Can functional exercise capacity discriminate older individuals with poor postural control? / A capacidade funcional de exercício pode discriminar idosos com pior controle postural? / La capacidad funcional de ejercicio puede discriminar ancianos con mal control postural?

Postural instability can be related to functional limitations as a result of the aging process. This study aimed to compare functional exercise capacity and postural control in older adults. Participants were allocated into three groups according to their functional exercise capacity based on the six minute walking test (6MWT): 1) Low performance group (LP: distance walked ≤ 80% of the predicted value n = 19), 2) Normal performance group (NP: distance walked 81-100% of the predicted value n = 21) and, 3) High performance group (HP: distance walked >100% of the predicted value n = 23). All groups performed three trials of a one-leg stance for 30s on a force platform. LP showed worse postural control in comparison to NP and HP, and significant differences (p < .05) were found between groups for area, velocity antero-posterior of center of pressure and time limit variables during the one-leg stance task. These results have implications for rehabilitation management with regard to exercise, balance assessment and intervention in older adults.

Instabilidade postural pode estar relacionada com as limitações funcionais, como um resultado do processo de envelhecimento. Este estudo teve como objetivo comparar a capacidade funcional de exercício e o controle postural em indivíduos idosos. Os participantes foram separados em três grupos de acordo com sua capacidade funcional de exercício baseada no teste de caminhada de seis minutos (TC6min): 1) grupo baixo desempenho (BD: distância caminhada ≤ 80% do valor predito n = 19), 2) grupo normal desempenho (ND : distância caminhada 81-100% do valor predito n = 21) e, 3) grupo alto desempenho (AD: distância caminhada >100% do valor predito n = 23). Todos os grupos realizaram três testes com apoio unipodal permanecendo por 30s sobre a plataforma de força. BD apresentou pior equilíbrio postural em comparação com ND e AD; com diferenças significativas (p < 0,05) encontradas entre os grupos para os parâmetros de área e velocidade antero-posterior do centro de pressão e a variável tempo-limite durante a posição unipodal. Estes resultados têm implicações para estratégias de reabilitação no que diz respeito ao exercício, avaliação do equilíbrio e intervenção em idosos.

Inestabilidad postural puede estar relacionada con las limitaciones funcionales como resultado del proceso de envejecimiento. Este estudio tuvo como objetivo evaluar la comparación entre la capacidad funcional del ejercicio en el control postural de las personas de edad avanzada. Los participantes fueron divididos en tres grupos de acuerdo a su capacidad de ejercicio funcional basado en la Prueba de Caminada de seis minutos (PC6M): 1) grupo Bajo Rendimiento (BR: distancia recorrida ≤ 80% del valor predijo, n = 19), 2) grupo Normal Rendimiento (NR: distancia recorrida 81-100% del valor predijo, n = 21) y 3) grupo Alto Rendimiento (AR: distancia recorrida >100% del valor predijo, n = 23). Todos los grupos realizaron tres pruebas sobre un solo pie por 30s en la plataforma de fuerza. BR presentó un mal equilibrio postural en comparación con NR y AR; con diferencias significativas (p < 0,05) encontrado entre los grupos de los parámetros área y velocidad antero-posterior del centro de presión y el límite de tiempo para la postura de una sola pierna. Estos resultados tienen implicaciones para las estrategias de rehabilitación en relación con el ejercicio, la evaluación del equilibrio y la intervención en los ancianos.

Are 30 minutes of rest between two incremental shuttle walking tests enough for cardiovascular variables and perceived exertion to return to baseline values?

Objective: To verify whether 30 minutes of rest between two incremental shuttle walking tests (ISWT) are enough for cardiovascular variables and perceived exertion to return to baseline values in healthy subjects in a broad age range. Method: The maximal exercise capacity of 334 apparently healthy subjects (age ≥18) was evaluated using the ISWT. The test was performed twice with 30 minutes of rest in between. Heart rate (HR), arterial blood pressure (ABP), dyspnea, and leg fatigue were evaluated before and after each test. Subjects were allocated to 6 groups according to their age: G1: 18-29 years; G2: 30-39 years; G3: 40-49 years; G4: 50-59 years; G5: 60-69 years and G6: ≥70 years. Results: All groups had a good performance in the ISWT (median >90% of the predicted distance). The initial HR (HRi) of the second ISWT was higher than the first ISWT in the total sample (p<0.0001), as well as in all groups (p<0.0001). No difference was observed in the behavior of ABP (systolic and diastolic) and dyspnea between the two tests, but this difference occurred for leg fatigue (greater before the second ISWT) in G1 (p<0.05). Most subjects (58%) performed better in the second test. Conclusion: 30 minutes of rest between two ISWTs are not enough for all cardiovascular variables and perceived exertion to return to baseline values. However, this period appears to be sufficient for blood pressure and performance to recover in most subjects. .

