Effect of Exercise on Cognition, Conditioning, Muscle Endurance, and Balance in Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Mild cognitive impairment (MCI) may be a precursor to dementia; however, its progression may be prevented or slowed with exercise. This study aimed at determining the effects of group aerobic and strength training on cognition, conditioning, muscle endurance, and balance in underprivileged community-dwelling older adults with MCI. METHODS: This was a single-blind, randomized, and matched-pair controlled (gender, age, body mass index, and Addenbrooke's Cognitive Examination-Revised for MCI diagnosis) clinical trial. It was developed in 4 community centers. Fifty-two sedentary, functionally independent individuals, aged 60 years or more, with MCI were randomized into intervention group (n = 26) and control group (n = 26). Participants were tested before and after a 24-week exercise program. Sociodemographic characteristics, cognition (Mini-Mental State Examination), conditioning (2-minute stationary walk test), lower-limb endurance (30-second sit/stand test), and balance data (Functional Reach test) were collected. The intervention group walked and exercised twice weekly (60 minutes each) using ankle weights, latex resistance bands, and dumbbells. The exercise load and intensity were regularly increased on the basis of a preestablished incremental number of sets and repetitions and on the basis of the participants' correct movement execution with a given load. Data were analyzed with Pearson χ test, Fisher exact test, Student t test, Mann-Whitney U test, 2-way repeated measures analysis of variance, and the Cohen d. RESULTS AND DISCUSSION: Before the intervention, no significant differences were found between groups for any of the variables. Postintervention, significant differences were observed in cognition, conditioning, muscle endurance, and balance. Significant time-by-group interactions were detected in all the intergroup analyses. The improvements observed in the intervention group had medium to large effect sizes (0.35-1.15). The control group's decrease in cognition (13.9%) had a large effect size, while its Functional Reach test decrease (11.4%) had a medium effect size, with no significant change in conditioning or muscle endurance. CONCLUSION: The training program improved cognitive function, muscle endurance, aerobic conditioning, and balance in older adults with MCI.

The effect of group exercises on balance, mobility, and depressive symptoms in older adults with mild cognitive impairment: a randomized controlled trial.

OBJECTIVE:: To determine the effects of group exercises on balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment. DESIGN:: Single blinded, randomized, matched pairs clinical trial. SETTING:: Four primary healthcare units. SUBJECTS:: Fifty-two sedentary subjects with mild cognitive impairment were paired (age, sex, body mass index, and Addenbrooke's Cognitive Examination Revised score), tested, and then randomized into an intervention group ( n = 26) and a control group ( n = 26). INTERVENTION:: The intervention group performed strength (ankle weights, elastic bands, and dumbbells) and aerobic exercises (walking) in their communities' public spaces, twice a week (60 minutes each), during 24 weeks. The control group maintained its usual routine. MAIN MEASURES:: Balance (Berg Balance Scale (BBS)), mobility (Timed Up and Go Test (TUG)), and depressive symptoms (Geriatric Depression Scale-15) were assessed before and after the intervention. RESULTS:: Before the intervention, the two groups did not differ statistically. After, the intervention group showed significant improvement ( P < 0.05) in balance (before: 53 ± 3; after: 55.1 ± 1.1 points), mobility (before: 10.7 ± 2.9 seconds; after: 8.3 ± 2 seconds), and depressive symptoms (median punctuation (interquartile range) before: 4 (1.8-6); after: 2.5 (1-4)). The control group presented a significant increase in their depressive symptoms (median before: 3.5 (2-7.3); after: 4 (2-5.3)), while their balance and mobility showed no significant modification. Small effect sizes were observed in the intervention group and control group depressive symptoms, as well as in the control group's mobility and balance. Large effect sizes were observed the intervention group's mobility and balance. CONCLUSION:: Group exercises improved balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment.

