Manuel Veríssimo

Effects of aerobic and strength-based training on metabolic health indicators in older adults

BackgroundThe weakening of the cardiovascular system associated with aging could be countered by increasing levels of physical activity and functional fitness. However, inconsistent findings have been found, and the variety of characteristics of exercise used in previous studies may partly explain that inconsistent results.ObjectiveTo investigate the training effect of sixteen weeks of moderate intensity, progressive aerobic and strength-based training on metabolic health of older women and men.MethodsSixty three sedentary individuals (mean (SD) age 76 (8) years) were randomly assigned to control (n = 31) or exercising (n = 32) groups. The training group was separated to aerobic (n = 18) or strength-based (n = 14). Training took place three times a week. Subjects agreed not to change their diet or lifestyle over the experimental period.ResultsExercising group attained after treatment significant differences on body weight, waist circumference, body mass index, diastolic blood pressure, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, total cholesterol/HDL-cholesterol relationship, high sensitivity C-reactive protein, and 6-minute walk distance. The control group only had significant differences on waist circumference.ConclusionThe training programs produced significant benefits on metabolic health indicators of sedentary older women and men.

Glycated hemoglobin and associated risk factors in older adults

BackgroundThe aim of this study is to investigate the relationships between HbA1c and other risk factors like obesity, functional fitness, lipid profile, and inflammatory status in older adults. Epidemiological evidence suggests that HbA1c is associated with cardiovascular and ischemic heart disease risk. Excess of body weight and obesity are considered to play a central role in the development of these conditions. Age is associated with several risk factors as increased body fat and abdominal fat, deterioration of the lipid profile, diabetes, raising in inflammatory activity, or decreased functional fitness.MethodsData were available from 118 participants aged 65-95 years, including 72 women and 46 men. Anthropometric variables were taken, as was functional fitness, blood pressure and heart rate. Blood samples were collected after 12 h fasting, and HbA1c, hs-CRP, TG, TC, HDL-C, LDL-C, and glycaemia were calculated. Bivariate and partial correlations were performed to explore associations amongst the variables of interest. Differences between groups were explored by performing factorial analysis of variance.ResultsHbA1c levels ranged from 4.6%-9.4% with 93% of the cases below 6.5%. Women had higher HbA1c, glycaemia, TC, BMI, and lower and upper flexibility than men. Men had higher BW, WC, 6-min walking distance, and VO2peak than women. Age, SBP, DBP, HRrest, HRpeak, HDL-C, LDL-C, TG, TG/HDL-C ratio, Log10 hs-CRP, upper and lower strength, and agility and dynamic balance were similar in men and women. HbA1c had positive associations with glycaemia, HDL-C, TG/HDL-C, BW, WC, BMI, but not with functional fitness, TC, LDL-C, Log10 hs-CRP, PAD, or PAS. Obese participants had higher HbA1c than non-obese only when IDF and not USDHHS criteria were applied.ConclusionsOlder women had higher HbA1c than men, even after controlling for BMI. HbA1c associates equally with BW, BMI or WC. Population-based criteria are recommended to classify obesity and to identify higher levels of HbA1c in obese older adults. HbA1c associates with atherogenic dyslipidemia particularly with TG and TG/HDL-C ratio, but not with TC, HDL-C, or LDL-C. HbA1c is not associated with hs-CRP, and with functional fitness and aerobic endurance.

A socio-demographic study of aging in the Portuguese Population - The EPEPP study

The increase in life expectancy (LE) observed in Western societies, has resulted in a steep rise of older population. This stresses the importance of the research on aging, to better adequate health and social care organization and improve the quality of life (QoL). The aim of the EPEPP-1 (abbreviated from the Portuguese name: Estudo do Perfil de Envelhecimento da População Portuguesa) study was to characterize the socio-demographic components of the elderly Portuguese population in order to disclose factors that could play a role in the aging process and in the elderly QoL. This observational descriptive study, was performed in 2672 individuals older than 54 years taking into account gender and the residence area (rural vs. urban). A questionnaire about social network (marital status, living alone, the hours spent alone, confidents), and social status (education, occupation) was applied. Social network score revealed significant age and gender trends, women and older people performing worst, but with no difference according to residence area. Almost a third was unmarried and spent eight or more hours per day alone, and a fifth lived alone. Social status revealed that being older female and resident in a rural area quoted worst in the prevalence of illiteracy and undifferentiated occupation. The authors concluded that social isolation, illiteracy and undifferentiated occupation are prevalent in Portuguese older population. Identification of further determinants of isolation, adjustment of procedures to be included in social networks and development of actions directed to education are important fields of intervention influencing the elderly QoL.