Reference equations for the six-minute walk distance based on a Brazilian multicenter study

BACKGROUND: It is important to include large sample sizes and different factors that influence the six-minute walking distance (6MWD) in order to propose reference equations for the six-minute walking test (6MWT). OBJECTIVE: To evaluate the influence of anthropometric, demographic, and physiologic variables on the 6MWD of healthy subjects from different regions of Brazil to establish a reference equation for the Brazilian population. METHOD: In a multicenter study, 617 healthy subjects performed two 6MWTs and had their weight, height, and body mass index (BMI) measured, as well as their physiologic responses to the test. Delta heart rate (∆HR), perceived effort, and peripheral oxygen saturation were calculated by the difference between the respective values at the end of the test minus the baseline value. RESULTS: Walking distance averaged 586±106m, 54m greater in male compared to female subjects (p<0.001). No differences were observed among the 6MWD from different regions. The quadratic regression analysis considering only anthropometric and demographic data explained 46% of the variability in the 6MWT (p<0.001) and derived the equation: 6MWDpred=890.46-(6.11×age)+(0.0345×age2)+(48.87×gender)-(4.87×BMI). A second model of stepwise multiple regression including ∆HR explained 62% of the variability (p<0.0001) and derived the equation: 6MWDpred=356.658-(2.303×age)+(36.648×gender)+(1.704×height)+(1.365×∆HR). CONCLUSION: The equations proposed in this study, especially the second one, seem adequate to accurately predict the 6MWD for Brazilians. .

Physical activity in daily life in physically independent elderly participating in community-based exercise program / Atividade física na vida diária de idosos fisicamente independentes participantes de programas de exercício físico oferecidos à comunidade

BACKGROUND: It is unclear whether participation in exercise programs specifically developed for elderly translates into a more active lifestyle. OBJECTIVES: To compare the objectively measured level of physical activity in daily life (PADL) between physically independent elderly who participate or do not participate in community-based exercise programs; and to evaluate which factors are associated with the higher level of PADL in these subjects. METHOD: 134 elderly participants in community-based exercise programs (PG) and 104 non-participants (NPG) had their level of PADL measured using pedometers during 7 days. Other measurements: 6-minute walking test (6MWT), incremental shuttle walking test (ISWT), muscle strength, flexibility and balance. RESULTS: The PG had higher 1-week mean daily step count than NPG (8314 [IQR 5971-10060] vs. 6250 [IQR 4346-8207] steps/day, p<0.0001), as well as higher step count in any day of the week. There was a higher proportion of physically active subjects (>8000 steps/day) in PG than in NPG (37% vs. 16%, respectively; p<0.001), as well as the proportion of sedentary subjects (<5000 steps/day) (14% vs. 33%, respectively; p<0.001). Participation in exercise programs, 6MWT and ISWT explained a higher daily steps count (model r²=0.56, p<0.0001). CONCLUSIONS: In physically independent elderly, a higher level of physical activity in daily life occurs in those who participate in community-based exercise programs, regardless of the weekday and including non-program days. Participation of elderly in community-based exercise programs should be more systematically available and encouraged due to its close link to higher activity levels and better exercise capacity.

