Patrícia dos Santos Vigário

Comportamento alimentar e imagem corporal em atletas

The sports environment can enhance social and cultural pressure towards a lean body. The close relationship between corporal image and performance makes the female athletes a group particularly vulnerable to eating disorders and weight-control practices. The aim of the present work is to evaluate the presence of behaviors suggestive of eating disorders, shifts in body perception, and menstrual dysfunctions in female athletes of the Federal University of Rio de Janeiro School of Physical Education (EEFD-UFRJ). Twelve female athletes (20 ± 2 years), who had been training for 4.6 ± 2.3 years, a total of 13.8 ± 2.9 hours per week, were examined. The results of the athletes and of 32 young non-athletes (15 ± 1.4 years) were compared. The Eating Attitudes Test (EAT-26) was used to evaluate weight-control and eating attitudes and behaviors. The Bulimic Investigatory Test Edimburgh (BITE) was used to identify suggestive behaviors of bulimia nervosa, and also to obtain data about cognitive and behavioral aspects of this disorder. The Body Shape Questionnaire (BSQ) was used to verify dissatisfaction with body image. The three self-applied questionnaires were used in their Portuguese versions. The athletes presented body mass of 59 ± 7.3 kg, height of 1.65 ± 0.03 m, percentage of body fat (%F) of 23.1 ± 4.1% and body mass index (BMI) of 21.6 ± 2.3 kg/m2. The entire sample had a %F compatible for age and sex, although 33% of the athletes presented some body image dissatisfaction. The BITE evidenced that 16.6% of the athletes presented a non-usual dietary pattern according to symptoms, but with no significance in terms of severity. These athletes are included among those who are not happy with their body. No athlete had a positive EAT-26 results. The findings of this study suggest the presence of symptoms that do not actually characterize bulimia or anorexia nervosa, but they point to the need of a careful surveillance and assessment of eating disorders and their precursors among athletes, as a way of prevention.

Functional Capacity and Muscular Abnormalities in Subclinical Hypothyroidism

Background:Neuromuscular abnormalities and low exercise tolerance are frequently observed in overt hypothyroidism, but it remains controversial if they can also occur in subclinical hypothyroidism (sHT). The aim of this study is to evaluate neuromuscular symptoms, muscle strength, and exercise capacity in sHT, compared with healthy euthyroid individuals. Methods:A cross-sectional study was performed with 44 sHT and 24 euthyroid outpatients from a university hospital. Neuromuscular symptoms were questioned. Muscle strength was tested for neck, shoulder, arm, and hip muscle groups, using manual muscle testing (MMT). Quadriceps muscle strength was tested with a chair dynamometer and inspiratory muscle strength (IS) by a manuvacuometer. Functional capacity was estimated based on the peak of oxygen uptake (mL/kg/min), using the Bruce treadmill protocol. Results:Cramps (54.8% versus 25.0%; P < 0.05), weakness (45.2% versus 12.6; P < 0.05), myalgia (47.6% versus 25.0%; P = 0.07), and altered MMT (30.8% versus 8.3%; P = 0.040) were more frequent in sHT. Quadriceps strength and IS were not impaired in sHT and the same was observed for functional capacity. IS was significantly lower in patients complaining of fatigue and weakness (P < 0.05) and tended to be lower in those with altered MMT (P = 0.090). Conclusion:Neuromuscular complaints and altered MMT were significantly more frequent in sHT than in controls, and IS was lower in patients with these abnormalities. Results suggest that altered muscle strength by MMT and the coexistence of neuromuscular complaints in patients with sHT may indicate neuromuscular dysfunction.

Perceived Health Status of Women with Overt and Subclinical Hypothyroidism

Objective: The objective of this study was to investigate the health status of women with overt and subclinical hypothyroidism and relate it to the presence of clinical signs and symptoms of the disease. Subjects and Methods: A cross-sectional study was conducted on 232 women divided into 3 groups: overt hypothyroidism (n = 14); subclinical hypothyroidism (n = 152), and controls (n = 66). Health status was evaluated by the questionnaire SF-36, and the clinical signs and symptoms of hypothyroidism were assessed with the Billewicz scale modified by Zulewski. The Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferroni correction was applied to compare continuous variables between the groups. To assess the relationship between SF-36 domains and the clinical score, as well as SF-36 domains and serum thyroid-stimulating hormone levels, the Spearman correlation coefficient was calculated. Results: Patients with overt hypothyroidism presented systematically lower scores in all SF-36 domains (p < 0.05), both in relation to subclinical hypothyroidism patients and controls. This indicates a great dissatisfaction with health status in this group. Patients with subclinical hypothyroidism presented statistically lower scores in relation to controls with the exception of the role-emotional and bodily pain domains, where although they were not statistically significant, scores were clinically different. Highly negative correlations between SF-36 domains and the clinical score were observed in overt hypothyroidism (physical function r = –0.80, p < 0.01; bodily pain r = –0.74, p < 0.01). Conclusion: Overt hypothyroidism seemed to be associated with worse perception of health status, negatively associated with clinical score.

