Gustavo de Carvalho da Costa

The association between osteoporosis and static balance in elderly women

SummaryThis study aimed at answering the question: do people with high bone loss have greater postural instability? Groups were separated into group 1: women with normal bone mineral density, group 2: women with osteopenia, and group 3: women with osteoporosis. The balance was evaluated in four upright postural situations. Osteoporosis group had greater oscillation in the anteroposterior displacement in all situations compared to control group and the greatest mediolateral displacement in all situations compared to other groups.IntroductionIt is not known whether the presence of osteoporosis can be considered a factor aggravating the postural control. This study aimed at answering the question: do people with high bone loss have greater postural instability?MethodsThis study was divided into three groups: group 1 (n = 20) consisting of women with normal bone mineral density, group 2 (n = 20) women with osteopenia, and group 3 (n = 20) women with osteoporosis. All the participants were submitted to evaluation of the balance using the Polhemus system in four upright postural situations.ResultsOsteoporosis group had greater oscillation in the anteroposterior displacement in all situations compared to control group. The osteoporosis group also showed the greatest mediolateral displacement in all situations compared to other groups.ConclusionThe results suggest that osteoporotic women had the worst balance, possibly due to the more pronounced body changes compared to non-osteoporotic women.

Postural Control and Functional Strength in Patients With Type 2 Diabetes Mellitus With and Without Peripheral Neuropathy

OBJECTIVE To assess the influence of diabetic neuropathy (DN) on balance and functional strength in patients with diabetes mellitus type 2 (DM2). DESIGN Cross-sectional study. SETTING Diabetes outpatient unit. PARTICIPANTS Adults (N=62; age range, 40-65y): 32 with DM2 (19 subjects without DN and 13 with DN) and 30 without DM2 (control group). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Upright balance, evaluated in 4 situations (fixed platform, unstable platform, with eyes open, with eyes closed), and functional strength, assessed with a five-times-sit-to-stand test, were analyzed using an electromagnetic system, with a sensor placed over C7 to allow maximum trunk displacements in the anterior-posterior and medial-lateral directions. The Berg Balance Scale and the Timed Up & Go test were also used. RESULTS Subjects with DM2 had greater anterior-posterior displacement (P<.05) in the unstable platform with eyes closed condition compared with those without DM2, whereas no difference in medial-lateral displacement was observed between these groups. A difference in time was observed in the five-times-sit-to-stand test (P<.05), with subjects in the control group performing the tasks faster than either group of subjects with DM2. Additionally, subjects in the control group showed a higher score in the Berg Balance Scale and performed the Timed Up & Go test in less time compared with subjects in other groups. CONCLUSIONS Subjects with DM2, with or without DN, showed deficits in postural control and functional strength compared with healthy individuals of the same age group.

Do muscle strengthening exercises improve performance in the 6-minute walk test in postmenopausal women?

BACKGROUND Walking speed seems to be related to aerobic capacity, lower limb strength, and functional mobility, however it is not clear whether there is a direct relationship between improvement in muscle strength and gait performance in early postmenopausal women. OBJECTIVE To evaluate the effect of muscle strengthening exercises on the performance of the 6-minute walk test in women within 5 years of menopause. METHODS The women were randomized into control group (n=31), which performed no exercise, and exercise group (n=27), which performed muscle strengthening exercises. The exercises were performed twice a week for 3 months. The exercise protocol consisted of warm-up, stretching, and strengthening of the quadriceps, hamstring, calf, tibialis anterior, gluteus maximus, and abdominal muscles, followed by relaxation. Muscular strength training started with 60% of 1MR (2 series of 10-15 repetitions), reaching 85% until the end of the 3-month period (4 series of 6 repetitions each). RESULTS The between-group comparisons pre- and post-intervention did not show any difference in distance walked, heart rate or blood pressure (p>0.05), but showed differences in muscle strength post-intervention, with the exercise group showing greater strength (p CONCLUSION The results suggest that muscle strengthening of the lower limbs did not improve performance in the 6-minute walk test in this population of postmenopausal women.

Body balance evaluation in osteoporotic elderly women.

