Marco Aurélio Vaz

Heliox Improves Oxygen Delivery and Utilization during Dynamic Exercise in Patients with Chronic Obstructive Pulmonary Disease

RATIONALE Normoxic heliox (mixture of 79% He and 21% O(2)) may enhance exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). It remains to be determined whether part of these beneficial effects could be ascribed to increased O(2) delivery (O(2)DEL) to locomotor muscles. OBJECTIVES To investigate the effects of heliox on peripheral O(2)DEL and utilization during exercise in moderate to severe COPD. METHODS Twelve mildly hypoxic or nonhypoxemic men (FEV(1) = 45.0 +/- 13.0% predicted) underwent constant-work rate tests (70-80% peak) to the limit of tolerance while receiving heliox or room air. Near-infrared spectroscopy determined changes (Delta) in leg muscle deoxygenation (deoxyhemoglobin concentration [HHb], an index of fractional O(2) extraction), and surface electromyography estimated muscle fiber recruitment (n = 5). Q and Sp(O(2)) were monitored by impedance cardiography and pulse oximetry, respectively. MEASUREMENTS AND MAIN RESULTS Heliox significantly decreased dynamic hyperinflation and increased exercise tolerance compared with room air (640 +/- 95 s vs. 371 +/- 100 s; P < 0.01). Heliox also accelerated on-exercise dynamics of Q, which were accompanied by faster O(2) uptake kinetics and slower Delta[HHb] responses (P < 0.05). During steady-state exercise, Sp(O(2))-corrected Delta[HHb] values decreased with heliox despite no significant changes in cardiac output. Muscle fiber recruitment and leg effort scores were also diminished (P < 0.05). On a multiple regression analysis, reductions in dynamic hyperinflation, dyspnea, and Delta[HHb] were independently related to improvements in exercise tolerance with heliox (R(2) = 0.91; P < 0.01). CONCLUSIONS Heliox increases lower limb O(2)DEL and utilization during dynamic exercise in patients with moderate to severe COPD. These effects enhance exercise tolerance in this patient population.

Echo intensity is associated with skeletal muscle power and cardiovascular performance in elderly men

The purpose of the present study was to investigate the relationship between echo intensity, neuromuscular and cardiorespiratory performances in the elderly. Thirty-one healthy elderly men (65.5±5.0) participated in this study. Echo intensity of rectus femoris and quadriceps femoris muscle thicknesses was determined by ultrasound images. Lower-body isometric and isokinetic peak torques (60, 180 and 360°(.s-1)), as well as rate of force development were evaluated as strength parameters. In addition, torque per unit of muscle mass was evaluated by the quotient between isometric peak torque of the knee extensors and the quadriceps femoris muscle thickness. The peak oxygen uptake (VO(2peak)), maximum aerobic workload (W(máx)), absolute (VT(1) and VT(2)) ventilatory thresholds, as well as workloads at VT(1) and VT(2) (W(VT1) and W(VT2)) were evaluated during a maximal incremental test on a cycle ergometer. There were significant negative correlations between the individual values of echo intensity with the corresponding individual values of isometric and isokinetic peak torques (60, 180 and 360°(.s-1)) (r=-0.48 to r=-0.64; P<0.05), as well as with W(VT1) (r=-0.46) and W(VT2) (r=-0.50) (P<0.05). In addition, significant positive correlations were observed between torque per unit of muscle mass and cardiovascular parameters (r=0.52 to r=0.60; P<0.001). The present results suggest that the echo intensity analysis using computer-aided gray-scale analysis is a low cost, easily accessible, and a safe method to evaluate the muscle quality, and may contribute to the research of neuromuscular and cardiovascular performances in the elderly.

Changes in contractile properties of muscles receiving repeat injections of botulinum toxin (Botox)

Botulinum toxin type A (BTX-A) is a frequently used therapeutic tool to denervate muscles in the treatment of neuromuscular disorders. Although considered safe by the US Food and Drug Administration, BTX-A can produce adverse effects in target and non-target muscles. With an increased use of BTX-A for neuromuscular disorders, the effects of repeat injections of BTX-A on strength, muscle mass and structure need to be known. Therefore, the purpose of this study was to investigate the changes in strength, muscle mass and contractile material in New Zealand White (NZW) rabbits. Twenty NZW rabbits were divided into 4 groups: control and 1, 3 and 6 months of unilateral, repeat injections of BTX-A into the quadriceps femoris. Outcome measures included knee extensor torque, muscle mass and the percentage of contractile material in the quadriceps muscles of the target and non-injected contralateral hindlimbs. Strength in the injected muscles was reduced by 88%, 89% and 95% in the 1, 3 and 6 months BTX-A injected hindlimbs compared to controls. Muscle mass was reduced by 50%, 42% and 31% for the vastus lateralis (VL), rectus femoris (RF) and vastus medialis (VM), respectively, at 1 month, by 68%, 51% and 50% at 3 months and by 76%, 44% and 13% at 6 months. The percentage of contractile material was reduced for the 3 and 6 months animals to 80-64%, respectively, and was replaced primarily by fat. Similar, but less pronounced results were also observed for the quadriceps muscles of the contralateral hindlimbs, suggesting that repeat BTX-A injections cause muscle atrophy and loss of contractile tissue in target muscles and also in non-target muscles that are far removed from the injection site.

