Analysis of biomechanics in athletes with disabilities: a systematic and narrative review / Análise da biomecânica em atletas com deficiência: uma revisão sistemática e narrativa

Abstract Introduction Specifically in athletes with disabilities, investigations and biomechanical understanding seem to be even more relevant, as they provide data on how a certain type of disability limits sports practice and also describe parameters that allow the suggestion of relevant adaptations capable of guaranteeing a higher level comfort to practitioners. Objective To describe patterns of biomechanical behavior during exercise in athletes with disabilities, and to discuss possible relationships between the type of disability and the sport practiced. Methods This study performed a search in five electronic databases from the oldest records available until July 2020 using a search strategy that combined terms related to "athletes with disabilities" and "biomechanical analysis." Inclusion criteria: population (amateur or professional athletes with disabilities), intervention (sports practice), study design (observational), outcome (having evaluated biomechanics during sports practice). The biomechanical variables of interest included kinematic, kinetic, or electromyographic outcome measures. Results Tewnty-six articles met the inclusion criteria (n = 705 participants). Biomechanical analysis showed that there is a greater inclination in the angle of the head and an increase in the kinematic variables in blind athletes, which result in less distance, speed, and performance; compensatory body patterns, reduced mooring strength, speed, joint amplitude, and reduced final performance are observed in amputated limbs of amputees; and there was a strong correlation between the subject's functional classification and kinematic parameters in wheelchair athletes, with this being proportional to the level of impairment. Conclusion The outcomes demonstrated that the type of disability and the level of functional limitation are proportionally related to biomechanics in athletes with disabilities.

Resumo Introdução Em atletas com deficiência, as investigações e o entendimento biomecânico parecem ser ainda mais relevantes ao fornecer dados sobre de que modo determinado tipo de deficiência limita a prática esportiva e, ainda, descrever parâmetros que permitam sugestão de adaptações pertinentes capazes de garantir maior nível de conforto aos praticantes. Objetivo Descrever padrões de comportamento biomecânico durante o exercício em atletas com deficiência e discutir possíveis relações entre o tipo de deficiência e o esporte praticado. Métodos Este estudo realizou uma busca em cinco bases de dados eletrônicas a partir dos registros mais antigos disponíveis até julho de 2020, utilizando uma estratégia de busca que combinou termos relacionados a "atletas com deficiência" e "análise biomecânica". Critérios de inclusão: população (atletas amadores ou profissionais com deficiência), intervenção (prática esportiva), desenho do estudo (observacional), resultado (ter avaliado a biomecânica durante a prática esportiva). As variáveis biomecânicas de interesse incluíram medidas de desfecho cinemáticas, cinéticas ou eletromiográficas. Resultados Vinte e seis estudos atenderam aos critérios de inclusão (n = 705 participantes). Os resultados mostraram que há maior inclinação do ângulo da cabeça e aumento das variáveis cinemáticas em atletas cegos, resultando em menor distância, velocidade e desempenho; padrões corporais compensatórios, redução da força de amarração, velocidade, amplitude articular e desempenho final reduzido são observados em membros amputados de amputados; e parece haver relação entre a classificação funcional do sujeito e os parâmetros cinemáticos em atletas de cadeira de rodas, sendo esta proporcional ao grau de comprometimento. Conclusão Os resultados demonstraram que o tipo de deficiência e o nível de limitação funcional estão proporcionalmente relacionados à biomecâ-nica em atletas com deficiência.

Sportomics suggests that albuminuria is a sensitive biomarker of hydration in cross combat.

