Prevalence of falls and associated factors in community-dwelling older Brazilians: a systematic review and meta-analysis.

Falls determine huge epidemiological, clinical, and economic burden in the older population worldwide, presenting high odds of severe disability. The present study aimed to estimate the prevalence of falls and associated factors in older Brazilians using a systematic review with meta-analysis. Searches were performed in SciELO, PubMed, LILACS, Web of Science, Scopus and PsycINFO databases with no date or language restrictions. Studies on community-dwelling older persons aged ≥ 60 years from both sexes and with a sample size of ≥ 300 participants included. Exclusion criteria were studies conducted specifically for older adults diagnosed with chronic disabling diseases that predispose them to falls. Risk of bias of included studies was assessed using a critical appraisal tool focusing on prevalence designs. A random-effects meta-analysis was used to pool the prevalence of falls across studies. Exploratory analysis was conducted examining subgroup estimates, prevalence ratios and meta-regression. Thirty-seven studies involving 58,597 participants were included. Twelve-month prevalence of falls was 27% (95%CI: 24.3-30.0), with significantly higher estimates in female than male (PR = 1.57; 95%CI: 1.32-1.86), in age group ≥ 80 years than age group 60-69 years (PR = 1.46; 95%CI: 1.15-1.84), and in participants from the Central region than participants from the South region (PR = 1.36; 95%CI: 1.10-1.69) of Brazil. Risk of bias scores did not impact heterogeneity in the 12-month meta-analysis. These estimates strongly support evidence-based public interventions to prevent falls in older Brazilians, especially in women and the oldest-old population.

Prevalence of falls and associated factors in community-dwelling older Brazilians: a systematic review and meta-analysis / Prevalência de quedas e fatores associados em uma amostra comunitária de idosos brasileiros: uma revisão sistemática e meta-análise / Prevalencia de caídas y factores asociados en ancianos brasileños residentes en una comunidad: revisión sistemática y metaanálisis

Falls determine huge epidemiological, clinical, and economic burden in the older population worldwide, presenting high odds of severe disability. The present study aimed to estimate the prevalence of falls and associated factors in older Brazilians using a systematic review with meta-analysis. Searches were performed in SciELO, PubMed, LILACS, Web of Science, Scopus and PsycINFO databases with no date or language restrictions. Studies on community-dwelling older persons aged ≥ 60 years from both sexes and with a sample size of ≥ 300 participants included. Exclusion criteria were studies conducted specifically for older adults diagnosed with chronic disabling diseases that predispose them to falls. Risk of bias of included studies was assessed using a critical appraisal tool focusing on prevalence designs. A random-effects meta-analysis was used to pool the prevalence of falls across studies. Exploratory analysis was conducted examining subgroup estimates, prevalence ratios and meta-regression. Thirty-seven studies involving 58,597 participants were included. Twelve-month prevalence of falls was 27% (95%CI: 24.3-30.0), with significantly higher estimates in female than male (PR = 1.57; 95%CI: 1.32-1.86), in age group ≥ 80 years than age group 60-69 years (PR = 1.46; 95%CI: 1.15-1.84), and in participants from the Central region than participants from the South region (PR = 1.36; 95%CI: 1.10-1.69) of Brazil. Risk of bias scores did not impact heterogeneity in the 12-month meta-analysis. These estimates strongly support evidence-based public interventions to prevent falls in older Brazilians, especially in women and the oldest-old population.

