Efeitos do exercício passivo precoce em cicloergômetro na espessura muscular do quadríceps femoral de pacientes críticos: estudo-piloto randomizado controlado / Efectos del ejercicio pasivo precoz en cicloergómetro en el espesor muscular del cuádriceps femoral de pacientes críticos: un estudio piloto aleatorizado controlado / Effects of early passive cycling exercise on quadriceps femoris thickness in critically ill patients: a controlled randomized pilot study

RESUMO O objetivo deste estudo foi avaliar os efeitos do exercício passivo precoce em cicloergômetro na espessura muscular (EM) do quadríceps femoral (EMQ) de pacientes críticos admitidos em uma Unidade de Terapia Intensiva (UTI) de um hospital universitário terciário. O método utilizado foi um estudo-piloto randomizado controlado conduzido em uma amostra de 24 pacientes (51±18,11 anos, 16 do sexo masculino), com 24 a 48 horas de ventilação mecânica (VM), aleatoriamente divididos em dois grupos: grupo-controle (n=12), que recebeu a fisioterapia convencional; e grupo-intervenção (n=12), que recebeu o exercício passivo em cicloergômetro, uma vez ao dia, durante o período de sete dias do protocolo, em adição à fisioterapia convencional. A EMQ foi mensurada através da ultrassonografia. A primeira medida ultrassonográfica foi realizada entre as primeiras 48 horas de VM e a segunda ao término do protocolo. Não houve diferenças significativas na EMQ esquerda (27,29±5,86mm vs. 25,95±10,89mm; p=0,558) e direita (24,96±5,59mm vs 25,9±9,21mm; p=0,682) do grupo-controle e na EMQ esquerda (27,2±7,38mm vs 29,57±7,89mm; p=0,299) e direita (26,67±8,16mm vs 28,65±8,04mm; p=0,381) do grupo-intervenção. Na comparação entre os grupos, não houve alterações significativas em relação à EMQ esquerda (3,61±1,07mm; p=0,248) e a EMQ direita (2,75±0,85mm; p=0,738). Os resultados deste estudo-piloto demonstraram que a aplicação precoce do exercício passivo em cicloergômetro não promoveu mudanças significativas na espessura da camada muscular avaliada. No entanto, nossos achados sinalizam que a fisioterapia convencional foi capaz de preservar a EMQ de pacientes críticos admitidos em UTI.

RESUMEN El presente estudio tuvo como objetivo evaluar los efectos del ejercicio pasivo precoz en cicloergómetro en el espesor muscular (EM) del cuádriceps femoral (EMC) de pacientes críticos ingresados en una Unidad de Cuidados Intensivos (UCI) de un hospital universitario terciario. Se utilizó como método un estudio piloto aleatorizado controlado con una muestra de 24 pacientes (51±18,11 años, 16 varones), con 24 a 48 horas de ventilación mecánica (VM), quienes fueron divididos aleatoriamente en dos grupos: grupo de control (n=12), que recibió fisioterapia convencional; y grupo intervención (n=12), que recibió el ejercicio pasivo en cicloergómetro una vez al día durante el período de protocolo de siete días, además de la fisioterapia convencional. El EMC se midió por ecografía. La primera medición ecográfica se realizó entre las primeras 48 horas de VM, y la segunda al final del protocolo. No hubo diferencias significativas en el EMC izquierdo (27,29±5,86 mm vs. 25,95±10,89mm; p=0,558) y derecho (24,96±5,59mm vs 25,9±9,21mm; p=0,682) del grupo de control; y en el EMC izquierdo (27,2±7,38mm vs 29,57±7,89mm; p=0,299) y derecho (26,67±8,16mm vs 28,65±8,04mm; p=0,381) del grupo intervención. En la comparación entre grupos, no hubo cambios significativos en el EMC izquierdo (3,61±1,07 mm; p=0,248) y en el EMC derecho (2,75±0,85 mm, p=0,738). Los resultados de este estudio piloto demostraron que la aplicación precoz del ejercicio pasivo en cicloergómetro no promovió cambios significativos en el espesor de la capa muscular evaluada. Sin embargo, nuestros hallazgos indican que la fisioterapia convencional pudo preservar el EMC de pacientes críticos ingresados en la UCI.

