Walking execution is not affected by divided attention in patients with multiple sclerosis with no disability, but there is a motor planning impairment / A execucao da marcha nao e afetada pela atencao dividida em pacientes com esclerose multipla sem incapacidade, mas existe um comprometimento do planejamento motor

Purpose: We analysed the cognitive influence on walking in multiple sclerosis (MS) patients, in the absence of clinical disability. Method: A case-control study was conducted with 12 MS patients with no disability and 12 matched healthy controls. Subjects were referred for completion a timed walk test of 10 m and a 3D-kinematic analysis. Participants were instructed to walk at a comfortable speed in a dual-task (arithmetic task) condition, and motor planning was measured by mental chronometry. Results: Scores of walking speed and cadence showed no statistically significant differences between the groups in the three conditions. The dual-task condition showed an increase in the double support duration in both groups. Motor imagery analysis showed statistically significant differences between real and imagined walking in patients. Conclusion: MS patients with no disability did not show any influence of divided attention on walking execution. However, motor planning was overestimated as compared with real walking.

O objetivo do estudo foi analisar a influência cognitiva na caminhada de pacientes com esclerose múltipla (EM) sem incapacidade clínica. Foi conduzido um estudo caso-controle com 12 pacientes com EM sem incapacidade com 12 pessoas saudáveis como controles pareados. Os sujeitos fizeram um teste de caminhada de 10 metros , acompanhado de análise cinemática 3D, e foram orientados a caminhar em velocidade confortável, realizando dupla-tarefa (tarefa aritmética), e o planejamento motor foi medido pela cronometria mental. Os valores de velocidade da caminhada e da cadência não evidenciaram diferenças estatisticamente significativas entre os grupos nas três condições. A condição de dupla-tarefa demonstrou um aumento na duração do duplo apoio em ambos os grupos. A imagética motora evidenciou diferenças estatisticamente significativas entre a caminhada real e a imaginada nos pacientes com EM. Pacientes com EM sem incapacidade não apresentaram influência da atenção dividida na execução da caminhada. Entretanto, o planejamento motor esteve superestimado.

Nutritional status is related to fat-free mass, exercise capacity and inspiratory strength in severe chronic obstructive pulmonary disease patients

INTRODUCTION: Being overweight or obese is associated with a higher rate of survival in patients with advanced chronic obstructive pulmonary disease (COPD). This paradoxical relationship indicates that the influence of nutritional status on functional parameters should be further investigated. OBJECTIVE: To investigate the impact of nutritional status on body composition, exercise capacity and respiratory muscle strength in severe chronic obstructive pulmonary disease patients. METHODS: Thirty-two patients (nine women) were divided into three groups according to their body mass indices (BMI): overweight/obese (25 < BMI < 34.9 kg/m², n=8), normal weight (18.5 < BMI < 24.9 kg/m², n=17) and underweight (BMI <18.5 kg/m², n=7). Spirometry, bioelectrical impedance, a six-minute walking distance test and maximal inspiratory and expiratory pressures were assessed. RESULTS: Airway obstruction was similar among the groups (p=0.30); however, overweight/obese patients had a higher fat-free mass (FFM) index [FFMI=FFM/body weight² (mean±SEM: 17±0.3 vs. 15±0.3 vs. 14±0.5 m/kg², p<0.01)], exercise capacity (90±8 vs. 79±6 vs. 57±8 m, p=0.02) and maximal inspiratory pressure (63±7 vs. 57±5 vs. 35±8 percent predicted, p=0.03) in comparison to normal weight and underweight patients, respectively. In addition, on backward multiple regression analysis, FFMI was the unique independent predictor of exercise capacity (partial r=0.52, p<0.01). CONCLUSIONS: Severe chronic obstructive pulmonary disease (COPD) patients who were overweight or obese had a greater FFM, exercise capacity and inspiratory muscle strength than patients with the same degree of airflow obstruction who were of normal weight or underweight, and higher FFM was independently associated with higher exercise capacity. These characteristics of overweight or obese patients might counteract the drawbacks of excess weight and lead to an improved prognosis in COPD.