Uso de Tai Chi para la salud del adulto mayor: revisión bibliográfica / Use of Tai Chi for the health of the elderly: A bibliographic review / Uso do Tai Chi para a saúde de idosos: uma revisão bibliográfica

RESUMEN Introducción: La población de adultos mayores está incrementando y se observa la necesidad emergente de implementar estrategias dirigidas a recuperar o conservar su salud para que puedan gozar de una vejez plena. Técnicas como el Tai Chi podrían contribuir, ya que han mostrado tener múltiples beneficios para quien la práctica, tales como mejoras en la concentración, memoria, marcha, equilibrio, reducción del riesgo de caídas, fortalecimiento del sistema cardiovascular, reducción del estrés y la depresión, entre otros beneficios. Objetivo: Analizar la evidencia científica del uso del Tai Chi para conservar la salud del adulto mayor. Desarrollo: Revisión bibliográfica realizada durante el periodo 2013-2019 en distintas bases de datos como: Pubmed, Dialnet, SciELO, LILACS, ScienceDirect y Google Académico. Se utilizaron las palabras Tai Chi Chuan, Tai Ji Quan, Tai Chi. Aplicando los criterios de elegibilidad se seleccionaron 29 artículos. Resultados: Gran porcentaje de los artículos revisados estudian la atención de síntomas físicos que deterioran la movilidad del adulto mayor, sin embargo, también se encontraron investigaciones dirigidas a la parte psicológica, como el estrés, la ansiedad, el insomnio, la depresión y el enfado-tensión, en las cuales la práctica del Tai Chi demostró mejoría. Conclusiones: El Tai Chi es una terapia alternativa para prevenir y conservar la salud del adulto mayor, fácil de aprender y de bajo costo. En la revisión bibliográfica realizada no se reportan reacciones adversas durante ni después de la práctica de la técnica; el profesional de enfermería puede recomendarla ampliamente para ser implementada como un cuidado dirigido al adulto mayor.

ABSTRACT Introduction: The population of older adults is increasing and an emergent need to implement strategies aimed at recovering or maintaining their health is observed. In this sense, techniques such as Tai Chi could contribute because they have demonstrated bringing diverse benefits for those who practice them, including improvements in the concentration, memory, gait, and equilibrium, a reduction in the risk of falls, a strengthening of the cardiovascular system, and a reduction of stress and depression, among other benefits. Objective: To analyze the scientific evidence on the use of Tai Chi as a health promoter and preserver among older adults. Development: This bibliographic review was conducted during 2013-2019 on the Pubmed, Dialnet, SciELO, LILACS, ScienceDirect and Academic Google databases. The keywords used were Tai Chi Chuan, Tai Ji Quan, and Tai Chi. After filtering through the eligibility criteria, 29 articles were selected for the review. Results: An important percentage of the articles were focused on the attention to physical symptoms which impair the mobility of older adults; nevertheless, some studies addressed psychological issues such as stress, anxiety, sleep disorders, depression, and anger-tension, as well. In these studies, the practice of Tai Chi was associated with health improvements among older adults. Conclusions: Tai Chi is an alternative therapy to promote and maintain health among older adults. This technique is easy to learn, and its practice is not expensive. No adverse reactions during or after the practice of this technique were reported in the studies of this literature review. Therefore, the nursing professional can recommend Tai Chi practice to be implemented as a complementary healthcare measure for older adults.

RESUMO Introdução: A população de idosos está aumentando e observa-se a necessidade emergente de implementação de estratégias que visem a recuperação ou preservação da saúde para que possam desfrutar de uma velhice plena. Técnicas como o Tai Chi podem contribuir, dado que têm se mostrado múltiplos benefícios para quem o pratica, tais como melhora na concentração, memória, marcha, equilíbrio, redução do risco de quedas, fortalecimento do sistema cardiovascular, redução de estresse e depressão, entre outros benefícios. Objetivo: Analisar a evidência científica do uso do Tai Chi na preservação da saúde de idosos. Desenvolvimento: Revisão bibliográfica realizada no período 2013-2019 em diferentes bases de dados como: Pubmed, Dialnet, SciELO, LILACS, ScienceDirect e Google Academic. Foram utilizadas as palavras Tai Chi Chuan, Tai Ji Quan, Tai Chi. Aplicando os critérios de elegibilidade, foram selecionados 29 artigos. Resultados: Grande porcentagem dos artigos revisados estuda a atenção aos sintomas físicos que prejudicam a mobilidade do idoso, porém, as pesquisas também foram direcionadas à parte psicológica, como estresse, ansiedade, insônia, depressão e raiva-tensão, em que a prática do Tai Chi demonstrou melhora. Conclusões: O Tai Chi é uma terapia alternativa para prevenir e preservar a saúde do idoso, de fácil aprendizado e de baixo custo. Na revisão bibliográfica realizada, não foram relatadas reações adversas durante ou após a prática da técnica; o profissional de enfermagem pode recomendar veementemente que seja implementada como cuidado ao idoso.

