Diogo Carvalho Felício

Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review

QUESTION How has adherence been measured in recent prospective studies focusing on adherence to exercise programs among older people? What is the range of adherence rates? Which factors are associated with better adherence? DESIGN Systematic review of prospective studies that had a primary aim of assessing adherence to exercise programs. PARTICIPANTS Older people undertaking exercise programs. INTERVENTION Exercise programs. OUTCOME MEASURES Measures of adherence, adherence rates and factors associated with adherence. RESULTS Nine eligible papers were identified. The most common adherence measures were the proportion of participants completing exercise programs (ie, did not cease participation, four studies, range 65 to 86%), proportion of available sessions attended (five studies, range 58 to 77%) and average number of home exercise sessions completed per week (two studies, range 1.5 to 3 times per week). Adherence rates were generally higher in supervised programs. The person-level factors associated with better adherence included: demographic factors (higher socioeconomic status, living alone); health status (fewer health conditions, better self-rated health, taking fewer medications); physical factors (better physical abilities); and psychological factors (better cognitive ability, fewer depressive symptoms). CONCLUSION Older peoples adherence to exercise programs is most commonly measured with dropout and attendance rates and is associated with a range of program and personal factors.

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.

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.

Confiabilidade intra e interexaminadores e erro da medição no uso do goniômetro e inclinômetro digital

INTRODUCAO: A amplitude de movimento articular (ADM) e um importante componente avaliado durante o exame fisico; porem, para que essa mensuracao possa ser utilizada, e necessario que ela seja confiavel e que suas propriedades de medida sejam conhecidas. OBJETIVOS: Verificar a confiabilidade inter e intraexaminadores das medidas realizadas pelo goniometro e inclinometro na avaliacao da ADM de flexao e extensao de joelho e cotovelo, e determinar o erro padrao da medicao (EPM) dos instrumentos em questao. METODOS: Foi avaliada ADM de flexao e extensao de cotovelo e joelho, bilateralmente, de uma amostra de individuos jovens saudaveis do genero masculino, com faixa etaria entre 18 e 30 anos, utilizando um inclinometro digital e um goniometro universal. RESULTADOS: A confiabilidade interexaminador variou de pequena a muito alta para os dois instrumentos, apresentando CCI de 0,24 a 0,96 para as medidas feitas com o goniometro, e de 0,02 a 0,98 para o inclinometro. O unico movimento que obteve confiabilidade muito alta para ambos os aparelhos e examinadores foi a flexao de joelho. O EPM determinado por meio da goniometria e inclinometria variou entre 0,21 e 12,75 graus. CONCLUSAO: O inclinometro digital apresenta melhores indices de confiabilidade que o goniometro para as medidas de ADM. Apenas quatro medidas obtiveram CCI alto e EPM abaixo de dois graus, e, assim, foram consideradas apropriadas para serem utilizadas clinicamente, todas essas realizadas com o inclinometro.

Interaction between cytokine gene polymorphisms and the effect of physical exercise on clinical and inflammatory parameters in older women: study protocol for a randomized controlled trial

BackgroundAging is associated with chronic low-grade inflammatory activity with an elevation of cytokine levels. An association between regular physical activity and reduction of blood levels of anti-inflammatory cytokines is demonstrated in the literature pointing to an anti-inflammatory effect related to exercise. However, there is no consensus regarding which type of exercise and which parameters are the most appropriate to influence inflammatory markers. Evidence indicates that the single nucleotide polymorphism (SNP) can influence the synthesis of those cytokines affecting their production.Methods/DesignThe design of this study is a randomized controlled trial. The aim of this study is to investigate the interaction between the cytokine genes SNP and the effect of physical activity on older women. The main outcomes are: serum levels of sTNFR-1, sTNFR-2, interleukin (IL)-6, IL-10, measured by the ELISA method; genotyping of tumor necrosis factor- (TNF)-alpha (rs1800629), IL6 (rs1800795), IL10 (rs1800896) by the TaqMan Method (Applied Biosystems, Foster City, CA, USA); and physical performance assessed by Timed Up and Go and 10-Meter Walk Tests. Secondary outcomes include: Geriatric Depression Scale, Perceived Stress Scaleand aerobic capacity, assessed by the six-minute walk; and lower limb muscle strength, using an isokinetic dinamometer (Biodex Medical Systems, Inc., Shirley, NY,USA). Both exercise protocols will be performed three times a week for 10 weeks, 30 sessions in total.DiscussionInvestigating the interaction between genetic factors and exercise effects of both protocols of exercise on the levels of inflammatory cytokine levels can contribute to guide clinical practice related to treatment and prevention of functional changes due to chronic inflammatory activity in older adults. This approach could develop new perspectives on preventive and treatment proposals in physical therapy and in the management of the older patient.Trial registration(ReBEC) RBR9v9cwf