We have been using sportomics to understand hypermetabolic stress. Cross Combat (CCombat) has recently been initiated as a high-intensity functional training method inspired by CrossFit. We used a CCombat session to induce metabolic stress and evaluated its effects on hydration and kidney function. Blood samples were collected from 16 elite-level professional male athletes engaged in training sessions over a 96-h protocol. Blood myoglobin increased by ~ 3.5-fold (119 ± 21 to 369 ± 62 nmol/L; p = .001) in response to the protocol, returning to the pre-exercise level within 48 h. Furthermore, D-dimer levels increased from 6.5 ± 0.6 to 79.4 ± 21.3 µmol/L (p < .001) in response to exercise decreasing during recovery with high variability among the studied athletes. Albuminemia and creatininemia increased ~ 10% and cystatin C increased ~ 240% (1.7 ± 0.1 to 5.7 ± 0.5 mg/L; p < .001; effect size = 2.4) in response to the protocol. We measured albuminuria (HuA) to assess kidney permeability to albumin caused by exercise. HuA increased ~ 16-fold (0.16 ± 0.03 to 2.47 ± 0.41 µmol/L; p < .001; effect size = 1.4) in response to exercise, dropping and reaching basal levels during 48 h. Here, we suggest that microalbuminuria can be used as an early, sensitive, easy, and inexpensive biomarker to evaluate hydration status changes during intensive exercise, decreasing chronic impairment in renal function.

Injuries in Judo Athletes With Disabilities: Prevalence, Magnitude, and Sport-Related Mechanisms.

CONTEXT: The participation of judo athletes with disabilities in competitions has increased over the years as well as the burden of sports-related injuries and illnesses in this population. However, there is limited knowledge about sports-related injuries in judo athletes with different disabilities. OBJECTIVE: To investigate the prevalence of injuries in judo athletes with disabilities, considering the different impairment groups, magnitude of injury (ie, mechanism, nature, and severity of injury), and specific body parts. DESIGN: Cross-sectional study (level of evidence, 3). SETTING: Brazilian Judo athletes with disabilities. PATIENTS: Fifty-one judo athletes with disabilities (15 men and 36 women) participated in this study. MAIN OUTCOME MEASURES: Data were obtained from an adapted injury report form. The prevalence of injuries was assessed, considering type of impairment, body parts, mechanisms, and severity as well as differences between male and female athletes, with the significance level set at P < .05. RESULTS: The results demonstrated a high prevalence of injuries in female athletes with visual impairment (n = 11, 73.3%) and male athletes with amputations (n = 14, 38.8%). A high prevalence was found in the national group, especially for male athletes (n = 29, 80.5%). Among athletes who had injuries, 69.4% (n = 12) of male and 80.0% (n = 25) of female athletes' injuries occurred due to direct contact with other athletes, and 72.2% (n = 26) of male and 86.6% (n = 13) of female athletes' injuries were in the training environment. The magnitude of injuries ranged from moderate to severe for male and female athletes. The knee (n = 25, 49.0%) and shoulder (n = 12, 23.5%) were the body parts most affected by injuries in both male and female athletes. CONCLUSION: A large percentage of judo athletes with disabilities reported experiencing an injury during the previous 2 years; percentages were greater in athletes with visual and physical impairment. Moreover, most injuries occurred in the knee or shoulder, during training, and in direct contact with other athletes and were of severe magnitude.

Outcomes between different validated questionnaires to assess the level of physical activity in cardiac patients adhering to a rehabilitation program / Desfechos entre diferentes questionários validados para a avaliação do nível de atividade física em cardiopatas adeptos a um programa de reabilitação