Cura húmeda de úlceras por presión. Atención en el ámbito domiciliar / Pressure ulcers humid healing: Attention within the home environment / Cura húmida de ulceras por pressão. Atenção no âmbito domiciliar

La necesidad de trabajar en el domicilio el tratamiento y prevención de las úlceras por presión (UPP) mediante sesiones basadas en cura húmeda es trascendente para la eversión y cicatrización en menor tiempo. Objetivo: Evaluar la eficacia del tratamiento de la cura húmeda en pacientes con UPP en un ambiente domiciliario. Método: Se realizó una intervención clínica con la técnica de cura húmeda en 11 UPP de 4 pacientes egresados del hospital con su problema de salud resuelto, pero no así las UPP observadas en puntos de presión, con lesiones grado II (n = 6) y grado III (n = 5). Se realizaron 12 curaciones, cada 72 h, en los domicilios de las personas. Se midió la severidad y su reversión con el instrumento Pressure Ulcers Scale for Healing (PUSH). Este instrumento tiene un alfa de Cronbach de 0.823. Resultados: Se curaron 9 UPP de 11; todas las de grado II (n = 6), mientras que de las de grado III se curaron 3 (n = 5). La cicatrización se dio en un lapso de 4 semanas, inferior a la cura tradicional que demora 2 veces más el tiempo de cicatrización. Conclusión: En el ámbito domiciliario, la cura húmeda fue eficaz para revertir las UPP de pacientes que las habían desarrollado durante su hospitalización y que egresaron sin tratamiento para ellas. La intervención se convierte en una opción para mejorar la calidad de vida de las personas y un medio que las instituciones de salud pueden poner en práctica.

The need to carry out prevention and treatment of pressure ulcers (PU) within the home environment by means of humid healing sessions is very important for the prompt eversion and cicatrization of the wounds. Objective: To assess the efficacy of the humid healing in patients with PU within the home environment. Method: A clinical intervention was performed using the humid healing technique on 11 PU in 4 discharged patients showing degree II lesions (n = 6), and degree III lesions (n = 5). Twelve healings every 72 h were carried out at the homes of these patients. The ulcers severity and progress were estimated using the Pressure Ulcers Scale for Healing (PUSH) instrument, which has a Cronbach alfa of 0.823. Results: Nine PU out of the total 11 healed-all degree II (n = 6) and 3 degree III (n = 5). The cicatrization process only took 4 weeks, a time which is much shorter than the usual 8 weeks which take the traditional healing. Conclusion: Within the home environment, humid healing was an effective method to address PU in patients previously discharged from hospitals. This kind of interventions represents an option which health institutions can promote in order to improve the quality of life of these patients.

A necessidade de trabalhar na residência o tratamento e prevenção das Ulceras por pressão (UPP) mediante sessões baseadas em cura húmida, é transcendente para a eversão e cicatrização em menor tempo. Objetivo: Avaliar a eficácia do tratamento da cura húmida em pacientes com UPP em um ambiente domiciliar. Método: Realizou-se uma intervenção clínica com a técnica de cura húmida em 11 UPP de quatro pacientes formados do hospital com seu problema de saúde resolvido, mas não assim as UPP observadas em pontos de pressão, com lesões grau II (n = 6) e III (n = 5). Realizaram-se 12 curas, cada 72 h nas residências das pessoas. Mediu-se a severidade e sua reversão com o instrumento Pressure Ulcers Scale for Healing (PUSH). Este instrumento tem um alfa de Cronbach de 0.80. Resultados: Foram curadas 9 UPP de 11, todas as de grau II (n = 6), enquanto que as de grau III, 3 (n = 5). A cicatrização deu-se em um lapso de 4 semanas, inferior à cura tradicional que demora duas vezes mais o tempo de cicatrização. Conclusão: No âmbito domiciliar, a cura húmida foi eficaz para reverter as UPP de pacientes que as tinham desenvolvido durante sua hospitalização e que se formaram sem tratamento para elas. A intervenção se tornou em una opção para melhorar a qualidade de vida das pessoas e um médio que as instituições de saúde podem pôr em prática.

