Juscélio P. Silva

Physical therapy intervention (PTI) increases plasma brain-derived neurotrophic factor (BDNF) levels in non-frail and pre-frail elderly women

Biomarkers are important factors in the identification of the frail elderly (higher risk of developing disease) and in assessing the impact of PTI. On the other hand, BDNF has been related to neuroprotection in a series of central nervous system diseases in older age. The levels of BDNF in groups of elderly women classified according to Fried phenotype (non-frail and pre-frail) were compared. We assessed the impact of a PTI on BDNF levels. A convenience sample of 48 elderly women was randomly selected. The PTI group was composed by 20 elderly women selected from this group. Plasma neurotrophic factors, such as BDNF, glial-derived neutrophic factor (GDNF), and nerve growth factor (NGF) were measured by enzyme-linked immunosorbent assay (ELISA). Timed-up-and-go (TUG) test, hand-grip and work/body weight were evaluated before and after the intervention. Plasma concentrations of BDNF were significantly higher in non-frail in comparison to pre-frail elderly women. After the PTI, higher levels of BDNF were found in elderly women (before 351±68 pg/ml and after 593±79 pg/ml; p<0.001). Both groups had an increase in BDNF levels after the PTI. The low levels of BDNF in pre-frail elderly women suggest that this neurotrophic factor may be a key pathophysiological mediator in the syndrome of frailty. The fact that PTI increased BDNF levels in both groups suggests that it may be possible to modify this phenotype.

Impact of resistance exercise program on functional capacity and muscular strength of knee extensor in pre-frail community-dwelling older women: a randomized crossover trial

BACKGROUND: Frailty syndrome in elderly people is characterized by a reduction of energy reserves and also by a decreased of resistance to stressors, resulting in an increase of vulnerability. OBJECTIVE: The aim of this study was to verify the effect of a muscle-strengthening program with load in pre-frail elder women with regards to the functional capacity, knee extensor muscle strength and their correlation. METHODS: Thrity-two pre-frail community-dwelling women participated in this study. Potential participants with cognitive impairment (MEEM), lower extremities orthopedic surgery, fractures, inability to walk unaided, neurological diseases, acute inflammatory disease, tumor growth, regular physical activity and current use of immunomodulators were excluded. All partcipants were evaluated by a blinded assessor using: Timed up and go (TUG), 10-Meter Walk Test (10MWT) and knee extensor muscle strength (Byodex System 3 Pro® isokinetic dynamometer at angular speeds of 60 and 1800/s). The intervention consisted of strengthening exercises of the lower extremities at 70% of 1RM, three times/ week for ten weeks. The statistical analysis was performed using the ANOVA and Spearman tests RESULTS: After the intervention, it was observed statistical significance on the work at 1800/s (F=12.71, p=0.02), on the power at 1800/s (F=15.40, p=0.02) and on the functional capacity (TUG, F=9.54, p=0.01; TC10, F=3.80, p=0.01). There was a good negative and statistically significant correlation between the TUG and work at 600/s, such as the TUG and work at 1800/s (r=-0.65, p=0.01; r=-0.72, p=0.01). CONCLUSION: The intervention improved the muscular power and the functional capacity. The increase of the power correlated with function, which is an important variable of the quality of life in the pre-frail elders. Article registered in the ISRCT register under number ISRCTN62824599.BACKGROUND Frailty syndrome in elderly people is characterized by a reduction of energy reserves and also by a decreased of resistance to stressors, resulting in an increase of vulnerability. OBJECTIVE The aim of this study was to verify the effect of a muscle-strengthening program with load in pre-frail elder women with regards to the functional capacity, knee extensor muscle strength and their correlation. METHODS Thrity-two pre-frail community-dwelling women participated in this study. Potential participants with cognitive impairment (MEEM), lower extremities orthopedic surgery, fractures, inability to walk unaided, neurological diseases, acute inflammatory disease, tumor growth, regular physical activity and current use of immunomodulators were excluded. All partcipants were evaluated by a blinded assessor using: Timed up and go (TUG), 10-Meter Walk Test (10MWT) and knee extensor muscle strength (Byodex System 3 Pro® isokinetic dynamometer at angular speeds of 60 and 180(0)/s). The intervention consisted of strengthening exercises of the lower extremities at 70% of 1RM, three times/ week for ten weeks. The statistical analysis was performed using the ANOVA and Spearman tests RESULTS After the intervention, it was observed statistical significance on the work at 180(0)/s (F=12.71, p=0.02), on the power at 180(0)/s (F=15.40, p=0.02) and on the functional capacity (TUG, F=9.54, p=0.01; TC10, F=3.80, p=0.01). There was a good negative and statistically significant correlation between the TUG and work at 60(0)/s, such as the TUG and work at 180(0)/s (r=-0.65, p=0.01; r=-0.72, p=0.01). CONCLUSION The intervention improved the muscular power and the functional capacity. The increase of the power correlated with function, which is an important variable of the quality of life in the pre-frail elders. Article registered in the ISRCT register under number ISRCTN62824599.

