O efeito da idade, da dupla tarefa e da visão no senso de posicionamento do tornozelo / Efectos de la edad, doble tarea y visión en el sentido de posicionamiento del tobillo / Effect of age, dual task and vision on the sense of ankle positioning

RESUMO O objetivo desta pesquisa foi mensurar de forma objetiva a propriocepção, em diferentes situações (com e sem o auxílio da visão, com e sem tarefa cognitiva concomitante e de forma ativa ou passiva), em indivíduos idosos e adultos. Participaram do estudo dez adultos saudáveis e dez idosos saudáveis. Foram estudados os efeitos de diferentes restrições no desempenho do movimento por meio dos erros absoluto (precisão) e relativo (consistência). A mensuração do senso de posicionamento do tornozelo foi realizada com o dinamômetro isocinético Biodex Sistem 3. A análise de variância de quatro fatores e o teste post hoc de Tukey foram utilizados para analisar os parâmetros. Os resultados mostraram que o fator sujeito interfere no erro absoluto, pois os grupos apresentaram diferença significativa: os idosos erram mais quando comparados com os adultos. Os demais fatores (visão, tarefa cognitiva e tipo de movimento) não apresentaram diferença significativa. No erro relativo os resultados mostraram que a tarefa cognitiva concomitante ao movimento foi capaz de produzir diferença significante; entretanto os demais fatores (indivíduos, visão e tipo de movimentação) não foram capazes de produzir uma diferença significativa. A idade afeta a precisão do sentido proprioceptivo, independentemente da situação. Não houve diferença entre a realização do movimento com e sem o auxílio da visão, e a dupla tarefa (motora associada à cognitiva) afeta a consistência do movimento.

RESUMEN En este estudio se propone medir objetivamente la propiocepción en situaciones diferentes (con y sin la ayuda de la visión, con y sin la tarea cognitiva concomitante y de forma activa o pasiva), en adultos y adultos mayores. Del estudio han participado diez adultos sanos y diez adultos mayores sanos. Se analizaron los efectos de diversas restricciones en el funcionamiento del movimiento por medio de los errores absoluto (precisión) y relativo (consistencia). La medición del sentido de posicionamiento del tobillo se llevó a cabo por medio del dinamómetro isocinético Biodex System 3. Se utilizaron el análisis de varianza de cuatro factores y la prueba posthoc de Tukey, para analizar los parámetros. Los resultados demostraron que el factor sujeto interfiere en el error absoluto, ya que los grupos presentaron una diferencia significativa: los adultos mayores cometen más errores que los adultos. Los otros factores (visión, tarea cognitiva y tipo de movimiento) no demostraron diferencias significativas. En el error relativo, los resultados desvelan que la tarea cognitiva y el movimiento fueron capaces de producir una diferencia estadísticamente significativa; sin embargo, otros factores (personas, visión y tipo de movimiento) no fueron capaces de producirla. La edad afecta a la exactitud del sentido propioceptivo, independientemente de la situación. No hubo diferencias entre el rendimiento del movimiento con y sin la ayuda de la visión, y la doble tarea -motora relacionada con la cognitiva- impacta en la consistencia del movimiento.

ABSTRACT The objective of this research was to measure objectively the proprioception in different situations (with and without the aid of vision, with or without a concomitant cognitive task, and actively and passively), in elder and adult individuals. Ten healthy adults and ten healthy seniors participated in the study. The effects of different restrictions were studied in the development of movement through absolute (accuracy) and relative (consistency) errors. The sense of ankle positioning was measured with a Biodex System 3isokinetic dynamometer. Four-factor analysis of variance and the Tukey post hoc test were used to analyze the parameters. The results showed that the subject factor interferes in the absolute error, since the groups showed significant difference: the elderly make more mistakes when compared with adults. The other factors (vision, cognitive task and type of movement) did not show significant difference. In the relative error, results showed that the cognitive task concomitant to movement was capable of producing significant difference; however, the other factors (individuals, vision and type of movement) were not. Age affects the accuracy of the proprioceptive sense, regardless of the situation. There was no difference between performing the movement with and without the aid of vision, and the double task (motor associated with cognitive) affects the consistency of the movement.

