Tales de Carvalho

Posicionamento oficial da Sociedade Brasileira de Medicina do Esporte e da Sociedade Brasileira de Geriatria e Gerontologia: atividade física e saúde no idoso

Antonio Claudio Lucas da Nobrega, Elizabete Viana de Freitas, Marcos Aurelio Brazao de Oliveira,Marcelo Bichels Leitao, Jose Kawazoe Lazzoli, Ricardo Munir Nahas, Claudio Aparicio Silva Baptista,Felix Albuquerque Drummond, Luciano Rezende, Josbel Pereira, Maurilio Pinto,Rosana Bento Radominski, Neiva Leite, Edilson Schwansee Thiele, Arnaldo Jose Hernandez,Claudio Gil Soares de Araujo, Jose Antonio Caldas Teixeira, Tales de Carvalho,Serafim Ferreira Borges e Eduardo Henrique De Rose

A Escala de Humor de Brunel (Brums): instrumento para detecção precoce da síndrome do excesso de treinamento

A sindrome do excesso de treinamento tem uma grande relevância no âmbito esportivo, principalmente no que se refere a atletas de elite que buscam superar seus limites e aqueles que se submetem a pratica de atividade fisica sem orientacao especializada. O uso periodico do instrumento POMS, Perfil dos Estados de Humor, tem demonstrado eficacia na deteccao de sinais iniciais da sindrome, prevenindo seu desenvolvimento completo. Em 2003, uma de suas versoes abreviadas, passou a se denominar BRUMS, Escala de Humor de Brunel. O objetivo desse trabalho e apresentar a escala traduzida para a lingua portuguesa juntamente com os dados obtidos em atletas brasileiros, referentes a primeira etapa do seu processo de validacao no Brasil. O instrumento foi submetido ao metodo traducao-traducao reversa. A amostra foi composta por 34 atletas de futebol profissional, do genero masculino, adolescentes e adultos. A aplicacao do instrumento foi efetuada antes e depois de um treino com cargas moderadas e antes e depois de um jogo com cargas de alta intensidade. Para verificar a sensibilidade do BRUMS nas duas situacoes, foi realizado um teste t de student, entre pre e pos de cada variavel, e aplicado uma correlacao linear de Pearson, para verificar a relacao entre os estados de humor. Os resultados indicaram que a raiva e a confusao mental reduziram significativamente (p<0,05) no treino moderado (adolescentes) e que a depressao, vigor, fadiga e confusao mental aumentaram significativamente no jogo de alta intensidade (adultos). Para verificar a consistencia do resultado obtido pelo BRUMS foi realizada uma entrevista semi estruturada junto aos atletas. Os relatos dos atletas em relacao as situacoes de treino e jogo ajudaram a explicar os resultados do BRUMS. Nessa primeira etapa da validacao, o instrumento BRUMS mostrou-se sensivel e fidedigno na avaliacao de estados de humor.

Atividade física e saúde na infância e adolescência

Um estilo de vida ativo em adultos está associado a uma redução da incidência de várias doenças crônico-degenerativas bem como a uma redução da mortalidade cardiovascular e geral. Em crianças e adolescentes, um maior nível de atividade física contribui para melhorar o perfil lipídico e metabólico e reduzir a prevalência de obesidade. Ainda, é mais provável que uma criança fisicamente ativa se torne um adulto também ativo. Em conseqüência, do ponto de vista de saúde pública e medicina preventiva, promover a atividade física na infância e na adolescência significa estabelecer uma base sólida para a redução da prevalência do sedentarismo na idade adulta, contribuindo desta forma para uma melhor qualidade de vida. Nesse contexto, ressaltamos que a atividade física é qualquer movimento como resultado de contração muscular esquelética que aumente o gasto energético acima do repouso e não necessariamente a prática desportiva. Este documento, elaborado por médicos especialistas em exercício e esporte, baseia-se em conceitos científicos e na experiência clínica, tendo como objetivos: 1) estabelecer os benefícios da atividade física na criança e no adolescente; 2) caracterizar os elementos de avaliação e prescrição do exercício para a saúde nessa faixa etária; 3) estimular a recomendação e a prática da atividade física nas crianças e adolescentes, mesmo na presença de doenças crônicas, visto que são raras as contra-indicações absolutas.

