Wagner Rodrigues Martins

Decreased functional capacity and muscle strength in elderly women with metabolic syndrome

Purpose To compare the metabolic parameters, flexibility, muscle strength, functional capacity, and lower limb muscle power of elderly women with and without the metabolic syndrome (MetS). Methods This cross-sectional study included 28 older women divided into two groups: with the MetS (n = 14; 67.3 ± 5.5 years; 67.5 ± 16.7 kg; 1.45 ± 0.35 m; 28.0 ± 7.6 kg/m2), and without the MetS (n = 14; 68.7 ± 5.3 years; 58.2 ± 9.9 kg; 1.55 ± 0.10 m; 24.3 ± 3.8 kg/m2). Body composition was evaluated by dual-energy X-ray absorptiometry and dynamic muscle strength was assessed by one-maximum repetition (1RM) tests in leg press, bench press and biceps curl exercises. Six-minute walk test, Timed Up and Go (TUG); 30-second sitting-rising; arm curl using a 2-kg dumbbell, sit-and-reach (flexibility), and vertical jump tests were performed. Results There was no difference between groups regarding age (P = 0.49), height (P = 0.46), body fat (%) (P = 0.19), systolic (P = 0.64), diastolic (P = 0.41) and mean blood pressure (P = 0.86), 30-second sitting-rising (P = 0.57), 30-s arm curl (P = 0.73), leg press 1RM (P = 0.51), bench press 1RM (P = 0.77), and biceps curl 1RM (P = 0.85). However, women without the MetS presented lower body mass (P = 0.001), body mass index (BMI) (P = 0.0001), waist circumference (P = 0.02), waist-to-height ratio (P = 0.02), fat body mass (kg) (P = 0.05), lean body mass (kg) (P = 0.02), blood glucose (P = 0.05), triglycerides (P = 0.03), Z-score for the MetS (P = 0.05), higher high-density lipoprotein-cholesterol (HDL-C) (P = 0.002), better performance on TUG (P = 0.01), flexibility (P = 0.03), six-minute walk test (P = 0.04), vertical jump (P = 0.05) and relative muscle strength for leg press (P = 0.03), bench press (P = 0.04) and biceps curl (P = 0.002) exercises as compared to women with the MetS. Conclusion Elderly women with the MetS have higher metabolic risk profile and lower functional capacity, muscle strength, lower limb power and flexibility as compared to women without the MetS. The evaluation of functional capacity may help to determine the degree of physical decline in older persons with the MetS, while exercise interventions should be encouraged.

Effects of hippotherapy on mobility, strength and balance in elderly §

OBJECTIVES To assess the chronic effects of hippotherapy on functional mobility, muscle strength and balance in elderly. METHODS 28 volunteers, between the age of 60 and 84, were randomly recruited and divided in experimental group (EG), with 12 individuals (8 women and 4 men) and control group (CG), with 16 individuals (14 women and 2 men). The EG group participated in an 8-week hippotherapy program. Before and after the study period functional mobility was assessed and measured by Time Up and Go Test (TUG), muscle strength of the lower limbs was measured by 30s Chair Stand Test (30CST) and performance in balance was measured by the Berg Balance Scale (BBS). A mixed ANOVA model (group×testing time) was applied to establish the effect of the different groups on the functional variables. RESULTS The functional capacity of the EG group was increased if compared to CG group after the intervention of the BBS (p=0.003) and 30CST (p=0.032), but not of the TUG (p=0.063). CONCLUSION The results indicated that hippotherapy improves the lower limb strength and balance in elderly.

Body Composition is Strongly Associated With Cardiorespiratory Fitness in a Large Brazilian Military Firefighter Cohort: The Brazilian Firefighters Study.