Effects of long-term multicomponent exercise on health-related quality of life in older adults with type 2 diabetes: evidence from a cohort study

PurposeTo establish the effect of a long-term multicomponent exercise (LTMEX) intervention (24 months) on health-related quality of life (HRQoL), in older adults with type 2 diabetes (T2D).MethodsThis longitudinal retrospective cohort study analyzes the effects of a supervised LTMEX program on HRQoL in older adults with T2D (n = 279). Participants underwent one of two conditions: LTMEX (n = 241) trained three times per week; and unchanged lifestyle—the control group (CO; n = 38). Participants completed baseline, and 2-year follow-up evaluations including the Short Form Health Survey 36 (SF-36), anthropometric, hemodynamic components, and cardiorespiratory fitness (VO2 peak).ResultsLTMEX improves HRQoL, specifically physical functioning (P < 0.001), general health (P < 0.05), vitality (P < 0.001), mental health (MH; P < 0.05), physical component score (P < 0.001), mental component score (P < 0.001), and total SF-36 (P < 0.001). LTMEX group also decreased body weight (BW; P < 0.005), waist circumference (WC; P < 0.001), waist-to-hip ratio (WHR; P < 0.001), and systolic blood pressure (SBP; P < 0.001), and increased VO2 peak (P < 0.001). CO group increased WC (P = 0.012), BMI (P = 0.024), waist-to-hip ratio (WHR; P = 0.003) and SBP (P < 0.001), and decreased vitality (P < 0.001) and MH (P < 0.05).ConclusionsA LTMEX intervention improves physical and mental HRQoL in older adults with T2D, and also anthropometric, hemodynamic profile, and cardiorespiratory fitness.

Exercise training improves functional status in hypertensive older adults under angiotensin converting enzymes inhibitors medication

Background: The study aims to analyze the effect of three types of treatment on functional status, and cardiovascular risk outcomes in hypertensive older adults with comorbidities. Methods: Participants (n = 418) underwent one of the following 3 conditions: i) multicomponent exercise training 3 times/week (MEX; n = 116); ii) angiotensin converting enzyme inhibitors used mono‐dose daily (ACEi; n = 70); iii) combined exercise and ACEi drugs (ACEiMEX; n = 232). The trial was completed by 82% of the participants (n = 342): MEX (n = 90); ACEi (n = 66); ACEiMEX (n = 186). Baseline and 2‐year follow‐up evaluations included the Senior Fitness Test battery, Short Form Health Survey 36 (SF‐36), the health history questionnaires, anthropometric and hemodynamic profile. Results: MEX and ACEiMEX groups improved all physical functional status outcomes, decreased systolic (SBP) and diastolic blood pressure (p < 0.001) and augmented the physical functioning, role physical and physical component score (PCS) (p < 0.05), but also bodily pain (p < 0.05). The ACEi group reduced the upper body strength, upper and lower body flexibility and aerobic endurance (p < 0.05); worsened the anthropometric profile, and SBP (p < 0.001); and decreased general health and PCS (p < 0.05). Conclusions: The improvement of the physical functioning and HRQoL in older hypertensive adults using ACEi medications only occur if they adopt an exercise training regimen, increasing also the management of the blood pressure and other cardiovascular risk factors. HighlightsExercise training improved functional status.ACEi jointly with exercise improved cardiovascular risk factors and HRQoL.Isolated ACEi use decreased physical functioning.Isolated ACEi use worsened anthropometric profile and physical HRQoL.

Statin combined with exercise training is more effective to improve functional status in dyslipidemic older adults

Exercise training (EX) and statins are first‐line therapies to manage dyslipidemia.

