Effects of a backward running training on backward peak velocity running, V̇O2max, vVO2max and 3 km forward running performance in male adults: a pilot study

Abstract Aims: The study aimed to evaluate the effects of a backward running (BR) training program prescribed by the peak backward running velocity (Vpeak_BR) on physiological variables and a 3 km forward running (FR) performance. Methods: Eight untrained running male adults in running took place in the study. All the participants underwent five weeks of BR training prescribed based on Vpeak_BR. They performed a maximal incremental test on the treadmill to determine the maximal oxygen uptake (V̇O2max) and the velocity associated with V̇O2max (vV̇O2max). The participants were also tested on the track field to determine the Vpeak_BR and undertook a 3 km FR performance. All initial assessments were also performed after the training period. Results: The results showed statistically significant improvements in 3 km FR performance (14.2 ± 1.2 min vs. 13.5 ± 1.0 min) and Vpeak_BR (8.0 ± 0.8 km·h−1 vs. 8.5 ± 0.5 km·h−1) after the training period. Conclusion: BR training effectively improved 3 km FR performance and Vpeak_BR, demonstrating that Vpeak_BR determined according to the protocol proposed in this study can be used for the prescription of BR training. Further, BR training represents an effective training method that can be inserted into an FR running training program.

Funcionalidade e velocidade da caminhada de pacientes após alta da unidade de terapia intensiva / Patient functionality and walking speed after discharge from the intensive care unit

RESUMO Objetivo: Mensurar e comparar a funcionalidade de pacientes após alta da unidade de terapia intensiva e no momento da alta hospitalar. Métodos: Pesquisa quantitativa de coorte prospectiva realizada entre agosto de 2016 e dezembro de 2017 em um hospital universitário. Foi realizado o teste de caminhada de 10m em dois momentos: após a alta da unidade de terapia intensiva e anteriormente à alta hospitalar. Os dados foram expressos pelos testes t de Student e a correlação de Pearson ou Spearman. O programa utilizado para análise foi o Statistical Package for Social Science (SPSS), versão 21.0, e o nível de significância adotado foi de p ≤ 0,05. Resultados: Foram avaliados 40 pacientes, com média de idade de 57,1 ± 12,2 anos, com predomínio do sexo masculino (60%). No teste pós-unidade de terapia intensiva verificou-se média de velocidade de 0,48m/s e no pré-alta hospitalar, houve aumento para 0,71m/s, evidenciando evolução da funcionalidade durante a internação hospitalar (p < 0,001). Conclusão: Houve melhora significativa da velocidade da marcha no momento da alta hospitalar quando comparada com a velocidade atingida no momento da alta da unidade de terapia intensiva.

ABSTRACT Objective: To measure and compare the functionality of patients after discharge from the intensive care unit and at the time of hospital discharge. Methods: Quantitative study of a prospective cohort performed between August of 2016 and December of 2017 at a university hospital. A 10-meter walk test was performed at 2 timepoints: after discharge from the intensive care unit and prior to hospital discharge. The data were analyzed using Student's t-test and Pearson or Spearman correlation. Statistical Package for Social Science (SPSS) version 21.0 was used for the analysis, and p ≤ 0.05 was adopted as the level of significance. Results: Forty patients, with a mean age of 57.1 ± 12.2 years and with a predominance of males (60%), were evaluated. For the post-intensive care unit test, a mean speed of 0.48m/s was observed, and for the pre-hospital discharge test, there was an increase to 0.71m/s, evidencing functional evolution during the hospital stay (p < 0.001). Conclusion: There was significant improvement in walking speed at the time of hospital discharge when compared to the walking speed at the time of intensive care unit discharge.

Rol de la información auditiva en el control motor del sistema del equilibrio en pacientes con implantes cocleares / Role of auditory information in motor control of the balance system in patients with cochlear implants / Papel das informações auditivas no controle motor do sistema de equilíbrio em pacientes com implante coclear