Reference Values for the 6-min Walk Distance in Healthy Children Age 7 to 12 Years in Brazil: Main Results of the TC6minBrasil Multi-Center Study.

INTRODUCTION: Brazil is a country with great climatic, socioeconomic, and cultural differences that does not yet have a reference value for the 6-min walk test (6MWT) in healthy children. To avoid misinterpretation, the use of equations to predict the maximum walk distance should be established in each country. OBJECTIVES: We sought to establish reference values and to develop an equation to predict the 6-min walk distance for healthy children in Brazil. METHODS: This is a cross-sectional multi-center study that included 1,496 healthy children, aged 7 to 12 y, assessed across 11 research sites in all regions of Brazil, and recruited from public and private schools in their respective regions. Each child was assessed for weight and height. Walk distance was our main outcome. An open-source software environment for statistical computing was used for statistical analysis. RESULTS: We observed a higher average distance walked by boys (531.1 m) than by girls (506.2 m), with a difference of 24.9 m (P < .001). We established 6MWT reference values for boys with the following equation: Distance = (16.86 × age) + (1.89 × Δ heart rate) - (0.80 × weight) + (336.91 × R1) + (360.91 × R2). For girls the equation is as follows: Distance = (13.54 × age) + (1.62 × Δ heart rate) - (1.28 × weight) + (352.33 × R1) + (394.81 × R2). CONCLUSION: Reference values were established for the 6MWT in healthy children aged 7-12 y in Brazil.

Aerobic training in aquatic environment improves the position sense of stroke patients: A randomized clinical trial

AIMS: (Stroke patients often present sensory-motor alterations and less aerobic capacity. Joint position sense, which is crucial for balance and gait control, is also affected in stroke patients). To compare the effect of two exercise training protocols (walking in deep water and on a treadmill) on the knee position sense of stroke patients. METHODS: This study was designed as a randomized controlled clinical trial. Twelve adults, who suffered a stroke at least one year prior to the start of the study, were randomly assigned to one of two groups: 1) pool group submitted to aerobic deep water walking training; and 2) the treadmill group which was submitted to aerobic walk on a treadmill. Measurements: The position sense, absolute error and variable error, of the knee joint was evaluated prior to and after nine weeks of aerobic training. RESULTS: The pool group presented smaller absolute (13.9o versus 6.1o; p < 0.05) and variable (9.2o versus 3.9o; p < 0.05) errors after nine-weeks gait training than the treadmill group. CONCLUSIONS: Nine-week aerobic exercise intervention in aquatic environment improved precision in the position sense of the knee joint of stroke patients, suggesting a possible application in a rehabilitation program.(AU)

Cardiac autonomic dysfunction in chronic stroke women is attenuated after submaximal exercise test, as evaluated by linear and nonlinear analysis.

BACKGROUND: We evaluated cardiac autonomic modulation in women with chronic ischemic stroke (at least 4 years post-stroke) at rest and in response to submaximal exercise test. METHODS: Fourteen post-stroke women (S group) and 10 healthy women (C group) participated in this study. Autonomic modulation (using linear and nonlinear analysis), blood pressure and metabolic variables at rest were evaluated immediately after the exercise test and during the recovery period (20 min). All participants underwent submaximal exercise test on cycle ergometer with gas analysis. RESULTS: At rest, the S group displayed higher lactate concentration, systolic (SBP) and diastolic blood pressure (DBP) values when compared to C group. Furthermore, the S group had lower heart rate variability (HRV) in time domain (SDNN: S = 30 ± 5 vs. 40 ± 8 ms; rMSSD: S = 14 ± 2 vs. C = 34 ± 3 ms), decreased high frequency band of pulse interval (S = 8.4 ± 2 vs. 33.1 ± 9 %) and 2V pattern of symbolic analysis (S = 17.3 ± 1 vs. 30 ± 3 %) (both indicators of cardiac vagal modulation) when compared to C group. Immediately after exercise, S group presented higher values of lactate, SBP, DBP and double product when compared to C group, as well as decreased heart rate recovery (HRR) measured at the first, second and third minutes. At recovery time, all HRV parameters in time and frequency domains improved in the S group; however, HF band remained lower when compared to C group. CONCLUSIONS: After the exercise test, women with chronic stroke presented reduced heart rate variability, reduced cardiac vagal modulation, as well as reduced HRR, while displayed an improvement of heart rate variability and cardiac vagal modulation when compared to their baseline. These results reinforce the importance of a physically active lifestyle for cardiovascular autonomic disorders observed in chronic stroke women.