Abstract Introduction The International Physical Activity Ques-tionnaire (IPAQ) and Baecke inventory are commonly used in cardiovascular rehabilitation routines. Thus, it is understood that investigations on the equivalence of outcomes between these two tools may be relevant to measure the magnitude of possible reproducibility and correlations between them. Objective To compare in cardiac patients the level of physical activity obtained through the IPAQ and Baecke inventory and correlate outcomes obtained with a 6-minute walk test. Methods In total, 65 heart disease patients included in a cardiovascular rehabilitation program (40 male and 25 female) were included, with a mean age of 65.8 ± 10.5 years. The data were obtained from the application of a standardized form, containing the proposed study objects, which were the IPAQ and Baecke inventory. In addition, data regarding anthropometric measurements (body mass, height, and body mass index - BMI), waist-to-hip ratio, blood pressure, and performance in the 6-minute walk test were measured. Results The main outcomes refer to the weak association between the instruments evaluated, which showed a strong relationship only between free time physical activity (r = 1), while in the other categories and when compared to the 6-minute walk test, the verified agreement was not significant. Conclusion The questionnaires are strongly equivalent only for free time physical activity, in the other categories and when compared to the 6-minute walk test, the agreement was not significant. Thus, based on the results, implementation in clinical practice considering the use of these tools with equivalence is not recommended.

Resumo Introdução O Questionário Internacional de Atividade Física (IPAQ) e o inventário de Baecke são comumente utilizados em rotinas de reabilitação cardiovascular. Assim, entende-se que investigações sobre a equiva-lência de desfechos entre essas duas ferramentas possam ser relevantes para mensurar a magnitude da possível reprodutibilidade e correlação entre tais métodos. Objetivo Comparar em cardiopatas o nível de atividade física obtido por meio do IPAQ e do Baecke e correlacionar desfechos obtidos com o teste de cami-nhada de 6 minutos (TC6). Métodos Foram incluídos no estudo 65 cardiopatias inseridos em um programa de reabilitação cardiovascular, sendo 40 do sexo masculino e 25 do sexo feminino, com idade média correspondente a 65,8 ± 10,5 anos. Os dados foram obtidos a partir de um formulário padronizado, contendo os objetos de estudo propostos (IPAQ e Baecke). Além disso, dados referentes a medidas antropométricas (massa corporal, estatura e índice de massa corpórea), relação de cintura quadril, pressão arterial e TC6 foram avaliados. Resultados Os principais desfechos se referem à fraca associação entre os instrumentos avaliados, que demonstraram relação forte somente entre atividade física de tempo livre (r = 1), sendo que nas demais categorias e quando comparadas ao TC6 a concordância verificada não apresentou significância estatística. Conclusão Os questionários se equivalem fortemente somente quando diz respeito à atividade física de tempo livre. Desta forma, não faz sentido a implementação de prática clínica que considere a utilização das ferramentas IPAQ e Baecke com equivalência, o que verificou-se não existir.

Anti-inflammatories for delayed onset muscle soreness: systematic review and meta-analysis / Antiinflamatorios para el dolor muscular de inicio tardío: revisión sistemática y metanálisis / Anti-inflamatórios para dor muscular de início tardio: revisão sistemática e metanálise

ABSTRACT Objective: To investigate the effectiveness of pharmacological interventions in the treatment of delayed onset muscle soreness (DOMS). Design: A systematic review and meta-analysis of randomized controlled clinical trials (RCTs). Data sources: The PubMed/MEDLINE, EMBASE, SPORTDiscus, Scielo and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for RCTs published prior to August 3, 2020. Eligibility criteria for selecting studies: Studies that 1) used an RCT design; 2) evaluated the effectiveness of steroidal or nonsteroidal anti-inflammatory drugs (NSAIDs) in treating DOMS; and 3) therapeutically used drugs after exercise were included. Results: In total, 26 studies (patients = 934) were eligible for inclusion in the qualitative analysis on the treatment of DOMS. The results of the meta-analysis showed no superiority between the use and non-use of NSAIDs in the improvement of late muscle pain, as no statistically significant differences were verified (21 studies, n= 955; standard mean difference (SMD)= 0.02; 95% confidence interval (CI) −0.58, 0.63; p=0.94; I2=93%). The quality of the synthesized evidence was very low according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and there was significant heterogeneity among the included studies. Conclusion: The results demonstrate that NSAIDs are not superior to controls/placebos in treating DOMS. The inclusion of both studies with dose-response protocols and those with exercise protocols may have influenced the results. In addition, the high risk of bias identified reveals that limitations need to be considered when interpreting the results. Level of evidence I; ystematic review of RCT (Randomized and Controlled Clinical Trials).