Efecto de la tibolona en la densidad de las espinas dendríticas en el hipocampo de la rata / Effect of tibolone on dendritic spine density in the rat hippocampus

Introducción: El hipoestrogenismo produce estrés oxidativo (EO) y cambios en las neuronas del hipocampo (H) y reduce la densidad de las espinas dendríticas (ED). Estas alteraciones repercuten en la respuesta plástica del H. La terapia de sustitución intraperitoneal con estrógenos revierte estos efectos, pero no se sabe si ocurre lo mismo con la tibolona (TB). El objetivo fue comprobar los efectos neuroprotectivos de la TB administrada por vía oral a largo plazo y su capacidad para revertir la poda de ED de las neuronas piramidales (NP) del CA1 del H. Métodos: Ratas Sprague Dawley jóvenes: distribuidas en 3 grupos: control en proestro (Pro) y 2 grupos ovariectomizados (Ovx), uno suplementado con dosis diaria de TB (1 mg/kg), OvxTB, y otro con vehículo (OvxV), por 40 días. Se analizaron la peroxidación de lípidos y la densidad de las ED en 3 segmentos de la dendrita apical de las NP del CA1 del H. Resultados: La TB no redujo la peroxidación de lípidos en el H, pero recuperó la poda de espinas en las NP del CA1 del H, producida por la ovariectomía. Conclusiones: La terapia de sustitución estrogénica en el hipoestrogenismo por ovariectomía tiene un efecto protector

Introduction: Oestrogen deficiency produces oxidative stress (OS) and changes in hippocampal neurons and also reduces the density of dendritic spines (DS). These alterations affect the plastic response of the hippocampus. Oestrogen replacement therapy reverses these effects, but it remains to be seen whether the same changes are produced by tibolone (TB). The aim of this study was to test the neuroprotective effects of long-term oral TB treatment and its ability to reverse DS pruning in pyramidal neurons (PN) of hippocampal area CA1. Methods: Young Sprague Dawley rats were distributed in 3 groups: a control group in proestrus (Pro) and two ovariectomised groups (Ovx), of which one was provided with a daily TB dose (1 mg/kg), OvxTB and the other with vehicle (OvxV), for 40 days in both cases. We analysed lipid peroxidation and DS density in 3 segments of apical dendrites from PNs in hippocampal area CA1. Results: TB did not reduce lipid peroxidation but it did reverse the spine pruning in CA1 pyramidal neurons of the hippocampus which had been caused by ovariectomy. Conclusions: Oestrogen replacement therapy for ovariectomy-induced oestrogen deficiency has a protective effect on synaptic plasticity in the hippocampus

Efectos de la morfina en la plasticidad cerebral / Effects of morphine on brain plasticity

Introducción: La morfina, como otros opiáceos y las drogas de abuso, tiene la capacidad de modificar la plasticidad cerebral de las áreas que regulan la morfología neuronal de las dendritas y espinas, que son el sitio primario de sinapsis excitatorias en regiones cerebrales que regulan funciones de incentivo motivación, recompensa y aprendizaje. Objetivo: En la presente revisión se analizan aspectos del impacto del uso de la morfina durante los periodos prenatales del desarrollo cerebral y las consecuencias a largo plazo en murinos, para relacionar estos efectos que ocurren en el humano neonato y adulto. Desarrollo: La exposición repetida a la morfina en el tratamiento del dolor en enfermos terminales produce cambios a largo plazo en la densidad postsináptica de sitios (dendritas y espinas) en áreas sensibles del cerebro, como la corteza prefrontal y el sistema límbico (hipocampo, amígdala), así como en los núcleos caudado y accumbens. Este artículo revisa los mecanismos celulares implicados, principalmente de los receptores dopaminérgicos y glutamatérgicos, así como la plasticidad sináptica lograda por los cambios en las dendritas y espinas en esta área. Conclusiones: Las acciones de la morfina durante el desarrollo del cerebro y también en el cerebro adulto producen alteraciones en la plasticidad de sitios excitatorios postsinápticos, áreas del cerebro que están implicadas en las funciones del sistema límbico (la recompensa y el aprendizaje). Se necesitan más estudios sobre la plasticidad en las dendritas y espinas en sus moléculas de señalización, tales como el calcio, con el fin de mejorar el tratamiento de la adicción