As quedas em idosos resultam em uma enorme carga epidemiológica, clínica e econômica nesta faixa etária no mundo inteiro, com alto risco de incapacitação grave. O estudo teve como objetivo estimar a prevalência de quedas e fatores associados entre idosos brasileiros, através de uma revisão sistemática com meta-análise. Foram realizadas buscas nas bases de dados SciELO, PubMed, LILACS, Web of Science, Scopus e PsycINFO, sem restrição de idioma ou ano de publicação. Foram incluídos estudos sobre idosos de ambos os sexos com 60 anos ou mais, residindo na comunidade, com amostras de ≥ 300 participantes em cada estudo. Os critérios de exclusão foram estudos realizados especificamente em idosos diagnosticados com doenças crônicas incapacitantes que predispõem a quedas. O risco de viés dos estudos incluídos foi avaliado com uma ferramenta de avaliação crítica focada em desenhos de prevalência. Foi utilizada uma meta-análise de efeitos aleatórios para combinar as prevalências de quedas entre estudos. A análise exploratória foi realizada pela investigação das estimativas de subgrupos, razões de prevalência e meta-regressão. Foram incluídos 37 estudos, com um total de 58.597 participantes. A prevalência de quedas nos últimos 12 meses foi de 27% (IC95%: 24,3-30,0), com estimativas significativamente mais altas em mulheres (RP = 1,57; IC95%: 1,32-1,86), na faixa etária ≥ 80 anos comparado com 60-69 anos (RP = 1,46; IC95%: 1,15-1,84) e em idosos da Região Centro-oeste, comparado com os da Região Sul (RP = 1,36; IC95%: 1,10-1,69). O tamanho do risco de viés não impactou a heterogeneidade na meta-análise de 12 meses. Essas estimativas apoiam fortemente as intervenções públicas baseadas em evidências para prevenir quedas em idosos, especialmente nas mulheres e nos idosos mais velhos.

En todo el mundo, las caídas representan una carga grande epidemiológica, clínica, y económicamente en la población mayor, presentando altas tasas de discapacidad severa. El objetivo de este estudio fue estimar la prevalencia de las caídas y los factores asociados en ancianos brasileños, usando una revisión sistemática con metaanálisis. Las búsquedas se realizaron en bases de datos como: SciELO, PubMed, LILACS, Web of Science, Scopus y PsycINFO sin restricciones de fecha o lengua. Se incluyeron estudios sobre ancianos residentes en comunidades con una edad ≥ 60 años de ambos sexos y con un tamaño de la muestra de ≥ 300 participantes. Los criterios de exclusión fueron estudios dirigidos específicamente a adultos mayores, diagnosticados con enfermedades crónicas incapacitantes que les predisponen a caídas. El riesgo de sesgo en los estudios incluidos fue evaluado usando una herramienta de evaluación crítica, centrándose en los diseños de prevalencia. Se utilizó un metaanálisis de efectos aleatorios para agrupar la prevalencia de caídas a través de estos estudios. Se realizó un análisis exploratorio, examinando estimaciones de subgrupos, tasas de prevalencia y meta-regresión. Se incluyeron treinta y siete estudios, implicando a 58.597 participantes. En doce meses la prevalencia de caídas fue 27% (IC95%: 24,3-30,0), con estimaciones significativamente más altas en mujeres que en hombres (PR = 1,57; IC95%: 1,32-1,86), en el grupo de edad ≥ 80 años, en comparación con el grupo de edad de 60-69 años (PR = 1,46; IC95%: 1,15-1,84), y en participantes procedentes de la región centro-oeste, respecto a los participantes de la región sur (PR = 1,36; IC95%: 1,10-1,69) de Brasil. El riesgo de sesgo en los resultados no impactó la heterogeneidad en el metaanálisis de 12 meses. Estas estimaciones apoyan fuertemente las intervenciones públicas basadas en evidencias para prevenir caídas en ancianos brasileños, especialmente en mujeres y en la población más anciana.

Effects of scapular taping in young adults with shoulder pain and scapular dyskinesis.

OBJECTIVE: To assess the immediate effects of scapular taping on pain, isometric force, and the level of activation of several scapular girdle muscles in individuals with shoulder pain and scapular dyskinesis. MATERIALS AND METHODS: Ten individuals with shoulder pain during arm elevation and scapular dyskinesis were included and evaluated by using a visual analogue scale (VAS), pressure algometry, dynamometry, and surface electromyography. All assessments were performed before and immediately after the application of scapular taping. RESULTS: Scapular taping did not change the electromyographic activity of the upper trapezius muscle (p = 0.041, IC95%: -0.8256 to 10.8752). The positive effects of taping application were related to pain reduction (p = 0.025) and improvement in pressure algometry in the middle deltoid muscle (p = 0.020, IC95%:-1.8910 to -0.0490). Maximal isometric force did not change after the application of taping (flexo-abduction p = 0.4136, external rotation p = 0.4261). Significant correlations were noted between the VAS and pressure pain threshold (PPT) for the upper trapezius muscle (r = -0.6643, p = 0.0361) as well as for the PPT measures of the middle deltoid and infraspinatus muscles before (r = 0.9491, p = 0.0001) and after (r = 0.9006, p = 0.0004) the application of taping. CONCLUSION: Scapular taping was not effective for inducing changes in the electromyographic activity of the upper trapezius, lower trapezius, and serratus anterior muscles, nor in altering the isometric force of shoulder flexo-abduction and external rotation. However, taping was effective at improving the pressure algometry values of the middle deltoid. Significant correlations between the pressure algometry of the middle deltoid and infraspinatus muscles, both before and after the application of scapular taping, were noted.