Abstract Nogueira, EC, Porto, LGG, Nogueira, RM, Martins, WR, Fonseca, RMC, Lunardi, CC, and de Oliveira, RJ. Body composition is strongly associated with cardiorespiratory fitness in a large Brazilian military firefighter cohort: The Brazilian Firefighters Study. J Strength Cond Res 30(1): 33–38, 2016—Firefighting is associated with high-level physical demands and requires appropriate physical fitness. Considering that obesity has been correlated with decreased cardiorespiratory fitness (CRF) and that the prevalence of obesity may also be elevated within firefighters (FF), we analyzed the association between CRF and body composition (BC) in Brazilian military FF. We assessed 4,237 male FF (18–49 years) who performed a physical fitness test that included BC and CRF. Body composition was assessed by body mass index (BMI), body adiposity index (BAI), body fat percentage (BF%), and waist circumference (WC). CRF was assessed by the 12-minute Cooper test. Comparisons of V[Combining Dot Above]O2max between the BC categories were analyzed using the Mann-Whitney test, and the analysis was adjusted for age using the General Linear Model. The Spearman test was used for correlation analysis and the odds ratio (OR) was calculated to assess the odds of the unfit group (⩽12 metabolic equivalents [METs]) for poor BC. Statistically significant differences were considered when p ⩽ 0.05. Considering the BMI categories, 8 volunteers (0.2%) were underweight, 1,306 (30.8%) were normal weight, 2,301 (54.3%) were overweight, and 622 (14.7%) were obese. The V[Combining Dot Above]O2max was negatively correlated with age (r s = −0.21), BMI (r s = −0.45), WC (r s = −0.50), and BAI (r s = −0.35) (p < 0.001). Cardiorespiratory fitness was lower in the obese compared with the nonobese for all age categories (−3.8 ml·kg−1·min−1; p < 0.001) and for all BC indices (−4.5 ml·kg−1·min−1; p < 0.001). The OR of the unfit group having poor BC in all indices varied from 2.9 to 8.1 (p < 0.001). Despite the metabolically healthy obesity phenomenon, we found a strong association between CRF and BC irrespective of age and the BC method (BMI, BAI, WC, or BF%). These findings may aid in improving FF training programs with a focus on health and performance.

Effects of Elastic Resistance Exercise on Muscle Strength and Functional Performance in Healthy Adults: A Systematic Review and Meta-Analysis

BACKGROUND Elastic Resistance Exercise (ERE) has already demonstrated its effectiveness in older adults and, when combined with the resistance generated by fixed loads, in adults. This review summarizes the effectiveness of ERE performed as isolated method on muscle strength and functional performance in healthy adults. METHODS A database search was performed (MEDLine, Cochrane Library, PEDro and Web of Knowledge) to identify controlled clinical trials in English language. The mean difference (MD) with 95% confidence intervals (CIs) and overall effect size were calculated for all comparisons. The PEDro scale was used assess the methodological quality. RESULTS From the 93 articles identified by the search strategy, 5 met the inclusion criteria, in which 3 presented high quality (PEDro > 6). Meta-analyses demonstrated that the effects of ERE were superior when compared with passive control on functional performance and muscle strength. When compared with active controls, the effect of ERE was inferior on function performance and with similar effect on muscle strength. CONCLUSIONS ERE are effective to improve functional performance and muscle strength when compared with no intervention, in healthy adults. ERE are not superior to other methods of resistance training to improve functional performance and muscle strength in health adults.

Effectiveness of Circuit-Based Exercises on Gait Speed, Balance, and Functional Mobility in People Affected by Stroke: A Meta-Analysis

Several interventions have been proposed to rehabilitate patients with neurologic dysfunctions due to stroke. However, the effectiveness of circuit‐based exercises according to its actual definition, ie, an overall program to improve strength, stamina, balance or functioning, was not provided.

