio fisico nas variaveis de forca de membros inferiores (FMI), agilidade (AGI), indice de massa corporal (IMC) e medo de cair (MCAIR) de mulheres idosas funcionalmente ativas. Participaram do estudo 28 mulheres (68 ± 7 anos) inseridas em um programa de exercicios fisicos desenvolvido pela Universidade Norte do Parana (Londrina - PR). As aulas foram realizadas duas vezes por semana com 70 minutos de duracao cada. As variaveis FMI, AGI, IMC e MCAIR foram avaliadas em tres momentos (antes, no 7o. e 19o. meses do programa), respectivamente pelos testes de levantar da cadeira em 30 segundos (Rikili & Jones, 1999), sentar e levantar-se da cadeira e locomover-se pela casa (Okuma & Andreotti, 2004), pelas medidas antropometricas peso e estatura (Matsudo, 2004) e por uma entrevista. Os dados foram analisados pela estatistica descritiva e testes nao parametricos com significância p < 0,05. Os resultados mostram que, durante o programa, as idosas tiveram melhoras significativas nas variaveis FMI e AGI, mas nao no IMC e MCAIR, e quando separadas por niveis de IMC, as idosas com niveis normais apresentaram melhor desempenho do que as com sobrepeso. Conclui-se que a nao diminuicao do medo de quedas durante o programa, apesar da melhora nas capacidades de FMI e AGI, deve-se aos objetivos do programa, que nao visou modificar as crencas das idosas sobre as quedas.

Angiotensin-II blockage, muscle strength, and exercise capacity in physically independent older adults.

[Purpose] This study aimed to assess the exercise capacity and muscle strength in elderly people using drugs for angiotensin-II blockage. [Subjects and Methods] Four hundred and seven older adults were recruited for this study. Data about comorbidities and medication use were recorded and the individuals were divided into three groups: control group- elderly people with normal exercise capacity (n=235); angiotensin-converting enzyme inhibitor group − individuals using angiotensin-converting enzyme inhibitors (n=140); and angiotensin-II receptor blocker group- patients using angiotensin-II receptor blockers (n= 32). Exercise capacity was evaluated by a 6-minute walking test and muscle strength was measured using a handgrip dynamometer. [Results] Patients from the angiotensin-converting enzyme inhibitor group (mean: 99 ± 12%) and the angiotensin-II receptor blocker group (mean: 101 ± 14%) showed higher predicted values in the 6-minute walking test than the control group patients (mean: 96 ± 10%). Patients from the angiotensin-converting enzyme inhibitor group (mean: 105 ± 19%) and the angiotensin-II receptor blocker group (mean: 105.1 ± 18.73%) showed higher predicted values of muscle strength than control group patients (mean: 98.15 ± 18.77%). [Conclusion] Older adults using angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers have better functional exercise capacity and muscle strength.

Efeitos de um programa de intervenção para idosos sobre a intenção de estudantes de educação física de trabalhar com este grupo etário

Esta pesquisa teve como objetivo verificar a intencao de estudantes de educacao fisica em trabalhar com idosos apos a aplicacao de um programa de intervencao especifico para atendimento deste grupo etario, assim como, verificar nesta intencao, a influencia da exposicao dos sujeitos as questoes do envelhecimento e se ha diferencas entre genero. A amostra foi constituida por 27 alunos de ambos os sexos com a media de 23,2 anos ± 3,85, bacharelandos em educacao fisica de uma universidade publica de Sao Paulo. O programa de intervencao foi composto por duas disciplinas, Educacao Fisica na Terceira Idade I e Educacao Fisica na Terceira Idade II, com um semestre letivo de duracao cada, nas quais os sujeitos foram submetidos a diversas estrategias de ensino. Os dados foram coletados antes e apos a intervencao atraves de dois questionarios, com questoes referentes aos tipos de experiencias com o envelhecimento, o interesse em trabalhar com idosos e as suas percepcoes sobre o contato direto com eles durante a intervencao. Para a analise dos dados foi utilizada a estatistica nao parametrica, testes de McNemar e Exato de Fisher. Os resultados mostram que a intencao dos sujeitos em trabalhar com idosos aumentou significativamente (p < 0,05), passando de 33% antes da intervencao para 81,4% apos ela. Diferencas de genero nessa intencao nao foram encontradas. Concluimos que as estrategias de ensino adotadas nas disciplinas foram eficientes para o aumento no interesse dos sujeitos em trabalhar com idosos.

