Physical exercise and its effects on people with Parkinson's disease: Umbrella review.

INTRODUCTION: Parkinson's disease is neurodegenerative, complex and progressive, manifesting in a slow and irreversible way. Physical exercise has been proposed as therapeutic alternative to people with Parkinson´s disease. OBJECTIVE: To synthesize knowledge about the effects of physical exercise on people with Parkinson´s Disease as presented by published systematic reviews. METHODS: Nine electronic databases and two grey literature databases were searched for systematic reviews reporting the effects of physical exercises on people with Parkinson´s Disease. Searches involved a two-phase process, by, at least, two independent reviewers. Methodological quality of the included systematic reviews was assessed using AMSTAR-2. RESULTS: From 2,122 systematic reviews, 139 were included. Motor outcomes were assessed in 91% of the studies, with balance being the most studied. Non-motor outcomes were assessed in 68% of the studies, with emphasis on quality of life. Physical exercises were classified into five categories: aerobic exercises, strength, combined, sensorimotor activities and other activity protocols. Findings of the systematic reviews suggest that all exercise categories can be prescribed to improve balance and mobility, while combined exercises, strength, and specific activities improve both motor and non-motor outcomes, and aerobic exercise and sensorimotor activities improve motor outcomes. CONCLUSION: Current evidence from systematic reviews suggests that physical exercises impacts both motor and non-motor outcomes in people with Parkinson´s Disease. Limits in evidence provided by the systematic reviews were related to methodological issues and to the description of the interventions and must be considered to improve decision-making and clinical application.

The use of a single resistance exercise with or without blood flow restriction in the treatment of pain in knee osteoarthritis: a randomized clinical trial / A utilização de um único exercício resistido com ou sem restrição do fluxo sanguíneo no tratamento da dor na osteoartrite de joelho: um ensaio clínico randomizado

ABSTRACT BACKGROUND AND OBJECTIVES: Physical exercise is an efficient non-pharmacological strategy for the treatment of knee osteoarthritis (KOA). Blood flow restriction (BFR) is a technique known to enhance strength and hypertrophy gains when combined with low-intensity resistance exercise. This study aimed to analyze the effects of 12 weeks of low-intensity resistance training with and without blood flow restriction (BFR) on pain control and strength improvement in patients with KOA. METHODS: Two intervention groups performed low-intensity resistance exercise (knee joint extension on the leg extension chair at 30% of one repetition maximum) with (LI+BFR, n=13) or without blood flow restriction (LI, n=13), twice a week for 12 weeks. Preand post-test of one repetition maximum, functional strength (Chair-test), peak torque for unilateral knee extension exercise and pain (Visual Analogue Scale) were evaluated. RESULTS: No statistically significant differences were observed between treatments in pain reduction (p>0.05). Both interventions increased muscle strength and functional strength after 12 weeks of intervention (p<0.05). The peak torque for knee joint extension increased only in the LI+BFR group (p<0.05). Has no difference in reducing pain in patients with KOA among the groups (p< 0.05), both in the LI+BFR and the LI group. CONCLUSION: The results of the present study showed that BFR associated with low-intensity resistance exercise does not produce additional effects in terms of pain reduction and strength gain in patients with knee osteoarthritis, when compared to resistance exercise alone.

RESUMO JUSTIFICATIVA E OBJETIVOS: O exercício físico é uma estratégia não farmacológica eficiente para o tratamento da osteoartrite de joelho (OAJ). A restrição do fluxo sanguíneo (RFS) é uma técnica conhecida por potencializar o ganho de força e hipertrofia quando combinada com exercícios de resistência de baixa intensidade. Este estudo teve como objetivo analisar os efeitos de 12 semanas de treinamento de resistência de baixa intensidade com e sem restrição de fluxo sanguíneo (RFS) no controle da dor e melhora da força em pacientes com OAJ. MÉTODOS: Dois grupos de intervenção realizaram exercício resistido de baixa intensidade (extensão da articulação do joelho na cadeira extensora a 30% de uma repetição máxima) com (ER+RFS, n=13) ou sem restrição do fluxo sanguíneo (ER, n=13), duas vezes por semana durante 12 semanas. Foram avaliados pré e pós-teste de uma repetição máxima, força funcional (Chair-test), pico de torque para exercício de extensão de joelho unilateral e dor (Escala Analógica Visual). RESULTADOS: Não foram observadas diferenças estatisticamente significativas entre os tratamentos na redução da dor (p>0,05). Ambas as intervenções aumentaram a força muscular e a força funcional após 12 semanas de intervenção (p<0,05). O pico de torque para extensão da articulação do joelho aumentou apenas no grupo ER+RFS (p<0,05). A dor crônica relacionada à OAJ não apresentou diferença estatisticamente significativa na redução da dor (p> 0,05) em resposta a ambas as intervenções. CONCLUSÃO: Os resultados do presente estudo evidenciaram que a RFS associada ao exercício de resistência de baixa intensidade não prouduz efeitos adicinais na redução da dor e no ganho de força em pacientes com osteoartrite de joelho, quando comparada apenas ao exercício de resistência.

