Does exergaming promote neurofunctional changes in Parkinson´s disease? A pilot clinical study / Os exergames promovem alterações neurofuncionais na doença de Parkinson? Um estudo clínico piloto

Abstract Introduction Previous studies have demonstrated beneficial effects in people with Parkinson´s disease trained with exergames. However, to the best of our knowledge, none of them evaluated whether these effects are sustained by neurofunctional changes. Objective To evaluate neurofunctional effects of a training, by means of functional magnetic resonance imaging, in people with Parkinson´s disease. Methods This study was a blind, randomized, and controlled pilot clinical trial with crossover design. The participants were submitted to an evaluation including cognitive performance and functional magnetic resonance imaging before and after the WiiTM or control trainings. Trainings were applied for 10 days, in two consecutive weeks. Participants starting with WiiTM training were then moved to the control training and vice versa. A wash-out period of 45 days between the trainings was respected. Results Memory, executive and visuo-spatial functions, and attention were significantly improved compared to baseline (p < 0.05). No differences were observed in cognition compared to the control training. Though not significant, results of functional magnetic resonance imaging analyses suggested that WiiTM training could promote improvements on the brain functional connectivity especially in areas involved in motor execution, planning, visual, memory and somatosensory functions. Conclusion In people with Parkinson´s disease, an intensive WiiTM training improved cognitive performance that underlined neurofunctional changes in areas involved in cognitive processing.

Resumo Introdução Estudos anteriores demonstraram efeitos bené-ficos em pessoas com doença de Parkinson treinadas com exergames. No entanto, até onde sabe-se, nenhum deles avaliou se esses efeitos são sustentados por alterações neurofuncionais. Objetivo Avaliar os efeitos neurofuncionais de um treinamento, por meio da ressonância magnética funcional, em pessoas com doença de Parkinson. Métodos Trata-se de um ensaio clínico piloto cego, randomizado e controlado com delineamento crossover. Os participantes foram submetidos a uma avaliação incluindo desempenho cognitivo e ressonância magnética funcional antes e após treinamentos com Wii® ou controle. Os treinamentos foram aplicados durante 10 dias, em duas semanas consecutivas. Os participantes que começaram o treinamento com Wii® foram depois movidos para o treinamento de controle e vice-versa. Respeitou-se um período de wash-out de 45 dias entre os treinamentos. Resultados Memória, funções executivas e visuoespaciais e atenção melhoraram significativamente em comparação com a linha de base (p < 0,05). Não foram observadas diferenças na cognição em comparação com o treinamento de controle. Embora não significativos, os resultados das análises de ressonância magnética funcional sugeriram que o treinamento com Wii® poderia promover melhorias na conectividade funcional do cérebro, especialmente em áreas envolvidas na execução motora, planejamento, funções visuais, de memória e somatossensoriais. Conclusão Em pessoas com doença de Parkinson, um treinamento intensivo com Wii® melhorou o desempenho cognitivo, que destacou mudanças neurofuncionais em áreas envolvidas no processamento cognitivo.

Prevalência de quadros álgicos em praticantes de brazilian jiu-jitsu / Prevalence of algic conditions in brazilian jiu-jitsu practitioners / Prevalencia de condiciones álgicas em practicantes brazilian de jiu-jitsu

Objetivo: Identificar a prevalência de queixas álgicas em praticantes de Brazilian Jiu-Jitsu (BJJ), as queixas que levaram ao afastamento dos treinamentos e as queixas de lesões prévias. Métodos: Trata-se de um estudo transversal, observacional e descritivo que incluiu praticantes regulares de BJJ do sexo masculino, com idades entre 18 e 40 anos. Foi elaborado um questionário para identificar o perfil dos praticantes: idade, graduação, tempo de prática da arte marcial, frequência de treinos, prática de outras atividades física e frequência. Para a investigação das queixas álgicas, foi aplicado o Questionário Nórdico de Sintomas Osteomusculares ­ QNSO, versão em português adaptada. Os dados foram registrados no programa Microsoft Excel 365 e foi realizada estatística descritiva. Resultados: Os 52 participantes da pesquisa possuíam idade média de 32 anos e tempo médio de 9 anos de prática de Jiu-Jitsu, 50% deles possuía graduação de faixa azul. Os praticantes apresentaram 45 relatos de queixas na semana anterior a aplicação do QNSO, 76 relatos no ano anterior, 43 relatos que levaram os praticantes a se afastarem do treinamento e 20 relatos de lesões prévias no ano anterior. Conclusão: A maior prevalência de queixas nos 7 dias prévios a aplicação do QNSO, ocorreu em joelhos, coluna lombar e quadril-coxas, e nos 12 meses prévios ocorreu em joelhos, coluna lombar e ombros. A maior prevalência que levou os praticantes ao afastamento dos treinamentos nos 12 meses prévios ocorreu em joelhos, coluna lombar e tornozelo-pés, e as queixas de lesões prévias ocorreram em joelhos, punhos e ombros.