Immediate electromyographic changes of the upper limb muscles following cervical manipulation in a patient with essential tremor: a case report / Alterações eletromiográficas imediatas dos músculos dos membros superiores após manipulação cervical em uma paciente com tremor essencial: estudo de caso

Introduction and Objective: The purpose of this case report is to evaluate upper limb muscle electric behavior by surface electromyography before and after cervical manipulation in a patient with essential tremor. Methods: In 2009, essential tremor was diagnosed by a neurologist in a 25-year-old woman. Previous treatment included Paroxetine for a number of months, without alteration of her symptoms. The patient was assessed by surface electromyography of the upper limb muscles (flexor and extensor of the wrist, long heads of biceps and triceps) before and after being subjected to high-velocity, low-amplitude spinal manipulation to her mid cervical spine (C3-C4 level, 1 manipulation/side). Results: There was an increase of the median frequency rate and a decrease of the electrical activity of these muscles. Conclusion: This case study showed the cervical manipulation technique acutely modifying the electromyographic activity, increasing the median frequency, and decreasing the muscle recruitment of the upper limb. It suggests improved motor control during the tasks.

Introdução e Objetivo: O objetivo neste estudo de caso foi avaliar o comportamento elétrico dos músculos do membro superior, por eletromiografia, antes e após manipulação cervical em paciente com tremor essencial. Métodos: Uma mulher (25 anos) apresentou-se com tremor essencial, diagnosticado em 2009 por neurologista. Foi empregado tratamento prévio com Paroxetina por meses, sem diminuição dos sintomas. A paciente foi avaliada por eletromiografia dos músculos dos membros superiores (flexores e extensores do punho, cabeça longa do bíceps e do tríceps) antes e após manipulação de alta velocidade e baixa amplitude na cervical média (nível C3-C4, 1 manipulação para cada lado). Resultados: Observou-se aumento na frequência mediana e diminuição na atividade elétrica dos músculos avaliados. Conclusão: A técnica de manipulação cervical modificou de forma imediata a atividade eletromiográfica, aumentando a frequência mediana e diminuindo o recrutamento dos músculos do membro superior para a paciente estudada, sugerindo melhor controle motor durante a atividade proposta.

The Pilates breathing technique increases the electromyographic amplitude level of the deep abdominal muscles in untrained people.

OBJECTIVE: To evaluate the behaviour of the upper rectus abdominis, lower rectus abdominis and transverse abdominis/internal oblique (TrA/IO) by using surface electromyography during trunk flexion with and without the Pilates breathing technique. METHODS: Nineteen female subjects (without experience of the Pilates method) were recruited. The muscles were evaluated while trunk flexion was performed by using the Pilates breathing technique (POW) and Step Barrel device, followed by another contraction without the technique (NORM). Normality was accepted, and the paired t-test was used to determine data differences (p < 0.05). RESULTS: Significant differences were noted in the amplitude level of activation between TrA/IO-POW and TrA/IO-NORM. The activation amplitude level of TrA/IO-POW significantly increased compared with all the other muscles under the NORM condition. CONCLUSION: The breathing technique of the Pilates method associated with trunk flexion increases TrA/IO electrical activity.

Immediate improvements in activation amplitude levels of the deep abdominal muscle following a sacroiliac joint manipulation during rapid upper limb movement.