Revisión de nuestros hallazgos experimentales sobre la relación entre audición y control motor del equilibrio en usuarios de implantes cocleares (UIC). Se realizó posturografía en 34 UIC en dos condiciones sensoriales:1- Implante encendido (ON). 2- Implante apagado (OFF) Se usó como medida el consumo de energía (CE) de la señal del centro de presión corporal. La marcha se analizó mediante la prueba de 10 m, implementada con: A - implante ON y ruido ambiental (EN), B - Implante ON, EN y Tarea dual cognitiva (DT) y C-implante OFF. Se registró la velocidad de marcha (GV) usando acelerómetros en los pies y la región retrosacra. Estadística: Se utilizaron las pruebas de Wilcoxon y Mann-Whitney y el nivel de significación fue p = 0.05. El análisis de la postura en la adolescencia mostró un ajuste adaptativo, disminuyendo la CE con el IC-ON.p = < 0,05, mientras con el CI-OFF no hubo disminución p => 0,05. En adultos, CI- OFF tuvieron valores más altos de CE en edades mayores, mientras que el CE no se incrementó con la edad con el CI-ON. En la marcha, la GV con el implante ON en EN solo disminuyó en UIC solo en aquellos que estaban implantado después de los 3 años. La UIC implantada antes de esta edad mostró un comportamiento de la marcha similar en comparación con los sujetos con audición normal como control. La información auditiva interviene en la postura y el comportamiento motor de la marcha, hechos que se analizan en esta revisión.

Review of publications of our group about the relationship between the auditory input and the balance motor control in subjects with profound hearing loss and cochlear implant users (UIC). A population of 34 UIC in which posturography in two different sensory information was performed, 1-Implant turned on (ON) giving acoustic information. 2-Implant turned off (OFF) and without auditory input. Energy consumption (CE) of the body center of pressure signal was used as measurement. Gait assessment was analyzed by the 10 m test, implemented with: A- Implant turned ON and environmental noise (EN). B- Implant ON, EN and cognitive dual task (DT) and C- Implant OFF with accelerometers in the feet and sacrum region to measure the gait velocity (GV). Statistics: Wilcoxon and Mann-Whitney test were used and significance level was p=0.05. Posture analysis for different ages in adolescence showed an adaptive adjustment, decreasing the EC significantly when the CI is ON (p<0.05). With the implant turned OFF, changes were not significant (p>0.05). In adults, (implant OFF) had higher values of CE related with age, while the CE did not show increment of CE with age when receiving auditory input with the implant ON. UIC implanted after being 3 years old showed a significant decrease in GV. The UIC implanted before this age showed similar gait behavior compared to normal hearing subjects as control. The auditory information intervenes in posture and gait motor behavior, facts which are analyzed in this review.

Revisão de publicações de nosso grupo sobre a relação entre a entrada auditiva e o controle motor do equilíbrio em indivíduos com perda auditiva profunda e usuários de implante coclear (UIC). Uma população de 34 UIC em que foi realizada a posturografia em duas informações sensoriais diferentes, o 1-Implant ativado (ON) fornece informações acústicas. 2-O implante foi desativado (OFF) e sem entrada auditiva. O consumo de energia (CE) do sinal do centro de pressão corporal foi utilizado como medida. A avaliação da marcha foi analisada pelo teste de 10 m, implementado com: A- Implante ligado e ruído ambiental (EN). B- Implante ON, EN e tarefa dupla cognitiva (TD) e C- Implante OFF com acelerômetros na região dos pés e sacro para medir a velocidade da marcha (GV). Estatísticas: Foram utilizados os testes de Wilcoxon e Mann-Whitney e o nível de significância foi de p = 0,05. A análise da postura para diferentes idades na adolescência mostrou um ajuste adaptativo, diminuindo significativamente a CE quando o IC está ligado (p <0,05). Com o implante desligado, as alterações não foram significativas (p> 0,05). Nos adultos, o (implante OFF) apresentou maiores valores de EC relacionados à idade, enquanto o CE não apresentou incremento do CE com a idade ao receber entrada auditiva com o implante ON. A UIC implantada após os 3 anos de idade mostrou uma diminuição significativa no GV. A UIC implantada antes dessa idade mostrou comportamento de marcha semelhante em relação aos indivíduos com audição normal como controle. As informações auditivas intervêm no comportamento motor da postura e da marcha, fatos analisados nesta revisão.

Estudo do fenótipo de fragilidade em idosos residentes na comunidade / Study of the fragility phenotype among elderly residents in the community

Resumo O objetivo foi estabelecer pontos de corte por sexo para a avaliação dos componentes de fragilidade de idosos residentes na comunidade. Estudo transversal de base populacional, com 555 idosos adscritos às Estratégias Saúde da Família; selecionados por amostragem estratificada proporcional. Foram avaliados dados socioeconômicos e os componentes do fenótipo de fragilidade. Quanto à classificação de fragilidade, 17,7% dos idosos eram frágeis, 45,4% pré-frágeis e 36,9% não frágeis. Os pontos de corte estabelecidos para essa população foram: para força de preensão palmar, em homens e mulheres respectivamente com 0 < IMC < 23 foi 20,30 e 13,36; 23 < IMC < 28 foi 23,52 e 16,12; 28 < IMC < 30 foi 22,04 e 15,17; e 30 < IMC < 50 foi 25,42 e 17,51; para velocidade da marcha, para homens com 0 < altura < 1,67 foi ≥ 7,08s e altura > 1,68 foi 6,46s; e mulheres com 0 < altura < 1,55 foi 7,60s e com altura > 1,56 foi 7,45s; e gasto metabólico semanal para homens foi de 1603,96 e para mulheres foi de 2182,25. Os resultados poderão apoiar as equipes de saúde para avaliar e estratificar o risco de fragilidade dos idosos na comunidade e subsidiar o planejamento de ações de promoção, prevenção e recuperação da capacidade funcional.