Qualitative Evaluation of Osteopathic Manipulative Therapy in a Patient With Gastroesophageal Reflux Disease: A Brief Report

CONTEXT Gastroesophageal reflux disease (GERD) is a chronic condition that affects a growing number of people and is currently among the most common disorders seen in clinical practice. OBJECTIVE To develop a protocol for the management of GERD with osteopathic manipulative therapy (OMTh) applied to the diaphragm and esophagus, and to evaluate the protocols effectiveness using the quality of life scale (QS-GERD) for the disease. METHODS In this single-blinded prospective study, an OMTh protocol focusing on the diaphragm and esophagus was applied to a single patient, who had received a diagnosis of GERD 4 years previously. Outcomes were measured using the QS-GERD, which has a total possible score ranging from 0 to 45 (the lower the score, the better the quality of life) and a level of satisfaction from very satisfied to incapacitated. The OMTh protocol was applied at 3 sessions (initial session, second session 1 week after the first, and third session 2 weeks after the second), and the patient completed the QS-GERD 4 times (before the first session, before the third session, and 2 and 4 weeks after the third session). RESULTS The OMTh protocol was administered without adverse events, and the patient reported positive outcomes after the third session. The QS-GERD showed a score improvement from 13 of 45 to 4 of 45. CONCLUSION The results in the present report show that OMTh applied to the diaphragm and esophagus may improve symptoms of GERD and should be added to the somatovisceral approach to the care of patients with this condition.

Diacutaneous fibrolysis versus passive stretching after articular immobilisation : muscle recovery and extracellular matrix remodelling

Introduction Atrophy and muscle shortening due to articular immobilisation are common problems in musculoskeletal rehabilitation. Muscle stretching mechanical stimuli might be considered as the golden standard procedure to improve muscle flexibility in rehabilitation. Muscle stretching generates mechanotransduction, potentiating specific gene expression and promotes sarcomerogenesis and extracellular matrix remodelling on shortened and atrophied muscles. Hypothesis Diacutaneous fibrolysis, like stretching, uses an external force to stress connective and muscle tissues mechanically to treat muscle shortening; thus, it is widely used in clinical practice even if there is no evidence to support it. Considering this subject, we have hypothesised that diacutaneous fibrolysis can generate mechanotransduction, affecting muscle hypertrophy and extracellular matrix remodelling after immobilisation. Evaluation of hypothesis We have designed a laboratory experimental study with a sample of 50 rats. The sample was randomly divided into five groups: Control group (n = 10) with non–immobilised rats; 3–week immobilisation group (n = 10); 3–week immobilisation/3–week non–immobilisation group (n = 10);3–week immobilisation/3–week stretching group (n = 10); and 3–week immobilisation/3–week diacutaneous fibrolysis group (n = 10). All rats had their left tibiotarsal joint immobilised in maximum plantar flexion with the orthotics for 3 consecutive weeks. After the immobilisation period, the intervention groups received their respective intervention on their left triceps suralis for 3 weeks. Dependent variables of the study were sarcomere analysis, polymerase chain reaction, connective tissue density, collagen birefringence and matrix metalloproteinases. Statistical analysis was performed using analysis of variance and Duncan post hoc test was applied for differences between groups. For all calculations, a 5% (p < 0.05) significance level was established. Conclusion If the hypothesis is confirmed, the present study might provide evidence to support the use of this physical therapy resource widely used to treat muscle dysfunctions.

Noninvasive Ventilation Improves the Cardiovascular Response and Fatigability During Resistance Exercise in Patients With Heart Failure.

PURPOSE: Noninvasive ventilation may improve cardiovascular function and exercise performance. We evaluated the physiologic impact of noninvasive ventilation during isokinetic knee extension resistance exercise in patients with heart failure. METHODS: This clinical trial included 10 male compensated patients with ischemic heart failure (age, 57 ± 9.1 years; ejection fraction, 28.5 ± 5.8%). Subjects underwent 2 bouts of exercise on an isokinetic dynamometer, separated by 72 hours of rest. The resistance exercise was concentric knee extension, at a speed of 60°/s. Five sets of 10 repetitions were performed during the 2 exercise bouts, and each set was separated by 2 minutes of rest. Subjects were administered either bilevel positive airway pressure ventilation (BV) or sham ventilation 20 minutes before and during the 2 exercise sessions in a randomized fashion. Heart rate, systolic blood pressure, and diastolic blood pressure were measured at rest, during exercise, and into recovery. Changes in peak torque (&Dgr;PT), total work (&Dgr;TW), and power (&Dgr;Pw) between the fifth and first sets were also measured. RESULTS: Compared with the sham intervention, BV significantly decreased heart rate, systolic blood pressure, and diastolic blood pressure at rest and during exercise (P < .01). There were no significant differences in these variables during recovery. Bi-level positive airway pressure ventilation also significantly reduced &Dgr;PT, &Dgr;TW, and &Dgr;Pw compared with the sham intervention (P < .01). CONCLUSIONS: Bi-level positive airway pressure ventilation significantly improved the cardiovascular response and fatigability during resistance exercise in patients with heart failure. These results suggest that use of BV during exercise training may be beneficial in this population with chronic disease.