ABSTRACT The objective of this study was to evaluate the effects of early passive cycling exercise on quadriceps femoris thickness (QFT) in critically ill patients admitted in the intensive care unit (ICU) of a tertiary care university hospital. A controlled randomized pilot study was conducted with a sample of 24 patients (51±18.11 years, 16 male), on mechanical ventilation (MV) from 24 to 48 hours, who were randomly divided into two groups: control group (n=12), receiving conventional physical therapy; and an intervention one (n=12), receiving passive cycle ergometer, once a day, throughout seven days of protocol, in addition to conventional physical therapy. The QFT was measured by ultrasonography. The first ultrasonographic measurement was performed within 48 hours after the start of MV, and the second at the end of the protocol. There were no significant differences in QFT of the left (27,29±5,86mm vs 25,95±10,89mm; p=0,558) and right (24,96±5,59mm vs 25,9±9,21mm; p=0,682) in the control group, and in QFT of the left (27,2±7,38mm vs 29,57±7,89mm; p=0,299) and right (26,67±8,16mm vs 28,65±8,04mm; p=0,381) in the intervention group. There were no significant between-groups differences for left QFT (3,61±1,07mm; p=0,248) and right QFT (2,75±0,85mm; p=0,738). The results of this pilot study demonstrate that application of early passive cycle ergometer exercises has not significantly change the muscle layer thickness. However, our findings indicate that conventional physical therapy is able to preserve the quadriceps femoris thickness in critically ill patients admitted in ICU.

Effects of physical exercise on skeletal muscles of rats with cerebral ischemia

Physical exercise is a known preventive and therapeutic alternative for several cerebrovascular diseases. Therefore, the objective of the present study was to evaluate the motor performance and histomorphometry of the biceps brachii, soleus, and tibialis anterior muscles of rats submitted to a treadmill training program prior to the induction of cerebral ischemia via occlusion of the middle cerebral artery (OMCA). A total of 24 Wistar rats were distributed into four groups: Sham-Sed: sedentary control animals (n=6), who underwent sham surgery (in which OMCA did not occur); Sham+Ex: control animals exercised before the sham surgery (n=6); I-Sed: sedentary animals with cerebral ischemia (n=6); and I+Ex: animals exercised before the induction of ischemia (n=6). The physical exercise consisted of treadmill training for five weeks, 30 min/day (5 days/week), at a speed of 14 m/min. The results showed that the type-I fibers presented greater fiber area in the exercised ischemic group (I+Ex: 2347.96±202.77 µm2) compared to the other groups (Sham-Sed: 1676.46±132.21 µm2; Sham+Ex: 1647.63±191.09 µm2; I+Ex: 1566.93±185.09 µm2; P=0.0002). Our findings suggested that the angiogenesis process may have influenced muscle recovery and reduced muscle atrophy of type-I fibers in the animals that exercised before cerebral ischemia.

Electrical stimulation attenuates morphological alterations and prevents atrophy of the denervated cranial tibial muscle / Eletroestimulação atenua alterações morfológicas e previne atrofia do músculo tibial cranial desnervado

ABSTRACT Objective To investigate if electrical stimulation through Russian current is able to maintain morphology of the cranial tibial muscle of experimentally denervated rats. Methods Thirty-six Wistar rats were divided into four groups: the Initial Control Group, Final Control Group, Experimental Denervated and Treated Group, Experimental Denervated Group. The electrostimulation was performed with a protocol of Russian current applied three times per week, for 45 days. At the end, the animals were euthanized and histological and morphometric analyses were performed. Data were submitted to statistical analysis with a significance level of p<0.05. Results The Experimental Denervated Group and the Experimental Denervated and Treated Group had cross-sectional area of smaller fiber compared to the Final Control Group. However, there was significant difference between the Experimental Denervated Group and Experimental Denervated and Treated Group, showing that electrical stimulation minimized muscle atrophy. The Experimental Denervated and Treated Group and Initial Control Group showed similar results. Conclusion Electrical stimulation through Russian current acted favorably in maintaining morphology of the cranial tibial muscle that was experimentally denervated, minimizing muscle atrophy.