Relação de indicadores antropométricos com fatores de risco para doença cardiovascular

FUNDAMENTO: Estudos tem sido realizados para identificar o melhor preditor antropometrico de doencas cronicas em diferentes populacoes. OBJETIVO: Verificar a relacao entre medidas antropometricas e fatores de risco (perfil lipidico e pressao arterial) para doencas cardiovasculares. METODOS: Estudo transversal com 180 homens e 120 mulheres, idade media de 39,6±10,6 anos. Avaliou-se: indice de massa corporal (IMC), circunferencia da cintura (CC), percentual de gordura corporal (%GC), relacao cintura quadril (RCQ), perfil lipidico, glicemia e pressao arterial. RESULTADOS: IMC, CC e RCQ foram maiores nos homens e %GC nas mulheres (p<0,001). A proporcao de casos alterados de RCQ e %GC em relacao a LDL-c e CT foi maior no sexo masculino. Individuos normais para CC tiveram alteracao para LDL-c, CT e HDL-c. Houve correlacao entre IMC e CC (homens: r=0,97 e mulheres: r=0,95; p<0,001). Nos homens a melhor correlacao (p<0,001) foi entre CC e RCQ (r=0,82) e nas mulheres %GC e CC (r=0,80). Triglicerideos (TG) teve correlacao com RCQ (masculino: r=0,992; feminino: r= 0,95; p<0,001), e com CC (masculino: r=0,82; feminino: r=0,79; p<0,001). Na analise multipla (Razao de prevalencia - RP, Intervalo de Confianca - IC), o IMC esteve associado ao colesterol total (RP=1,9; IC95% 1,01-3,69; p=0,051) no sexo masculino e fracamente associado com TG/HDL-colesterol (RP= 1,8; IC95% 1,01-3,45; p=0,062) no sexo feminino. CONCLUSAO: O IMC e a RCQ foram os indicadores antropometricos com maior correlacao com o perfil lipidico em ambos os sexos. Esses dados suportam a hipotese de que o IMC e a RCQ podem ser considerados como fatores de risco para a doenca cardiovascular.BACKGROUND Studies have been carried out to identify the best anthropometric predictor of chronic diseases in different populations. OBJECTIVE To verify the relation between anthropometric measures and risk factors (lipid profile and blood pressure) for cardiovascular diseases. METHODS Transversal study carried out with 180 males and 120 females, with mean age 39.6+/-10.6 years old. Body mass index (BMI), waist circumference (WC), body fat percentage (%BF), waist-to-hip ratio (WHR), lipid profile, glycemia and blood pressure were the variables assessed. RESULTS BMI, WC and WHR were higher among males, and %BF were higher among females (p<0.001). The proportion of altered cases of WHR and %BF in relation to LDL-cholesterol and total cholesterol (TC) was higher among males. The individuals considered normal for WC presented alteration in the values of LDL-c, TC and HDL-cholesterol. There was a correlation between BMI and WC (males: r=0.97 and females: r=0.95; p<0.001). Among males, the best correlation (p<0.001) was presented between WC and WHR (r=0.82) and among females, %BF and WC (r=0.80). Triglycerides (TG) presented correlation to WHR (males: r=0.992; females r=0.95; p<0.001), and to WC (males: r=0.82; females r=0.79; p<0.001). In the multiple analysis (Prevalence ratio - PR, Confidence interval - CI), the BMI were associated with total cholesterol (PR=1.9; 95%CI 1.01-3.69; p=0.051) among males and slightly associated with TG/HDL-cholesterol (PR= 1.8; IC95% 1.01-3.45; p=0.062) among females. CONCLUSION BMI and WHR were the anthropometric indicators with strongest relation to lipid profile in both sex groups. This data support the hypothesis that BMI and WHR may be considered as risk factors for cardiovascular disease.

