Constraint-induced movement therapy versus bimanual intensive therapy in children with hemiplegia showing low/very low bimanual functional performance: A randomized clinical trial.

INTRODUCTION: Children with infantile hemiplegia with low or very low bimanual functional performance have great impediments to spontaneously use their affected upper limb, which affects their performance of day-to-day activities and their quality of life. OBJECTIVE: To determine whether the order of application and the dose of modified constraint-induced movement therapy within a combined (hybrid) protocol influences the results of bimanual functional performance of the affected upper limb and the quality of life of children with congenital hemiplegia (5 to 8 years old) with low/very low bimanual functional performance. DESIGN: Single-blinded randomized controlled trial. PARTICIPANTS: Twenty-one children with congenital hemiplegia (5 to 8 years old) were recruited from two public hospitals and an infantile hemiplegia association in Spain. INTERVENTIONS: The experimental group (n = 11) received 100 hours of intensive therapies for the affected upper limb: 80 hours of modified constraint-induced movement therapy and 20 hours of bimanual intensive therapy. The control group (n = 10) received the same dose with 80 hours of bimanual intensive therapy and 20 hours of modified constraint-induced movement therapy. The protocol was provided 2 hours per day, 5 days per week, for 10 weeks. OUTCOME MEASURES: The primary outcome was bimanual functional performance, measured with the Assisting Hand Assessment, and the second outcome was quality of life, measured with the Pediatric Quality of Life Inventory Cerebral-Palsy module (PedsQL v. 3.0, CP module). Four assessments were performed: Weeks 0, 4, 8, and 10. RESULTS: The experimental group obtained an increase of 22 assisting hand assessment (AHA) units at week 8 with the application of modified constraint-induced movement, in contrast with the control group, which obtained an increase of 3.7 AHA units after bimanual intensive therapy. At week 10, the control group showed its greatest increase in bimanual functional performance, with 10.6 AHA units after modified constraint-induced movement therapy. Regarding quality of life, the greatest improvement occurred after modified constraint-induced movement, with 13.1 points in the experimental group (80 hours) and 6.3 points in the control group (20 hours). The protocol interaction was statistically significant for bimanual functional performance (p = .018) and quality of life (p = .09). CONCLUSIONS: Modified constraint-induced movement therapy is more beneficial than bimanual intensive therapy for improving upper limb functioning and quality of life in children with congenital hemiplegia showing low/very low bimanual performance. GOV IDENTIFIER: NCT03465046.

Chronic obstructive pulmonary disease patients' experience with pulmonary rehabilitation: a systematic review of qualitative research.

The aim of this study was to give an in-depth consideration of the chronic obstructive pulmonary disease (COPD) patients' subjective view of the impact of pulmonary rehabilitation (PR) on their lives. A systematic review in PubMed, Embase, CINAHL and PsychInfo databases yielded 3306 articles, of which 387 were duplicates, 263 remained after screening abstract and title; of them, 4 were excluded (editorial or due to lacking of full text) remaining a total of 259 for full text reading. Among these, eight studies met the inclusion criteria and were finally included. The meta-ethnography approach synthesized an understanding of the studies, which focused on constructing interpretations and developed a 'line-of-argument' synthesis. The psychosocial support of PR contributes to the patients' strength and desire for participation and the health education leads to illness-perception learning. Both psychosocial support and health education develop patients' empowerment, while PR promotes opportunities to health transitions. The empowerment experienced by the patients in taking advantage of these opportunities leads to positive impacts over time. If they do not exploit these occasions, negative impacts arise in their life, which make the treatment assistance or follow-up more difficult. The COPD patients' feedback revealed that PR promotes a better 'way of life', well-being and important behavioural changes towards health promotion.