Objective: To identify the prevalence of pain complaints in Brazilian Jiu- Jitsu (BJJ) practitioners, the complaints that led to withdrawal from training and the complaints of previous injuries. Methods: This is a cross-sectional, observational and descriptive study that included regular male BJJ practitioners aged between 18 and 40 years. A basic questionnaire was created to collect variables: age, graduation, time practicing martial art, frequency of training, practice of other physical activities and frequency. For the investigation of pain complaints, the Nordic Questionnaire of Musculoskeletal Symptoms - NQSO, adapted Portuguese version, was applied. Data were recorded in the Microsoft Excel 365 program and descriptive statistics were performed. Results: The 52 research participants had average an age of 32 years old and average time of 9 years of BJJ practice, 50% of them were blue belt graduation. The practitioners presented 45 reports of complaints in the week before the application of NQSO, 76 reports in previous year, 43 reports that led to withdrawal training and 20 reports of previous injuries in the previous year. Conclusion: The highest prevalence of complaints in the previous 7 days of the application of NQSO occurred in the knees, lumbar spine and hip- thighs, and in the previous 12 months occurred in the knees, lumbar spine and shoulders. The major prevalence that led to withdrawal training in the previous 12 month occurred in the knees, lumbar spine and ankle-foots, and the complaints of previous injuries occurred in the knees, wrists and shoulders.

Objetivo: Identificar la prevalencia de quejas de dolor en practicantes de Brazilian Jiu-Jitsu (BJJ), las quejas que llevaron a la retirada del entrenamiento y las quejas de lesiones anteriores. Métodos: Se trata de un estudio transversal, observacional y descriptivo que incluyó practicantes regulares de BJJ del sexo masculino, con edades entre 18 y 40 años. Se elaboró un cuestionario para identificar el perfil de los practicantes: edad, grado, tiempo de práctica del arte marcial, frecuencia de entrenamiento, práctica de otras actividades físicas y frecuencia. Para la investigación de las quejas de dolor, se aplicó el Cuestionario Nórdico de Síntomas Musculoesqueléticos ­ CNSO, versión portuguesa adaptada. Los datos se registraron en el programa Microsoft Excel 365 y se realizó estadística descriptiva. Resultados: Los 52 participantes de la investigación tenían una edad promedio de 32 años y un tiempo promedio de práctica de BJJ de 9 años, el 50% de ellos tenían graduación de cinturón azul. Los practicantes presentaron 45 reportes de denuncias en la semana anterior a la aplicación de la CNSO, 76 reportes en el año anterior, 43 reportes que llevaron a los practicantes a retirarse del entrenamiento y 20 reportes de lesiones anteriores en el año anterior. Conclusión: La mayor prevalencia de quejas en los 7 días previos a la aplicación de la CNSO se presentó en rodillas, columna lumbar y cadera-muslos, y en los 12 meses anteriores se presentó en rodillas, columna lumbar y hombros. La prevalencia más alta que llevó a los practicantes a retirarse del entrenamiento en los 12 meses anteriores ocurrió en rodillas, columna lumbar y tobillo-pie, y las quejas de lesiones previas ocurrieron en rodillas, muñecas y hombros.

Associação dos parâmetros clínicos de sarcopenia e comprometimento cognitivo em pessoas idosas: estudo transversal / Association of clinical parameters of sarcopenia and cognitive impairment in older people: cross-sectional study

Resumo Objetivo Associar os parâmetros clínicos de sarcopenia com o comprometimento cognitivo em pessoas idosas. Método Estudo transversal, com 263 idosos (≥60 anos) usuários de um serviço público de atenção especializada. Variáveis sociodemográficas e clínicas caracterizaram a amostra e os parâmetros clínicos de sarcopenia (força, massa muscular e desempenho físico) foram avaliados, respectivamente, por meio da Força de Preensão Palmar (FPP), circunferência da panturrilha (CP) e o Teste Timed Up and Go (TUG). Utilizou-se o Miniexame do Estado Mental (MEEM) para avaliar o estado cognitivo. As associações foram investigadas por regressões lineares e logísticas simples e múltiplas considerando os parâmetros clínicos de sarcopenia (variáveis independentes) e o estado cognitivo (variável dependente), ajustadas para idade, sexo, anos de estudo, número de medicação, estado nutricional e capacidade funcional. Resultados Dos participantes com comprometimento cognitivo, 59,6% apresentaram baixa força muscular. O Conclusão A baixa força muscular foi o parâmetro de sarcopenia independentemente associado ao comprometimento cognitivo. Essa informação é útil para atentar-se para a probabilidade de comprometimento cognitivo quando identificada baixa força muscular em pessoas idosas.