Urinary incontinence in elderly women from Porto Alegre: its prevalence and relation to pelvic floor muscle function / La incontinencia urinaria en mujeres mayores de Porto Alegre: su prevalencia y su relación con la función muscular del piso de la pelvis / Incontinência urinária em idosas de Porto Alegre: sua prevalência e sua relação com a função muscular do assoalho pélvico

The purpose of this cross-sectional study was to assess the prevalence of self-reported urinary loss in elderly women living in the city of Porto Alegre (Rio Grande do Sul, Brazil), as well as to determine the relation between urinary incontinence (UI) and pelvic floor muscle function (PFMF). It included 270 elderly women (aged from 60 to 92 years) from a population sample, who reported the presence (n=155; 69.1±7.8 years) or absence (n=115; 67.7±7.9 years) of urine loss. Those who reported UI were asked about how long they had been experiencing urinary leakage, the amount of urine lost (drops, jets or complete micturition) and situations in which they lost urine. Out of the total number of individuals, 178 agreed to undergo the assessment of PFMF by means of a perineometry and a bidigital test. The prevalence of elderly women who reported UI (57.4%) was significantly higher, and the most common isolated situation of urine loss was being unable to get to the toilet in time (26.1%), and this occurred mainly in drops (52.3%). The UI lasted for a median of three years. The elderly women with UI had significantly lower PFMF than those without it, regardless of the type of measurement used (perineometry or bidigital test). Therefore, we conclude that, in this sample, UI had a high prevalence and was associated with decreased PFMF. Bearing these findings in mind and taking into account the data available in the literature about the impact of UI on health and quality of life, as well as the low cost of its assessment and treatment, we suggest that the management and care of this dysfunction should be carried out at the Primary Health Care level...

El objetivo de este estudio es evaluar la prevalencia del relato de pérdida urinaria en mujeres mayores residentes en el municipio de Porto Alegre (RS-Brasil), y determinar la relación entre la incontinencia urinaria (IU) y la función muscular del piso de la pelvis (FMPP). Participaron 270 mujeres mayores (60-92 años) las cuales provenían de una muestra poblacional, que relataron (n= 115; 69,1±7,8 años) o no (n=155; 67,7±7,9 años) pérdida urinaria. Las mayores que informaron IU fueron interrogadas cuanto a: la duración de la pérdida urinaria, la cantidad de orina perdida (gotas, jet o completa) y las situaciones en las que perdían orina. De este total, 178 aceptaron ser sometidas a una revisión de la FMPP a través de la perineometría y del test bidigital. La prevalencia de mayores que informaron IU (57,4%) fue significativamente mayor, siendo que la situación aislada de pérdida urinaria más común fue la incapacidad de llegar al baño a tiempo (26,1%), lo que se produjo principalmente en gotas (52,3%). La duración de la IU mostró un promedio de tres años. Las mayores con IU presentaron FMPP significativamente más baja que la de las que no tenían IU, independientemente de la forma de medición (perineometría o test bidigital). Por lo tanto, es posible concluir que, en esta muestra, la IU tuvo alta prevalencia y se asoció con una más baja FMPP. Considerando estos resultados y teniendo en cuenta el conocimiento disponible en la literatura sobre el impacto de la IU en la salud y calidad de vida de las personas, así como el bajo costo de su evaluación y su tratamiento, se sugiere que el manejo y cuidado de esta disfunción sean hechos en la Atención primaria de Salud...

O objetivo deste estudo foi avaliar a prevalência do relato de perda urinária em idosas residentes no município de Porto Alegre (RS-Brasil), bem como determinar a relação entre incontinência urinária (IU) e a função muscular do assoalho pélvico (FMAP). Participaram 270 idosas (60 a 92 anos) provenientes de uma amostra populacional, que relataram (n=155; 69,1±7,8 anos) ou não (n=115; 67,7±7,9 anos) perda urinária. As idosas que referiram IU foram questionadas quanto a: duração da perda urinária, quantidade de urina perdida (gotas, jato ou completa) e situações em que perdiam urina. Desse total, 178 aceitaram ser submetidas a uma avaliação da FMAP por meio da perineometria e do teste bidigital. A prevalência de idosas com relato de IU (57,4%) foi significativamente mais elevada, sendo que a situação isolada de perda miccional mais comum foi não conseguir chegar a tempo no banheiro (26,1%), a qual ocorreu principalmente em gotas (52,3%). A duração da IU apresentou uma mediana de três anos. As idosas com IU apresentaram FMAP significativamente menor do que aquelas sem, independente da forma de mensuração (perineometria ou teste bidigital). Assim sendo, é possível concluir que, na presente amostra, a IU teve alta prevalência e foi associada a menor FMAP. Tendo esses achados em mente e levando em consideração o conhecimento disponível na literatura sobre o impacto da IU na saúde e na qualidade de vida das pessoas, assim como o baixo custo da sua avaliação e do seu tratamento, sugere-se que o manejo e o cuidado dessa disfunção passem a ser feitos na Atenção Primária à Saúde...