OBJECTIVE: To assess the immediate effects on the electrical activity of the transversus abdominis/internal oblique (TrA/IO) muscle during rapid voluntary upper limb movements before and after a sacroiliac joint (SIJ) manipulation. METHODS: Twenty healthy subjects who had innominate fixation, assessed by standing flexion test, were recruited. All subjects were submitted to SIJ manipulation and the TrA/IO muscles were evaluated bilaterally, before and after the procedure, through surface electromyography while ten random rapid upper limb flexions or abductions were performed. Normality was accepted, and the paired t-test was used to determine data differences (p < 0.05). The correlations were calculated using Pearson correlation coefficient. RESULTS: All subjects presented an increase of SIJ mobility after manipulation (negative standing flexion test). Significant differences in muscle activation were noted to ipsi- and contralateral TrA/IO recruitment, prior to (A1) and after (A2) the manipulation. The A2 data were statistically greater than those in the A1. The Pearson coefficient revealed a strong correlation between the TrA/IO side and the increase in muscle activation amplitude level. Also, the data showed a moderate to strong correlation between this last variable and the moments of evaluation. CONCLUSION: The SIJ manipulation immediately improved the electrical activity of the TrA/IO muscle during rapid voluntary upper limb movements, suggesting improved segment stability and an increment to the afferent stimuli in order to affect the motor response.

Immediate electromyographic changes of the biceps brachii and upper rectus abdominis muscles due to the Pilates centring technique.

OBJECTIVE: To evaluate the electrical behaviour of the biceps brachii (BB) and upper rectus abdominis (URA) by surface electromyography (sEMG) during a forearm flexion with and without the Pilates centring technique. METHODS: Ten female subjects (with a minimum of one week of experience with the Pilates method) were recruited. The long head of the BB and URA were evaluated while an isotonic contraction of the BB was performed using the Pilates breathing technique and powerhouse contraction, followed by another contraction without these techniques. The data were normalised by a maximal voluntary isometric contraction. Normality was accepted, and the paired t-test was used to determine data differences (p < 0.05). RESULTS: The recruitment increased with the centring technique for both muscles, with greater activity during the concentric compared to the eccentric phase. In addition, this last phase, the centring activation was greater than without the Pilates technique. CONCLUSION: The Pilates method seems to influence the increase in BB activity during dynamic contraction, especially during the eccentric phase.

Características da dor no ombro após acidente vascular encefálico e perfil de pacientes de Diamantina/MG / Characteristics of shoulder pain after stroke and profile of patients of Diamantina/MG

O Acidente Vascular Encefálico (AVE) é considerado umproblema de saúde pública, podendo gerar sequelas permanentesque levam à limitação funcional e afastamento do trabalho. A dorno ombro é uma das complicações mais comuns após o AVE; temetiologia multifatorial e está associada à má qualidade de vida, piorprognóstico e hospitalização prolongada. O presente estudo teve porobjetivo geral traçar o perfil, com ênfase na dor no ombro após AVE,dos pacientes com este diagnóstico na cidade de Diamantina/MG. Osinstrumentos utilizados nos 52 pacientes estudados foram: formuláriosemiestruturado, contendo dados pessoais e referentes ao AVE; MiniExame do Estado Mental (Mini-Mental) e Escala Visual Analógica(EVA). Tais instrumentos foram selecionados por serem padrão ouronas suas áreas de investigação e por atenderem adequadamente aosobjetivos do trabalho. Testes ortopédicos foram selecionados para avaliaçãoespecífica de padrões no complexo articular do ombro. Comoresultado notou-se: Neer (38,5%); Rowe (17,3%); Speed (38,5%) eApreensão (9,6%), bem como significativa relação entre sensibilidadee EVA (p = 0,026). Observou-se uma maior prevalência de AVE empacientes do sexo masculino (51,9%), idade avançada (26,9%) ebaixa escolaridade (67,3%). A dor no ombro teve alta prevalência(61,5%) e correlação significativa com alteração de sensibilidade tátilno ombro comprometido (13,5%). Conclui-se que há a necessidadede implantação de medidas preventivas e de promoção da saúde comfoco no AVE, bem como intervenções precoces visando a prevençãoda dor no ombro advinda desta condição.