Hidratação e nutrição no esporte

Some disorders derived from flaws in eating as well as hydric, electrolytic and energetic substrate reposition greatly harm tolerance to exertion and respond for health risk and even death to practitioners of physical exercise. Such disorders, which are more commonly observed in long-duration activities, are strongly influenced by environmental conditions. This article, which is focused on professionals from the sports field who work with physical exercise programs to the general population, presents data based on scientific evidence, with the aim to present safe exercise practice and health maintenance. This information should be considered by all sports practitioners, either competitive or simply health clubs goers. This article approaches some of the essential aspects of sports hydration and nutrition which were didatically sorted in six sessions: body fluid compartments; thermorregulation in physical exercise; sweat composition; dehydration; hydrogluco electrolytic reposition and nutritional recommendations.

Aplicação de instrumentos de avaliação de estados de humor na detecção da síndrome do excesso de treinamento

The pressures tempted by the exigencies from the competitive sport lead many athletes to exceed the limits of their physical and psychological capacity, causing the manifestation of overtraining syndrome. The purpose of this review article is to discuss, through the original material, the validation process of the Profile of Mood States-Adolescents (POMS-A) for use with adults(1). This instrument was developed to serve as a brief measure of mood states among adolescents and adult populations, and had already demonstrated, in recent researches, effectiveness in the diagnosis of these altered states by intensive training. The POMS-A was administered to adult athletes prior to competition, adult student athletes, adolescent athletes prior to competition, and adolescent students. A subset of adult student athletes was used to test the criterion validity of the POMS-A. Confirmatory factor analysis provided support for the factorial validity of 24-item, six-factor model using both independent and multi-sample analyses. Relationships between POMS-A scores and previously validated measures, that were consistent with theoretical predictions, supported the criterion validity. Evidences were found in support of the psychometric integrity of the POMS-A when extended from adolescent to adult populations. It is suggested that the POMS-A is an appropriate tool with which mood profiles will be tested, besides the brevity of the test facilitates data collection in research environments. Subsequent studies aim the validation and applicability of the instrument BRUMS (current name of the POMS-A) in detection of overtraining syndrome in Brazilian athletes, for what already exists authorization by the authors Terry, Lane and Fogarty(1).As pressoes provocadas pelas exigencias do esporte competitivo levam muitos atletas a excederem os limites de sua capacidade fisica e psicologica, acarretando a manifestacao da sindrome do excesso de treinamento (overtraining). O intuito deste artigo de revisao e, a partir do material original, discutir o processo de validacao do Perfil dos Estados de Humor-Adolescentes (POMS-A) para uso em adultos(1). Esse instrumento foi desenvolvido para permitir uma rapida mensuracao dos estados de humor entre populacoes de adolescentes e adultos, ja tendo sido demonstrada, em recentes pesquisas, sua eficacia no diagnostico desses estados alterados pelo treinamento intensivo. O POMS-A foi administrado a atletas adultos de competicao, atletas estudantes adultos, atletas adolescentes de competicao e estudantes adolescentes. Um subgrupo de atletas estudantes adultos foi utilizado para testar a validade do criterio do POMS-A. A analise do fator confirmatorio deu suporte para a validade fatorial do modelo de 24 itens e seis fatores, usando ambas as analises: independente e amostras multiplas. Relacoes entre os escores do POMS-A e medidas validadas previamente, que eram coerentes com fundamentacoes teoricas, sustentaram a validade do criterio de medida. Evidencias foram encontradas dando suporte a integridade psicometrica do POMS-A quando se estendeu de adolescentes para populacoes de adultos. Tais evidencias sugerem que o POMS-A e um instrumento apropriado para avaliacao de perfis do humor, alem do que a brevidade do teste facilita a coleta de dados em ambientes de pesquisa. Pretende-se, em estudos posteriores, validar e aplicar o instrumento BRUMS (nome atual do POMS-A) na deteccao da sindrome do excesso de treinamento em atletas brasileiros, para o que ja existe autorizacao dos autores Terry, Lane e Fogarty(1).