SummaryOsteoporotic Brazilian women balance was evaluated by timed up and go test (TUG) and to the Berg balance scale (BBS). In the BBS, women with and without osteoporosis had normal range scores, even with history of fall. In the TUG test, women with osteoporosis were slower, but in the normal parameter. Results suggest that the references values of these tests are not appropriate for Brazilians.PurposesThe purposes of this study were to evaluate balance and functional mobility in women with osteoporosis and without osteoporosis and to verify if the history of falls has association to the TUG and to the BBS, both largely used in the clinical practice.Materials and methodsForty-five women were divided into three groups: group 1, young women with normal body mineral density (BMD); group 2, elderly with normal BMD; and group 3, elderly with osteoporosis. BBS and TUG were performed, and the history of falls was collected.ResultsBBS and TUG showed differences in the scores obtained for young women compared with both elderly with and without osteoporosis. In the TUG test, there were differences between elderly with and without osteoporosis. The fall’s history did not present correlations either for TUG or BBS.ConclusionsAlthough the results showed that all women were within the normal range for BBS and TUG, the results suggest that the reference values for TUG and BBS are not appropriate for Brazilian population.

Impact of First 10 Years of Post Menopause on Muscle Function, MuscleMass and Bone Mineral Density in Adult Women

Background: Previous studies suggested that the early identification of risk factors for the development of osteoporosis should reduce medical complications, which are associated with increased morbidity and mortality in older women. Purpose: The present study had the objective to identify the relationship between Bone Mineral Density (BMD), anthropometric characteristics, years of post-menopause, strength, muscle mass and the performance on functional tests in up 10 years postmenopausal women. Methods: Participated of the study fifty-eight post menopause women who were assessed by dual-energy X-ray absorptiometry (DXA) of femoral neck and whole-body to determine BMD and relative skeletal muscle index (RSMI). Also, the muscle strength was assessed by handgrip strength test (HGS) and two functional tests were performed: Timed Up-and-Go (TUG) and Five-Times-Sit-To-Stand (FTSTS). Results: The results shown a positive correlation between BMD and weight (r = 0.54, p < 0.05), BMD and BMI (r = 0.56, p < 0.05), BMD and RSMI (r = 0.38, p < 0.05). Conclusions: The findings of the present study demonstrated a correlation between muscle mass and BMD and also shown that anthropometric characteristics, such as higher weight and BMI were correlated with higher BMD and muscle mass in up 10 years postmenopausal women.

Impaired Ability to Perform the Sit-to-Stand Task in Osteoporotic Women

The process of aging causes several physiological alterations and body modification in elderly people. These changes include decrease in bone mass and muscular strength, rigidity in joints, and range of movement reduction in addition to changes in the central nervous system such as slow nerve conduction velocity (Deschenes, 2011), cocontraction of antagonist muscles, and alterations in the sensorial systems (visual, somatosensitive, vestibular functions), all contributing for the impairment of postural control and functional activities (Gauchard et al., 2003). The maintenance of the postural stability is important during functional activities such as sitting down and standing up, walking, as well as for performing volitional movements coordinately, which is essential for daily tasks. The increase of postural control system deficit, which is associated to aging, has a strong relation to the risk of falls. In Brazil, data from the Ministry of Health shown that 28,459 elderly persons had died between 1979 and 1995 due to falls and, in February 2000, the inpatient mortality rate for falls was 2.58%. Changes in postural control and decreased muscle strength and power are important risk factors for falls, especially in the elderly, since there is a reduction in muscle strength of 30-50% between 30 -80 years, especially in the lower limbs (Burke et al., 2010; Janssen et al., 2002). The reduction in muscle strength occurs due to the reduction in the number and size of muscle fibers. Mainly type II fibers (fast contraction), which are most affected in relation to type I fibers (slow contraction) (Frontera et al., 1991). The intensity of the muscle fibers loss depends on the degree of physical activity, nutrition, hereditary factor and lifestyle throughout life. In addition to losing in maximum muscle strength due to the aging process, there is also the loss of muscle power (force x speed), leading to a greater impairment in performance of functional activities, which requires agility, such as standing and walking, and increase susceptibility to falls (Marsh, 2000; Hunter et al., 2004). The sit-to-stand test is a widely used tool in clinical practice because it is easy to apply and it requires simple matters, which are chair (without armrests) and a stopwatch. There are several ways to perform the test, but the way that is most commonly used, is to perform five

