Frailty and health-related quality of life among older people living with HIV pre- and post-COVID-19 pandemic onset: A cross-sectional study

ABSTRACT Introduction: Antiretroviral therapy increased the survival and life expectancy of People living With HIV (PWH). Frailty-related syndromes among older PWH (aged 50+ years) may affect their Health-related Quality of Life (HQoL). Additionally, the COVID-19 pandemic has impacted health-related outcomes. This study aimed to estimate the prevalence of frailty and pre-frailty among older PWH, and to explore associations of HQoL with the study assessment period and frailty status. Methods: Cross-sectional study conducted pre- (23-Mar-2019 to 5-Mar-2020) and post-COVID-19 pandemic onset (23-Jun-2021 to 5-May-2022), among older PWH at INI-Fiocruz, the largest cohort of PWH in Rio de Janeiro, Brazil. We measured frailty using Fried assessment, consisting of five domains: unintentional weight loss; self-reported exhaustion, weakness, slow walking speed, low physical activity. HQoL was assessed using the ACTG SF-21, which contains 21 questions divided into 8 domains. We used Chi-Square test, Fisher's exact test, Kruskal-Wallis and ranksum test for comparisons. Results: We included 250 older PWH: 109 (43.6 %) pre- and 141 (56.4 %) post-COVID-19 pandemic onset. Median age was 60-years (IQR: 55‒64). Most self-identified as cisgender men 152 (60.8 %), Pardo/Black 146 (58.4 %), with completed secondary education or less 181 (72.7 %) and low income 132 (52.8 %). Overall, prevalence of frailty and pre-frailty were 9.2 % (95 % CI: 8.1‒10.3) and 61.6 % (95 % CI: 54.0‒69.2). Prevalence of frailty in the pre- and pos-COVID-19 pandemic periods were 7.3 % and 10.6 % (p = 0.66). HQoL scores were lower among participants with frailty compared to those with non-frailty and pre-frailty in all eight domains, and among those included in the post-COVID-19 compared to pre-COVID-19 period for four domains. Conclusions: We observed low prevalence of frailty, but high prevalence of pre-frailty among older PWH. Frailty status did not differ according to the COVID-19 assessment period. Assessment of frailty and HQoL should be incorporated in clinical practice for older PWH. Programs to reverse or prevent frailty should be implemented within the public health system.

Os efeitos de um programa de exercícios domiciliares em pacientes com Paraparesia Espástica Tropical/Mielopatia Associada ao HTLV-1 (PET/MAH) / The effects of a home-based exercise program in Tropical Spastic Paraparesis/HTLV-1 Associated Myelopathy (TSP/HAM) patients

Os efeitos da prática de exercícios sobre a funcionalidade de indivíduos com Paraparesia Espástica Tropical/Mielopatia Associada ao HTLV-1 (PET/MAH) são desconhecidos. O objetivo deste estudo é avaliar os efeitos de um Programa de Exercícios Domiciliares (PED) e a sua taxa de adesão em indivíduos com PET/MAH. Métodos: Vinte e três participantes com o diagnóstico de PET/MAH, marcha preservada e que não praticavam exercícios há pelo menos um mês foram submetidos ao PED de 20 semanas. Os desfechos primários incluíram os escores de força muscular, contração isométrica voluntária máxima (CIVM) e comprimento muscular dos membros inferiores, dor lombar e nos membros inferiores, EDSS, Escala de Incapacidade do IPEC, Índice de Barthel e SF-36. A taxa de adesão e os eventos adversos também foram mensurados e caracterizados. Resultados: No momento da análise os pacientes foram divididos em dois grupos de acordo com o teste Timed Up and Go (TUG) (<20s vs maior ou igual 20s). O comprimento dos músculos isquiotibiais e plantiflexores, a CIVM dos membros inferiores e o componente Aspectos Sociais da SF-36 apresentaram melhora significativa no grupo TUG <20s. Os indivíduos do grupo TUG maior ou igual 20s melhoraram significativamente o componente Capacidade Funcional da SF-36. A taxa de adesão foi de 90 por cento no total e os eventos adversos, como fadiga, dor muscular e caimbras foram de intensidade leve a moderada. Discussão: Foi observada uma boa adesão ao PED, além de melhora significativa da incapacidade e da qualidade de vida dos indivíduos com PET/MAH. É possível que o grupo TUG maior ou igual 20s apresente um maior componente neurodegenerativo e, portanto, uma menor probabilidade de incremento da funcionalidade. Conclusões: O PED foi eficaz em melhorar algumas incapacidades e a qualidade de vida dos indivíduos com PET/MAH...