RESUMO Objetivo Investigar se a estimulação elétrica pela corrente russa é capaz de manter a morfologia do músculo tibial cranial de ratos desnervados experimentalmente. Métodos Foram utilizados 36 ratos Wistar, distribuídos em quatro grupos: Grupo Controle Inicial, Grupo Controle Final, Grupo Experimental Desnervado Tratado, Grupo Experimental Desnervado. A eletroestimulação foi realizada com um protocolo de corrente russa aplicada três vezes por semanas, durante 45 dias. Ao final, os animais foram eutanasiados e, em seguida, foram realizadas as análises histológica e morfométrica. Os dados foram submetidos à análise estatística, com nível de significância de p<0,05. Resultados Os Grupos Experimental Desnervado e o Grupo Experimental Desnervado Tratado apresentaram área de secção transversal da fibra menor quando comparados ao Grupo Controle Final. Entretanto, constatou-se diferença significativa entre o Grupo Experimental Desnervado e o Grupo Experimental Desnervado Tratado, mostrando que a estimulação elétrica minimizou atrofia muscular. Ainda, observou-se que o Grupo Experimental Desnervado Tratado apresentou resultados semelhantes ao Grupo Controle Inicial. Conclusão A estimulação elétrica por meio da corrente russa foi favorável na manutenção da morfologia do músculo tibial cranial desnervado experimentalmente, minimizando a atrofia muscular.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients

OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Fraqueza muscular adquirida na UTI (ICU-AW): efeitos sistêmicos da eletroestimulação neuromuscular / Muscular weakness acquired in ICU (ICU-AW): effects of systemic neuromuscular electrical stimulation

Com os avanços tecnológicos alcançados atualmente na terapia intensiva e maior sobrevida dos pacientes, outros desafios têm surgido para os profissionais de saúde. Dentre alguns, destaca-se a fraqueza muscular adquirida na UTI (ICU-AW), caracterizada por paresia esquelética e respiratória dos músculos promovendo aumento nas taxas de mortalidade e comprometimento da qualidade de vida. Sua incidência varia de 30% a 60% e tem na síndrome da resposta inflamatória sistêmica (SIRS) e na disfunção de múltiplos órgãos (DMO) sua principal etiologia. Outros fatores de risco como a hiperglicemia, o uso de bloqueadores neuromusculares e sedativos, a imobilidade e a própria ventilação mecânica estão entre os mais comuns. Entre as medidas de combate à ICU-AW, está o conceito de mobilização precoce, bem como despertar diário e controle estreito da glicemia. Nesse contexto, a letroestimulação muscular apresenta-se como recurso de grande valia. Sua principal vantagem está no fato de poder ser empreendida independentemente da cooperação do paciente, e por ser capaz de gerar respostas musculares eficientes, bem como resultados satisfatórios na preservação da massa muscular, condicionamento físico e funcionalidade dos que usam essa ferramenta. Desfechos interessantes têm sido observados em diversos perfis de pacientes, como os de doença pulmonar obstrutiva crônica (DPOC) e traumatismo raquimedular (TRM). No paciente crítico, seu uso tem mostrado redução nos tempos de ventilação mecânica (VM), internação na UTI e maior funcionalidade dos pacientes. A relevância dos efeitos sistêmicos e metabólicos provenientes da eletroestimulação neuromuscular (ENM) tem sido a base para os estudos nos pacientes críticos. Portanto, a ICU-AW é uma realidade no cenário da terapia intensiva e sua prevenção tem dado margem à aparição de novas propostas e ferramentas na prevenção dessas complicações.

With technological advances currently achieved in intensive care and increased patient survival, other challenges have emerged to health professionals. Among some, there is acquired weakness in the ICU (ICU-AW), characterized by skeletal and respiratory muscle paresis promoting an increase in mortality and impaired quality of life. The range of occurrence is 30% to 60% of critically ill patients, and systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction (MOD) are is the main etiology. Other risk factors such as hyperglycemia, the use of neuromuscular blockers and sedatives, immobility and mechanical ventilation are among the most common. Preventing ICU-AW is the concept of early mobilization and daily awakening and tight control of blood glucose. In this context, muscle electrostimulation appears as a great resource. This can be used undertaken regardless of the cooperation of the patient, and be able to generate efficient muscle responses showing satisfactory results in the preservation of muscle mass, physical fitness and functionality of using this tool. Interesting outcomes have been observed in several profiles of patients, such as chronic obstructive pulmonary disease (COPD) and spinal cord injury (SCI). In critically ill patients, its use has shown reduction in mechanical ventilation (MV) days, ICU length and increased functionality of patients. The relevance of the systemic and metabolic effects from the electrostimulation neuromuscular (NMES) has been the basis for studies in critically ill patients. The refore, the ICU-AW is a reality in the setting of intensive care and prevention has given rise to appearance of new proposals and tools in preventing these complications.