Evaluación de la ca lidad de vida relacionada con la salud en pacientes confibro mialgia / Assessment of quality of life related to health in patients with fibromyalgia

Determinar el impacto que la fibromialgia tiene sobre la calidad de vida; comparar la calidad de vida de pacientes fibromiálgicos con la población española sana; y conocer la correlación y sensibilidad de dos instrumentos de calidad de vida en la fibromialgia. Método: Estudio transversal y observacional. Participaron 27 sujetos (25 mujeres y 2 hombres) con una media de edad de 50,5 años (SD 7,9) pertenecientes a la Asociación Salmantina de Fibromialgia y Fatiga Crónica. Se utilizaron las versiones españolas del Perfil de Salud Nottingham (NHP) y el cuestionario de Salud del SF-36 (SF36) para estudiar La calidad de vida (CV). Resultados: Se obtivieron altas puntuaciones en las dimensiones, Energía, Dolor, Sueño y Movilidad física del NHP y bajas puntuaciones em las dimensiones del SF36, Problemas físicos, Dolor, Vitalidad y Percepción de La Salud General. Se han encontrado diferencias estadísticamente significativas en todas lãs dimensiones con la población española sana. Las seguintes dimensiones se correlacionaron negativamente estadísticamente: Energía (NHP) - Vitalidad (SF-36); Dolor(NHP)- Función física, Dolor y Vitalidad (SF-36); Movilidad física (NHP)-Función física y Problemas físicos (SF-36), Reacciones emocionales (NHP)- Salud mental, Problemas emocionales y Percepción de la salud general (SF-36). Resulta más sensible al deterioro de la Fibromialgia el cuestionario SF36. Conclusiones: La fibromialgia produce un importante deterioro de la calidad de vida que puede ser valorada por las dimensiones de los cuestionarios NHP y SF36.

To determine the impact that fibromyalgia (FM) has on quality of life; to compare the quality of life of patients with fibromyalgia with the healthy Spanish population and to know the correlation and sensibility of two instruments of quality of life in FM. Method: A cross-sectional and observational study. Twenty-seven subjects joined in (25 women and 2 men) with a mean age of 50.5 years (SD 7.9), belonging to the Salmantina Association ofFibromyalgia and Chronic Fatigue. The Spanish versions of the Nottingham Health Profile (NHP) and the the Short-Form 36 (SF36) were used to study quality of life. Results: High scores were obtained in the Energy, Pain, Sleep and Physical mobility dimensions of the NHP and low scores in the Physical problems, Pain, Vitality and General health perception dimensions of the SF-36. Statistical significant differences were found in all dimensions comparing to the healthy Spanish population. The following dimensions were negatively statistically correlated: Energy(NHP)-Vitality (SF-36); Pain(NHP)- Physical function, Pain and Vitality (SF-36); Physical mobility (NHP)- Physical function and Physical problems (SF-36); Emotional reactions (NHP)- Mental health, Emotional problems and General health (SF-36). The SF-36 is more sensitive than the NHP to evaluate the deterioration of the fibromyalgia. Conclusions: The fibromyalgia produces a significant deterioration in quality of life that can be assessed by the dimensions of the NHP and the SF-36.

Antioxidantes, atividade física e estresse oxidativo em mulheres idosas / Antioxidants, physical activity and oxidative stress in older women

OBJETIVO: Verificar a influência da suplementação de vitaminas antioxidantes na dieta de mulheres idosas que praticam exercícios físicos regulares, sobre o estresse oxidativo, indicadores da saúde física e risco de enfermidades cardiovasculares (ECV). MÉTODO: Foram observados dois grupos (S e C) de mulheres com idades entre 60 e 80 anos participantes de um programa de atividades físicas durante 58 semanas, com freqüência de três vezes por semana e duração de 50 a 55 minutos cada sessão. A dieta habitual do Grupo S (n=36) foi suplementada diariamente com 330 ml de uma bebida antioxidante (FuncionaTM); o Grupo C (n=32) ingeriu água e se caracterizou como controle. Como indicadores do estresse oxidativo foram determinadas as concentrações plasmáticas de glutationa reduzida (GSH) e oxidada (GSSG), calculada a relação molar GSH/GSSG, e identificado o dano oxidativo em lipídios e proteínas. As condições físicas e cardiovasculares foram avaliadas por meio dos parâmetros antropométricos habituais (peso, altura e índice de massa corporal) e da pressão arterial. RESULTADOS: O Grupo C apresentou aumentos significativos do estresse oxidativo, redução da pressão arterial e dos valores médios de indicadores de risco de ECV. O Grupo S teve o estresse oxidativo reduzido significativamente e apresentou incremento dos ganhos cardiovasculares. Não foram identificadas significâncias em relação aos efeitos ergogênicos. CONCLUSÃO: Os dados indicam que mulheres idosas que realizam exercícios físicos freqüentes melhoram suas condições físicas e cardiovasculares e que o suplemento dietético continuado de alimentos funcionais antioxidantes podem minimizar os efeitos danosos das espécies reativas de oxigênio.