Influência da ordem de execução de exercícios resistidos na hipotensão pós-exercício em idosos hipertensos

Existem evidencias de que exercicios resistidos contribuem para o controle de hipertensao arterial sistemica, porem, sao necessarios estudos que indiquem a melhor forma de utiliza-los. O objetivo deste estudo foi analisar a influencia da ordem de execucao de exercicios resistidos na hipotensao pos-exercicio em idosos com hipertensao arterial bem controlada. A amostra foi composta por oito idosos com hipertensao arterial sistemica bem controlada (quatro homens e quatro mulheres). No protocolo 1 (P1) foram realizados inicialmente tres exercicios para membros superiores e, posteriormente, tres exercicios para membros inferiores. No protocolo 2 (P2) a sequencia foi inversa. Ja no protocolo 3 (P3) os exercicios foram realizados de forma alternada. Todos os exercicios foram realizados em tres series de 12 RM. Apos cada protocolo a pressao arterial (PA) foi verificada em intervalos de 10 minutos, ate 60 minutos pos-exercicio. Os dados obtidos foram analisados atraves da ANOVA de fator duplo e fator unico com post-hoc de Tukey e teste t de Student pareado com distribuicao bicaudal (p < 0,05). Em relacao ao repouso, as seis verificacoes de PA pos-exercicio de P1 nao apresentaram diferencas significativas; no P2 foram significantemente diferentes apenas as verificacoes de 20 e 40 minutos na PAS; no P3 foram observadas diferencas significativas em todas as seis verificacoes da PAS e nas de 10, 20, 30 e 60 minutos da PAD. A verificacao de 20 minutos na PAD do P3 demonstrou-se significantemente diferente das de 20 minutos de P1 e P2. Conclui-se que a ordem de realizacao de exercicios resistidos em idosos com hipertensao arterial bem controlada influenciou na duracao da resposta hipotensiva, mas nao diretamente em sua magnitude.

Oxidative Stress and Inflammatory Parameters After an Ironman Race

Objective: The aim of the present study was to investigate oxidative stress markers and inflammatory response in triathletes after an Ironman race (IR). Design: Descriptive research. Participants: Eighteen well-trained male triathletes (mean age, 34.7 ± 2.15 years; weight, 69.3 ± 1.9 kg; height, 1.81 ± 0.58 cm) participated in the study. Setting: Ironman Triathlon (3.8-km swim, 180-km cycle, 42.2-km run). Mean environmental conditions ranged from 20 to 25°C and from 79% to 85% relative humidity. Interventions: None. Main Outcome Measures: Before the race and up to 20 minutes after completing the full race, the weights and heights of volunteers were measured and a 10 mL blood sample was drawn from an antecubital vein. Aliquots of washed/lysed red blood cells and plasma/serum samples were stored at −80°C. Lipid peroxidation, protein carbonylation, superoxide dismutase and catalase activities, and cytokines levels [tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, IL-10, and IL-1ra] were determined. Results: After the IR, the results showed a significant increase in TBARS levels (prerace = 1.15 ± 0.11; postrace = 1.98 ± 0.27), lipid hydroperoxide content (prerace = 0.75 ± 0.03; postrace = 1.46 ± 0.18), protein carbonylation (prerace = 0.67 ± 0.12; postrace = 2 0.15 ± 0.60), superoxide dismutase (prerace = 2.67 ± 0.62; postrace = 3.97 ± 1.48), and catalase (prerace = 1.48 ± 0.18; postrace = 2.84 ± 0.39). TNF-α, IL-6, and IL-10 were not detected at basal conditions, but all markers were significantly increased after the IR (TNF-α: prerace = ND and postrace = 67.47 ± 10.34; IL-6: prerace = ND and postrace = 55.41 ± 3.45; IL-10: prerace = ND and postrace = 122.53 ± 9.69; IL-1ra: prerace = 127.79 ± 25.65 and postrace = 259.51 ± 32.9). Conclusions: An Ironman race provokes significant alterations in oxidative stress and inflammatory parameters. Thus, more studies with other markers and different designs are needed to elucidate the cellular alterations induced by an IR.

Spinocerebellar ataxias in 114 Brazilian families: clinical and molecular findings.