CONTEXTUALIZAÇÃO: Não está claro se a participação em programas de exercício físico específicos para idosos se traduz em um estilo de vida mais ativo. OBJETIVOS: Comparar o nível de atividade física na vida diária (AFVD) entre idosos fisicamente independentes (IFI) participantes e não participantes de programas de exercício oferecidos à comunidade e estudar os fatores associados ao maior nível de AFVD nesses indivíduos. MÉTODO: Cento e trinta e quatro IFI participantes de programas de exercício (GP) e 104 não participantes (GNP) tiveram seu nível de AFVD avaliado utilizando-se pedômetros durante sete dias. Outras avaliações foram teste de caminhada de 6 minutos (TC6min), incremental shuttle walking test (ISWT), força muscular, flexibilidade e equilíbrio. RESULTADOS: O GP apresentou maior média de passos/dia em sete dias do que o GNP (mediana [IRQ25%-75%] 8314[5971-10060] vs 6250[4346-8207] passos/dia, p<0,0001), bem como maior número de passos em qualquer dia da semana. Houve maior proporção de idosos fisicamente ativos (>8000 passos/dia) no GP em comparação com o GNP (37% vs 16%, respectivamente; p<0,001), assim como menor proporção de sedentários (<5000 passos/dia) (14% vs 33% respectivamente; p<0,001). Um modelo de regressão linear múltipla mostrou que participação em programas, TC6min e ISWT explicaram uma maior média de passos/dia (r²=0,56, p<0,0001). CONCLUSÕES: Em IFI, maior nível de AFVD ocorreu naqueles participantes de programas de exercício oferecidos à comunidade, mesmo analisando-se finais de semana e dias sem programa. A participação nesse tipo de programa deveria ser encorajada devido à sua relação com um estilo de vida mais ativo e melhor capacidade de exercício.

Does the BODE index reflect the level of physical activity in daily life in patients with COPD? / O índice BODE reflete o nível de atividade física na vida diária de pacientes com DPOC?

OBJECTIVES: To study the relationship between the level of physical activity in daily life and disease severity assessed by the BODE index in patients with chronic obstructive pulmonary disease (COPD). METHODS: Sixty-seven patients with COPD (36 men) with forced expiratory volume in the first second (FEV1) of 39 (27-47) percent predicted and age of 66 (61-72) years old were evaluated by spirometry, dyspnea levels (measured by the Medical Research Council scale, MRC) and by the 6-minute walking test (6MWT). The BODE index was calculated based on the body mass index (weight/height²), FEV1, MRC and 6MWT, and then the patients were divided in four quartiles according to their scores (Quartile I: 0 to 2 points, n=15; Quartile II: 3 to 4 points, n=20; Quartile III: 5 to 6 points, n=23; Quartile IV: 7 to 10 points, n=9). Two activity monitors (DynaPort® and SenseWear®) were used to evaluate the level of physical activity in daily life. The Kruskal-Wallis test (Dunns's post-hoc test), the Mann-Whitney test and the Spearman Correlation Coefficient were used for statistical analysis. RESULTS: There were modest correlation between the BODE index and the time spent walking per day, the total daily energy expenditure and the time spent in moderate and vigorous activities per day (-0.32 < r <- 0.47; p<0.01 for all variables). When comparing the pooled quartiles I+II with III+IV, there were significant difference between the time spent walking per day, the total daily energy expenditure and the time spent in moderate activities per day (p<0.05). CONCLUSION: The level of physical activity in daily life has a modest correlation with the classification of COPD severity assessed by the BODE index, reflecting only differences between patients with classified as mild-moderate and severe-very severe COPD.

OBJETIVOS: Estudar a relação entre nível de atividade física na vida diária (AFVD) e gravidade da Doença Pulmonar Obstrutiva Crônica (DPOC) avaliada pelo índice BODE. MÉTODOS: Sessenta e sete pacientes com DPOC (36 homens), com volume expiratório forçado no primeiro segundo (VEF1) 39(27-47) por centoprevisto, e 66(61-72)anos foram submetidos a avaliações de espirometria, grau de dispneia (Medical Research Council scale, MRC) e teste de caminhada de 6 minutos (TC6). O índice BODE foi calculado com base no índice de massa corpórea (peso/estatura²), VEF1, MRC e TC6, e os pacientes foram subdivididos em quatro quartis de acordo com sua pontuação no BODE (quartil I: 0 a 2 pontos, n=15; quartil II: 3 a 4 pontos, n=20; quartil III: 5 a 6 pontos, n=23; quartil IV: 7 a 10 pontos, n=9). O nível de AFVD foi avaliado por dois monitores de atividade física (DynaPort® e SenseWear®). Os testes de Kruskal-Wallis (pós-teste Dunns), Mann-Whitney e Coeficiente de Correlação de Spearman foram utilizados na análise estatística. RESULTADOS: Houve correlação modesta entre os escores do índice BODE e o tempo gasto andando/dia, gasto energético total e tempo gasto/dia em atividades moderadas e vigorosas (-0,32< r <-0,47; p<0.01 para todos). Quando comparados os quartis agrupados I+II com III+IV, houve diferença significante entre o tempo gasto andando/dia, gasto energético total e tempo gasto em atividades moderadas (p<0,05). CONCLUSÃO: O nível de AFVD apresenta correlação modesta com a classificação da gravidade da DPOC dada pelo índice BODE, refletindo apenas diferenças entre pacientes com doença leve-moderada e grave-muito grave.