RESUMEN Objetivo: Investigar la efectividad de las intervenciones farmacológicas en el tratamiento del dolor muscular de aparición tardía (DOMS). Metodología: Revisión sistemática y metanálisis de ensayos clínicos controlados aleatorios (RCT). Fuentes de datos: Se realizaron búsquedas en las bases de datos de PubMed/MEDLINE, EMBASE, SPORTDiscus, Scielo y Cochrane Central Register of Controlled Trials (CENTRAL) para ECA publicados antes del 3 de agosto de 2020. Criterios de elegibilidad para la selección de estudios: Estudios en los que 1) se utilizó un diseño de RCT; 2) se evaluó la eficacia de los fármacos antiinflamatorios no esteroideos (AINE) y esteroideos en el tratamiento de DOMS; y 3) se incluyó el uso terapéutico de medicamentos para dolor después del ejercicio. Resultados: En total, 26 estudios (pacientes = 934) fueron elegibles para su inclusión en el análisis cualitativo sobre el tratamiento de DOMS. Los resultados encontrados en el metanálisis no demostraron superioridad entre el uso y no uso de AINE para mejorar el dolor muscular tardío cuando se comparó con una condición de control, ya que no hubo diferencias estadísticamente significativas (21 estudios, n = 955; media estándar diferencia = 0,02; intervalo de confianza (IC) del 95% −0,58, 0,63; p = 0,94; I2 = 93%). La calidad de la evidencia encontrada se clasificó como muy baja según los criterios del "Grading of Recommendations Assessment, Development and Evaluation" (GRADE), principalmente porque existe una heterogeneidad significativa entre los estudios incluidos. Conclusión: Los resultados demuestran que los AINE no son superiores a los controles o placebos en el tratamiento de DOMS. La inclusión de ambos modelos de estudio con protocolos de dosis-respuesta y protocolos de ejercicio puede haber influido en los resultados. Además, el alto riesgo de sesgo identificado revela que la interpretación de los resultados debe verse con limitaciones. Nivel de evidencia: I; Revisión sistemática de ECRC (Ensayos clínicos aleatorizados y controlados).

RESUMO Objetivo: Investigar a eficácia das intervenções farmacológicas no tratamento da dor muscular de início tardio (DOMS). Desenho: Revisão sistemática e metanálise de estudos clínicos randomizados e controlados (RCTs). Fontes de dados: Os bancos de dados PubMed/MEDLINE, EMBASE, SPORTDiscus, Scielo e Cochrane Central Register of Controlled Trials (CENTRAL) foram pesquisados em busca de RCTs publicados antes de 3 de agosto de 2020. Critérios de elegibilidade para selecionar estudos: Estudos que 1) usaram um desenho de RCT; 2) avaliaram a eficácia de anti-inflamatórios esteroides ou não esteroides (AINEs) no tratamento de DOMS e 3) incluíram tratamento medicamentoso depois de exercício. Resultados: No total, 26 estudos (pacientes = 934) foram elegíveis para inclusão na análise qualitativa do tratamento de DOMS. Os resultados da metanálise não mostraram superioridade entre o uso e não uso de AINEs na melhora da dor muscular tardia, pois não foram verificadas diferenças estatisticamente significativas (21 estudos, n = 955; diferença média padronizada (SMD) = 0,02; Intervalo de confiança (IC) de 95% −0,58, 0,63; p = 0,94; I2 = 93%). A qualidade da evidência encontrada foi muito baixa de acordo com os critérios da Grading of Recommendations Assessment, Development and Evaluation (GRADE), e verificou-se heterogeneidade significante entre os estudos incluídos. Conclusão: Os resultados demonstram que os AINEs não são superiores aos controles ou placebos no tratamento de DOMS. A inclusão de estudos com protocolos de dose-resposta e com protocolos de exercícios podem ter influenciado os resultados. Além disso, o alto risco de viés identificado revela que as limitações devem ser consideradas na interpretação dos resultados. Nível de evidência I; Revisão sistemática de ECRC (Estudos clínicos randomizados e controlados).