Abstract The objective was to establish cutoff points per gender for the evaluation of the fragility components of elderly residents in the community. It involved a cross-sectional population-based study with 555 elderly people enrolled in the Family Health Strategies selected by proportional stratified sampling. Socioeconomic data and the components of the fragility phenotype were evaluated. Regarding the classification of fragility, 17.7% of the elderly were fragile, 45.4% pre-fragile and 36,9% non-fragile. The cutoff points established for this population were: for hand grip strength, in men and women respectively with 0 < BMI < 23 was 20.30 and 13.36; 23 < BMI < 28 was 23.52 and 16.12; 28 < BMI < 30 was 22.04 and 15.17; And 30 < BMI < 50 was 25.42 and 17.51; For gait speed, for men with < height < 1.67 was ≥ 7.08s and height > 1.68 was 6.46s; And women with < height < 1.55 were 7.60s and with height > 1.56 were 7.45s; And weekly metabolic expenditure for men was 1,603.96 and for women it was 2,182.25. The results may support health teams to assess and stratify the risk of frailty of the elderly in the community and to subsidize the planning of actions to promote, prevent and recover functional capacity.

Influência do desempenho físico na mortalidade, funcionalidade e satisfação com a vida de idosos: dados do estudo FIBRA / Influence of physical performance on elderly mortality, functionality and life satisfaction: FIBRA's study data

Resumo O objetivo deste artigo é verificar a influência do desempenho físico na mortalidade, funcionalidade e satisfação com a vida de idosos. Foi realizado o seguimento de 900 idosos brasileiros não hospitalizados entre os anos de 2008 e 2016, no qual foram incluídos na análise de sobrevivência 154 óbitos por causas naturais. Os piores desempenhos de força de preensão manual (R.R. = 1,60; IC 95% = 1,15-2,23; p = 0,005) e de velocidade usual de marcha (R.R. = 1,82; IC 95% = 1,30-2,55; p < 0,001) associaram-se com o aumento do risco de mortalidade. A idade foi um fator de confusão para a força (R.R. = 1,06; IC 95% = 1,03-1,09; p < 0,001) e a artrite reumatoide foi um fator de confusão para a velocidade (R.R. = 2,02; IC 95% = 1,36-3,01; p < 0,001). Os idosos com bom desempenho físico faziam mais atividades instrumentais e avançadas da vida diária, e o bom desempenho de marcha apresentou efeito significativo na satisfação com a vida (F = 6,87; p = 0,009). O bom desempenho físico parece ser fundamental para a longevidade e para a realização de tarefas do cotidiano. Além disso, a boa mobilidade pode afetar mecanismos relacionados à satisfação com a vida.

Abstract Objective: To verify the influence of physical performance on elderly mortality, functionality and life satisfaction. Materials and methods: A follow-up was performed on 900 Brazilian non-hospitalized elderly in the period 2008-2016, in which 154 deaths from natural causes were included in the survival analysis. Results: the worst grip strength (RR = 1.60; CI 95% = 1.15-2.23, p = 0.005) and gait speed (RR = 1.82; CI 95% = 1.30-2.55, p < 0.001) performances were associated with increased mortality risk. Age was a confounding factor for strength (RR = 1.06; CI 95% = 1.03-1.09, p < 0.001) and rheumatoid arthritis was a confounding factor for speed (RR = 2.02; CI 95% = 1.36-3.01, p < 0.001). The elderly with good physical performance realized more instrumental and advanced activities of daily living, and good gait performance had a significant effect on life satisfaction (F = 6.87, p = 0.009). Conclusions: good physical performance seems to be fundamental for longevity and for accomplishing daily tasks. Furthermore, good mobility can affect life satisfaction-related mechanisms.