A introdução de atendimentos por fisioterapeutas em unidades da atenção primária em saúde / The introduction of individual treatment by resident physical therapists in primary care units

Objetivos: Avaliar o efeito, em indicadores clínicos, da introdução de atendimentos fisioterapêuticos individuais semanais em cinco unidades de Atenção Primária à Saúde em Porto Alegre, RS. Métodos: Foram analisados os prontuários dos 59 usuários tratados entre abril de 2010 e maio de 2011 por duas fisioterapeutas do Programa de Residência Multiprofissional em Saúde da Família e Comunidade da Pontifícia Universidade Católica do Rio Grande do Sul. Foram coletados dados para a determinação dos perfis sociodemográfico (sexo, idade, estado civil e ocupação) e clínico (diagnóstico médico, ingesta medicamentosa, quantidade de medicamentos e presença de dor, dispnéia ou perda urinária). Os dados foram analisados através dos testes t-Student, Mann Whitney, Qui-quadrado de Pearson e Exato de Fisher; o Odds Ratio foi empregado quando identificada uma associação significativa. Resultados: Predominaram mulheres (81,4%), adultas (62%), que não conviviam maritalmente (62,7%), trabalhadoras domésticas (35,6%) com alterações osteomusculares e do tecido conjuntivo (86,4%). Trinta e dois usuários utilizavam medicamentos no início da intervenção e, ao final, apenas cinco. Após o tratamento, a quantidade de medicamento administrado também reduziu significativamente. O escore da Escala Análogo Visual (dor ou dispneia) reduziu significativamente ao final de uma média de 7,7 ± 3,2 sessões. Aqueles usuários que relataram ter seguido as orientações domiciliares apresentaram uma chance 8,3 vezes maior de ter alta. Conclusões: Os atendimentos fisioterapêuticos semanais realizados em unidades de Atenção Primária reduziram os sintomas, o uso e a quantidade de medicamentos ingeridos pelos usuários tratados e tiveram maior sucesso naqueles que seguiram as orientações dadas pelas fisioterapeutas residentes.

Objectives: To assess the effect on clinical indicators of the introduction of individual weekly physical therapy sessions in five Primary Health Care units in Porto Alegre, RS. Methods: The medical records from 59 patients were analyzed. They were treated between April 2010 and May 2011 by two physical therapists from the Multidisciplinary Residency Program in Family and Community Health at the Pontifical Catholic University of Rio Grande do Sul. Data was collected for the determination of the sociodemographic (gender, age, marital status and occupation) and clinical profiles (medical diagnosis, medication intake, number of medications and the presence of pain, dyspnea, or urinary loss). Data was analyzed using Student’s t test, Mann Whitney, Chi-square and Fisher’s exact test; the odds ratio was used when a significant association has been identified. Results: Most participants were female (81.4%), adult (62%), who did not cohabitated (62.7%), domestic workers (35.6%) with musculoskeletal and connective tissue disorders (86.4%). Thirty-two participants took medicine at the beginning of the intervention and, at the end, only five did so. After treatment, the amount of administered medications was also significantly reduced. The score of the Visual Analogue Scale (pain or dyspnea) was significantly reduced at the end of an average of 7.7 ± 3.2 sessions. Those users who reported having followed the domiciliary advice had an 8.3 times greater chance of being discharged. Conclusions: The weekly physical therapy sessions carried out at Primary Care units reduced symptoms, the use and amount of medication taken by the users treated and achieved greater success among those who followed the domiciliary advice given by the resident physical therapists.