To the Editor: Dominant spinocerebellar ataxias (SCAs) are a group of neurodegenerative diseases that affect the cerebellum, brain stem, and spinocerebellar tracts. SCA1, SCA2, SCA3, SCA6, SCA7, SCA12, SCA17 and dentatorubral pallidoluysian atrophy (DRPLA) are caused by CAG trinucleotide repeat expansions (1). SCA8 has a CTG expansion in the causative gene. SCA10 has been found to represent a large expansion of a pentanucleotide (ATTCT) repeat (2). The frequency of each SCA varies between regions and ethnic groups. Machado–Joseph disease (MJD/SCA3) is the most common SCA among populations with Portuguese and Azorean background and populations in Japan and Germany (3–10). SCA2 is common in Cuba, India, Korea, and Italy (11– 14). SCA10 has been only described in the New World (15–19). Our aim was to determine the frequency of the SCA1, SCA2, SCA3, SCA6, SCA7, SCA10, SCA17 and DRPLA among SCA families who have the same geographic origin, namely southern Brazil (Rio Grande do Sul). Clinical, epidemiological, and molecular features are also described herein. Cases were recruited based on the following inclusion criteria: (1) ataxia, often associated with other neurological signs; and (2) inheritance as an autosomal dominant trait. Neurological examination followed a standard examination already published (19). Presence and gradation of several neurological findings were evaluated as numeric ordinal variables. Peripheral blood was collected, and genomic DNA was isolated from peripheral blood leukocytes, using the salting-out technique, as previously described (20). Molecular analyses of the repeat loci were performed by molecular tests specific to each ataxia by PCR amplification. Southern blot was performed to SCA10 locus. Patients were stratified according to their molecular diagnosis. Clinical variables were then compared between these groups. Comparisons were performed using analysis of variance (ANOVA), when the variable was parametric, or the Kruskal–Wallis test (KW test), when the variable was nonparametric. A Bonferroni procedure was done, in order to correct for multiple testing. This study was approved by the ethics committee of the institution where it was conducted; informed consent forms were filled out by all patients. A total of 114 families with autosomal dominant trait were investigated during an 8-year period (up to 2004). Diagnosis, ethnicity, and main clinical features are presented in Tables 1 and 2. SCA3 was the most prevalent, comprising 84.2% of all SCAs. The other SCAs were far less common and represented from one to five pedigrees each. The number of clinically examined patients with the diverse molecular diagnoses was variable. Due to this, some statistical comparisons could not be done: SCA1 and SCA10 patients were excluded from comparisons. Neurological findings that showed statistical differences among groups were (1) nystagmus, less frequent in cases with SCA2 and SCA7 than in the general sample; (2) limb ataxia, more severe in SCA6 patients; and (3) pyramidal findings and optic atrophy, more common in SCA7 patients than in other groups (p , 0.0025, 0.0025, 0.041 and 0.0411, respectively; KW test). Most of the present families were of mixed ancestry but Portuguese surnames prevailed. In our region, the main Portuguese ancestry was Azorean in origin, dating from circa 1750 (7). The Amerindians are another important ancestry. The composition of mitochondrial Amerindian markers in urban Brazilian populations is high and varies between 22% and 54% (26). This finding shows the importance of this Brazilian ancestry. So far, SCA10 has only been described in American families (15–18, 27). The finding of two SCA10 kindreds is in line with the hypothesis that this mutation is somehow restricted to patients with an Amerindian ancestry. Although some of the present families have already been described (7, 18, 19, 28), they had never been compared. We made these comparisons

Validation of the International Index of Erectile Function (IIFE) for use in Brazil.

Background The International Index of Erectile Function has been proposed as a method for assessing sexual function assisting the diagnosis and classification of erectile dysfunction. However, IIEF was not validated for the Portuguese language. Objective Validate the International Index of Erectile Function in patients with cardiopulmonary and metabolic diseases. Methods The sample consisted of 108 participants of to Cardiopulmonary and Metabolic program Rehabilitation (CPMR) in southern Brazil. The clarity assessment of the instrument was performed using a scale ranging from zero to 10. The construct validity was carried out by confirmatory factor analysis (KMO = 0.85; Barllet p < 0.001), internal consistency by Cronbachs alpha and reproducibility and interrater reliability via the test retest method. Results The items were considered very clear with averages superior to 9. The internal consistency resulted in 0.89. The majority of items related correctly with their domains, with exception of three questions from sexual satisfaction domain, and one from erectile function. All items showed excellent stability of measure and substantial to almost perfect agreement. Conclusion The present study showed that the IIEF is valid and reliable for use in participants of a cardiopulmonary and metabolic rehabilitation program.