Static balance, quadriceps strength and ankle dorsiflexor torque in fertile and post-menopausal women

INTRODUCTION: Menopause is the period of life in which women experience progressive changes in their body. Muscular strength and balance are important examples of changes occurring in this group of individuals. OBJECTIVE: Evaluation and correlation of the static balance, quadriceps strength and ankle dorsiflexor torque in fertile (n = 20) and post-menopausal women (n = 45) were studied. METHODS: A device was used to record the ankle dorsiflexion torque and the quadriceps strength was measured according to the concept of one repetition maximum. The assessment of the static balance was made with the Polhemus system. RESULTS: The control group presented ankle dorsiflexor torque and quadriceps strength greater than the post-menopausal women, but the static balance was not different between groups. In control group, correlation was observed only between quadriceps strength and using the fixed platform with eyes closed. In the post-menopausal women there was a correlation between static balance and the ankle dorsiflexor torque in the fixed platform with eyes open (r = 0.386; p = 0.008); fixed platform with eyes closed (r = 0.373; p = 0.01) and unstable platform with eyes open (r = 0.343; p = 0.02). In this group correlation between static balance and quadriceps strength was observed in testing the use of fixed platform with eyes closed (r = 0.315; p = 0.03). CONCLUSIONS: The results suggest that the diminished muscular strength after menopause seems to be related to the hypoestrogenism and that the ankle dorsiflexor torque is an important factor for the maintenance of static balance in the first years of menopause.

Avaliação da curvatura torácica e da presença de dor em mulheres de diferentes faixas etárias

OBJETIVO: demostrar la utilizacion de este metodo flexicurva para la evaluacion y la comparacion de cifosis toracica en mujeres sanas de diferentes edades, y si hay correlacion entre el grado de dolor y la cifosis toracica mediante una Escala Analogica Visual (EVA). METODOS: el estudio se compone de un grupo de mujeres G1 (n = 24), con un promedio de 20,67 ± 1,69 anos y otro grupo G2 (n = 24), con un promedio de 65,63 ± 8,07 anos, que fueron presentados para la evaluacion de pecho curvatura (utilizando el metodo flexicurva) y dolor de espalda (usando la EVA). RESULTADOS: se encontro una diferencia estadisticamente significante en el angulo de cifosis toracica en el grupo 2 en comparacion con el grupo 1 y una correlacion debil entre el angulo de cifosis y la clasificacion del dolor en el pecho de la Escala Analogica Visual de los grupos 1 y 2. CONCLUSION: el grupo 1 mostraron un grado de curvatura de pecho dentro del rango normal, Grupo 2 ha exacerbado un cierto grado de cifosis toracica, que caracterizan a si mismo como hipercifose. Sin embargo, no hubo correlacion entre el grado de dolor y la cifosis toracica en ambos grupos.reSuMo Objetivo: demonstrar a utilização do método flexicurva para avaliação e comparação da cifose torácica em mulheres saudáveis de diferentes faixas etárias, além de detectar se há correlação entre dor e grau de cifose torácica utilizando-se a Escala Visual Analógica (EVA). Métodos: o estudo foi composto por um grupo de mulheres G1 (n=24), com média de 20,67±1,69 anos e outro grupo G2 (n=24), com média de 65,63 ±8,07 anos, que foram submetidas à avaliação da curvatura torácica, com a utilização do método flexicurva, e dor nas costas, com a EVA. Resultados: foi encontrada uma diferença estatisticamente significante no ângulo de cifose torácica no grupo 2 quando comparada ao grupo 1 e uma fraca correlação entre o ângulo de cifose torácica e a classificação da ABStrAct Objective: to demonstrate the use of the flexicurve method for evaluation and comparison of thoracic kyphosis in healthy women of different ages, and to observe if there is a correlation between degree of pain and thoracic kyphosis using the Visual Analog Scale (VAS). Methods: the study was composed by a group of young G1 (n = 24) and another group G2 (n = 24) which were submitted for evaluation of thoracic curvature (using the flexicurve method) and back pain (using VAS). Results: found a statistically significant difference in the angle of thoracic kyphosis in group 2 compared to group 1 and a weak correlation between the angle of thoracic kyphosis and pain classification of the VAS in groups 1 and 2. Conclusion: the group 1 showed a normal degree of thoracic curvature reSuMeN Objetivo: demostrar la utilización de este método flexicurva para la evaluación y la comparación de cifosis torácica en mujeres sanas de diferentes edades, y si hay correlación entre el grado de dolor y la cifosis torácica mediante una Escala Analógica Visual (EVA). Métodos: el estudio se compone de un grupo de mujeres G1 (n = 24), con un promedio de 20,67 ± 1,69 años y otro grupo G2 (n = 24), con un promedio de 65,63 ± 8,07 años, que fueron presentados para la evaluación de pecho curvatura (utilizando el método flexicurva) y dolor de espalda (usando la EVA). Resultados: se encontró una diferencia estadísticamente significante en el ángulo de cifosis torácica en el grupo 2 en comparación con el grupo 1 y una correlación débil entre el ángulo de cifosis y la clasificación del dolor en el