Effect of Light-Emitting Diodes Therapy (LEDT) on Knee Extensor Muscle Fatigue

OBJECTIVE The purpose of this study was to evaluate the effects of light-emitting diodes therapy (LEDT) on quadriceps muscle fatigue by using torque values from the isokinetic dynamometer as an outcome measure. BACKGROUND DATA Light therapy is considered an innovative way to prevent muscle fatigue. Although positive results have been obtained in animal models and in clinical experiments, no results are available on the effects of this therapeutic modality on human performance studies with isokinetic dynamometry. MATERIALS AND METHODS Seventeen healthy and physically active male volunteers were included in a crossover randomized double-blinded placebo-controlled trial. They performed two sessions of an isokinetic fatigue test (30 maximal concentric knee flexion-extension contractions; range of motion, 90 degrees; angular velocity, 180 degrees per second) after LEDT or placebo treatment. Maximal knee extensor muscle isokinetic voluntary contractions were performed before (PRE-MVC) and after (POST-MVC) the fatigue test. LEDT treatment was performed with a multidiode cluster probe (34 red diodes of 660 nm, 10 mW; 35 infrared diodes of 850 nm, 30 mW) at three points of the quadriceps muscle, with a total irradiating dose of 125.1 J. RESULTS No differences were observed in the PRE-MVC between LEDT (284.81 ± 4.52 Nm) and placebo (282.65 ± 52.64 Nm) treatments. However, for the POST-MVC, higher torques (p = 0.034) were observed for LEDT (237.68 ± 48.82 Nm) compared with placebo (225.68 ± 44.14 Nm) treatment. CONCLUSION LEDT treatment produced a smaller maximal isometric torque decrease after high-intensity concentric isokinetic exercise, which is consistent with an increase in performance.

MUSCLE ARCHITECTURE ADAPTATIONS TO KNEE EXTENSOR ECCENTRIC TRAINING: RECTUS FEMORIS VS. VASTUS LATERALIS

Introduction: Changes in muscle architecture induced by eccentric knee extensor training remain unclear, as well the adaptive responses of synergistic knee extensor muscles with different geometrical designs. Methods: Ultrasonography images were taken from rectus femoris (RF) and vastus lateralis (VL) of 20 male volunteers before and after a non‐training control period of 4 weeks, and additional evaluations were performed after 4, 8, and 12 weeks of isokinetic eccentric training. Results: RF and VL had significant changes in muscle architecture within the first 4 training weeks, and the adaptive response throughout the intervention was similar. Muscle thickness increased by around 7–10%, fascicle length increased 17–19%, and pennation angle was unchanged. Conclusions: Increased muscle thickness due to eccentric training was related to increased fascicle length and not to pennation angle changes. Although RF and VL have a different fascicular geometry, they had similar morphological adaptations to eccentric training. Muscle Nerve 48: 498–506, 2013

O trabalho entre prazer, sofrimento e adoecimento: a realidade dos portadores de lesões por esforços repetitivos

In this article we present and discuss the results of investigations that took place at the Ambulatorio de Doencas do Trabalho (Occupational Medicine Ambulatory) in the Hospital de Clinicas of Porto Alegre (University Hospital). The main purpose was to determine the relationship between Work-Related Musculoskeletal Disorders, the work process and the consequences over the mental and physical health of the studied workers. We conclude that mental suffering is associated to physical pain, but not exclusively. Beyond the physiopathological aspects of the illness, we perceive the existence of a complex relationship between physical pain and the subjective experiences and social identity.