Efeito do exercício aeróbico em modelo experimental de artrite / Effect of aerobic exercise on an experimental model of arthritis

INTRODUÇÃO: A artrite reumatoide é uma doença inflamatória sistêmica autoimune que acomete preferencialmente as articulações, mas também outros tecidos, como o músculo esquelético. A perda de massa muscular determina uma grande repercussão na funcionalidade e qualidade de vida desses pacientes e o exercício físico surge como uma alternativa terapêutica para esse acometimento. OBJETIVO: Avaliar o efeito do exercício físico aeróbico moderado sobre a perda muscular em artrite induzida por colágeno (CIA). MÉTODOS: Esse é um estudo-piloto em que CIA foi induzida em camundongos machos DBA1/J divididos em dois grupos: (i) animais com exercício (EXE, n=5), (ii) animais sem exercício (semEXE, n=4). Foram avaliados o escore clínico, o edema da pata traseira, o peso do animal e a locomoção espontânea periodicamente. Após a morte, a histopatologia da articulação tibiotarsal e a área da miofibra dos músculos gastrocnêmio e tibial anterior foram avaliados. Significância foi considerada se p<0,05.RESULTADOS: Não foi observada diferença significativa entre os grupos nos parâmetros de atividade da doença, peso e locomoção espontânea. Entretanto, a histopatologia da articulação demonstrou redução da erosão cartilaginosa no grupo EXE. Também se observou aumento significativo na área seccional da miofibra do grupo EXE, representando uma diferença média de 24%. CONCLUSÃO: Este é o primeiro estudo com exercício aeróbico moderado em esteira em modelo experimental de artrite. O protocolo de exercício testado não parece impactar no desenvolvimento clínico da doença, mas demonstrou benefício sobre a perda muscular consequente da artrite, reduzindo a atrofia da miofibra.

BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease that affects primarily the joints, but also other tissues such as skeletal muscle. Muscle wasting significantly impairs the functionality and quality of life of patients with RA and physical exercise is an alternative therapy for this outcome. AIM: To evaluate the effect of moderate aerobic physical exercise on muscle loss caused by collagen-induced arthritis (CIA). METHODS: This is a pilot study in which CIA was induced in DBA/1J mice divided into two groups: (i) animals which exercised (EXE, n=5), (ii) animals which did not exercise (semEXE, n=4). Clinical score, hind paw swelling, weight, and spontaneous locomotion were evaluated periodically. After death, the histopathological score of the ankle and the myofiber area of the gastrocnemius and tibialis anterior muscles were evaluated. Significance was considered when p<0.05. RESULTS: No significant difference was observed between groups regarding clinical parameters of disease activity, animal weight, and spontaneous locomotion. However, joint histopathology demonstrated a decrease in cartilage erosion in the EXE group. There was also significant difference in the myofiber sectional area, with a 24% increase in the EXE group. CONCLUSION: This is the first interventional study with moderate aerobic exercise on a treadmill in an arthritis experimental model. The tested exercise program does not seem to have a clinical impact on the process of arthritis. However, it has a positive effect on muscle wasting caused by arthritis, demonstrated mainly by the reduction of myofiber atrophy.

The effect of a low dose of clenbuterol on rat soleus muscle submitted to joint immobilization