Declínio da velocidade da marcha e desfechos de saúde em idosos: dados da Rede Fibra / Disminución de la velocidad de la marcha y resultados en la salud de los ancianos: datos de la Red Fibra / Decreased gait speed and health outcomes in older adults: Rede FIBRA's data

RESUMO A velocidade da marcha (VM) tem sido considerada um marcador de saúde em idosos capaz de predizer desfechos adversos de saúde, mas a compreensão de fatores associados a ela ainda é limitada e controversa. O objetivo deste trabalho é identificar desfechos adversos de saúde relacionados ao declínio da velocidade de marcha em idosos comunitários. Trata-se de estudo transversal e multicêntrico, que avaliou o autorrelato de doenças crônicas e de hospitalização no último ano, polifarmácia e velocidade de marcha. Utilizou-se análise de regressão logística para estimar os efeitos de cada variável independente na chance de os idosos apresentarem declínio na velocidade de marcha inferior (VM<0,8m/s) (α=0,05). Participaram da pesquisa 5.501 idosos. A menor velocidade da marcha mostrou-se associada a portadores de doenças cardíacas (OR=2,06; IC: 1,67-2,54), respiratórias (OR=3,25; IC: 2,02-5,29), reumáticas (OR=2,16; IC: 1,79-2,52) e/ou depressão (OR=2,51; IC: 2,10-3,14), hospitalizados no último ano (OR=1,51; IC: 1,21-1,85) e polifarmácia (OR=2,14; IC: 1,80-2,54). Assim, os resultados indicaram que idosos com velocidade de marcha menor que 0,8m/s apresentam maior risco de eventos adversos de saúde. Dessa forma, sugere-se que a velocidade de marcha não seja negligenciada na avaliação de idosos comunitários, inclusive na atenção básica.

RESUMEN La velocidad de la marcha (VM) se ha considerado un marcador de salud en los ancianos capaz de predecir resultados adversos en la salud, pero la comprensión de sus factores asociados todavía es limitada y controvertida. El presente estudio tiene como objetivo identificar los resultados adversos para la salud relacionados con la disminución de la velocidad de la marcha en los ancianos comunitarios. Se trata de un estudio transversal y multicéntrico, el que evaluó el autoinforme de enfermedades crónicas y de la hospitalización en el último año, la polifarmacia y la velocidad de la marcha. Se utilizó el análisis de regresión logística para estimar los efectos de cada variable independiente sobre la posibilidad de que los ancianos presenten una disminución más baja en la velocidad de la marcha (VM<0,8 m/s) (α=0,05). Participaron en el estudio 5.501 ancianos. La velocidad de marcha más baja estuvo asociada a portadores de enfermedades cardíacas (OR=2,06; IC: 1,67-2,54), respiratorias (OR=3,25; IC: 2,02-5,29), reumáticas (OR=2,16; IC: 1,79-2,52) y/o depresión (OR=2,51; IC: 2,10-3,14), hospitalizados en el último año (OR=1,51; IC: 1,21-1,85) y polifarmacia (OR=2,14; IC: 1,80-2,54). De esta manera, los resultados indicaron que los ancianos con velocidades de marcha por debajo de 0,8m/s presentan un mayor riesgo de eventos adversos para la salud. Por lo tanto, se sugiere que la velocidad de la marcha no debe ser descuidada en la evaluación de ancianos comunitarios, incluso en la atención primaria.

Abstract Gait speed (GS) can predict adverse health outcomes. However, an understanding of its associated factors is still limited and with some controversy. The objective of this study was to identify adverse health outcomes related to the decline in gait speed in community-dwelling older adults. This is a cross-sectional study that evaluated records of chronic diseases and hospitalization in the last year, polypharmacy, and gait speed. Logistic regression analysis was used to estimate the effects of each independent variable on the chance of older adults presenting a decline in gait speed (GS<0.8 m/s) (α=5%). In total, 5,501 older adults participated. Brazilian older adults with heart diseases (OR=2.06; 1.67-2.54 CI), respiratory diseases (OR=3.25; 2.02-5.29 CI), rheumatic (OR=2.16; 1.79-2.52 CI) and/ or depression diseases (OR=2.51; 2.10-3.14 CI); hospitalized in the last year (OR=1.51; 1.21-1.85 CI) and under polypharmacy (OR=2.14; 1.80-2.54 CI) were associated with lower gait speed. Thus, the results showed that those with gait speed lower than 0.8 m/s are at higher risk of some adverse health events. Therefore, it is suggested that gait speed should not be neglected in the evaluation in community-dwelling older adults, including basic health care.

Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease

OBJECTIVE: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD). METHODS: One hundred sixty-nine patients (age 66.6±9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ - Walking Impairment Questionnaire and WELCH - Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations. RESULTS: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (r<0.55, p<0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (β=0.001, p<0.001), sit-to-stand test score (β=-0.005, p=0.012), and WIQ stairs score (β=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (β=0.002, p<0.001), WIQ stairs score (β=0.003, p=0.010), and WELCH total score (β=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender. CONCLUSION: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients.