Measuring fatigue with multiple instruments in a Brazilian cohort of early rheumatoid arthritis patients

OBJECTIVE To assess the prevalence of fatigue in a Brazilian population with early rheumatoid arthritis using multiple instruments, and the predictors of these instruments by differents independent variables. METHODS Cross-sectional study with direct interview and medical records review. Fatigue, dependent variable, was assessed using eight instruments: Profile of Mood States (POMS), Multidimensional Assessment of Fatigue scale (MAF), Fatigue Severity Scale (FSS), Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), Numerical Rating Scales (BRAF-NRS), Short-form Survey 36 (SF-36), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) and Visual Analogic Scale for Fatigue (VASf). INDEPENDENT VARIABLES sociodemographic, clinical and serological, were measured using medical records and direct interview. Disability and disease activity were assessed using the Health Assessment Questionnaire (HAQ) and disease activity assessed using the Disease Activity Score 28 joints (DAS28). The scores of scales demonstrated the level of fatigue and multiple linear regression method used in statistical analysis to demonstrate prediction models. RESULTS A total of 80 patients was assessed, and 57 reported clinically relevant fatigue (VASf>2), representing 71.25% prevalence point (51 women [89.5%], mean age 48.35±15 years, and mean disease duration of 4.92±3.8 years). Eight predictive models showed statistical significance, one for each fatigue instrument. The highest coefficient of determination (R2) was 56% for SF-36 and the lowest (R2=21%) for FSS. The HAQ was the only independent variable to predict fatigue on all instruments. CONCLUSION Clinically relevant fatigue is a highly prevalent symptom and is mostly predicted by disability and age in the population assessed.

Immediate changes in electroencephalography activity in individuals with nonspecific chronic low back pain after cranial osteopathic manipulative treatment: study protocol of a randomized, controlled crossover trial

BackgroundOsteopathic medicine is based on a diagnostic and therapeutic system to treat tissue mobility/ motility dysfunctions in general, using different approaches (depending on the target tissue) known as osteopathic manipulative treatment. Among the available techniques those ones addressed to the cranial field are the most questioned because of the lack of scientific evidence; but the compression of the 4th ventricle technique has been largely studied in clinical trials. Studies have shown that the technique may affect both central and autonomous nervous system, modulating some reflexes (Traube-Hering baro signal), and modifying brain cortex electrical activity through central sensitization in subjects with chronic low back pain. Thus, investigators hypothesize that the compression of the 4th ventricle may modulate peak alpha frequency (eletroencephalographic assessment) and promote physical relaxation in subjects in vigil.Methods/DesignA randomized, controlled crossover trial with blinded assessor was designed to test the hypothesis. A total of 81 participants will be assigned to three treatment conditions, with seven days of washout: (I) compression of the 4th ventricle; (II) sham compression of the fourth ventricle; (III) control (no intervention). The (I) power amplitude and the (II) frequencies of the dominant peak in the alpha band will be the primary outcome measures of the study. All participants will be recruited at the Outpatient Rehabilitation Service of the University Hospital of Brasília – University of Brasília. All the electroencephalographic exams will be conducted by a blinded assessor.DiscussionThe investigators hypothesize that patients with chronic low back pain submitted to the technique would have the peak alpha frequency modulated and, thus, would experience physical relaxation.Trial registrationNCT02111382