Clinical muscular evaluation in patellofemoral pain syndrome / Avaliação clínica muscular na síndrome de dor patelofemoral

ABSTRACT Objective: To define a profile of the muscle groups affected by patellofemoral pain syndrome (PFPS) to determine a pattern of functional weaknesses around the knee. Methods: Sixty-three female patients were randomly selected, and 17 included in this study, receiving a clinical evaluation with pre-established protocol which evaluated the quadriceps, abductors, range of motion in the internal rotators and ankle dorsiflexors, pelvic tilt, and dynamic valgus. Results: Losses were seen in abductor strength and ankle dorsiflexor range of motion in comparison with the contralateral limb (0.031 and 0.040, respectively). There was a loss of quadriceps strength and decreased amplitude of internal hip rotation when compared to the Kujala score (0.032 and 0.002, respectively). Dynamic valgus and pelvic fall were greater in comparison with the Kujala score (0.668 and 0.567, respectively). Conclusion: Clinical evaluation showed deficits in the quadriceps and abductor muscle groups, as well as decreased range of motion in the internal hip rotators and ankle dorsiflexors and increased dynamic valgus and pelvic drop. Level of Evidence IV; Case series.

RESUMO Objetivo: Definir o perfil de acometimento de grupos musculares envolvidos na síndrome de dor patelofemoral (SDPF) a fim de determinar um padrão de fraqueza funcional em torno do joelho. Métodos: Foram selecionados randomicamente 63 pacientes do sexo feminino, dos quais 17 foram incluídos no trabalho e submetidos a uma avaliação clínica com protocolo preestabelecido que avaliou quadríceps, abdutores, amplitude de movimento de rotadores internos e dorsiflexores de tornozelo, além de inclinação pélvica e valgo dinâmico. Resultados: Houve déficit de força de abdutores e diminuição de amplitude do movimento de dorsiflexores de tornozelo em comparação com o membro contralateral (0,031; 0,040, respectivamente). Houve déficit de força de quadríceps e diminuição de amplitude de rotação interna do quadril quando em comparação com o escore de Kujala (0,032; 0,002, respectivamente). Verificou-se aumento do valgo dinâmico e queda pélvica com relação ao escore de Kujala (0,668; 0,567, respectivamente). Conclusões: Após avaliação clínica dos pacientes incluídos, observaram-se déficits dos seguintes grupos musculares: quadríceps e abdutores, além da diminuição da amplitude de movimento de rotadores internos do quadril e dorsiflexores de tornozelo; por fim, foram identificados aumento do valgo dinâmico e queda pélvica. Nível de Evidência IV; Série de casos.

Effects of simple long-term respiratory care strategies in older men with COPD / Efeitos de estratégias de longo prazo simples de cuidados respiratórios em homens idosos com DPOC

ABSTRACT Objective: To evaluate a 24-month supervised, community-based maintenance exercise program after 3 months of pulmonary rehabilitation (PR) in comparison with a 27-month physical activity counseling program, in terms of the effects on maximal muscle strength, muscle power output, and exercise capacity, in individuals with COPD. Methods: Sixty-three men with moderate-to-severe COPD were recruited from two previous studies. Of those 63 participants, 31 were offered 3 months of PR followed by a 24-month supervised maintenance exercise program (24MME group) and 32 were offered a 27-month physical activity counseling program (27MPAC group). Measurements at 3 months and at the end of the study period included maximal strength of the upper and lower limbs, power output of the lower limbs, six-minute walk distance (6MWD), and quality of life. Results: At 27 months, the improvements in maximal strength of the upper and lower limbs were greater in the 24MME group than in the 27MPAC group (37.6 ± 28.3% and 28.4 ± 13.3%, respectively, vs. 8.8 ± 16% and 13.6 ± 16.4%, respectively; p < 0.05), as was the improvement in power output of the lower limbs (24.6 ± 18.4% vs. −2.3 ± 28.5%; p < 0.01). The increase in the 6MWD after 3 months was also greater in the 24MME group than in the 27MPAC group (33.2 ± 36.6 m vs. 2.9 ± 34.7 m; p < 0.05), although there were no differences between the two groups in terms of the Δ6MWD at 27 months (vs. baseline). Conclusions: A supervised, community-based maintenance program is a successful long-term strategy to preserve the benefits of PR on peripheral muscle function and exercise capacity in individuals with COPD. However, physical activity counseling can maintain maximal muscle strength and exercise capacity in such individuals.