The effect of exercises on functioning in Tropical Spastic Paraparesis/HTLV-1 Associated Myelopathy (TSP/HAM) individuals is unknown. This study aimed to investigate the effects of a home-based exercise program and its adherence in TSP/HAM individuals. Methods: Twenty-three TSP/HAM ambulators participants that did not practice any kind of exercise for at least one month were submitted to a 20-week home-based exercise program. Primary outcomes included lower limb muscular strength scores, maximum voluntary isometric contraction (MVIC) and muscle length, low back and lower limb pain, EDSS, IPEC Disability Scale, Barthel Index and SF-36. Adherence and adverse effects were also measured and characterized.Results: At analysis the participants were divided in two groups according to Timed Up and Go Test (TUG) (<20s vs greater than or equal to 20s). Muscle length of hamstrings and ankle flexors; hip flexors and total score of lower limb MVIC and the social functioning domain in SF-36 improved significantly in TUG <20s group. The individuals in the TUG greater than or equal to 20s group improved significantly the physical functioning domain in SF-36. The total adherence to the 20-weekhome-based exercise program was 90 percent. There were mild to moderate adverse events, like fatigue, muscle soreness and cramp. Discussion: There was a very good adherence to the home-based exercise program, besidesimprovements in disabilities and quality of life in TSP/HAM participants. It is possible that TUG greater than or equal to 20s group has a worse neurodegenerative component and then a lower probability tofunctioning increments. Conclusions: The home-based exercise program was effective in improving disabilities andquality of life in individuals with TSP/HAM. Those results reinforce the need for alternative strategies to face-to-face model that improve participation of these people to rehabilitationprograms...

Os riscos do exercício excessivo na esclerose lateral amiotrófica: atualização da literatura / Risks of overuse in Amiotrophic Lateral Sclerosis: update

A Esclerose Lateral Amiotrófica (ELA) é uma doença inexorável e degenerativa que afeta os neurônios motores superiores e inferiores, levando à morte cerca de dois a quatro anos após o início das primeiras manifestações. A proposta do presente artigo será apresentar, com base naliteratura vigente, um panorama das principais técnicas utilizadas e resultados de estudos acerca da reabilitação física desses pacientes. Os exercícios terapêuticos devem ser prescritos e encarados como uma maneira de melhorar a qualidade de vida dos pacientes, sendo os objetivosdirecionados para um melhor desempenho nas atividades básicas e instrumentais da vida diária. Os profissionais engajados na reabilitação física devem auxiliar os pacientes e os cuidadores na luta diária contra as perdas proporcionadas pela doença, decorrentes do comprometimento damotricidade voluntária.

Amyotrophic Lateral Sclerosis (ALS) is a fatal degenerative disease that affects upper and lower neurons and takes approximately two to four years between the first sign and symptoms to death. The aim of the present study is to present the main interventions used in physicalrehabilitation and their results in patients with ALS. The therapeutic exercises should be prescribed with the objective to improve the patient?s quality of life and enhance the performance during basic and instrumental daily activities. The professionals involved in physical rehabilitationshould aid patients and caregivers to overcome their difficulties, especially those related to voluntary motor impairments.