The aim of the present study was to evaluate the effect of joint immobilization on morphometric parameters and glycogen content of soleus muscle treated with clenbuterol. Male Wistar (3-4 months old) rats were divided into 4 groups (N = 6 for each group): control, clenbuterol, immobilized, and immobilized treated with clenbuterol. Immobilization was performed with acrylic resin orthoses and 10 µg/kg body weight clenbuterol was administered subcutaneously for 7 days. The following parameters were measured the next day on soleus muscle: weight, glycogen content, cross-sectional area, and connective tissue content. The clenbuterol group showed an increase in glycogen (81.6 percent, 0.38 ± 0.09 vs 0.69 ± 0.06 mg/100 g; P < 0.05) without alteration in weight, cross-sectional area or connective tissue compared with the control group. The immobilized group showed a reduction in muscle weight (34.2 percent, 123.5 ± 5.3 vs 81.3 ± 4.6 mg; P < 0.05), glycogen content (31.6 percent, 0.38 ± 0.09 vs 0.26 ± 0.05 mg/100 mg; P < 0.05) and cross-sectional area (44.1 percent, 2574.9 ± 560.2 vs 1438.1 ± 352.2 µm²; P < 0.05) and an increase in connective tissue (216.5 percent, 8.82 ± 3.55 vs 27.92 ± 5.36 percent; P < 0.05). However, the immobilized + clenbuterol group showed an increase in weight (15.9 percent; 81.3 ± 4.6 vs 94.2 ± 4.3 mg; P < 0.05), glycogen content (92.3 percent, 0.26 ± 0.05 vs 0.50 ± 0.17 mg/100 mg; P < 0.05), and cross-sectional area (19.9 percent, 1438.1 ± 352.2 vs 1724.8 ± 365.5 µm²; P < 0.05) and a reduction in connective tissue (52.2 percent, 27.92 ± 5.36 vs 13.34 ± 6.86 percent; P < 0.05). Statistical analysis was performed using Kolmogorov-Smirnov and homoscedasticity tests. For the muscle weight and muscle glycogen content, two-way ANOVA and the Tukey test were used. For the cross-sectional area and connective tissue content, Kruskal-Wallis and Tukey tests were used. This study emphasizes the importance of anabolic pharmacological...

Repaired ulnar nerve and effect on its innervating muscles in rat / 法医学杂志

OBJECTIVE@#To study the morphological changes of the rat claw inner skeletal muscle after ulnar nerve injury at different sections and different recovery times.@*METHODS@#Forty-two adult male Sprague-Dawley rats were selected and placed randomly in seven groups. After establishing model of injury and repair of claw inner skeletal muscle by cutting off the ulnar nerve, the muscle wet weight, cross section area of myocytes, and collagen fibers were measured.@*RESULTS@#Claw inner skeletal muscle atrophy was significantly less in experiment groups compared with the control groups after ulnar nerve injuries. The functional recovery was better in the early repair groups than the late repair group. Collagen fibers increased slowly in earlier stage, but more significantly in late stage. The muscle atrophy was similar in wrist and elbow after ulnar nerve injury during the same recovery period.@*CONCLUSION@#The function can recover completely or partly in early repair groups, but not quite effective in late stage. The increase of collagen fiber is one of the reasons to undermine the recovery effect of damaged ulnar nerve. There is no obvious difference of effect on the morphological changes of the rat claw inner skeletal muscle no matter the ulnar nerve is injured at wrist or elbow.

Effect of passive stretching on the immobilized soleus muscle fiber morphology

The aim of the present study was to determine the effect of stretching applied every 3 days to the soleus muscle immobilized in the shortened position on muscle fiber morphology. Eighteen 16-week-old Wistar rats were used and divided into three groups of 6 animals each: a) the left soleus muscle was immobilized in the shortened position for 3 weeks; b) during immobilization, the soleus was stretched for 40 min every 3 days; c) the non-immobilized soleus was only stretched. Left and right soleus muscles were examined. One portion of the soleus was frozen for histology and muscle fiber area evaluation, while the other portion was used to identify the number and length of serial sarcomeres. Immobilized muscles (group A) showed a significant decrease in weight (44 ± 6 percent), length (19 ± 7 percent), serial sarcomere number (23 ± 15 percent), and fiber area (37 ± 31 percent) compared to the contralateral muscles (P < 0.05, paired Student t-test). The immobilized and stretched soleus (group B) showed a similar reduction but milder muscle fiber atrophy compared to the only immobilized group (22 ± 40 vs 37 ± 31 percent, respectively; P < 0.001, ANOVA test). Muscles submitted only to stretching (group C) significantly increased the length (5 ± 2 percent), serial sarcomere number (4 ± 4 percent), and fiber area (16 ± 44 percent) compared to the contralateral muscles (P < 0.05, paired Student t-test). In conclusion, stretching applied every 3 days to immobilized muscles did not prevent the muscle shortening, but reduced muscle atrophy. Stretching sessions induced hypertrophic effects in the control muscles. These results support the use of muscle stretching in sports and rehabilitation.