OBJECTIVE: To verify the influence of dietary antioxidant supplementation in older women who regularly practice physical activities, on the occurrence of oxidative stress, physical health and risk of cardiovascular diseases (CVD). METHOD: Two groups (S and C) of women, with age ranging from 60 to 80 years old, were observed. Both groups took part in a physical activity program for 58 weeks, three times a week, for about 50 to 55 minutes each session. The diet of group S (n=36) was daily supplemented with 330 ml of a functional antioxidant beverage, FuncionaTM; Group C (n=32) ingested water and was used as Control. As oxidative stress indicators, the plasmatic concentrations of reduced (GSH) and oxidized (GSSG) glutathione were determined; the molar GSH/GSSG ratio was calculated, and the oxidative damage in lipids and proteins was evaluated. The physical and cardiovascular conditions were evaluated through routine anthropometric parameters (weight, stature and BMI) and blood pressure. RESULTS: Group C presented significant increases of oxidative stress, reduction in the blood pressure and in the indicators of cardiovascular risks. Group S presented significant reduction of the oxidative stress and increment of the cardiovascular gains. Significance concerning the ergogenic effects has not been identified. CONCLUSION: Our data suggest that regular exercise in older women can improve physical and cardiovascular conditions. Moreover, daily intake of functional antioxidant supplement can minimize harmful effects of the reactive oxygen species.

O comportamento do VO2max de mulheres idosas participantes de um programa prolongado de atividade física / VO2max in elderly women participating in a long-term

Objetivo: O objetivo deste estudo foi analisar o comportamento do consumo máximo de oxigênio em idosas ativas e participantes de um programa de atividades físicas de longa duração (86 semanas). Método: Participaram do estudo 68 mulheres, com idades entre 65 – 80 anos não institucionalizadas, selecionadas dentre 300 participantes do Programa de Revitalização Geriátrica da Universidade de Salamanca (Espanha). A seleção considerou: freqüência superior a 74% nas atividades do Programa, o sexo e a idade e foram excluídas as portadoras de doenças ou características físicas que impedissem as atividades do programa. O período total do trabalho foi de 86 semanas, sendo que as sessões de atividade foram em número de 174, durante 58 semanas, com freqüência de três vezes por semana e duração de 50 a 55 minutos cada uma. O VO2max foi medido indiretamente, por meio do Rockport Walking Test. Resultados: Os resultados evidenciam ausência de diferenças significativas entre as medidas tomadas no período do experimento. Conclusão: O programa desenvolvido evitou as perdas de VO2max características do processo de envelhecimento, mas o fato de não ter havido significância permite afirmar que, para o incremento do VO2max é necessário um programa específico, com controle individual de variáveis cardíacas e respiratórias.

Objective: This study analyzed the VO2max in active elderly women and participants in a long-term physical program. Methods: Sixty eight non-institutionalized women, 65 to 80 years old, took part on that study, selected from a universe of 300 participants at the Geriatric Revitalization Program promoted by the University of Salamanca in Spain. That selection took into consideration: frequency superior to 74% in the program activities, sex and age. There were 174 physical activity sessions, three times a week lasting 50 to 55 minutes each. The maximum volume of oxygen (VO2max) was measured indirectly using the Rockport Walking Test. Results: The results evidence absence of significant differences between the measures taken in the period of the experiment. Conclusion: a) The program prevented the characteristic losses of VO2max of the aging process; b) For the significant increment of VO2max is necessary a specific program, with individual control of cardiac and respiratory parameters.