Introduction: Morphine shares with other opiates and drugs of abuse the ability to modify the plasticity of brain areas that regulate the morphology of dendrites and spines, which are the primary sites of excitatory synapses in regions of the brain involved in incentive motivation, rewards, and learning. Objective: In this review we discuss the impact of morphine use during the prenatal period of brain development and its long-term consequences in murines, and then link those consequences to similar effects occurring in human neonates and adults. Development: Repeated exposure to morphine as treatment for pain in terminally ill patients produces long-term changes in the density of postsynaptic sites (dendrites and spines) in sensitive areas of the brain, such as the prefrontal cortex, the limbic system (hippocampus, amygdala), and caudate nuclei and nucleus accumbens. This article reviews the cellular mechanisms and receptors involved, primarily dopaminergic and glutamatergic receptors, as well as synaptic plasticity brought about by changes in dendritic spines in these areas. Conclusions: The actions of morphine on both developing and adult brains produce alterations in the plasticity of excitatory postsynaptic sites of the brain areas involved in limbic system functions (reward and learning). Doctors need further studies on plasticity in dendrites and spines and on signaling molecules, such as calcium, in order to improve treatments for addiction

Effects of morphine on brain plasticity.

INTRODUCTION: Morphine shares with other opiates and drugs of abuse the ability to modify the plasticity of brain areas that regulate the morphology of dendrites and spines, which are the primary sites of excitatory synapses in regions of the brain involved in incentive motivation, rewards, and learning. OBJECTIVE: In this review we discuss the impact of morphine use during the prenatal period of brain development and its long-term consequences in murines, and then link those consequences to similar effects occurring in human neonates and adults. DEVELOPMENT: Repeated exposure to morphine as treatment for pain in terminally ill patients produces long-term changes in the density of postsynaptic sites (dendrites and spines) in sensitive areas of the brain, such as the prefrontal cortex, the limbic system (hippocampus, amygdala), and caudate nuclei and nucleus accumbens. This article reviews the cellular mechanisms and receptors involved, primarily dopaminergic and glutamatergic receptors, as well as synaptic plasticity brought about by changes in dendritic spines in these areas. CONCLUSIONS: The actions of morphine on both developing and adult brains produce alterations in the plasticity of excitatory postsynaptic sites of the brain areas involved in limbic system functions (reward and learning). Doctors need further studies on plasticity in dendrites and spines and on signaling molecules, such as calcium, in order to improve treatments for addiction.

Effect of tibolone on dendritic spine density in the rat hippocampus.

INTRODUCTION: Oestrogen deficiency produces oxidative stress (OS) and changes in hippocampal neurons and also reduces the density of dendritic spines (DS). These alterations affect the plastic response of the hippocampus. Oestrogen replacement therapy reverses these effects, but it remains to be seen whether the same changes are produced by tibolone (TB). The aim of this study was to test the neuroprotective effects of long-term oral TB treatment and its ability to reverse DS pruning in pyramidal neurons (PN) of hippocampal area CA1. METHODS: Young Sprague Dawley rats were distributed in 3 groups: a control group in proestrus (Pro) and two ovariectomised groups (Ovx), of which one was provided with a daily TB dose (1mg/kg), OvxTB and the other with vehicle (OvxV), for 40 days in both cases. We analysed lipid peroxidation and DS density in 3 segments of apical dendrites from PNs in hippocampal area CA1. RESULTS: TB did not reduce lipid peroxidation but it did reverse the spine pruning in CA1 pyramidal neurons of the hippocampus which had been caused by ovariectomy. CONCLUSIONS: Oestrogen replacement therapy for ovariectomy-induced oestrogen deficiency has a protective effect on synaptic plasticity in the hippocampus.

Deficits in odor-guided behaviors in the transgenic 3xTg-AD female mouse model of Alzheimer׳s disease.