The Quadruple Helix-Based Innovation Model of Reference Sites for Active and Healthy Ageing in Europe: The Ageing@Coimbra Case Study

Challenges posed by demographic changes and population aging are key priorities for the Horizon 2020 Program of the European Commission. Aligned with the vision of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), the development, exchange, and large-scale adoption of innovative good practices is a key element of the responses required to ensure all European citizens remain as active and healthy as possible as they age. Urged by the need of developing scalable disruptive innovation across Europe, the European Commission and the EIP on AHA created the Reference Sites; local coalition of partners that develop good practices to support AHA. Ageing@Coimbra is an example of how this can be achieved at a regional level. The consortium comprises over 70 institutions that develop innovative practices to support AHA in Portugal. Ageing@Coimbra partners support a regional network of stakeholders that build a holistic ecosystem in health and social care, taking into consideration the specificities of the territories, living environments and cultural resources (2,243,934 inhabitants, 530,423 aged 65 or plus live in the Centre Region of Portugal). Good practices in reducing the burden of brain diseases that affect cognition and memory impairment in older people and tackling social isolation in urban and rural areas are among the top priorities of Ageing@Coimbra. Profiting from the collaborative work of academia, business companies, civil society, and authorities, the quadruple helix of Ageing@Coimbra supports: early diagnosis of frailty and disease; care and cure; and active, assisted, and independent living. This paper describes, as a Community Case Study, the creation of a Reference Site of the EIP on AHA, Ageing@Coimbra, and its impact in Portugal. This Reference Site can motivate other regions to develop innovative formulas to federate stakeholders and networks, building consortia at regional level. This growing movement, across Europe, is inspired by the quadruple helix concept and by the replication of innovative good practices; creating new Reference Sites for the benefit of Citizens.

Antihypertensive monotherapy or combined therapy: which is more effective on functional status?

ABSTRACT Background: This study aims to analyze the effects of anti-hypertensive monotherapy and combined therapy on functional status, and cardiovascular risk outcomes in older adults. Methods: This longitudinal non-randomized cohort study, involved hypertensive older adults (n = 440) aged 60 or more years with comorbidities. Participants underwent a community exercise training program and one of the following 2 conditions: i) use of daily mono-dose angiotensin-converting enzyme inhibitors (ACEi; n= 232); ii) combined therapy including ACEi plus other class agent (Combined; n= 208). Baseline and 2-year follow-up evaluations included the functional fitness, health-related quality of life (HRQoL), health history questionnaires, anthropometric and hemodynamic profile. Results: Both experimental groups have significantly improved physical functional status, and have significantly decreased blood pressure and waist circumference. ACEi group has significantly reduced body mass and body mass index, the Combined group significantly reduced the waist-to-hip ratio. Additionally, both groups perceived better physical HRQoL. Conclusions: Functional status has improved with ACEi medication and exercise training, regardless the ACEi medication therapy. Exercise training plus ACEi antihypertensive therapy should be recommended into the standard prescription practice to reduce the rate of physical disability among hypertensive older adults.

Acute Granulomatous Interstitial Nephritis – A Rare Case of Sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown etiology with a wide range of clinical presentations. Authors describe the case of a 72-year-old man with severe acute renal injury secondary to granulomatous interstitial nephritis. Despite the suggestive renal biopsy, only the exclusion of other granulomatous diseases enabled the definitive diagnosis of renal sarcoidosis. The patient underwent hemodialysis and therapy with prednisolone 1mg/kg/day. His serum creatinine returned to baseline over the following months, with no evidence of residual injury. Sarcoid interstitial nephritis is usually silent, and there are very few reported cases associated with severe acute renal failure.

Secondary obstructive giant megaureter leading to massive pyogenic urinary infection

Abstract is not required for Clinical Imagesis not required for Clinical Images (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 8 No. 10, October 2017. ISSN: 0976-3198 Int J Case Rep Images 2017;8(10):684–686. www.ijcasereportsandimages.com Fonseca et al. 684 CASE REPORT OPEN ACCESS Secondary obstructive giant megaureter leading to massive pyogenic urinary infection João Fonseca, Maria Amparo Castellano, Manuel Veríssimo, Armando Carvalho