Stroke is considered an important public health problem andcan cause permanent sequelae that lead to functional limitationand absence from work. Shoulder pain is one of the most commoncomplications after stroke, has a multifactorial etiology and isassociated with poor quality of life, poor prognosis and prolongedhospitalization. This study aimed to profile, with emphasis inshoulder pain after stroke, patients with this diagnosis in the city ofDiamantina/MG. The sample consisted of 52 patients. The instrumentsused were semi-structured form with personal data relating tostroke, Mini Mental State Examination (Mini-Mental) and VisualAnalogue Scale (VAS). The orthopedic tests that were positive were:Neer (38.5%); Rowe (17.3%); Speed (38.5%) and Apprehension(9.6%), and significant relationship between sensitivity and VAS (p= 0.026). There was a higher prevalence of stroke in males (51.9%),elderly (26.9%) and low education (67.3%). Shoulder pain hadhigh prevalence (61.5%) and significant correlation with changesin tactile sensitivity shoulder compromised (13.5%). We concludedthat there is a need for preventive measures and health promotionfocused on stroke as well as early interventions aimed at preventionof shoulder pain arising from this condition.

A leucine-rich diet and exercise affect the biomechanical characteristics of the digital flexor tendon in rats after nutritional recovery.

An increase in the capacity of athletic performance depends on adequate nutrition, which ensures optimal function of the musculoskeletal system, including tendon stability. However, little is known about the status of tendons and extracellular matrix modifications during malnutrition and nutritional recovery when leucine is used in response to exercise conditioning. The purpose of this study was to evaluate the collagen content and biomechanical aspects of the deep digital flexor tendon (DDFT) in malnourished rats submitted to nutritional recovery (control diet or leucine-rich diet) and aerobic physical activity. After 60 days of undernourishment (6% protein diet), the malnourished rats were subsequently nutritionally recovered with a control diet or leucine-rich diet and trained or not (swimming, without overload) for 5 weeks. The biomechanical analysis and quantification of hydroxyproline were assessed in the DDFT in all experimental groups. The leucine-rich diet increased hydroxyproline content in the tension region, independently of the training. In the compression region, hydroxyproline content was higher in the malnourished and leucine-trained groups. Biomechanical analysis showed a lower load in the malnourished and all-trained groups. The lowest stress was observed with control-trained animals. The nutritional-recovered groups showed higher strain values corresponding to control group, while the lowest values were observed in malnourished and trained groups. The results suggest that a leucine-rich diet stimulates collagen synthesis of the DDFT, especially when in combination with physical exercise, and seems to determine the increase of resistance and the biomechanical characteristics of tendons.

Efeito agudo do exercício resistido em diferentes intensidades nos níveis pressóricos de hipertensos do programa saúde da família / Acute effect of resisted exercise in different intensities on pressoric levels of hypertense patients from family health program

Introdução: A prevenção primária e o tratamento da hipertensão arterial sistêmica podem ser realizados parcialmente pela execução de exercícios físicos. Exercícios resistidos (ER) em hipertensos apontam para melhora das variáveis hemodinâmicas. Objetivo: Neste estudo, objetivamos verificar o efeito agudo do ER em diferentes intensidades nos níveis pressóricos de hipertensos. Método: Hipertensos controlados com medicação anti-hipertensiva foram submetidos ao ER (GE 50% e GE 75% - exercícios a 50% e 75% de 1 repetição máxima, respectivamente) tendo um grupo controle (GC), sem atividade. Foi aferida a pressão arterial (PA) Pré-Teste e 10 minutos pós-término dos exercícios. A aferição continuou por 30 minutos após a realização dos testes. Resultados: Observamos elevação na PA sistólica e diastólica, do repouso para pós-exercício nos GC e GE 50%, e na PA sistólica no GE 75%. No GC a sistólica diminuiu enquanto a diastólica se manteve; no GE 50% e no GE 75%, ambas diminuíram, comparando pós-exercício imediato e 30 minutos após. Conclusão: Os efeitos agudos apontam que hipertensos leves e moderados podem ter resultados que, se associados a mudanças adequadas no estilo de vida, tornam menos necessária a terapia medicamentosa.