Fatores associados à velocidade da marcha em idosos submetidos aos exames para habilitação veicular / Gait speed associated factors in elderly subjects undergoing exams to obtain the driver's license / Factores asociados a la velocidad de la marcha en los adultos mayores sometidos a los exámenes para habilitación vehicular

Objetivo analisar os fatores associados à velocidade da marcha em idosos submetidos aos exames de aptidão física e mental para habilitação veicular. Método estudo quantitativo de corte transversal realizado nas clínicas de trânsito, no qual fizeram parte da amostra do tipo probabilística 421 idosos (≥ 60 anos). O estudo foi desenvolvido mediante aplicações de questionários e testes que constituem o fenótipo da fragilidade. Para avaliar a velocidade da marcha, cronometrou-se o tempo gasto pelo participante para percorrer uma distância de 4,6 metros, de maneira habitual e em superfície plana. Os dados foram analisados utilizando a regressão linear múltipla por meio do método stepwise. Adotou-se o programa estatístico R versão 3.4.0. Resultados houve associação significativa entre velocidade da marcha e trabalho remunerado (<0,0000), índice de massa corporal (<0,0000), escore do Mini-Exame de Estado Mental (=0,0366), fragilidade física (pré-frágeis =0,0063 e não frágeis <0,0000), idade (<0,0000), sexo (=0,0255) e força de preensão manual (<0,0000). Conclusão idosos motoristas que não trabalham, mulheres, com idade avançada, elevado índice de massa corporal, baixo escore no Mini-Exame de Estado Mental, baixa força de preensão manual e frágeis possuem tendência de diminuição da velocidade da marcha e devem ser prioridade das intervenções.

Objective to analyze the factors associated with gait speed in elderly subjects undergoing physical and mental fitness tests to obtain a driver's license. Method a cross-sectional quantitative study conducted in transit agencies. The probabilistic sample included 421 elderly (≥ 60 years old). The study was developed through application of questionnaires and tests that assess the frailty phenotype. For evaluating gait speed, the time spent by each participant to walk a 4.6 meter distance at normal pace on a flat surface was timed. Data were analyzed by using multiple linear regression and the stepwise method. The R statistical program version 3.4.0 was adopted. Results there was a significant association between gait speed and paid work (<0.0000), body mass index (<0.0000), Mini-Mental State Examination (=0.0366), physical frailty (pre-frail =0.0063 and non-frail <0.0000), age (<0.0000), sex (=0.0255), and manual grip strength (<0.0000). Conclusion elderly drivers who do not work, women of advanced age, high body mass index, low score in the Mini-Mental State Examination, low hand grip strength, and frail tend to decrease gait speed and should be a priority of interventions.

Objetivo analizar los factores asociados a la velocidad de la marcha en adultos mayores sometidos a los exámenes de aptitud física y mental para habilitación vehicular. Método estudio cuantitativo de corte transversal realizado en las clínicas de tránsito, en el cual hicieron parte de la muestra del tipo probabilística 421 adultos mayores (≥ 60 años). El estudio fue desarrollado mediante aplicaciones de cuestionarios y pruebas que constituyen el fenotipo de fragilidad. Para evaluar la velocidad de la marcha fue cronometrado el tiempo gasto por el participante para andar una distancia de 4,6 metros, de manera habitual y en una superficie plana. Los datos fueron analizados utilizándose la regresión linear múltiple por medio del método stepwise. Fue adoptado el programa estadístico R versión 3.4.0. Resultados hubo una asociación significativa entre velocidad de la marcha y trabajo remunerado (<0,0000), índice de masa corporal (<0,0000), puntaje del Mini-Examen de Estado Mental (=0,0366), fragilidad física (pre-frágiles =0,0063 y no frágiles <0,0000), edad (<0,0000), sexo (=0,0255) y fuerza de prensión manual (<0,0000). Conclusión adultos mayores conductores que no trabajan, mujeres, con edad avanzada, elevado índice de masa corporal, bajo puntaje en el Mini-Examen de Estado Mental, baja fuerza de prensión manual y frágil poseen tendencia de disminución de la velocidad de la marcha y deben ser prioridad de las intervenciones.