Effect of levothyroxine replacement on exercise performance in subclinical hypothyroidism

Although muscle metabolism and exercise capacity seem to be affected in patients with subclinical hypothyroidism, there is little evidence indicating improvement of the exercise tolerance due to levothyroxine (L-T4) replacement. The aim of the present study was to verify possible cardiopulmonary changes during exercise in patients with subclinical hypothyroidism on L-T4 replacement with a normal serum TSH for six months. Twenty-three patients with subclinical hypothyroidism were randomized into treated (no.=11) and untreated (no.=12) patients. A cardiopulmonary test was performed with a treadmill, using the modified Balke protocol. Heart rate, oxygen uptake, minute ventilation and other cardiopulmonary parameters were assessed at the 5th minute of exercise. FT4 levels increased while TSH normalized after hormone replacement. Oxygen uptake decreased significantly after hormone replacement (24.1 ±6.3 vs 17.1 ±4.2 ml.kg.min−1; p=0.03). Minute ventilation also showed an enhanced performance in treated patients (28.0±8.1 vs 23.5±5.6 l.min−1; p=0.03), as did the heart rate (128±17 vs 121±17 bpm; p=0.03). There were no changes in the untreated group. The results demonstrate that submaximal cardiopulmonary exercise performance improved after six months of TSH normalization and this improvement can help enhance the ability to carry out daily life activities in patients with subclinical hypothyroidism.

Effects of physical activity on body composition and fatigue perception in patients on thyrotropin-suppressive therapy for differentiated thyroid carcinoma.

BACKGROUND Subclinical thyrotoxicosis (scTox) may be associated with alterations in body composition and fatigue that can be possibly reversed with physical activity. The aim of the present study was to evaluate whether the systematic practice of physical activity improves lower extremity muscle mass and fatigue perception in patients with scTox. MATERIALS AND METHODS We studied 36 patients (2 men) with median age of 48.0 (43.0-51.0) years, body mass index of 27.4 (22.1-30.2) kg/m(2), thyrotropin <0.4 mU/L, and free thyroxine between 0.8 and 1.9 ng/dL and 48 control subjects (C group; 7 men). Patients were randomly divided in two groups according to the adherence to the exercise training: scTox-Tr (n = 19)-patients who adhered to the exercise intervention and scTox-Sed (n = 17)--patients who did not adhere to it. The C group did not participate in the randomization. The exercise training was supervised by a physical education instructor, and it was composed of 60 minutes of aerobic activity and stretching exercises, twice a week, during 12 weeks. In both groups, body composition was assessed (anthropometric method), and the Chalder Fatigue Scale was determined at baseline and after 3 months of intervention (scTox-Tr group) or observation (scTox-Sed group). RESULTS At baseline, patients with scTox had lower muscle mass and mid-thigh girth and more fatigue on the Chalder Fatigue Scale than euthyroid control subjects. The scTox-Tr group had an increase in muscle mass, reduction in the variables reflecting whole body fat, and lesser perception of fatigue during the exercise training period (p ≤ 0.05 for these parameters at the start and end of the exercise training period). CONCLUSIONS scTox is associated with lower muscle mass and mid-thigh girth and more fatigue. Physical activity training can partially ameliorate these characteristics. More studies are needed to determine what training program would be optimum, both in terms of beneficial effects and for avoiding potential adverse responses.

Eating behavior and body image in athletes

The sports environment can enhance social and cultural pressure towards a lean body. The close relationship between corporal image and performance makes the female athletes a group particularly vulnerable to eating disorders and weight-control practices. The aim of the present work is to evaluate the presence of behaviors suggestive of eating disorders, shifts in body perception, and menstrual dysfunctions in female athletes of the Federal University of Rio de Janeiro School of Physical Education (EEFD-UFRJ). Twelve female athletes (20 ± 2 years), who had been training for 4.6 ± 2.3 years, a total of 13.8 ± 2.9 hours per week, were examined. The results of the athletes and of 32 young non-athletes (15 ± 1.4 years) were compared. The Eating Attitudes Test (EAT-26) was used to evaluate weight-control and eating attitudes and behaviors. The Bulimic Investigatory Test Edimburgh (BITE) was used to identify suggestive behaviors of bulimia nervosa, and also to obtain data about cognitive and behavioral aspects of this disorder. The Body Shape Questionnaire (BSQ) was used to verify dissatisfaction with body image. The three self-applied questionnaires were used in their Portuguese versions. The athletes presented body mass of 59 ± 7.3 kg, height of 1.65 ± 0.03 m, percentage of body fat (%F) of 23.1 ± 4.1% and body mass index (BMI) of 21.6 ± 2.3 kg/m2. The entire sample had a %F compatible for age and sex, although 33% of the athletes presented some body image dissatisfaction. The BITE evidenced that 16.6% of the athletes presented a non-usual dietary pattern according to symptoms, but with no significance in terms of severity. These athletes are included among those who are not happy with their body. No athlete had a positive EAT-26 results. The findings of this study suggest the presence of symptoms that do not actually characterize bulimia or anorexia nervosa, but they point to the need of a careful surveillance and assessment of eating disorders and their precursors among athletes, as a way of prevention.