Abstract Objective To associate clinical parameters of sarcopenia with cognitive impairment in older people. Method Cross-sectional study with 263 older adults (≥60 years) treated at a specialized public health facility. Sociodemographic and clinical variables were used to characterize the sample and the clinical parameters of sarcopenia (muscle strength, muscle mass and physical performance) were assessed based on handgrip strength (HGS), calf circumference (CC) and the Timed Up and Go (TUG) test. The Mini-Mental State Examination (MMSE) was used to evaluate cognitive status. Associations were analyzed by simple and multiple linear and logistic regression considering the clinical parameters of sarcopenia (independent variables) and cognitive status (dependent variable), adjusted for age, sex, years of schooling, number of medications, nutritional status and functional capacity. Results Of participants with cognitive impairment, 59.6% exhibited low muscle strength. Conclusion Low muscle strength was the sarcopenia parameter independently associated with cognitive impairment. This information is useful in highlighting the likelihood of cognitive impairment when poor muscle strength is identified in older people.

A postura fletida está associada à independência funcional, mobilidade e qualidade de vida em pessoas com doença de Parkinson? / The forward flexed posture is associated with functional independence, mobility and quality of life in people with Parkinson's disease?

Objetivo: Avaliar se a postura fletida (FFP) está associada à independência funcional, mobilidade e qualidade de vida em pacientes com doença de Parkinson (DP). Métodos: Estudo transversal e comparativo em Brasília/DF. Para avaliar a FFP, foi utilizado o teste de distância occipito-parede (DOP) e este foi comparado com medidas de força muscular (preensão palmar, extensão dorsal e membros inferiores), mobilidade funcional e qualidade de vida para verificar se há associações entre eles. Também foi verificado se havia correlação entre o estágio da doença, medido pela escala de Hoehn e Yahr (HY) e o tempo de diagnóstico. Resultados: Foram observadas correlações fortes entre DOP e HY, tempo de diagnóstico e qualidade de vida, e correlações moderadas entre marcadores de força muscular e mobilidade em indivíduos com DP. Conclusão: O FFP medida pelo DOP está fortemente associada com estágios de gravidade, tempo de diagnóstico e qualidade de vida e moderado com força muscular e mobilidade reduzida em pacientes com doença de Parkinson e representa uma medida simples e de baixo custo para a prática clínica.

Efeitos de um treinamento com dispositivo comercial de realidade virtual imersiva sobre a marcha e cognição de pessoas com doença de Parkinson / Effects of a commercial immersive virtual reality device-based training on gait and cognition in people with Parkinson's disease

Objetivo: Avaliar a eficácia e a usabilidade de um treinamento imersivo de realidade virtual usando o Samsung Gear VR OculusTM (SGVR) para marcha e cognitivo em pessoas com doença de Parkinson (DP). Foi realizado um ensaio clínico controlado, quase experimental e cego. Método: Quarenta pessoas com DP foram divididas em dois grupos. O Samsung Gear Virtual Reality Group (VRG) participou de 10 sessões, duas vezes por semana, com duração de uma hora cada, realizando quatro jogos que exigiam movimento da cabeça e deslocamento do centro de gravidade. O grupo controle não recebeu tratamento. Os participantes foram avaliados antes, após a intervenção e 30 dias após a intervenção, com avaliação da marcha por meio do teste Timed Up and Go, teste de caminhada de 10 metros, teste de caminhada de 30 segundos com tarefa simples e dupla e avaliação cognitiva com teste de fluência verbal, dígito para frente e para trás Testes de amplitude e teste Stroop Color. Ao final do treinamento, a VRG respondeu ao questionário System Usabilidade Scale para avaliar a usabilidade do sistema. Resultados: Embora o sistema tenha sido avaliado com excelente usabilidade pelos usuários, não houve efeitos de interação e, portanto, nossos resultados não suportam que o treinamento de realidade virtual imersiva usando jogos SGVR foi superior a nenhum treinamento. Conclusão: No entanto, quando cada grupo foi examinado separadamente, o VRG apresentou melhoras, após a intervenção e 30 dias após a intervenção, para velocidade da marcha (p<0,005 e p<0,001, respectivamente), memória de trabalho, atenção e processamento de informações (p<0,01 em ambos os momentos de avaliação), inibição de resposta, memória de trabalho e de longo prazo (p< 0,01 em 30 dias após a intervenção). A avaliação adicional do dispositivo SGVR é necessária