Evaluación de la curvatura torácica y de la presencia de dolor em mujeres con diferentes rangos de edad

OBJETIVO: demostrar la utilizacion de este metodo flexicurva para la evaluacion y la comparacion de cifosis toracica en mujeres sanas de diferentes edades, y si hay correlacion entre el grado de dolor y la cifosis toracica mediante una Escala Analogica Visual (EVA). METODOS: el estudio se compone de un grupo de mujeres G1 (n = 24), con un promedio de 20,67 ± 1,69 anos y otro grupo G2 (n = 24), con un promedio de 65,63 ± 8,07 anos, que fueron presentados para la evaluacion de pecho curvatura (utilizando el metodo flexicurva) y dolor de espalda (usando la EVA). RESULTADOS: se encontro una diferencia estadisticamente significante en el angulo de cifosis toracica en el grupo 2 en comparacion con el grupo 1 y una correlacion debil entre el angulo de cifosis y la clasificacion del dolor en el pecho de la Escala Analogica Visual de los grupos 1 y 2. CONCLUSION: el grupo 1 mostraron un grado de curvatura de pecho dentro del rango normal, Grupo 2 ha exacerbado un cierto grado de cifosis toracica, que caracterizan a si mismo como hipercifose. Sin embargo, no hubo correlacion entre el grado de dolor y la cifosis toracica en ambos grupos.reSuMo Objetivo: demonstrar a utilização do método flexicurva para avaliação e comparação da cifose torácica em mulheres saudáveis de diferentes faixas etárias, além de detectar se há correlação entre dor e grau de cifose torácica utilizando-se a Escala Visual Analógica (EVA). Métodos: o estudo foi composto por um grupo de mulheres G1 (n=24), com média de 20,67±1,69 anos e outro grupo G2 (n=24), com média de 65,63 ±8,07 anos, que foram submetidas à avaliação da curvatura torácica, com a utilização do método flexicurva, e dor nas costas, com a EVA. Resultados: foi encontrada uma diferença estatisticamente significante no ângulo de cifose torácica no grupo 2 quando comparada ao grupo 1 e uma fraca correlação entre o ângulo de cifose torácica e a classificação da ABStrAct Objective: to demonstrate the use of the flexicurve method for evaluation and comparison of thoracic kyphosis in healthy women of different ages, and to observe if there is a correlation between degree of pain and thoracic kyphosis using the Visual Analog Scale (VAS). Methods: the study was composed by a group of young G1 (n = 24) and another group G2 (n = 24) which were submitted for evaluation of thoracic curvature (using the flexicurve method) and back pain (using VAS). Results: found a statistically significant difference in the angle of thoracic kyphosis in group 2 compared to group 1 and a weak correlation between the angle of thoracic kyphosis and pain classification of the VAS in groups 1 and 2. Conclusion: the group 1 showed a normal degree of thoracic curvature reSuMeN Objetivo: demostrar la utilización de este método flexicurva para la evaluación y la comparación de cifosis torácica en mujeres sanas de diferentes edades, y si hay correlación entre el grado de dolor y la cifosis torácica mediante una Escala Analógica Visual (EVA). Métodos: el estudio se compone de un grupo de mujeres G1 (n = 24), con un promedio de 20,67 ± 1,69 años y otro grupo G2 (n = 24), con un promedio de 65,63 ± 8,07 años, que fueron presentados para la evaluación de pecho curvatura (utilizando el método flexicurva) y dolor de espalda (usando la EVA). Resultados: se encontró una diferencia estadísticamente significante en el ángulo de cifosis torácica en el grupo 2 en comparación con el grupo 1 y una correlación débil entre el ángulo de cifosis y la clasificación del dolor en el