Fiabilidad de dos pruebas de velocidad de marcha de diferentes fases cronometradas e iguales fases no cronometradas en personas mayores que viven en la comunidad / Reliability of two gait speed tests of different timed phases and equal non-timed phases in community-dwelling older persons

ANTECEDENTES La velocidad de la marcha es una medida rápida, económica y precisa para evaluar la capacidad funcional de las personas mayores, tanto saludables como con diferentes comorbilidades. Estudios previos han evaluado la velocidad de la marcha medida a lo largo de cursos de diferentes distancias, pero las fases no cronometradas no se miden de manera uniforme y se desconoce si esto afecta los resultados de la prueba. OBJETIVO El objetivo de este estudio fue evaluar la confiabilidad de la prueba de velocidad de marcha de diferentes fases cronometradas e iguales fases no cronometradas. MÉTODOS Estudio de confiabilidad descriptivo, con diseño observacional analítico y de corte transversal. Se incluyeron 136 personas mayores. Se realizaron pruebas de 4 y 10 metros, con 2 metros para la fase de aceleración/desaceleración de ambas. El promedio de dos intentos se obtuvo como la medida final de cada prueba. Los resultados se obtuvieron mediante el coeficiente de correlación intraclase (CCI) con un modelo de efectos fijos y el método Bland y Altman (con un intervalo de confianza del 95%). Se complementaron con los valores de error estándar de la media y del cambio mínimo detectable (CMD95). RESULTADOS Los resultados indican un excelente nivel de acuerdo entre los intentos de las pruebas de 4 y 10 metros (CCI = 0,959 y 0,976, respectivamente), así como entre el promedio de las dos pruebas (CCI = 0,867). Destaca un nivel de acuerdo ligeramente mejor entre los dos intentos de la prueba de 10 metros. Por lo tanto, el número de intentos no es capaz de afectar los resultados de la velocidad de la marcha; sin embargo, se requieren análisis adicionales para concluir lo mismo con respecto a la distancia de la prueba. La diferencia del análisis Bland Altman para el promedio de las pruebas de 4 y 10 metros fue 1,5945 m/s (intervalo de confianza 95%: 0,9759 a 2,2130 m/s), siendo demasiado grande y más alto que el valor CMD95. CONCLUSIONES El CCI fue excelente en todos los casos, pero se requiere un análisis adicional para concluir lo mismo con respecto a la distancia de la prueba. Existe un acuerdo insuficiente entre las dos pruebas para permitir que se utilicen indistintamente en poblaciones con las características de este estudio.

BACKGROUND Gait speed is a fast, low cost and accurate measurement for evaluating older persons' functional ability, both health and with comorbidities. Previous studies have evaluated gait speed measured over courses of varying distances, but the non-timed phases are not measured uniformly. It is unknown if this affects the results of the test. OBJECTIVE This study aims to evaluate the reliability of the running speed test of two different timed phases compared to the same nontimed phases. METHODS We conducted a descriptive reliability study, with an observational and cross-sectional analytical design. One hundred thirty-six older persons were included. Two gait speed tests were taken, one of 4 and 10 meters, and 2 meters for the acceleration/deceleration phase for both tests. The average of two attempts was obtained as a final measure of each test. The intraclass correlation coefficient was used to express the results (ICC) with a fixed effects model and the Bland and Altman method (confidence interval of 95%), complemented with the standard error of the mean and minimal detectable change with 95% confidence values (MDC95). RESULTS The results indicate an excellent level of agreement between the attempts of the tests of 4- and 10-m (ICC = 0.959 and 0.976, respectively), as well as between the average of the two tests (ICC = 0.867). The agreement was slightly better between the two attempts in the 10-meter test. The number of attempts does not affect the results of gait speed. Further analysis is required to conclude the same regarding the distance of the test (4 and 10 meters). The difference in the results of the Bland Altman analysis for the average of the 4 and 10-meter tests was 1.5945 m/s (95% confidence interval: 0.9759 to 2.2130 m/s), which is too wide and higher than the MDC95 value. CONCLUSIONS The ICC value was excellent in all cases, and the number of attempts does not affect the results of gait speed. However, further analysis is required to conclude the same regarding the distance of the test. There is an insufficient agreement between the two tests to allow them to be used interchangeably in populations with the characteristics of this study.

Velocidad de marcha del adulto mayor funcionalmente saludable / Gait speed in functionally and healthy elder people / Velocidade da marcha do idoso funcionalmente saudável

El proceso de envejecimiento conlleva trastornos conocidos como síndromes geriátricos, los cuales pueden afectar la reserva funcional e incidir en la velocidad de la marcha, la que es un indicador que puede predecir eventos adversos y reflejar alteraciones fisiopatológicas subyacentes. Se realizó un estudio descriptivo, observacional y transversal con el objetivo de medir la velocidad de la marcha en adultos mayores saludables, y su correlación con variables clínicas y demográficas. Se calculó la velocidad de la marcha mediante análisis observacional en video, midiendo parámetros espacio-temporales (longitud y tiempo del ciclo de marcha). Se evaluó una muestra de 60 individuos mayores de 65 años, la edad media fue de 76 años. La velocidad de la marcha media fue 1,10 m/s (Rango 0, 60 - 1,47 m/s). Para el grupo de menos de 75 años fue de 1,20 m/s, entre los mayores de 80 fue de 1,0 m/s. Se vio un comportamiento similar al encontrado en estudios internacionales. Se evidenció que la velocidad de la marcha del adulto mayor funcionalmente saludable disminuye con la edad. Este estudio es el primero realizado en la población anciana uruguaya.