Poor correlation between handgrip strength and isokinetic performance of knee flexor and extensor muscles in community‐dwelling elderly women

To investigate the correlation between handgrip strength and performance of knee flexor and extensor muscles determined using an isokinetic dynamometer in community‐dwelling elderly women.

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.

Association Between the Plasma Levels of Mediators of Inflammation With Pain and Disability in the Elderly With Acute Low Back Pain: Data From the Back Complaints in the Elders (BACE)-Brazil Study.

Study Design. Cross-sectional study with subsample of elderly women with acute low back pain (LBP), from Back Complaints in the Elders-Brazil (BACE-Brazil) Objective. To investigate the association between plasma levels of mediators of inflammation (interleukin-1 beta (IL-1&bgr;), IL-6, tumor necrosis factor alpha (TNF-&agr;), and soluble TNF receptor 1 (sTNF-R1)) with pain and disability experienced by elderly women with acute LBP. Summary of Background Data. Among the elderly, LBP is a complaint of great importance and can lead to disability. Inflammatory cytokines are elevated in painful conditions, and may promote pain. Methods. We included 155 community-dwelling elderly women (age ≥ 65 yr), who presented with a new (acute) episode of LBP. Enzyme-linked immunosorbent assays were used to measure TNF-&agr;, sTNF-R1, IL-1&bgr;, and IL-6. Disability was assessed using the Roland Morris Disability Questionnaire; pain was assessed using the McGill Pain Questionnaire. Linear regression models were fit with each pain and disability outcome as dependent variables: Present Pain Intensity; Qualities of pain; Severity of pain in the last week; LBP frequency and disability. Results. Depressive symptoms and IL-6 were associated and explained 20.9% of “qualities of pain” variability. TNF-&agr;, sTNFR1, education, body mass index, and depressive symptoms explained 8.4% of “Severity of pain in the past week” variability. TNF-&agr;, education, BMI, depressive symptoms, present pain intensity, qualities of pain, and LBP frequency explained 48.6% of “disability.” No associations between inflammatory cytokines and “present pain intensity” and “LBP frequency” were found. Conclusion. Our results demonstrate associations between inflammatory markers (TNF-&agr; and sTNFR1) and pain severity, IL-6 was associated with the qualities of pain, and TNF-&agr; was also associated with disability. These inflammatory mediators represent new markers to be considered in the assessment and treatment of elderly patients with LBP. Level of Evidence: 5

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.

Inflammatory mediators, muscle and functional performance of community-dwelling elderly women

The purpose of this study was to investigate the correlation and association between inflammatory mediators and muscle and functional performance in elderly women. We conducted a cross-sectional study. Plasma concentrations of interleukin-6 (IL-6) and soluble receptor for tumor necrosis factor alpha (sTNFR1) were determined by enzyme-linked immune sorbent assay. The muscle performance was measured using a isokinetic dynamometer and assessment of handgrip strength was performed using a Jamar® dynamometer. Functional performance was assessed through a walking speed test. Statistical analysis was performed using the Pearson or Spearman correlation. The association between the variables was determined by multiple regression analysis. 221 volunteers (71.07±4.93 years) participated in the study. Plasma levels of IL-6 (0.87pg/mL) correlated with the power of the knee extensors (r=0.14; p=0.03) and the power of the knee flexors (r=0.16; p=0.01); the plasma levels of sTNFR1 (1051.70pg/mL) did not correlate with any dependent variable. The regression models showed that the variables IL-6, level of physical activity and depressive status explained 5.5% (R(2)=0.055, p<0.01) of average power of knee extensors variability. For the average power of knee flexors, the final model showed that the factors IL-6 and level of physical activity explained 4.1% (R(2)=0.041, p<0.01). There was no negative correlation between inflammatory mediators and muscle or physical performance in elderly women. These results may be explained by the fact that the cytokine levels did not reach the threshold needed to influence the muscle tissue and functionality of the participants.