The effects of a muscle resistance program on the functional capacity, knee extensor muscle strength and plasma levels of IL-6 and TNF-α in pre-frail elderly women: a randomized crossover clinical trial - a study protocol

BackgroundWith the increase in the elderly population, a growing number of chronic degenerative diseases and a greater dependency on caregivers have been observed. Elderly persons in states of frailty remain more susceptible to significant health complications. There is evidence of an inverse relationship between plasma levels of inflammatory mediators and levels of functionality and muscle strength, suggesting that muscle-strengthening measures can aid in inflammatory conditions. The purpose of this study will be verified the effect of a muscle-strengthening program with load during a ten-week period in pre-frail elderly women with attention to the following outcomes: (1) plasma levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), (2) functional capacity and (3) knee extensor muscle strength.Methods/DesignThe study design is a randomized crossover clinical trial evaluating 26 elderly women (regardless of their race and/or social condition) who are community residents, older than 65, and classified as pre-frail according to the criteria previously described by Fried et al. (2004). All subjects will be assessed using the Timed up and go and 10-Meter Walk Test functional tests. The plasma levels of IL-6 and TNF-α will be assessed by ELISA (enzyme-linked immunosorbent assay) with high sensitivity kits (Quantikine®HS, R&D Systems Minneapolis, MN, U.S.). Knee extensor muscle strength will be assessed using the Byodex System 3 Pro®isokinetic dynamometer at angular speeds of 60 and 180°/s. The intervention will consist of strengthening exercises of the lower extremities at 50 to 70% of 1RM (maximal resistance) three times per week for ten weeks. The volunteers will be randomized into two groups: group E, the intervention group, and group C, the control group that did not initiate any new activities during the initial study period (ten weeks). After the initial period, group C will begin the intervention and group E will maintain everyday activities without exercising. At the end of the total study period, all volunteers will be reassessed.DiscussionTo demonstrate and discuss possible influences of load-bearing exercises on the modification of plasma levels of IL-6 and TNF-α and in the functional performance of pre-frail elderly women.Trial RegistrationISRCTN62824599

Fatores clínicos, funcionais e inflamatórios associados à fadiga muscular e à fadiga autopercebida em idosas da comunidade

BACKGROUND: Fatigue is a common and nonspecific symptom associated with chronic health problems in the elderly. The modifications and adaptations of the aging process associated with complex and multidimensional nature of fatigue favors the interaction of multiple factors in the genesis of this phenomenon. OBJECTIVES: To investigate the association of clinical, functional and inflammatory factors with muscle fatigue and self perceived fatigue in elderly women. METHODS: Participated in the study one hundred and thirty five community elderly women, all sedentary, with a mean age of 71.2±4.57. A structured questionnaire and functional testing were used to evaluate clinical and functional characteristics. Plasma concentrations of inflammatory mediators (IL-6 and sTNFR1) were measured by ELISA method. Muscle fatigue was measured by isokinetic dynamometer and self-perceived fatigue was measured by a visual analog scale. Statistical analysis was performed by multiple linear regression and Spearman correlation coefficient with statistical significance of 5%. RESULTS: The regression models showed that the variables age, body mass index, physical activity level, functional capacity and peak torque were associated with muscle fatigue (R2=0.216, p<0.01). Self-perceived fatigue was associated with number of comorbidities, depression, physical activity level, functional capacity, peak torque and perceived health (R2=0.227, p<0.01). CONCLUSION: This study showed a psychophysical interaction of the fatigue, by identifying the main factors associated with muscle fatigue and self-perceived fatigue in elderly women. These findings demonstrate the importance of evaluation and treatment of modifiable factors in both muscle fatigue and self-perceived fatigue, seeking a better physical and functional performance of elders.