Mini-trampoline exercise related to mechanisms of dynamic stability improves the ability to regain balance in elderly

Falls have been described by several studies as the major cause of hip and femur fractures among the elderly. Therefore, interventions to reduce fall risks, improve dynamic stability and the falling recovery strategies in the elderly population are highly relevant. This study aimed at investigating the effects of a 14-week mini-trampoline exercise intervention regarding the mechanisms of dynamic stability on elderly balance ability during sudden forward falls. Twenty-two elderly subjects participated on mini-trampoline training and 12 subjects were taken as controls. The subjects of the experimental group were evaluated before and after the 14-week trampoline training (exercised group), whereas control subjects were evaluated twice in the forward fall task with a three-month interval. The applied exercise intervention increased the plantarflexors muscle strength (∼10%) as well as the ability to regain balance during the forward falls (∼35%). The 14-week mini-trampoline training intervention increased elderly abilities to recover balance during forward falls; the improvement was attributed to the higher rate of hip moment generation.

Time course of neuromuscular adaptations to knee extensor eccentric training.

This study investigated the chronology of neural and morphological adaptations to knee extensor eccentric training and their contribution to strength gains in isometric, concentric and eccentric muscle actions. 20 male healthy subjects performed a 12-week eccentric training program on an isokinetic dynamometer, and neuromuscular evaluations of knee extensors were performed every 4 weeks. After 12 training weeks, significant increases were observed for: isometric (24%), concentric (15%) and eccentric (29%) torques; isometric (29%) and eccentric (33%) electromyographic activity; muscle thickness (10%) and anatomical cross-sectional area (19%). Eccentric and isometric torques increased progressively until the end of the program. Concentric torque and muscle mass parameters increased until the eighth training week, but did not change from this point to the twelfth training week. Eccentric and isometric activation increased at 4 and 8 training weeks, respectively, while no change was found in concentric activation. These results suggest that: 1) the relative increment in concentric strength was minor and does not relate to neural effects; 2) eccentric and isometric strength gains up to 8 training weeks are explained by the increased neural activation and muscle mass, whereas the increments in the last 4 training weeks seem to be associated with other mechanisms.

Neuromuscular electrical stimulation (NMES) reduces structural and functional losses of quadriceps muscle and improves health status in patients with knee osteoarthritis

Knee osteoarthritis (OA) is associated with quadriceps atrophy and weakness, so muscle strengthening is an important point in the rehabilitation process. Since pain and joint stiffness make it often difficult to use conventional strength exercises, neuromuscular electrical stimulation (NMES) may be an alternative approach for these patients. This study was aimed at (1) identifying the associations of knee OA with quadriceps muscle architecture and strength, and (2) quantifying the effects of a NMES training program on these parameters. In phase 1, 20 women with knee OA were compared with 10 healthy female, asymptomatic, age‐matched control subjects. In phase 2, 12 OA patients performed an 8‐week NMES strength training program. OA patients presented smaller vastus lateralis thickness (11.9 mm) and fascicle length (20.5%) than healthy subjects (14.1 mm; 24.5%), and also had a 23% smaller knee extensor torque compared to the control group. NMES training increased vastus lateralis thickness (from 12.6 to 14.2 mm) and fascicle length (from 19.6% to 24.6%). Additionally, NMES training increased the knee extensor torque by 8% and reduced joint pain, stiffness, and functional limitation. In conclusion, OA patients have decreased strength, muscle thickness, and fascicle length in the knee extensor musculature compared to control subjects. NMES training appears to offset the changes in quadriceps structure and function, as well as improve the health status in patients with knee OA.

Inter-machine reliability of the Biodex and Cybex isokinetic dynamometers for knee flexor/extensor isometric, concentric and eccentric tests

OBJECTIVES To assess the inter-machine reliability of the Biodex System 3 Pro and Cybex Humac Norm Model 770 dynamometers for knee extensor and knee flexor peak torque measurements in isometric, concentric and eccentric tests. DESIGN Randomized/crossover. SETTING Exercise Research Laboratory, Federal University of Rio Grande do Sul (Brazil). PARTICIPANTS 25 healthy male subjects. MAIN OUTCOME MEASURES Isometric, concentric and eccentric knee extensor and knee flexor peak torques recorded in the same test procedure performed on both isokinetic dynamometers. One-way ANOVA, intraclass correlation coefficient (ICC), standard error of measurement (SEM) and coefficient of variation (CV) were used to verify significant differences, relative and absolute reliability between devices. RESULTS No significant differences were found between tests performed on Biodex and Cybex (p > 0.05). ICC values indicated a high to very high reproducibility for isometric, concentric and eccentric peak torques (0.88-0.92), and moderate to high reliability for agonist-antagonist strength ratios (0.62-0.73). Peak torque did not show great difference between dynamometers for SEM (3.72-11.27 Nm) and CV (5.27-7.77%). Strength ratios presented CV values of 8.57-10.72%. CONCLUSION Maximal knee extensor and knee flexor tests performed in isometric (60° of knee flexion), concentric and eccentric modes at 60°/s in Biodex and Cybex dynamometers present similar values.