Introduction: The primary prevention and treatment to systemic arterial hypertension can be carried through partially by the execution of physical exercises. Resisted exercises (ER) in hyper tense patient improve the hemodynamic variables. Objective: At this study, we aim to verify the acute effect of the ER in different intensities in the pressure levels of hyper tense patient. Method: Controlled hyper tense with anti-hypertensive medication had been submitted to the ER (GE 50%and GE 75% - exercises 50% and 75% of 1 maximum repetition, respectively) having a controlled group (GC), withoutactivity. We observed the arterial pressure (PA) pre-test and 10 minutes after-ending of the exercises. The gauging continued per 30 minutes after the accomplishment of the tests. Results: We observed a rise in systolic and diastolic PA, from the beginning to immediately after-exercise moment in GC and GE 50%, and in the systolic PA in GE 75%. The systolic diminished at GC while the diastolic was maintained. In GE 50% and GE 75% both had diminished comparing immediate after-exercise and 30 minutes after. Conclusion: The acute effect suggests that light and moderate hypertense patient, in association with adjusts at life style may have results, becoming less necessary drug therapy.

Efeito do exercício aeróbico nos níveis pressóricos em idosos hipertensos do programa saúde da família / Effect of aerobic exercise on pressoric levels of hypertense patients of family health program

Introdução: A pressão arterial é produto do débito cardíaco pela resistência vascular periférica. A elevação de um ou ambos ocasiona hipertensão arterial sistêmica (HAS), sendo fator de risco para doenças cardiovasculares, principalmente em idosos. O exercício físico parece ser estratégico na redução dos níveis tensionais em hipertensos. Objetivo: Nosso objetivo foi verificar o efeito do treinamento aeróbico em hipertensos participantes do PSF-AP. Método: Dois grupos foram selecionados: Grupo Experimental (GTA) que realizou atividade física aeróbica e Grupo Controle (GC) que não realizou nenhuma atividade; o GTA era composto por 17 idosos com média de idade 66,9±7,5 e peso 64,3±5,4, o GC também possuía 17 idosos com média de idade 61,2±8,2 e peso 64.1±8,1, portadores de HAS e em uso de anti-hipertensivos. O grupo GTA foi submetido a um tratamento 3 vezes na semana por 10 semanas, com duração de 25 minutos cada sessão. A pressão arterial foi aferida ao início e ao final de cada sessão e após 10 minutos do término. Resultados: Os resultados para o GTA foram estatisticamente significativos no que diz respeito ao efeito agudo, obtendo redução da pressão arterial pós-teste (PAS 131,3±11,1 e PAD 86, 9±13,2) quando comparado à medida pré-teste (PAS 140,2±20,9 PAD 88,1±7,5). Na aferição tardia, tanto o GTA como o GC obtiveram resultados significantes. Conclusão: O protocolo reduziu os níveis pressóricos de hipertensos na amostra estudada. Sugerimos que esta medida seja adotada como parte do tratamento não-farmacológico.

Introduction: Arterial pressure is product of cardiac debit and peripheral vascular resistance. The rise of one or both causes arterial hypertension, being a factor of risk for cardiovascular diseases mainly in elderly people. The physical exercise seems to be a strategy for the reduction of the tensional levels in hypertense population. Objective: Ourobjective was to verify the effect of the aerobic training in hypertenses participants of PSF-AP. Method: Two groups were selected: Experimental group (GTA) which underwent aerobic physical activity and Control group (GC) who did not perform any activity; there were 17 subjects in the GTA, with a mean age of 66,9±7,5 years-old and mean weight of 64.3±5,4 kg and also 17 subjects in the GC, with a mean age of 61,2±8,2 years-old and mean weight of 64.1±8,1 kg, with arterial hypertension and in use of antihypertensive. The GTA group underwent a treatment program 3 times per week for 10 weeks with 25 minutes each session. The arterial pressure was measured at the beginning and at the endof each session and after 10 minutes of the end. Results: The results for GTA had been statistical significant regardingto the acute effect, obtaining a reduction of the post-test blood pressure (SBP 131,3±11,1 and DBP 86, 9±13,2) whencompared to the pre-test blood pressure (SBP 40,2±20,9 DBP 88,1±7,5). In the delayed measurement GTA and GCgroups obtained significant results. Conclusion: The protocol reduced the pressure levels of hypertense subjects in the studied sample. We suggest that this measure can be adopted as part of the non-pharmacologic treatment.