Objective: Evaluate the effectiveness and the usability of an immersive virtual reality training using Samsung Gear VR OculusTM (SGVR) for gait and cognitive in people with Parkinson's disease (PD). Controlled, quasi-experimental and blinded clinical trial was carried out. Methods: Forty people with PD were divided into two groups. Samsung Gear Virtual Reality Group (VRG) participated in 10 sessions, twice a week, lasting one hour each, performing four games that required head movement and center of gravity shift. Control group didn't receive treatment. Participants were evaluated before, after the intervention and 30 days after intervention, with the Timed Up and Go test, 10 meters walking test, single and dual tasking 30 seconds walking test, verbal fluency test, forward and backward Digit Span tests and Stroop Color test. At the end of the training, VRG responded to the System Usability Scale questionnaire to assess the usability of the system. Results: Even though the system was rated with excellent usability by the users, there were no interaction effects and, therefore, our results do not support that immersive virtual reality training using SGVR games was superior to no training. However, when each group was examined separately, the VRG experienced improvements, after the intervention and 30 days after intervention, for gait velocity (p<0.005, p<0.001, respectively), working memory, attention, and information processing (p<0.01 in both evaluation time points), response inhibition, working and long-term memory (p< 0.01 in 30 days after intervention). Conclusion: Further evaluation of the SGVR device is required

Multidimensional Factors Can Explain the Clinical Worsening in People With Parkinson's Disease During the COVID-19 Pandemic: A Multicenter Cross-Sectional Trial.

Background: Self-reported clinical worsening by people with Parkinson's disease (PD) during social distancing may be aggravated in Brazil, where the e/tele-health system is precarious. Objectives: This study aims to investigate self-reported changes in motor and non-motor aspects during social distancing in people with PD living in Brazil and to investigate the factors that might explain these changes. Methods: In this multicenter cross-sectional trial, 478 people with a diagnosis of idiopathic PD (mean age = 67, SD = 9.5; 167 female) were recruited from 14 centers distributed throughout the five geographical regions of Brazil. The evaluators from each center applied a questionnaire by telephone, which included questions (previous and current period of social distancing) about the motor and non-motor experiences of daily living, quality of life, daily routine, and physical activity volume. Results: Self-reported clinical worsening in non-motor and motor aspects of daily life experiences (Movement Disorder Society-Unified PD Rating Scale-parts IB and II-emotional and mental health, and fear of falling) and in the quality of life was observed. Only 31% of the participants reported a guided home-based physical activity with distance supervision. Perceived changes in the quality of life, freezing of gait, decreased physical activity volume, daily routine, and fear of falling explained the self-reported clinical worsening (P < 0.05). Conclusions: Self-reported clinical worsening in people with PD living in Brazil during social distancing can also be aggravated by the precarious e/tele-health system, as perception of decreased physical activity volume and impoverishment in daily routine were some of the explanatory factors. Considering the multifaceted worsening, the implementation of a remote multi-professional support for these people is urgent.

Effectiveness of Virtual Reality Rehabilitation in Persons with Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Multiple Sclerosis (MS) is a chronic disease with physical, cognitive, and psychosocial impairments. Virtual Reality (VR) has been used as an innovative tool in neurological rehabilitation. There are promising new studies that have used commercial video games consoles for the rehabilitation of people with MS. OBJECTIVES: The aim of this systematic review is to summarize the effectiveness of using VR on functional mobility, fatigue, quality of life and balance in people with MS, compared with conventional exercises or no intervention. METHODS: Six databases (Scielo, Lilacs, Pubmed, Cochrane library, Embase and PEDro) were searched using some of following terms: "Virtual reality" AND "Multiple sclerosis" AND " randomized controlled trial". Two reviewers performed the search, selection, and extraction of data from the studies. The methodological quality of the articles was assessed using the PEDro scale and the risk of bias was independently assessed by two reviewers using the Cochrane Collaboration Risk of Bias tool. Mean differences and confidence intervals were combined and calculated in meta-analysis. RESULTS: Nine randomized clinical trials were included, with a total sample of 424 participants. In general, functional mobility presented similar improvement between groups, while for fatigue, quality of life and balance, VR promoted improvement equal to or greater than the conventional exercises. The meta-analysis confirmed that for functional mobility, VR does not promote significant improvement, while for fatigue, quality of life and balance, VR promotes superior improvement. CONCLUSION: This systematic review demonstrated a positive effect of using VR in people with MS in relation to fatigue, quality of life and balance, compared to the conventional exercises. For functional mobility, VR associated or not with conventional exercises does not seem to bring additional benefits. Larger and methodologically robust studies are need. OTHER: There was no funding for this systematic review. PROSPERO Registration Number CRD42021226471.

Immediate changes in post-stroke gait using a shoe lift on the nonaffected lower limb: A preliminary study.