Registros de absenteísmo-doença: o que os conteúdos revelam sobre a funcionalidade de trabalhadores da higienização? / Absenteeism-disease records: what do the content reveal about the functioning of hygienization workers?

Objetivo: Utilizar os registros de absenteísmo-doença de trabalhadores de limpeza do setor de higienização de uma instituição de ensino superior para estabelecer um subsídio inicial de conteúdo com as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Método: Estudo quantitativo, descritivo e retrospectivo. Foram analisados 2.881 atestados médicos, de trabalhadores de limpeza durante o período de 2010 a 2014, classificados de acordo com a CID-10. Variáveis estudadas: sexo, data admissional e demissional, início e fim do atestado, número de dias de afastamento e códigos da CID-10. A partir das regras propostas por Cieza et al. 2016, em um processo efetuado por três pesquisadoras, estabeleceu-se o conteúdo dos registros de absenteísmo-doença com a CIF. Os dados foram tratados pelo programa IBM SPSS Statistics 2.0. Resultados: Foram identificados 29 conceitos significativos da CID-10, referentes aos 6 capítulos mais frequentes. Vinte e seis deles foram relacionados a 17 categorias da CIF, majoritariamente às funções e estruturas do Corpo, seguido de 1 categoria de Atividades e Participação. Um conceito foi classificado como condição de saúde e 2 como não cobertos pela CIF. Os dados disponíveis não evidenciaram categorias do componente Fatores Ambientais. Conclusão: O conteúdo dos registros de absenteísmo-doença permitiu subsidiar a seleção de categorias da CIF, refletindo os aspectos biofísicos contemplados na CID-10. Porém, para considerar os aspectos biopsicossociais da CIF e da política de saúde do trabalhador, será importante contemplar nos registros de absenteísmo-doença conteúdos referentes as Atividades e Participação e, Fatores Ambientais, nos quais os trabalhadores experenciam sua funcionalidade.

Objective: To use sickness absence data of cleaning workers from an educational institution to establish an initial content subsidy with the categories of the International Classification of Functioning, Disability and Health (ICF). Method: Quantitative, descriptive and retrospective study. It was analyzed 2881 medical certificates during 2010 and 2014, classified according to ICD-10. Variables studied: sex, admission and dismissal date, start and end of the certificate, number of days off and ICD-10 codes. Based on the linking rules proposed by Cieza, 2016 and in a process carried out by three researchers, the content of the absenteeism-disease records with the ICF was established. The data were processed by IBM SPSS 2.0 program. Results: It was identified 29 meaningful concepts of ICD-10 referring to the six most common chapters. Twenty-six of them were related to 17 categories of ICF, mostly to the functions and structures of the Body, followed by 1 category of Activities and Participation. One was classified as health condition and 2 as not covered by ICF. The available data did not allow relate meaningful concepts of ICD-10 to the categories of Environmental Factors component of ICF. Conclusion: The content of the absenteeism-disease records allowed to subsidize the selection of ICF categories, reflecting the biophysical aspects contemplated in ICD-10. However, in order to consider the biopsychosocial aspects of the ICF and the worker's health policy, it will be important to include in the absenteeism-disease records contents referring to Activities and Participation and Environmental Factors, in which workers experience their functionality.

Physical therapy interventions for the treatment of delayed onset muscle soreness (DOMS): Systematic review and meta-analysis.