Possíveis conseqüências de não se atingir a mínima atividade física diária recomendada em pacientes com doença pulmonar obstrutiva cronica estável / Potential consequences for stable chronic obstructive pulmonary disease patients who do not get the recommended minimum daily amount of physical activity

OBJETIVO: O presente estudo investigou se pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) atingem a mínima atividade física recomendada pelos guidelines do American College of Sports Medicine (ACSM), assim como as consequências da não-aderência a esses guidelines. MÉTODOS: Atividade física na vida diária (DynaPort activity monitor), função pulmonar, força muscular, capacidade de exercício, qualidade de vida, estado funcional e diferentes índices de severidade (GOLD, BODE, MRC) foram avaliados em 23 pacientes (61[59-69] anos; VEF1 39[34-53] por centopredito; IMC 24[21-27]kg/m²; mediana [intervalo interquartílico 25-75 por cento]). RESULTADOS: De acordo com a aderência aos guidelines (andar no mínimo 30 minutos todo dia), 12 pacientes foram considerados "fisicamente ativos", e 11 "fisicamente inativos". Não foram observadas diferenças significativas entre os dois grupos em termos de idade, sexo, composição corporal, força muscular, reserva ventilatória, hiperinsuflação e qualidade de vida. O grupo inativo tinha pior função pulmonar, capacidade de exercício, MRC e BODE (p<0.05). Além disso, na vida diária, o grupo inativo andou menos tempo e numa velocidade menor (p<0.05). O BODE e a MRC foram superiores ao GOLD na predição de aderência aos guidelines (especificidade 0.83 para BODE e MRC e 0.50 para o GOLD). O BODE aumentou significativamente para cada dia de inatividade física. CONCLUSÃO: Grande parte dos pacientes com doença pulmonar obstrutiva crônica não andam mais de 30 minutos por dia, e portanto não atingem a mínima atividade física recomendada pelos guidelines do American College of Sports Medicine. Inatividade está relacionada com maior taxa de mortalidade. O BODE e a MRC mostraram-se superiores ao GOLD para predizer pacientes fisicamente inativos na vida diária.

OBJECTIVE: The present study attempted to determine whether patients with chronic obstructive pulmonary disease (COPD) get the minimum daily amount of physical activity recommended in the guidelines established by the American College of Sports Medicine (ACSM), as well as to characterize the consequences of noncompliance with those guidelines. METHODS: This study involved 23 patients (median age: 61 - range, 59-69 years; FEV1: 39 percent of predicted - range, 34-53 percent; BMI: 24 kg/m² - range, 21-27 kg/m²). The following parameters were evaluated: daily physical activity (DynaPort activity monitor); pulmonary function; muscle force; exercise tolerance; quality of life; functional status; and various indices of disease severity (GOLD, BODE and MRC). RESULTS: Based on compliance with the guidelines (minimum of 30 minutes of walking per day), 12 patients were considered "physically active", and 11 were considered "physically inactive". No significant differences were observed between the two groups in terms of age, gender, BMI, muscle force, ventilatory reserve, hyperinflation or quality of life. The inactive group presented more impaired pulmonary function and lower exercise tolerance, as well as lower MRC and BODE scores (p < 0.05). In their daily life, patients in the inactive group also walked for less time and more slowly than did those in the active group (p < 0.05). The MRC and BODE indices were superior to the GOLD index in predicting compliance with the guidelines, both presenting a specificity of 0.83, compared with 0.50 for the GOLD index. The BODE index score increased significantly with each day of inactivity. CONCLUSION: A large number of COPD patients do not walk more than 30 minutes per day and are therefore not getting the minimum daily amount of physical activity recommended by the ACSM. Inactivity correlates with a higher mortality rate. The MRC and BODE indices proved superior to the GOLD index in predicting whether...