Introduction: Gait impairment is one of the most important post-stroke complications and is associated with reduced mobility, limitations in activities of daily living and decreased quality of life. Gait recovery is an important goal in post-stroke rehabilitation and shoe lifts have been used on the nonaffected lower limb (NLL) to reduce compensatory strategies such as vaulting, pelvic hiking and hip circumduction during the swing phase of the affected lower limb. Moreover, in clinical practice shoe lifts seem to reduce tripping and the risk of falls.Objective: Evaluate walking speed and functional mobility with and without a 1.5 cm shoe lift under the non-affected lower limb in post-stroke gait.Methods: Forty-two subjects with hemiparesis after stroke were evaluated on a single day, under two conditions: with and without a 1.5 cm shoe lift. The assessment sequence was randomized and clinical tests (Ten-meter walk Test - 10MWT and Timed Up and Go - TUG) were performed one after the other.Results: There was a significant increase in walking speed in the 10MWT and shorter TUG times, with mean differences of 0.78 (CI95% 0.15-1.41, P ≤ 0.001, EF = 0.55) and 0.57 seconds (-0.11-1.25, P = .022, EF = 0.35), respectively.Conclusion: The results showed that the immediate use of 1.5 cm shoe lifts seems to improve gait speed and functional mobility in chronic stroke patients. Further studies should focus on understanding the kinematics strategies and gait pattern alterations caused by shoe lifts under the NLL of post-stroke individuals.

Dynamic and Static Postural Control in Volleyball Players with Transfemoral Amputation / Controle Postural Dinâmico e Estático em Jogadores de Vôlei com Amputação Transfemoral / Control Postural Dinámico y Estático de Jugadores de VÓLEY con Amputación Transfemoral

ABSTRACT Introduction: A decrease in postural control and proprioception is a common result of lower limb amputation. However, postural control adaptation in Paralympic sitting volleyball players with lower limb amputation is not yet understood. Objective: The purpose of this cross-sectional controlled study was to investigate static and dynamic postural control in sitting volleyball players with unilateral transfemoral amputation. Methods: Sixteen subjects participated in the study, eight of whom were amputees with unilateral transfemoral amputation (amputee group: age: 33.5 ± 5.6 years, weight: 77.7 ± 5.3 kg, height: 179.4 ± 5.3 cm) and eight physically active non-amputees (control group age: 27.2 ± 8.4 years, weight: 82.7 ± 6.6 kg, height: 178.7 ± 6.1 cm). Static and dynamic postural control was evaluated using the Neurocom® Balance Master System platform (Modified Clinical Test of Sensory Interaction on Balance, Limits of Stability, Rhythmic Weight Shift, Sit-to-Stand, Walk Across, and Step and Quick Turn). Statistical analyses were performed with the Shapiro-Wilk test, Levene's test, and Student's t-test for paired samples (p <0.05). Results: The amputee group demonstrated impaired postural control in all tests when compared to the control group (p <.05) for all postural tests except for the rhythmic change and sit-to-stand tests (p >.05). Conclusion: Despite training in sitting volleyball, our results demonstrated that amputees have poorer postural control in both static and dynamic tasks when compared to physically active non-amputees. Level of Evidence II; Prognostic Studies—Investigating the Effect of a Patient Characteristic on Disease Outcome / Retrospectivef Study.

RESUMO Introdução: Uma diminuição no controle postural e propriocepção é um resultado comum da amputação dos membros inferiores. No entanto, a adaptação do controle postural nos jogadores paralímpicos de vôlei sentado com amputação de membros inferiores ainda não é compreendida. Objetivo: O propósito desse estudo transversal controlado consistia em investigar o controle postural estático e dinâmico em jogadores de vôlei sentado com amputação transfemoral unilateral. Métodos: Dezesseis indivíduos participaram do estudo, oito deles eram amputados com amputação transfemoral unilateral (grupo amputado: idade: 33,5 ± 5,6 anos, peso: 77,7 ± 5,3 kg, altura: 179,4 ± 5,3 cm) e oito eram fisicamente ativos não-amputados (idade do grupo controle: 27,2 ± 8,4 anos, peso: 82,7 ± 6,6 kg, altura: 178,7 ± 6,1 cm). O controle postural estático e dinâmico foi avaliado usando a plataforma Neurocom® Balance Master System (Teste Clínico Modificado de Interação Sensorial no Equilíbrio, Limites de Estabilidade, Variação Rítmica de Carga, Sentado para de Pé, Marcha na Plataforma e Passo com Inversão Rápida). As análises estatísticas foram realizadas com o teste Shapiro-Wilk, o teste de Levene e o teste t de Student para amostras pareadas (p <0,05). Resultados: O grupo de amputados demonstrou comprometimento do controle postural em todos os testes quando comparado ao grupo controle (p<0,05) em todos os testes posturais, com exceção dos testes de Variação Rítmica e Sentado para de Pé (p>0,05). Conclusão: Apesar do treinamento no vôlei sentado, nossos resultados demonstraram que os amputados apresentam um controle postural mais precário tanto em tarefas estáticas como dinâmicas, quando comparados com os não-amputados fisicamente ativos. Nível de Evidência II; Estudo prognóstico - investigar o efeito da característica do paciente no resultado de uma doença/Estudo Retrospectivo.