The effect of gait training and exercise programs on gait and balance in post-stroke patients / O efeito do treinamento de marcha e programas de exercícios na marcha e equilibrio postural em pacientes após acidente vascular encefálico crônico

The aim of this review is to evaluate studies about gait training and exercise interventions applied to patients following chronic stroke on gait and balance. The studies included in this review were random clinical trials, including only chronic post-stroke individuals that evaluated gait and balance outcomes and with a PEDro scale score ≥ 7.0. Eight studies were selected. The results suggest gait and balance will only be affected in chronic post-stroke patients if training sessions last at least 30 minutes, are repeated three times a week, and maintained for at least five weeks. Gait training affects how chronic post-stroke individuals walk. They will probably walk faster and with a lower risk of falling; however, it is unclear whether the consequences of these procedures affect the quality of life.

RESUMO O objetivo desta revisão é avaliar estudos sobre intervenções com treino de marcha e exercícios específicos sobre marcha e equilíbrio postural, aplicados a pacientes após acidente vascular encefálico em fase crônica. Os estudos incluídos nesta revisão foram ensaios clínicos randomizados, incluindo apenas indivíduos pós-acidente vascular encefálico em fase crônica que avaliaram marcha e equilíbrio postural, com uma pontuação em escala PEDro ≥ 7.0. Oito estudos foram selecionados. Os resultados sugerem que a marcha e o equilíbrio somente são afetados em pacientes crônicos pós-acidente vascular encefálico se as sessões de treinamento tiverem duração mínima de 30 minutos, forem repetidos três vezes por semana, e mantidos durante pelo menos cinco semanas. O treino de marcha e os exercícios afetam a forma como os indivíduos pós-acidente vascular encefálico em fase crônica andam. Eles provavelmente andarão mais rápido e com menor risco de quedas; no entanto, não está claro se as consequências destes procedimentos afetam a qualidade de vida.

Estudo comparativo da reabilitação virtual e cinesioterapia em relação ao torque do joelho em idosos / Comparative study of virtual rehabilitation and kinesiotherapy for knee torque among the elderly

O envelhecimento provoca uma série de alterações neuropsicomotoras, como a diminuiçãoda força muscular, da propriocepção, do equilíbrio, da cognição, entre outros. Os exercíciosterapêuticos visam diminuir estes déficits e contribuir para uma melhora funcional e da qualidadede vida. Objetivo: Este estudo teve como objetivo comparar os efeitos da reabilitação virtual ecinesioterapia, no torque do joelho em idosos saudáveis. Método: Os idosos foram divididosem dois grupos aleatoriamente: sete participantes realizaram exercícios com reabilitação virtualformando o grupo Reabilitação Virtual (RV) (69,7 ± 5,5 anos; 71,8 ± 13,7 kg), e sete participantesrealizaram cinesioterapia formando o grupo Cinesio (75,4 ± 5,7 anos; 64,7 ± 17,2 kg). O torquedos músculos extensores e flexores do joelho foi avaliado no dinamômetro isocinético, da marcaBiodex, System 3. O protocolo consistiu de três contrações isométricas de 5 segundos, nasposições angulares de 45 e 600 de flexão do joelho e cinco repetições de contrações isocinéticasconcêntricas nas velocidades de 60, 180 e 3000/s. O protocolo de tratamento foi realizado noperíodo de 3 meses, com duas sessões por semana e 50 minutos cada sessão. No grupo RV foramutilizadas duas modalidades de jogos, incluindo tarefas de desafios e feedback interativo dapercepção corporal. Para o grupo Cinesio, foram realizados os mesmos exercícios do protocolode reabilitação virtual, porém sem estímulo do video game. Para análise estatística, foi utilizadoo teste ANOVA, seguido de post hoc Tukey HDS com nível de significância de 0,05. Resultados: Opico de torque isocinético concêntrico e isométrico de extensão e flexão do joelho foram maioresapós a intervenção para ambos os grupos. Conclusão: A cinesioterapia, assim como a reabilitaçãovirtual, são eficazes para o aumento do torque extensor e flexor do joelho, o que pode auxiliar nadiminuição da incidência de quedas em idosos.