RESUMO Objetivo: Avaliar um programa comunitário supervisionado de 24 meses de exercícios de manutenção precedido de 3 meses de reabilitação pulmonar (RP) em comparação com um programa de 27 meses de aconselhamento de atividade física, quanto aos efeitos na força muscular máxima, potência muscular e capacidade de exercício em indivíduos com DPOC. Métodos: Foram recrutados 63 homens com DPOC moderada a grave de dois estudos anteriores. A 31 desses 63 participantes foram oferecidos 3 meses de RP seguidos de um programa supervisionado de 24 meses de exercícios de manutenção (grupo 24MEM), e a 32, um programa de 27 meses de aconselhamento de atividade física (grupo 27MAAF). Medidas realizadas aos 3 meses e ao final do período estudado incluíram força máxima dos membros superiores e inferiores, potência dos membros inferiores, distância percorrida no teste de caminhada de seis minutos (DTC6) e qualidade de vida. Resultados: Aos 27 meses, a melhora da força máxima dos membros superiores e inferiores foi maior no grupo 24MEM que no grupo 27MAAF (37,6 ± 28,3% e 28,4 ± 13,3%, respectivamente, vs. 8,8 ± 16% e 13,6 ± 16,4%, respectivamente; p < 0,05), e houve melhora da potência dos membros inferiores (24,6 ± 18,4% vs. −2,3 ± 28,5%; p < 0,01). O aumento da DTC6 após 3 meses também foi maior no grupo 24MEM que no grupo 27MAAF (33,2 ± 36,6 m vs. 2,9 ± 34,7 m; p < 0,05), mas não houve diferenças entre os grupos quanto a ΔDTC6 aos 27 meses (vs. basal). Conclusões: Um programa comunitário supervisionado de manutenção é uma estratégia de longo prazo bem sucedida para preservar os benefícios da RP na função muscular periférica e capacidade de exercício em indivíduos com DPOC. No entanto, o aconselhamento de atividade física consegue manter a força muscular máxima e a capacidade de exercício nesses indivíduos.

Effects of cold exposure on cardiovascular function and skeletal muscle contraction in rats / 中国医师杂志

Objective To investigate the effects of cold exposure with different time courses on cardiovascular function and skeletal muscle contraction in Sprague-Dawley (SD) rats.Methods The male SD rats were randomly divided into control,12-h cold,24-h cold,and 48-h cold groups.The rats in all cold group were maintained in 4 ℃ environment for indicated time and allowed free access to standard rat chow and water ad libitum.After the animal model was established,the heart,thoracic aorta,soleus,and extensor digitorum longus (EDL) were rapidly isolated from rats under anesthesia and then fixed into the respective organ perfusion system that was connected to physiological recorders and data acquisition system.Lanendorff heart persusion was used to detect some parameters of cardiac function,such as coronary flow (CF),mean left ventricular systolic pressure (mLVSP),mean left ventricular diastolic pressure (mLVDP) and maximum ascending and declining rate of left ventricular pressure (± dp/dt max) ; and then the heart was suffered from 30 min ischemia followed by 60 min reperfusion,the changes of above cardiac function indexes were recorded again.Organ bath method was employed to detect contraction response to potassium chloride (KCl) or phenylephrine (PE) and endothelium-dependent relation responses to acetylcholine (ACh) of aortic rings.The twitch tension,titanic tension,and fatigue test of soleus and EDL were examined by electrical stimulation to reflect contractive function of skeletal muscle.Results The coronary flow (CF) were significantly reduced in 24-h and 48-h cold groups compared to control group [(9.0 ± 1.7) ml/g and (9.8 ± 1.3) ml/g vs (11.6 ± 1.2) ml/g,P ＜ 0.05] ; 48-h cold exposure also showed significantly increased mLVSP (P ＜0.01) and mLVP (P ＜ 0.05) of rats.After ischemia-reperfusion,the heart re-beat time was shorter in all cold exposure groups (all P ＜ 0.01),mLVP and mLVDP were higher in 24-h and 48-h cold group than control group (all P ＜ 0.01).The contraction of aortic rings responses to 60 mmol/L KCl [(0.63 ±0.13) g and (0.79 ±0.11)g vs (1.28±0.17)g,P ＜0.01] and 1 μmol/L PE [(0.62 ±0.18)g and (0.68 ±0.13)g vs (1.25 ± 0.18)g,P ＜ 0.01] were decreased while the endothelium-dependent relaxation responses to low concentration ACh (3 × 10-8 ～ 3 × 10-7) were increased in 24-h and 48-h cold groups relative to control group (all P ＜ 0.05).The 48-h cold also reduced titanic tension of SOL and EDL in comparison with control [(4.14 ± 0.62) N/cm2 vs (5.50 ± 0.75) N/cm2,P ＜ 0.05 and (3.00 ± 0.57) N/ cm2 vs (4.70 ± 0.85) N/cm2,P ＜ 0.01].Conclusions 24 ～ 48 h cold exposure could reduce CF but enhance the tolerance of heart from rats to ischemia reperfusion injury and also decrease the contraction of aortic rings response to KCl or PE but increase the sensitive responses to ACh of aortic rings from rats.The 48-h cold could decrease the contraction of skeletal muscle elicited by electrical stimulation.