Multimodal protocol for the treatment of chronic headache. Case report / Protocolo multimodal para tratamento da cefaleia crônica. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic headache can be defined as a primary disorder that falls into four categories: migraine, tension-type headache, autonomic headache, and trigeminal headache. In rare cases, headaches can develop acute damage to both the micro-vessels and the white matter, which can shape foci of gliosis. In this case, the patient was diagnosed with chronic headache and had severe physical disability. Many treatments have been performed without achieving satisfactory control of the clinical condition. The objective of this study was to demonstrate the resolution potential of an interprofessional therapeutic proposal based on an interdisciplinary approach, which united Physical Therapy, Psychology, Physical Education, and Nutrition in the treatment of chronic headache. CASE REPORT: Female caucasian patient, with chronic headache for 14 years, with early progressive gliosis and rare T2 lesions with hypersignal in the supratentorial white matter. The protocol, planned in an articulated manner between the professionals, included dry needling and laser on the frontal, temporal, and masseter muscles during the physical therapy sessions, psychological care with relaxation techniques, guided imagery, meditation, and biofeedback, nutritional counseling based on the anamnesis with a 24-hour recall that guided the correct distribution of macro and micronutrients, as well as a resistance training for 12 weeks (three times a week) of resistance and aerobic exercises, and a 12-week follow-up after the intervention. CONCLUSION: The program of the proposed protocol proved to be safe and effective in the treatment of chronic headache, with results that were maintained after the intervention.

RESUMO JUSTIFICATIVA E OBJETIVOS: A cefaleia crônica pode ser definida como um distúrbio primário, que se enquadra em quatro categorias: enxaqueca, cefaleia do tipo tensional, cefaleia autonômica e cefaleia trigeminal. Em casos raros, as cefaleias podem desenvolver lesões agudas nos microvasos e na substância branca, que podem formar focos de gliose. No caso aqui relatado, a paciente foi diagnosticada com cefaleia crônica e apresentava incapacidade física grave. Muitos foram os tratamentos realizados sem se obter um controle satisfatório da sua condição clínica. O objetivo deste estudo foi demonstrar o potencial resolutivo de uma proposta terapêutica interprofissional fundamentada em uma abordagem interdisciplinar, que uniu Fisioterapia, Psicologia, Educação Física e Nutrição no tratamento da cefaleia crônica. RELATO DO CASO: Paciente do sexo feminino, caucasiana, com cefaleia crônica há 14 anos, com gliose progressiva precoce e que apresentou lesões raras com hipersinal em T2 na substância branca supratentorial. O protocolo, planejado de maneira articulada entre os profissionais, incluiu agulhamento a seco e 'laser' nos músculos frontal, temporal e masseter durante atendimentos com a fisioterapia, atendimento psicológico com técnicas de relaxamento, imagens guiadas, meditação e biofeedback, uma orientação nutricional que partiu da anamnese com recordatório de 24 horas, que orientou sobre a correta distribuição de macro e micronutrientes, além de um treinamento resistido por 12 semanas (três vezes por semana), com exercícios resistidos e aeróbicos e um acompanhamento de 12 semanas após a intervenção. CONCLUSÃO: A aplicação do protocolo proposto mostrou-se segura e eficaz no tratamento da cefaleia crônica e com resultados que se mantiveram após a intervenção.

Acute effects of the resistance exercise associated with different blood flow restriction pressures on bone remodeling biomarkers.

Background: The present study analyzed the acute responses of parathyroid hormone (PTH) and bone-specific alkaline phosphatase (BSAP) to the low-intensity resistance exercise with blood flow restriction using different occlusion pressures. Methods: Twelve women completed the three protocols of this crossover study: resistance exercise without blood flow restriction (RE), resistance exercise with blood flow restriction and occlusion pressure corresponding to 70% of systolic blood pressure (RE + BFR70), and resistance exercise with blood flow restriction and occlusion pressure corresponding 130% of systolic blood pressure (RE + BFR130). All exercises were performed in a guided squat apparatus with load corresponded to 30% of one-repetition maximum test. Results: Relative to resting levels, PTH concentrations decreased significantly (p = .000) post-exercise in all groups and increased significantly (p = .000) 15 min post-exercise in RE + BFR70 and RE + BFR130 groups; PTH concentrations returned to resting levels after the 30-min recovery period in all groups. There was no significant difference (p >.05) between BSAP values at rest and 30 min post-exercise. Conclusion: In conclusion, our results showed that protocols with blood flow restriction using occlusion pressures equivalent to 70% and 130% of systolic blood pressure were more effective than RE alone to induce PTH peaks, and to promote a metabolic condition favorable to bone anabolism.