Evaluation of the thoracic curvature and the presence of pain in women of different age groups

OBJETIVO: demostrar la utilizacion de este metodo flexicurva para la evaluacion y la comparacion de cifosis toracica en mujeres sanas de diferentes edades, y si hay correlacion entre el grado de dolor y la cifosis toracica mediante una Escala Analogica Visual (EVA). METODOS: el estudio se compone de un grupo de mujeres G1 (n = 24), con un promedio de 20,67 ± 1,69 anos y otro grupo G2 (n = 24), con un promedio de 65,63 ± 8,07 anos, que fueron presentados para la evaluacion de pecho curvatura (utilizando el metodo flexicurva) y dolor de espalda (usando la EVA). RESULTADOS: se encontro una diferencia estadisticamente significante en el angulo de cifosis toracica en el grupo 2 en comparacion con el grupo 1 y una correlacion debil entre el angulo de cifosis y la clasificacion del dolor en el pecho de la Escala Analogica Visual de los grupos 1 y 2. CONCLUSION: el grupo 1 mostraron un grado de curvatura de pecho dentro del rango normal, Grupo 2 ha exacerbado un cierto grado de cifosis toracica, que caracterizan a si mismo como hipercifose. Sin embargo, no hubo correlacion entre el grado de dolor y la cifosis toracica en ambos grupos.reSuMo Objetivo: demonstrar a utilização do método flexicurva para avaliação e comparação da cifose torácica em mulheres saudáveis de diferentes faixas etárias, além de detectar se há correlação entre dor e grau de cifose torácica utilizando-se a Escala Visual Analógica (EVA). Métodos: o estudo foi composto por um grupo de mulheres G1 (n=24), com média de 20,67±1,69 anos e outro grupo G2 (n=24), com média de 65,63 ±8,07 anos, que foram submetidas à avaliação da curvatura torácica, com a utilização do método flexicurva, e dor nas costas, com a EVA. Resultados: foi encontrada uma diferença estatisticamente significante no ângulo de cifose torácica no grupo 2 quando comparada ao grupo 1 e uma fraca correlação entre o ângulo de cifose torácica e a classificação da ABStrAct Objective: to demonstrate the use of the flexicurve method for evaluation and comparison of thoracic kyphosis in healthy women of different ages, and to observe if there is a correlation between degree of pain and thoracic kyphosis using the Visual Analog Scale (VAS). Methods: the study was composed by a group of young G1 (n = 24) and another group G2 (n = 24) which were submitted for evaluation of thoracic curvature (using the flexicurve method) and back pain (using VAS). Results: found a statistically significant difference in the angle of thoracic kyphosis in group 2 compared to group 1 and a weak correlation between the angle of thoracic kyphosis and pain classification of the VAS in groups 1 and 2. Conclusion: the group 1 showed a normal degree of thoracic curvature reSuMeN Objetivo: demostrar la utilización de este método flexicurva para la evaluación y la comparación de cifosis torácica en mujeres sanas de diferentes edades, y si hay correlación entre el grado de dolor y la cifosis torácica mediante una Escala Analógica Visual (EVA). Métodos: el estudio se compone de un grupo de mujeres G1 (n = 24), con un promedio de 20,67 ± 1,69 años y otro grupo G2 (n = 24), con un promedio de 65,63 ± 8,07 años, que fueron presentados para la evaluación de pecho curvatura (utilizando el método flexicurva) y dolor de espalda (usando la EVA). Resultados: se encontró una diferencia estadísticamente significante en el ángulo de cifosis torácica en el grupo 2 en comparación con el grupo 1 y una correlación débil entre el ángulo de cifosis y la clasificación del dolor en el