RESUMEN Introducción: Una disminución en el control postural y propiocepción es un resultado común de la amputación de los miembros inferiores. Sin embargo, la adaptación del control postural en los jugadores paralímpicos de vóley sentado con amputación de miembros inferiores aún no es comprendida. Objetivo: El propósito de ese estudio transversal controlado consistía en investigar el control postural estático y dinámico en jugadores de vóley sentado con amputación transfemoral unilateral. Métodos: Dieciséis individuos participaron en el estudio, ocho de ellos eran amputados con amputación transfemoral unilateral (grupo amputado: edad: 33,5 ± 5,6 años, peso: 77,7 ± 5,3 kg, altura: 179,4 ± 5,3 cm) y ocho eran físicamente activos no amputados (edad del grupo control: 27,2 ± 8,4 años, peso: 82,7 ± 6,6 kg, altura: 178,7 ± 6,1 cm). El control postural estático y dinámico fue evaluado usando la plataforma Neurocom® Balance Master System (Test Clínico Modificado de Interacción Sensorial en el Equilibrio, Límites de Estabilidad, Variación Rítmica de Carga, Sentado para de pie, Marcha en la Plataforma y Paso con Inversión Rápida). Los análisis estadísticos fueron realizados con el test Shapiro-Wilk, el test de Levene y el test t de Student para muestras pareadas (p <0,05). Resultados: El grupo de amputados demostró compromiso del control postural en todos los tests cuando comparado al grupo control (p<0,05) en todos los tests posturales, con excepción de los tests de variación rítmica y sit-to-stand (p>0,05). Conclusión: A pesar del entrenamiento en el vóley sentado, nuestros resultados demostraron que los amputados presentan un control postural más precario tanto en tareas estáticas como dinámicas, cuando comparados con los no amputados físicamente activos. Nivel de Evidencia II; Estudio pronóstico - investigar el efecto de la característica del paciente en el resultado de una enfermedad/Estudio Retrospectivo.

Resistance exercise leading to failure versus not to failure: effects on cardiovascular control.

BACKGROUND: The aim of the present study was to evaluate the acute effects of resistance exercise (RE) leading to failure and RE that was not to failure on 24 h blood pressure (BP) and heart rate variability (HRV) in sedentary normotensive adult women. METHODS: Ten women (33.2 ± 5.8 years; 159.3 ± 9.4 cm; 58.0 ±6.4 kg; body fat 28.4 ± 2.8%) randomly underwent three experimental sessions: control (40 minutes of seated rest), RE leading to failure with 3 sets of 10 repetitions maximum (10-RM), and RE not to failure at 60% of 10-RM with 3 sets of 10 repetitions. Immediately post session BP and HRV were measured for 24 h. RESULTS: Ratings of perceived exertion and heart rate were higher during the 10-RM session when compared with 60% of 10-RM (6.4 ± 0.5 vs 3.5 ± 0.8 and 123.7 ± 13.9 vs 104.5 ± 7.3 bpm, respectively). The systolic, diastolic and mean BP decreased at 07:00 a.m. after the 10-RM session when compared with the control session (-9.0 ± 7.8 mmHg, -16.0 ± 12.9 mmHg and -14.3 ± 11.2 mmHg, respectively). The root mean square of the squared differences between R-R intervals decreased after both the 60% of 10-RM and 10-RM sessions compared with the control session. CONCLUSIONS: An acute RE session leading to failure induced a higher drop of BP upon awakening, while both RE sessions reduced cardiac parasympathetic modulation. RE may be an interesting training strategy to acutely decrease BP in adult women.

Decreased functional capacity and muscle strength in elderly women with metabolic syndrome.

