Do virtual reality games improve mobility skills and balance measurements in community-dwelling older adults? Systematic review and meta-analysis.

OBJECTIVE: To summarize evidence on the effectiveness of virtual reality games and conventional therapy or no-intervention for fall prevention in the elderly. DATA SOURCES: An electronic data search (last searched December 2016) was performed on 10 databases (Web of Science, EMBASE, PUBMED, CINAHL, LILACS, SPORTDiscus, Cochrane Library, Scopus, SciELO, PEDro) and retained only randomized controlled trials. REVIEW METHOD: Sample characteristics and intervention parameters were compared, focusing on clinical homogeneity of demographic characteristics, type/duration of interventions, outcomes (balance, reaction time, mobility, lower limb strength and fear of falling) and low risk of bias. Based on homogeneity, a meta-analysis was considered. Two independent reviewers assessed the risk of bias. RESULTS: A total of 28 studies met the inclusion criteria and were appraised ( n: 1121 elderly participants). We found that virtual reality games presented positive effects on balance and fear of falling compared with no-intervention. Virtual reality games were also superior to conventional interventions for balance improvements and fear of falling. The six studies included in the meta-analysis demonstrated that virtual reality games significantly improved mobility and balance after 3-6 and 8-12 weeks of intervention when compared with no-intervention. The risk of bias revealed that less than one-third of the studies correctly described the random sequence generation and allocation concealment procedures. CONCLUSION: Our review suggests positive clinical effects of virtual reality games for balance and mobility improvements compared with no-treatment and conventional interventions. However, owing to the high risk of bias and large variability of intervention protocols, the evidence remains inconclusive and further research is warranted.

Body Composition is Strongly Associated With Cardiorespiratory Fitness in a Large Brazilian Military Firefighter Cohort: The Brazilian Firefighters Study.

Firefighting is associated with high-level physical demands and requires appropriate physical fitness. Considering that obesity has been correlated with decreased cardiorespiratory fitness (CRF) and that the prevalence of obesity may also be elevated within firefighters (FF), we analyzed the association between CRF and body composition (BC) in Brazilian military FF. We assessed 4,237 male FF (18-49 years) who performed a physical fitness test that included BC and CRF. Body composition was assessed by body mass index (BMI), body adiposity index (BAI), body fat percentage (BF%), and waist circumference (WC). CRF was assessed by the 12-minute Cooper test. Comparisons of VO2max between the BC categories were analyzed using the Mann-Whitney test, and the analysis was adjusted for age using the General Linear Model. The Spearman test was used for correlation analysis and the odds ratio (OR) was calculated to assess the odds of the unfit group (≤ 12 metabolic equivalents [METs]) for poor BC. Statistically significant differences were considered when p ≤ 0.05. Considering the BMI categories, 8 volunteers (0.2%) were underweight, 1,306 (30.8%) were normal weight, 2,301 (54.3%) were overweight, and 622 (14.7%) were obese. The VO2max was negatively correlated with age (rs = -0.21), BMI (rs = -0.45), WC (rs = -0.50), and BAI (rs = -0.35) (p < 0.001). Cardiorespiratory fitness was lower in the obese compared with the nonobese for all age categories (-3.8 ml · kg(-1) · min(-1); p < 0.001) and for all BC indices (-4.5 ml · kg(-1) · min(-1); p < 0.001). The OR of the unfit group having poor BC in all indices varied from 2.9 to 8.1 (p < 0.001). Despite the metabolically healthy obesity phenomenon, we found a strong association between CRF and BC irrespective of age and the BC method (BMI, BAI, WC, or BF%). These findings may aid in improving FF training programs with a focus on health and performance.

Acute and chronic effects of resistive exercise on blood pressure in hypertensive elderly women.

The purpose of this study was to investigate postexercise hypotension (PEH) during a 4-month period of resistance training in hypertensive elderly women. Sixty-four women were divided into 2 groups: an experimental group (EG), which performed resistance training, and a control group (CG) that did not practice any exercise. The EG carried out the following steps: (a) 3 weeks of exercise adaptation and 1 repetition maximum (1RM) test (month 1); (b) resistance exercise at 60% 1RM (month 2); (c) resistance exercise at 70% 1RM (month 3); (d) resistance exercise at 80% 1RM (month 4); and (e) PEH analyses at the end of each month. Measurements of systolic (SBP) and diastolic blood pressure (DBP) were calculated each 5 minutes during a 20-minute resting period before the sessions and each 15 minutes during 1 hour of post-session recovery. Analysis of covariance for repeated measures showed a reduction in SBP of about 14 mm Hg (p ≤ 0.05) and in DBP of 3.6 mm Hg (p ≤ 0.05) between resting values after the training period. In the EG group, SBP showed acute PEH during months 2 and 3, whereas DBP showed acute PEH during months 2 and 4. The CG did not show acute PEH or variations during the 4-month period. Postexercise hypotension occurrence and chronic reduction of resting blood pressure observed in the EG may have a protective effect on the cardiovascular system of the study participants.

Effects of a physical activity governmental health programme on the quality of life of elderly people.