OBJECTIVE: To evaluate the impact of interventions on pain associated with DOMS. DATA SOURCES: PubMed, EMBASE, PEDro, Cochrane, and Scielo databases were searched, from the oldest records until May/2020. Search terms used included combinations of keywords related to "DOMS" and "intervention therapy". ELIGIBILITY CRITERIA: Healthy participants (no restrictions were applied, e.g., age, sex, and exercise level). To be included, studies should be: 1) Randomized clinical trial; 2) Having induced muscle damage and subsequently measuring the level of pain; 3) To have applied therapeutic interventions (nonpharmacological or nutritional) and compare with a control group that received no intervention; and 4) The first application of the intervention had to occur immediately after muscle damage had been induced. RESULTS: One hundred and twenty-one studies were included. The results revealed that the contrast techniques (p = 0,002 I2 = 60 %), cryotherapy (p = 0,002 I2 = 100 %), phototherapy (p = 0,0001 I2 = 95 %), vibration (p = 0,004 I2 = 96 %), ultrasound (p = 0,02 I2 = 97 %), massage (p < 0,00001 I2 = 94 %), active exercise (p = 0,0004 I2 = 93 %) and compression (p = 0,002 I2 = 93 %) have a better positive effect than the control in the management of DOMS. CONCLUSION: Low quality evidence suggests that contrast, cryotherapy, phototherapy, vibration, ultrasound, massage, and active exercise have beneficial effects in the management of DOMS-related pain.

Effects of circuit resistance training on muscle power, functional agility, and bones' mineral content in people with spinal injury.

BACKGROUND: Physical exercise is one of the main agents when it comes to rehabilitation and changes in health aspects of people with SCI. This study aimed to establish the effects of circuit resistance training (CRT) on people with spinal cord injury (SCI), specifically on their body composition, muscle strength, anaerobic power, and functional capacity. METHODS: Sample consisted of five people with SCI: both sexes, ages between 25 and 62 years, and 12 weeks of CRT, twice a week. Before and after the 12 weeks of intervention, this research adopted clear-cut tests (medicine ball pitch, Wingate, zigzag, and dual-energy X-ray densitometry) to analyze the desired variables (muscle strength, anaerobic power, functional capacity, and body composition). RESULTS: Showed muscle strength improvement (P=0.028), agility increase (P=0.028), and equal levels of lean mass, bone mineral content, and bone loss index throughout life (T-score). CONCLUSIONS: Therefore, one can consider that CRT is an alternative to develop the upper limbs muscle power and functional agility. Together, all these variables may imply an overall improvement of the functional capacity in people with SCI. Additionally, these 12 weeks of CRT were responsible for helping the maintenance of lean mass, bone mineral content and T-score in this study's sample.

Hematological parameters in champion of Brazilian jiu-jitsu paradesport: Case study.

The behavior of biochemical and immunological parameters investigated in the field conditions in athletes is important to influence in the management of recovery and disease prevention as well as, to support the training program, as well as to improve the physical conditioning associated with health and performance. However, for amputee athletes, Brazilian jiu-jitsu paradesport practitioners, there are no published data to date. Thus, the objective of this case study was to quantify the magnitude of biochemical, hematological, and urinary alterations after a simulated fight session in elite athlete with world titles. Outcomes were obtained through blood analysis of samples collected at four different moments (M1-fasting; M2-1.5 hr after caloric intake; M3-Immediately after the simulated fight; M4-24 hr after the simulated fight). Responses triggered by the simulated fight between baseline and after 24 hr were found to increase in monocyte (100%), neutrophil (20%), and insulin (57%) concentrations, while reductions were observed in eosinophils (-50%), lymphocytes (-26.6%), platelets (-22%), cortisol (-50%), and creatine phosphokinase (-45.2%). After 24 hr lactate values returned to baseline levels. The different changes in biochemical and hematological parameters observed constitute responses to acute physical exercise and were according to the level of the high performance athlete. From these data it will be possible to evaluate the periodization, training load, and recovery techniques according to the individual response verified. In addition, these data may be used for comparison purposes within this specific sport, whose literature is still limited.