The aging process involves disorders known as geriatric syndromes, which can affect the functional reserve and the gait speed, which is an indicator that can predict adverse events and reflect underlying pathophysiological changes. A descriptive, observational and cross-sectional study was carried out with the aim of measuring the gait speed in healthy elderly adults, and its relation with clinical and demographic characteristics. Gait speed was calculated by means of observational video analysis, measuring space-time parameters (length and time of the walking cycle). A sample of 60 individuals older than 65 years was evaluated, the average age was 76 years. The average gait speed was 1.10 m/s (range 0, 60 - 1.47 m/s). For the group of less than 75 years it was 1.20 m/s, among those over 80 it was 1.0 m/s. These findings are similar to that found in international studies. It was evidenced that the gait speed of the functionally healthy older individuals decreases with age. This study is the first performed in the Uruguayan elderly population.

O processo de envelhecimento envolve distúrbios conhecidos como síndromes geriátricas, que podem afetar a reserva funcional e a velocidade da marcha, que é um indicador que pode prever eventos adversos e refletir alterações fisiopatológicas subjacentes. Foi realizado um estudo descritivo, observacional e transversal, com o objetivo de medir a velocidade da marcha em idosos saudáveis ​​e sua correlação com variáveis ​​clínicas e demográficas. A velocidade da marcha foi calculada por meio de análise de vídeo observacional, medindo os parâmetros espaço-tempo (duração e tempo do ciclo da marcha). Uma amostra de 60 indivíduos com mais de 65 anos foi avaliada, a idade média foi de 76 anos. A velocidade da marcha média foi de 1,10 m/s (Faixa 0,60 - 1,47 m/s). Para o grupo de menos de 75 anos, foi de 1,20 m / s, entre aqueles com mais de 80 anos foi de 1,0 m/s. Houve um comportamento semelhante ao encontrado em estudos internacionais. Evidenciou-se que a velocidade de marcha do idoso funcionalmente saudável diminui com a idade. Este estudo é o primeiro realizado na população idosa do Uruguai.

The effect of matinal active walking on cognitive, fine motor coordination task performances and perceived difficulty in 12-13 young school boys

The current study examined the relationship between cognitive performances (executive function, selective attention and reaction time), fine motor coordination skills and perceived difficulty after active transport to school. Method: Fifteen right-handed children's underwent session, 15-min walking session at 30% (WS1) and 15-min walking session (WS2) at 50% of maximal aerobic speed. Subjects performed tests to evaluate executive function, reaction time and selective attention. After each trial, a questionnaire of perceived difficulty (PD) was completed. Results: Average time in TMT part A (F(2,22) = 4.44; p = 0.024; η2= 0.288) and TMT part B (F(2,22) = 4.54; p = 0.022; η2= 0.292), and committed errors (F(2,22) = 7.78; p = 0.003; η2= 0.414) was improved after walking sessions in comparison by CS. The mean scores were significantly higher after walking sessions for both long and short-distance throws (p < 0.05). Moreover, a significant negative correlation was found between committed errors (TMT part B) and both dart throwing consistency and accuracy (r = - 0.6; r = - 0.64; p < 0.05) (respectively). Post-hoc analysis showed that PD was better after walking sessions with low intensity for both short and long throwing distance. However, it seems that walking session with sustained intensity allows speed and accuracy improvement of cognitive processing. Conclusion: Thus, active walking to school with low intensity was sufficient to produce positives changes in psychomotor performance and decrease in perceived difficulty scores. By including individual differences in gross motor coordination as well as physical activity level, the exact nature of the link between psychomotor skills and cognitive performance could be more addressed.(AU)

Cutoff values for appendicular skeletal muscle mass and strength in relation to fear of falling among Brazilian older adults: cross-sectional study