PURPOSE: To compare the metabolic parameters, flexibility, muscle strength, functional capacity, and lower limb muscle power of elderly women with and without the metabolic syndrome (MetS). METHODS: This cross-sectional study included 28 older women divided into two groups: with the MetS (n = 14; 67.3 ± 5.5 years; 67.5 ± 16.7 kg; 1.45 ± 0.35 m; 28.0 ± 7.6 kg/m(2)), and without the MetS (n = 14; 68.7 ± 5.3 years; 58.2 ± 9.9 kg; 1.55 ± 0.10 m; 24.3 ± 3.8 kg/m(2)). Body composition was evaluated by dual-energy X-ray absorptiometry and dynamic muscle strength was assessed by one-maximum repetition (1RM) tests in leg press, bench press and biceps curl exercises. Six-minute walk test, Timed Up and Go (TUG); 30-second sitting-rising; arm curl using a 2-kg dumbbell, sit-and-reach (flexibility), and vertical jump tests were performed. RESULTS: There was no difference between groups regarding age (P = 0.49), height (P = 0.46), body fat (%) (P = 0.19), systolic (P = 0.64), diastolic (P = 0.41) and mean blood pressure (P = 0.86), 30-second sitting-rising (P = 0.57), 30-s arm curl (P = 0.73), leg press 1RM (P = 0.51), bench press 1RM (P = 0.77), and biceps curl 1RM (P = 0.85). However, women without the MetS presented lower body mass (P = 0.001), body mass index (BMI) (P = 0.0001), waist circumference (P = 0.02), waist-to-height ratio (P = 0.02), fat body mass (kg) (P = 0.05), lean body mass (kg) (P = 0.02), blood glucose (P = 0.05), triglycerides (P = 0.03), Z-score for the MetS (P = 0.05), higher high-density lipoprotein-cholesterol (HDL-C) (P = 0.002), better performance on TUG (P = 0.01), flexibility (P = 0.03), six-minute walk test (P = 0.04), vertical jump (P = 0.05) and relative muscle strength for leg press (P = 0.03), bench press (P = 0.04) and biceps curl (P = 0.002) exercises as compared to women with the MetS. CONCLUSION: Elderly women with the MetS have higher metabolic risk profile and lower functional capacity, muscle strength, lower limb power and flexibility as compared to women without the MetS. The evaluation of functional capacity may help to determine the degree of physical decline in older persons with the MetS, while exercise interventions should be encouraged.

Aprendizado motor após treinamento baseado em realidade virtual na Doença de Parkinson: efeitos das demandas motoras e cognitivas dos jogos / Motor learning after virtual reality-based training in Parkinson's disease: effect of motor and cognitive demands of games

O objetivo principal deste estudo foi investigar a aprendizagem de pacientes com Doença de Parkinson (DP) em 10 jogos do vídeo game Nintendo Wii Fit Plus®, com diferentes demandas motoras e cognitivas, por meio das modificações do desempenho após o treinamento, comparando-a com a aprendizagem de indivíduos saudáveis da mesma faixa etária, em um estudo clínico, longitudinal e controlado. Dezesseis pacientes em estágio inicial da DP e 11 idosos saudáveis participaram de um treinamento que compreendeu 14 sessões de exercícios de aquecimento que precederam o treino no Nintendo Wii Fit Plus®, realizadas 2 vezes por semana. Nessas sessões, duas tentativas em 5 de 10 jogos foram realizadas, sendo que nas sessões pares foram treinados 5 jogos diferentes das sessões ímpares. Uma sessão de treino e avaliação adicional foi feita sessenta dias após o final do treinamento em cada jogo, totalizando 2 sessões adicionais para treino e avaliação da retenção. Ao final do estudo foram realizadas no total 16 sessões de treino. Aprendizado foi a principal medida de resultado sendo baseada nas pontuações obtidas durante todas as sessões, nos 10 jogos. Encontrou-se que os pacientes com DP não mostraram deficiências de aprendizado em 7 dos 10 jogos, embora tenham mostrado desempenho inferior em 5 jogos, quando comparados aos idosos. Os pacientes mostraram importantes deficiências de aprendizado em 3 outros jogos, independentemente do desempenho inicial inferior. Esta deficiência pareceu estar associada às demandas cognitivas desses jogos, que requerem tomadas de decisão rápidas, inibição de resposta, atenção dividida e memória operacional. Concluiu-se que a capacidade de pacientes com DP em melhorar e reter o desempenho após o treinamento no Nintendo Wii Fit Plus® depende grandemente das demandas dos jogos envolvidos, sobretudo as demandas cognitivas, reiterando a importância da seleção adequada dos jogos com proposta de reabilitação.(AU)