Aging causes a variety of neurological and psychomotor changes, such as decreases in musclestrength, proprioception, balance, and cognition, among other things. Therapeutic exercises help inreducing these deficits and contribute to functional improvement and quality of life. Objective: Thisstudy aimed to compare the effects of virtual rehabilitation and exercise therapy on knee torqueamong the healthy elderly. Method: The subjects were divided randomly into two groups: sevenparticipants performed exercises with virtual rehabilitation composing the Virtual Rehabilitationgroup (RV) (69.7 ± 5.5 years, 71.8 ± 13.7 kg) and seven participants performed exercise therapycomposing the ?Kinesio? group (75.4 ± 5.7 years, 64.7 ± 17.2 kg). The torque of the knee extensorand flexor muscles was assessed with the Biodex System 3 isokinetic dynamometer. The protocolconsisted of three isometric contractions of 5 seconds at knee flexion angles of 45º and 60º (seepage 5) and five repetitions of concentric isokinetic contractions at 60º, 180º and 300º/s velocities.The treatment protocol was conducted for 3 months, with 50 minutes per session, twice a week. Inthe VR group, two modes of games were used, involving tasks of challenges and interactive feedbackof body awareness. The Kinesio group performed the same virtual rehabilitation exercise protocol,but without video game stimulus. The ANOVA test was used for statistical analysis, followed by thepost hoc Tukey HDS with a significance level of p < 0.05. Results: The peak isokinetic concentricand isometric torques of knee extension and flexion were higher after intervention for both groups.Conclusion: Therefore, it can be concluded that conventional rehabilitation through exercise, as wellas the innovative technique of virtual rehabilitation, are effective to increase extensor and flexorknee torque, which can help to reduce the incidence of falls among the elderly.

Treinamento físico melhora a saúde cardiovascular em mulheres no climatério: [revisão] / Exercise training improves cardiovascular health in post menopause women: [revision]

As doenças cardiovasculares (DCV) constituem a mais importante causa de morte em ambos os sexos no mundo ocidental. Nesse sentido, o climatério é uma etapa no ciclo de vida das mulheres no qual o risco cardiovascular está muito aumentado favorecendo um incremento da morbi-mortalidade observada nesta população. Esse fato pode ser explicado, pelo menos em parte, pelas atuais evidências de que o estrogênio tem uma função cardioprotetora, e este hormônio tem sido associado ao controle de alguns fatores de risco como a obesidade, hipertensão arterial e a dislipidemia. Todavia, muitos estudos têm postulado que o treinamento físico pode ser uma importante abordagem não farmacológica na redução e/ou atenuação de fatores de risco cardiovascular em mulheres após a menopausa.

Cardiovascular diseases are the most important cause of death in both sexes in the Western world. Accordingly, the climacterium, is a women life phase in which the cardiovascular risk is much higher leading to an elevated morbi-mortality observed in this population. This fact may be justified, at least in part, by the current evidences that estrogen has a cardio protector function, and this hormone has been associated to the control of some risk factors such as obesity, hypertension and dislipidemia. However, many studies have indicated that the exercise training can be an important non-pharmacological approachin the reduction and/or attenuation of cardiovascular risk.