Efficacy of Ultrasound for Localized Fat Treatment on Clinical and Psychological Outcomes: A Randomized, Single-Blind, Placebo-Controlled Clinical Trial.

BACKGROUND: The use of ultrasound for localized fat treatment on possible psychological influences is little explored to date. Therefore, it is relevant to elaborate studies that include a placebo group in order to measure the real effects of the exclusive application of ultrasound. OBJECTIVES: To verify the influence of ultrasound application for localized fat treatment on clinical, functional, and psychological outcomes. METHODS: Thirty female participants who were candidates for localized abdominal fat treatment were included and randomly divided into three groups: control (CG, n = 10), experimental (EG, n = 10), and placebo (PG, n = 10). The CG did not receive any intervention. The EG received 10 ultrasound sessions for 20 minutes. For the PG, ultrasound was also applied for 20 minutes, but with zero intensities. Anthropometric assessment, cardiovascular parameters, circumference measurements, photography, endurance test, and subjective questionnaires were performed before and after the treatment protocols. RESULTS: The EG photographs show an improvement of 60% in the visual appearance. Regarding the other analyzed outcomes, no statistically significant differences were found between moments and groups (P > 0.05). CONCLUSIONS: Pretreatment and posttreatment photographs analysis demonstrate visual improvement in the appearance of abdominal localized fat in the EG. However, ultrasound application, when compared with CG and PG, is not a superior method for improving clinical, functional, and psychological parameters.

Phototherapy on Management of Creatine Kinase Activity in General Versus Localized Exercise: A Systematic Review and Meta-Analysis.

OBJECTIVE: The main focus of this systematic review was to determine the efficacy of phototherapy in the management of creatine kinase (CK) activity after exercise and furthermore to identify for which exercise model protocol phototherapy provides the best results. DESIGN: Meta-analysis comparing phototherapy with a control condition. SETTING: The MEDLINE, EMBASE, SPORTDiscus, PEDro, and CENTRAL databases were searched from their earliest records to October 03, 2016. Data were pooled in a meta-analysis and described as standardized mean difference (SMD) with 95% confidence intervals (CIs) using a random effects model. PARTICIPANTS: Healthy subjects (no restrictions were applied, eg, age, sex, and exercise level). INTERVENTION: Phototherapy (low-level laser therapy and/or light-emitting diode therapy) before or after exercise and a placebo or control condition. MAIN OUTCOME MEASURES: Creatine kinase activity (no restriction to any analysis, eg, serum, plasma, or capillary blood). RESULTS: Fourteen studies were included for review. The results revealed that phototherapy has a more positive effect than control condition in management of CK activity [SMD = 0.77, 95% CI (0.32 to 1.22); P = 0.0007; I = 72%]. In exploratory analysis, the results showed that phototherapy was effective only in the exercise protocol with localized exercise with large effect size [localized exercise: SMD = 0.89, 95% CI (0.26 to 1.51); P = 0.0002; I = 76%; general exercise: SMD = 0.61, 95% CI (-0.05 to 1.26); P = 0.07; I = 67%]. CONCLUSIONS: The available evidence suggest that phototherapy has beneficial effects on the management of CK activity and demonstrate a possible relationship based on damage caused by exercise, providing a greater effect in studies that used localized exercise.

Risk Factors for Low Muscle Mass in a Population-based Prospective Cohort of Brazilian Community-dwelling Older Women: The São Paulo Ageing & Health (SPAH) Study.