ABSTRACT CONTEXT AND OBJECTIVE: Sarcopenia is an emerging public health issue in Brazil. Because of its high prevalence and the lack of national data, the objective here was to identify cutoff points for appendicular skeletal muscle (ASM) and handgrip strength in relation to fear of falling among Brazilian older adults. DESIGN AND SETTING: Cross-sectional study; in the community. METHODS: Participants underwent morphological and functional evaluations; and were asked about previous falls and fear of falling. Different adjustments to ASM and handgrip strength were used. Slow walking speed was defined as < 0.8 m/s or 1.0 m/s. Gender and age groups were compared using t tests, analysis of variance (ANOVA), chi-square test or Fisher's exact test. Receiver operating characteristic curves were used to identify cutoffs for ASM and handgrip strength in relation to fear of falling. RESULTS: 578 older adults participated in this study. Function levels decreased with increasing age, and body composition differed between the sexes. In relation to fear of falling, the cutoffs for ASM adjusted for body mass index (BMI) were < 0.85 for men and < 0.53 for women; the cutoffs for absolute handgrip strength and relative handgrip strength (adjusted for BMI) were 30.0 kgf and 21.7 kgf, and 1.07 and 0.66, for men and women, respectively. CONCLUSION: The values presented can be used as references in clinical practice and research. We recommend use of ASM adjusted for BMI and choosing between absolute and relative handgrip strength for men and women, according to study needs.

Viability of gait speed test in hospitalized elderly patients / Viabilidade do teste de velocidade de marcha em idosos hospitalizados

ABSTRACT Objective: The gait speed test (GST) is a physical test that can predict falls and aid in the diagnosis of sarcopenia in the elderly. However, to our knowledge, there have been no studies evaluating its reproducibility in hospitalized elderly patients. The objective of this study was to evaluate the safety and reproducibility of the six-meter GST (6GST) in hospitalized elderly patients. Methods: This repeated measures study involved hospitalized elderly patients (≥ 60 years of age) who underwent the 6GST by the fifth day of hospitalization, were able to walk without assistance, and presented no signs of dyspnea or pain that would prevent them from performing the test. The 6GST was performed three times in sequence, with a rest period between each test, in a level corridor. Gait speed was measured in meters/second. Reproducibility was assessed by comparing the means, intraclass correlation coefficients (ICCs) and Bland-Altman plots. Results: We evaluated 110 elderly patients in a total of 330 tests. All participants completed all of the tests. The comparisons between the speeds obtained during the three tests showed high ICCs and a low mean bias (Bland-Altman plots). The correlation and accuracy were greatest when the mean maximum speed was compared with that obtained in the third test (1.26 ± 0.44 m/s vs. 1.22 ± 0.44 m/s; ICC = 0.99; p = 0.001; mean bias = 0.04; and limits of agreement = −0.27 to 0.15). Conclusions: The 6GST was proven to be safe and to have good reproducibility in this sample of hospitalized elderly patients. The third measurement seems to correspond to the maximum speed, since the first two measurements underestimated the actual performance.

RESUMO Objetivo: O teste de velocidade de marcha (TVM) é um teste físico que pode predizer quedas e auxiliar no diagnóstico de sarcopenia em idosos da comunidade. Entretanto, pelo que sabemos, não há estudos que avaliaram sua reprodutibilidade em idosos hospitalizados. O objetivo deste estudo foi avaliar a segurança e a reprodutibilidade do TVM de seis metros (TVM6) em idosos hospitalizados. Métodos: Estudo com medidas repetidas envolvendo idosos hospitalizados (idade ≥ 60 anos) que realizaram o TVM6 até o quinto dia de hospitalização, sendo capazes de andar sem auxílio e não apresentando dispneia ou dor que os incapacitasse para a realização dos testes. O TVM6 foi realizado sequencialmente três vezes, com período de descanso, em um corredor plano, e a velocidade de marcha foi calculada em metros/segundo. A reprodutibilidade foi avaliada pela comparação das médias, coeficientes de correlação intraclasse (CCI) e disposições gráficas de Bland-Altman. Resultados: Foram avaliados 110 idosos avaliados com um total de 330 testes. Todos os participantes completaram todos os testes. As comparações entre as velocidades obtidas nos três testes realizados indicaram CCIs elevados e viés médio baixo pela disposição gráfica de Bland-Altman. Em relação à maior velocidade aferida, a correlação e a precisão foram maiores quando comparadas à obtida no terceiro teste (1,26 ± 0,44 m/s vs. 1,22 ± 0,44 m/s; CCI = 0,99; p = 0,001; viés médio = 0,04; e limites de concordância = −0,27 a 0,15). Conclusões: O TVM6 mostrou-se seguro e teve boa reprodutibilidade nessa amostra de idosos hospitalizados. A terceira aferição parece corresponder à velocidade máxima, já que duas primeiras subestimaram o desempenho real.