Quality of life, muscle strength, and fatigue perception in patients on suppressive therapy with levothyroxine for differentiated thyroid carcinoma.

Objectives: The aim of this study was to evaluate the fatigue perception, the muscle function, and the health-related quality of life (QoL) in subclinical hyperthyroidism (SCH) induced by levothyroxine in the treatment of differentiated thyroid carcinoma, in comparison with a group of euthyroid (EU) subjects. Patients and Methods: A cross-sectional study with 38 SCH individuals and 54 EU subjects was performed. They were submitted to Short Form-36 and Chalder questionnaires to evaluate QoL and fatigue, respectively. The tests performed to evaluate muscle function of upper and lower limbs were: maximum quadriceps isometric strength (QS); quadriceps fatigue resistance (T50% QS), QS at 30 seconds (QS30s); quadriceps functional capacity (QFC); maximum isometric handgrip strength (HS); fatigue handgrip resistance (T50% HS), HS at 30 seconds (HS30s); and functional capacity of the shoulder. Results and Conclusions: The SCH patients had worse muscle function, regarding HS (25.19±7.00 vs. 30.45±9.98 kgf in EU, P=0.009) and functional capacity of the shoulder (41.28±48.36 vs. 56.68±37.44 s in EU, P=0.004). The self-perception of fatigue by Chalder questionnaire (23.91±5.39 vs. 29.77±7.03, P=0.000) and the QoL in terms of functional capacity (70.20±21.57 vs. 56.25±28.79, P=0.025), physical aspects (71.42±36.44 vs. 45.83±42.88, P=0.004), pain (62.48±22.20 vs. 50.05±24.80, P=0.035), and emotional aspects (70.74±38.26 vs. 46.29±44.56, P=0.008) were also worse in SCH. In conclusion, the SCH was associated with alterations in the QoL, reduction in the muscle function of upper limbs, and higher degree of fatigue.

Fatores motivacionais de jovens atletas de vôlei

O estudo objetivou identificar o quanto os fatores motivacionais determinam a permanencia de jovens atletas no voleibol de alto nivel e compara-los quanto ao genero e categoria. A coleta de dados foi realizada por meio da aplicacao do questionario de Escala de Motivos para a Pratica Esportiva (EMPE) a 96 jovens atletas de volei de quadra (46 meninas e 50 meninos). Os fatores que mais motivaram os atletas para a pratica do volei foram: aperfeicoamento tecnico, saude e afiliacao. Na comparacao quanto ao genero, com excecao dos fatores saude e status, as atletas apresentaram maiores indices de motivacao do que os atletas. Comparando os fatores motivacionais segundo a categoria, todos os itens analisados, exceto afiliacao, motivam da mesma forma os atletas.

Impaired functional and hemodynamic response to graded exercise testing and its recovery in patients with subclinical hyperthyroidism.

OBJECTIVE To evaluate the functional and hemodynamic responses during exercise and its recovery in patients with subclinical hyperthyroidism (SCH). SUBJECTS AND METHODS A cross-sectional study was carried out with 29 patients on TSH-suppressive therapy with levothyroxine for thyroid carcinoma and 35 euthyroid subjects. All volunteers underwent a cardiopulmonary exercise testing on a treadmill and functional and hemodynamic variables were measured during exercise and its recovery. RESULTS SCH patients showed impaired functional response to exercise, marked by lower values for oxygen consumption and exercise duration in addition to premature achievement of the anaerobic threshold. Heart-rate and blood pressure recovery immediately after exercise were slower among SCH patients when compared to euthyroid subjects. CONCLUSION SCH is associated with impaired functional and hemodynamic responses during exercise and its recovery.

Functional Capacity of Oldest Old Living in a Long-stay Institution in Rio De Janeiro, Brazil.

[Purpose] A significant increase in the number of oldest old has occurred worldwide. The aim of this study was to characterize the functional capacity of the oldest old residents in a long-stay institution in Rio de Janeiro, Brazil. [Subjects and Methods] All participants were evaluated according to the following metrics: anthropometry, body composition (bioelectrical impedance), handgrip strength, balance (Berg scale and stabilometry), ankle mobility (electrogoniometry), physical capacity (six-minute walk test), quality of life (WHOQOL-OLD), and dietary habits (questionnaire). [Results] Twenty elderly subjects with a mean age of 85.75 ± 5.22 years and a mean fat percentage of 39.02 ± 5.49% participated in the study. The group at risk of falls (n = 8) had a lower handgrip strength and walked a shorter distance over the course of six minutes compared with the group not at risk of falls. The obese group (n = 15) had higher values for stabilometric variables than the nonobese group. There was a positive and significant correlation between ankle joint mobility and physical capacity (r = 0.47). [Conclusion] High values for obesity and low values for handgrip strength and physical capacity were associated with worse body balance. Low values for ankle mobility were also associated with worse physical capacity in this population.