The main objective of this study was to investigate the learning of Parkinson´s Disease (PD) patients in 10 games of the video game Nintendo Wii Fit Plus ® with different motor and cognitive demands, through changes in performance after training, comparing it with health elderly, in a clinical, longitudinal and controlled study. Sixteen patients in early stages of PD and 11 healthy elderly subjects participated in a training program which comprised 14 warm exercises sessions that preceded the Nintendo Wii Fit Plus® training, twice a week. In these sessions, two attempts in 5 of 10 games were held, being that on even sessions were trained 5 different games of odd sessions. A training session and further evaluation was made sixty days after the end of training in each game, totaling two additional sessions to assess retention. At the end of the study were performed, in total, 16 training sessions. Learning was the main outcome measure being based on the scores obtained during all sessions, in 10 games. It was found that PD patients showed no learning impairments in 7 of 10 games, although they have shown a lower performance in 5 games, compared to the elderly. The patients showed significant deficiencies in learning in 3 other games, regardless of the initial performance lower. This deficiency appeared to be related to the cognitive demands of those games that require quick decision making, response inhibition, divided attention and working memory. It was concluded that the ability of PD patients to improve and retain the performance after training on the Nintendo Wii Fit Plus® depends greatly on the demands of the games involved, especially the cognitive demands, reiterating the importance of proper selection of games with proposed rehabilitation.(AU)

Effect of Nintendo Wii™-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial.

OBJECTIVES: To investigate the effect of Nintendo Wii™-based motor cognitive training versus balance exercise therapy on activities of daily living in patients with Parkinson's disease. DESIGN: Parallel, prospective, single-blind, randomised clinical trial. SETTING: Brazilian Parkinson Association. PARTICIPANTS: Thirty-two patients with Parkinson's disease (Hoehn and Yahr stages 1 and 2). INTERVENTIONS: Fourteen training sessions consisting of 30 minutes of stretching, strengthening and axial mobility exercises, plus 30 minutes of balance training. The control group performed balance exercises without feedback or cognitive stimulation, and the experimental group performed 10 Wii Fit™ games. MAIN OUTCOME MEASURE: Section II of the Unified Parkinson's Disease Rating Scale (UPDRS-II). RANDOMISATION: Participants were randomised into a control group (n=16) and an experimental group (n=16) through blinded drawing of names. STATISTICAL ANALYSIS: Repeated-measures analysis of variance (RM-ANOVA). RESULTS: Both groups showed improvement in the UPDRS-II with assessment effect (RM-ANOVA P<0.001, observed power=0.999). There was no difference between the control group and the experimental group before training {8.9 [standard deviation (SD) 2.9] vs 10.1 (SD 3.8)}, after training [7.6 (SD 2.9) vs 8.1 (SD 3.5)] or 60 days after training [8.1 (SD 3.2) vs 8.3 (SD 3.6)]. The mean difference of the whole group between before training and after training was -0.9 (SD 2.3, 95% confidence interval -1.7 to -0.6). CONCLUSION: Patients with Parkinson's disease showed improved performance in activities of daily living after 14 sessions of balance training, with no additional advantages associated with the Wii-based motor and cognitive training. Registered on http://www.clinicaltrials.gov (identifier: NCT01580787).

Efeito de um programa de reeducacao funcional na flexibilidade de idosos saudaveis / Effect of a program of funcional reeducation in the senior peoples flexibility

O envelhecimento produz alteracoes em quase todos os sistemas organicos, principalmente no sistema musculoesqueletico. Uma das alteracoes mais frequentes e a diminuicao da...

Avaliacao de dois testes de flexibilidade em idosos do sexo feminino: metodo fotografico / Evaluation of two tests of flexibility in female senior individuals: photographic method

O teste do terceiro dedo ao chao, onde o participante, a partir da posicao da bipedestacao realiza a flexao anterior do tronco, sem fletir os joelhos ou deslocar a pelve posteriormente, levando as maos em direcao ao chao, fornece indicacoes sobre a flexibilidade da cadeia muscular posterior, sendo utilizado como parametro de evolucao para os tratamentos propostos. Este quando realizado pelo metodo fotografico, propicia uma avaliacao com dados mensuraveis e qualitativos sobre a performance do teste. Com o objetivo de analisar o...

Efeitos da sessao isolada de massagem, de mobilizacao ou da associacao destes dois recursos terapeuticos na melhora da flexibilidade / Effects of isolated session of massage, mobilization and both the therapeutic treatment together improving flexibility

Este trabalho utilizou-se da massagem classica e da mobilizacao passiva funcional, realizada em padroes diagonais e em espiral, de acordo com o metodo de Facilitacao Neuromuscular Proprioceptiva (FNP). Na pratica clinica, temos observado resultados positivos quando da utilizacao das duas tecnicas. Assim, o objetivo deste trabalho e estudar o efeito da...

Influencia da massagem classica segmentar e geral na flexibilidade de individuos adultos jovens / Influency of segmentar and geral classic massage in flexibility of young adults

A massagem classica e definida como uma compressao metodica e ritmica do corpo, ou parte dele, para que se obtenha efeitos terapeuticos, didaticamente divididos em circulatorios, neuromusculares, metabolicos, mecanicos e psicologicos. Tambem podem ser divididos em local, por liberacao local de substancias vasoativas - e geral, quando a massagem e realizada em todo o corpo...