Physical Activity in the Prevention of Benign Paroxysmal Positional Vertigo: Probable Association

Introduction Physical inactivity is an important risk factor for many age-related diseases and symptoms such as dizziness and vertigo. Objective The aim of the study was to investigate the possible association between benign paroxysmal positional vertigo (BPPV) and regular physical activity in elderly subjects. Methods This cross-sectional study included 491 elderly individuals who lived independently. Physical exercise was assessed through a questionnaire and BPPV by history and the Dix-Hallpike maneuver. Results The present study indicates no significant association between BPPV with lack of physical activity in men and in the total population. We have confirmed associations between BPPV with lack of physical activity in women (p = 0.01). Women with a sedentary lifestyle who do not practice physical activity are 2.62 more likely to have BPPV than those with regular physical activity. Conclusion These results highlight the importance of identifying risk factors for BPPV that can be modified through specific interventions. Regular physical activity is a lifestyle with potential to decrease the risk of vertigo in women.

Static and Functional Balance in Individuals With COPD: Comparison With Healthy Controls and Differences According to Sex and Disease Severity

BACKGROUND: Studies have shown that individuals with COPD have impaired body balance, probably caused by the diseases multisystemic manifestations plus age-related decline in balance, potentially increasing the risk of falling and its consequences. However, little is known about the profile of individuals with COPD who present balance impairments, especially related to sex and disease severity stages. The aim of this work was to compare static and functional balance between subjects with COPD and healthy controls and to check possible differences according to sex and degrees of disease severity. METHODS: Forty-seven subjects with COPD and 25 healthy controls were included in this study. Their static balance was assessed in one-legged stance using a force platform and functional balance with the Timed Up and Go test. Additionally, participants performed spirometry, the 6-min walk test and isometric quadriceps maximal voluntary contraction assessment. Disease severity was classified according to the Global Initiative for Obstructive Lung Disease stages and BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) scores. RESULTS: In comparison with healthy controls, subjects with COPD had worse static (center of pressure displacement area: 9.3 ± 1.9 cm2 vs 11.6 ± 4.0 cm2, respectively, P = .01) and functional balance (Timed Up and Go test: 8.5 ± 1.3 s vs 10.3 ± 1.8 s, respectively, P < .001). In the COPD group, men performed better in the Timed Up and Go test than women (9.8 ± 1.2 s vs 10.9 ± 2.2 s, respectively, P = .03), whereas women presented a better static balance in comparison with men for all parameters related to center of pressure (P < .005 for all). Disease severity did not affect any balance results. CONCLUSIONS: Individuals with COPD had worse static and functional balance in comparison with healthy controls. Sex can mediate these results, depending on the type of balance evaluation (force platform or functional test). Balance performance was similar among the groups classified according to disease severity.

Postural control during one-leg stance in active and sedentary older people

Physical inactivity and aging are functional disability factors for older individuals, causing loss of balance and increasing the risk of falls. The purpose of this study was to compare the balance of physically independent older individuals, both participants and non-participants in a regular exercise program. Fifty six physically independent older participants were divided into G1ACTIVE = 28 individuals who participate in a regular exercise program and G2SEDENTARY = 28 individuals who did not participate in any physical exercise program. All participants underwent an eyes-open during one-leg balance test on a force platform. The postural oscillation parameters included center of pressure (COP); sway mean velocity and frequency of COP oscillations. G2 SEDENTARY showed higher postural instability than G1ACTIVE. Significant differences were observed for the main balance parameters. The results of this study support the concept that participation in regular physical activity is beneficial for postural balance of older individuals.