Impact of an Exercise Program on Muscular and Functional Performance and Plasma Levels of Interleukin 6 and Soluble Receptor Tumor Necrosis Factor in Prefrail Community-Dwelling Older Women: A Randomized Controlled Trial

OBJECTIVE To examine the impact of a muscle resistance program (MRP) on muscular and functional performance and on interleukin 6 (IL-6) and soluble tumor necrosis factor receptor-1 (sTNFr1) plasma levels in prefrail community-dwelling women. DESIGN Randomized controlled trial crossover design with a postintervention and short-term follow-up. SETTING University hospital. PARTICIPANTS Prefrail community-dwelling women (N=32; ≥65y). INTERVENTION The MRP was designed based on the exercise at 75% of each participants maximum load (10wk, 3 times/wk). MAIN OUTCOME MEASURES Plasma concentrations of IL-6 and sTNFr1 (high-sensitivity enzyme-linked immunosorbent assay kits), muscle strength of the knee extensors (isokinetic), and functional performance (Timed Up & Go [TUG] test and 10-meter walk test [10MWT]). RESULTS There were significant differences in functional and muscular performance between the pre-MRP, post-MRP, and 10-week follow-up period. After the MRP, both functional (TUG, pre-MRP=11.1s vs post-MRP=10.4s, P=.00; 10MWT, pre-MRP=4.9s vs post-MRP, 4.4s, P=.00) and muscular performances (pre-MRP=77.8% and post-MRP=83.1%, P=.02) improved. After cessation of the MRP (follow-up period), sTNFr1 plasma levels increased by 21.4% at 10-week follow-up (post-MRP, 406.4pg/mL; 10-week follow-up, 517.0pg/mL; P=.03). There were significant differences in sTNFr1 (P=.01). CONCLUSIONS The MRP was effective in improving functional and muscular performances, although alterations in plasma levels of IL-6 and sTNFr1 could not be identified after the MRP. Cessation of the MRP after 10 weeks resulted in increased plasma levels of sTNFr1.

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.

Impacto das alterações visuais nas quedas, desempenho funcional, controle postural e no equilíbrio dos idosos: uma revisão de literatura

Visual impairment in the elderly may alter their life style and functional independence. Visual alterations may cause depression, falls and a reduction in social interaction, altering the quality of life. The control of body balance may be impaired in individuals with visual deficits. The objective of this study was to review the last 15 years of literature on the impact of visual alterations through feedback from the visual system, on functional performance, on postural control and on balance in the elderly. The assessment of visual acuity may not be sufficient to identify those individuals who are at risk of falling. Other measurements related to visual function, such as contrast, sensitivity and depth perception, are also important. Many problems related to impaired vision in the elderly are correctable or treatable, either by the use of reflective vision correction or by extraction of cataracts, thus improving both visual and motor functions.

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

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.

The Brazilian Back Complaints in the Elders (Brazilian BACE) study: characteristics of Brazilian older adults with a new episode of low back pain

Highlights • Brazilian older adults with low back pain presented severe and disabling low back pain and pain is accompanied by relevant psychological distress.• Participants aged 55–64 years old reported more disabling low back pain when considering levels of perceived physical health, trunk mobility and fall-related self-efficacy compared to those aged 65 years and older.• Participants with lower socioeconomic status were more disabled and reported more pain catastrophizing scale when compared to those with higher socioeconomic status.