Alzheimer׳s disease (AD) is characterized by a number of alterations including those in cognition and olfaction. An early symptom of AD is decreased olfactory ability, which may affect odor-guided behaviors. To test this possibility we evaluated alterations in sexual incentive motivation, sexual olfactory preference, sexual olfactory discrimination, nursing-relevant olfactory preference and olfactory discrimination in female mice. We tested 3xTg-AD (a triple transgenic model, which is a "knock in" of PS1M146V, APPSwe, and tauP300L) and wild type (WT) female mice when receptive (estrous) and non-receptive (anestrous). Subjects were divided into three groups of different ages: (1) 4-5 months, (2) 10-11 months, and (3) 16-18 months. In the sexual incentive motivation task, the receptive 3xTg-AD females showed no preference for a sexually active male at any age studied, in contrast to the WT females. In the sexual olfactory preference test, the receptive WT females were able to identify sexually active male secretions at all ages, but the oldest (16-18 months old) 3xTg-AD females could not. In addition, the oldest 3xTg-AD females showed no preference for nursing-relevant odors in dam secretions and were unable to discriminate between cinnamon and strawberry odors, indicating olfactory alterations. Thus, the present study suggests that the olfactory deficits in this mouse model are associated with changes in sexual incentive motivation and discrimination of food-related odors.

Effect of 17ß-estradiol on zinc content of hippocampal mossy fibers in ovariectomized adult rats.

Sex hormones such as estrogen (17ß-estradiol) may modulate the zinc content of the hippocampus during the female estrous cycle. The mossy fiber system is highly plastic in the adult brain and is influenced by multiple factors including learning, memory, and stress. However, whether 17ß-estradiol is able to modulate the morphological plasticity of the mossy fibers throughout the estrous cycle remains unknown. Ovariectomized (Ovx) female 70- to 90-day-old Sprague-Dawley rats without or with estrogen supplement (OvxE) were compared with control rats in three stages of the estrous cycle: diestrus, proestrus, and estrus. The brain tissue from each of the five groups was processed with Timm's silver sulfide technique using the Image J program to measure the mossy fiber area in the stratum lucidum of CA3. Total zinc in the hippocampus was measured using Graphite Furnace Atomic Absorption Spectrophotometry. Two additional (Ovx and OvxE) groups were examined in spatial learning and memory tasks using the Morris water maze. Similar increases in total zinc content and mossy fiber area were observed. The mossy fiber area decreased by 26 ± 2 % (difference ± SEM percentages) in Ovx and 23 ± 4 % in estrus as compared to the proestrus group and by 18 ± 2 % in Ovx compared to OvxE. Additionally, only the OvxE group learned and remembered the task. These results suggest that estradiol has a significant effect on zinc content in hippocampal CA3 during the proestrus stage of the estrous cycle and is associated with correct performance in learning and memory.

Increase of mushroom spine density in CA1 apical dendrites produced by water maze training is prevented by ovariectomy.

Dendritic spine density increases after spatial learning in hippocampal CA1 pyramidal neurons. Gonadal activity also regulates spine density, and abnormally low levels of circulating estrogens are associated with deficits in hippocampus-dependent tasks. To determine if gonadal activity influences behaviorally induced structural changes in CA1, we performed a morphometric analysis on rapid Golgi-stained tissue from ovariectomized (Ovx) and sham-operated (Sham) female rats 7 days after they were given a single water maze (WM) training session (hidden platform procedure) or a swimming session in the tank containing no platform (SC). We evaluated the density of different dendritic spine types (stubby, thin, and mushroom) in three segments (distal, medial, and proximal) of the principal apical dendrite from hippocampal CA1 pyramidal neurons. Performance in the WM task was impaired in Ovx animals compared to Sham controls. Total spine density increased after WM in Sham animals in the proximal and distal CA1 apical dendrite segments but not in the medial. Interestingly, mushroom spine density consistently increased in all CA1 segments after WM. As compared to the Sham group, SC-Ovx rats showed spine pruning in all the segments, but mushroom spine density did not change significantly. In Ovx rats, WM training increased the density of stubby and thin, but not mushroom spines. Thus, ovariectomy alone produces spine pruning, while spatial learning increases spine density in spite of ovariectomy. Finally, the results suggest that mushroom spine production in CA1 after spatial learning requires gonadal activity, whereas this activity is not required for mushroom spine maintenance.