BACKGROUND: The population ageing occurring worldwide resulted in multiple researches on sedentary ageing and quality of life. PURPOSE: To verify the effects of a physical activity programme on the quality of life (QOL) of elderly individuals served by a governmental health programme. DESIGN: Descriptive inquiry research. METHODS: Randomly distributing 70 elderly individuals in a control group (n=35; mean±SD 69.80±8.05 years) and an experimental group (n=35; 68.66±5.93 years) plus QOL evaluation via WHOQOL-Old. RESULTS: The experimental group showed significant best results on the post-test by repeated-measures ANOVA on sensorial functioning (Δ%=0.022%, p=0. 0001), social participation (Δ%=0.012%, p=0.013), perceptions of death and dying (Δ%=0.04%, p=0.009), intimacy (Δ%=0.059%, p=0.05), and total score (Δ%=0.001, p=0.000). CONCLUSIONS: Sensorial functioning, social participation, perceptions of death and dying, and intimacy play an important role in the positive relationship between physical activity and QOL.

The influence of the level of physical activity and human development in the quality of life in survivors of stroke.

BACKGROUND: The association between physical activity and quality of life in stroke survivors has not been analyzed within a framework related to the human development index. This study aimed to identify differences in physical activity level and in the quality of life of stroke survivors in two cities differing in economic aspects of the human development index. METHODS: Two groups of subjects who had suffered a stroke at least a year prior to testing and showed hemiplegia or hemiparesis were studied: a group from Belo Horizonte (BH) with 48 people (51.5 ± 8.7 years) and one from Montes Claros (MC) with 29 subjects (55.4 ± 8.1 years). Subsequently, regardless of location, the groups were divided into Active and Insufficiently Active so their difference in terms of quality of life could be analyzed. RESULTS: There were no significant differences between BH and MCG when it came to four dimensions of physical health that were evaluated (physical functioning, physical aspect, pain and health status) or in the following four dimensions of mental health status (vitality, social aspect, emotional aspect and mental health). However, significantly higher mean values were found in Active when compared with Insufficiently Active individuals in various measures of physical health (physical functioning 56.2 ± 4.4 vs. 47.4 ± 6.9; physical aspect 66.5 ± 6.5 vs. 59.1 ± 6.7; pain 55.9 ± 6.2 vs. 47.7 ± 6.0; health status 67.2 ± 4.2 vs. 56.6 ± 7.8) (arbitrary units), and mental health (vitality 60.9 ± 6.8 vs. 54.1 ± 7.2; social aspect 60.4 ± 7.1 vs. 54.2 ± 7.4; emotional aspect 64.0 ± 5.5 vs. 58.1 ± 6.9; mental health status 66.2 ± 5.5 vs. 58.4 ± 7.5) (arbitrary units). CONCLUSIONS: Despite the difference between the cities concerning HDI values, no significant differences in quality of life were found between BH and MCG. However, the Active group showed significantly better results, confirming the importance of active lifestyle to enhance quality of life in stroke survivors.

Effects of 24 weeks of progressive resistance training on knee extensors peak torque and fat-free mass in older women.

This study examined the effects of resistance training (RT) on knee extensor peak torque (KEPT) and fat-free mass (FFM) in older women. Seventy-eight volunteers (67.1 ± 5.9 years old) underwent 24 weeks of progressive RT (RTG) while 76 (67.4 ± 5.9 years old) were studied as controls (CG). Dominant knee extension peak torque was assessed using an isokinetic dynamometer (Biodex System 3) and FFM measurements were performed by dual-energy x-ray absorptiometry. Muscle strength and FFM were evaluated before and after the intervention in all volunteers. Participants in the RTG trained major muscle groups 3 times per week during 24 weeks. Training load was kept at 60% of 1 repetition maximum in the first 4 weeks, 70% in the following 4 weeks, and 80% in the remaining 16 weeks, with repetitions, respectively, decreasing from 12, 10, and 8. A Split-plot analysis of variance was performed to examine between- and within-group differences, and the level of significance was accepted at p ≤ 0.05. It was observed that the RTG showed significant increases in KEPT (from 89.9 ± 21.8 to 102.8 ± 22.6 N·m; p < 0.05) and FFM (from 36.4 ± 4.0 to 37.1 ± 4.2 kg, p < 0.05). Appendicular FFM was also significantly increased after the intervention period in the RTG (13.9 ± 1.8 to 14.2 ± 1.9 kg, p < 0.05). None of these changes were observed for the CG. Consistent with the literature, it is concluded that a progressive RT program promotes not only increases in muscle strength, as evaluated by an isokinetic dynamometer, but also in FFM as evaluated by the DXA, in elderly women.

Fat-free mass, strength, and sarcopenia are related to bone mineral density in older women.

This study examined the association between fat-free mass (FFM) and muscle strength with bone mineral density (BMD), and compared the BMD values between sarcopenic and nonsarcopenic older women. After the exclusion criteria were applied, a total of 246 volunteers (age: 66.51+/-6.37 yr) participated in the analysis. Subjects underwent FFM and BMD evaluation by dual-energy X-ray absorptiometry and quadriceps strength by an isokinetic dynamometer. To address the potential for confounding by height, FFM values were considered relative to body height squared. For fat mass correction, fat-adjusted FFM was calculated. Individuals were classified as sarcopenic if their appendicular FFM was less than 5.45 kg/m2. All the evaluated FFM indexes were significantly correlated with the measured BMD sites. Sarcopenic individuals presented significantly lower whole body and trochanter BMD, and were significantly more prone to have low BMD. Muscle strength was also correlated with BMD sites; however, when it was expressed relative to body weight, the significance disappeared. Nevertheless, volunteers with low relative strength had higher risk of having low trochanter BMD. It can be concluded, in older women, that FFM is significantly correlated with BMD independently of height and fat mass. Muscle strength was also correlated with BMD, although the correlation was weaker when corrected for body weight. Finally, sarcopenic elderly women were more likely to have low BMD and muscle strength.