INTRODUCTION: Sarcopenia is characterized by progressive loss of skeletal muscle mass, which results in decreased muscle strength, functional impairment, and increased risk of death. Few studies have performed a concomitant evaluation of clinical, laboratory, and body composition variables to accurately determine the contribution of each parameter to low muscle mass (LMM) in older subjects. This study aimed to identify risk factors (clinical, laboratory parameters, BMD, and body composition by DXA including visceral fat) for LMM in a prospective cohort of older Brazilian women. METHODS: A total of 408 women aged ≥65 yr from the São Paulo Ageing & Health study were evaluated with clinical data, laboratory bone tests, BMD, and body composition by DXA using Hologic QDR 4500A equipment. Risk factors were measured at baseline (2005-2007). After a follow-up of 4.3 ± 0.8 yr, subjects were classified according to the LMM definition of the Foundation for the National Institutes of Health criteria. LMM was defined when appendicular lean mass divided by body mass index was less than 0.512. Multivariate logistic regression models were used to identify independent risk factors for LMM. RESULTS: At the end of follow-up, 116 women (28.4%) had LMM. Age averages were 73.3 ± 4.9 yr in the LMM group and 72.5 ± 4.5 yr in the normal group (p = 0.11). Mean BMI was 30.6 ± 5.2 kg/m2 in the LMM group and 28.1 ± 4.7 kg/m2 in the normal group (p < 0.001). In multivariate analyses, predictors of LMM were: falls (OR = 1.14, p = 0.016), TSH levels (OR = 1.08, p = 0.018, per 1 µUI/L-increase), serum creatinine levels (OR = 11.11, p < 0.001, per 1 mg/dL-decrease), and visceral adipose tissue (VAT) mass (OR = 1.17, p < 0.001, per 100 g increase). CONCLUSIONS: Falls, high TSH, low creatinine, and high VAT were risk factors for LMM in older women. More attention should be paid to these factors, since they are potentially reversible with adequate intervention.

Obstructive Sleep Apnea and Wake-up Stroke - A 12 Months Prospective Longitudinal Study.

BACKGROUND: Wake-up stroke (WUS) are strokes that are noted upon awakening in patients previously going to bed in a normal state of health. The role of sleep abnormalities in WUS is uncertain. The objective was to determine clinical characteristics, respiratory abnormalities during sleep and outcomes in patients with WUS versus non-WUS. METHODS: At baseline, patients with ischemic stroke were examined clinically and with a portable sleep recorder. Apnea-Hypopnea Index greater than or equal to 20 defined a cut-off severity index. At follow-up (3 and 12-months), patients were re-evaluated clinically and with questionnaires: Epworth Sleepiness Scale, Modified Rankin (MR) and Modified Barthel Index Results: Among all (N = 102, 64% male), hypertension (73%), Type 2 diabetes (29.4), heart disease (16.7%), physical inactivity (69.6%), smoking (32.4%) and alcohol consumption (17.6) were found. Apnea-Hypopnea Index (AHI) greater than 5 (92.9%), AHI greater than 15 (44.7%), AHI greater than or equal to 20 (35.3%) and AHI greater than 30 (11.8%) were registered. Cases with and without WUS did not differ regarding polygraphic findings. Long apneas (apnea duration > 20 s) was equally found in patients with WUS (23.1%) and non-WUS (23.7%). Type 2 diabetes mellitus (T2D) was independently associated with WUS (OR = 2.76; CI: 1.10-6.05; P = .03). Prospectively, symptom severity was not different between WUS and non-WUS. Overall, patients with OSA (IAH≥20) evolved with worse functional performance (MR, P = .02). CONCLUSIONS: Wake-up stroke occurred in approximately 1 of 3 of cases. Irrespective of WUS, half of the patients had moderate to severe sleep apnea; those with OSA (AHI≥ 20) evolved with worse functional performance after 1 year. WUS was associated with TDM reinforcing a relationship with cerebral small vessel disease.

Training with elastic and conventional devices on body composition: systematic review and meta-analysis / Treinamento em dispositivos elásticos e convencionais sobre a composição corporal: revisão sistemática e meta-análise / Entrenamiento en dispositivos elásticos y convencionales sobre composición corporal: revisión sistemática y metaanálisis

Abstract Introduction: Given the practicality and low cost of elastic devices, a comparison with conventional devices may be able to quantify gains from both tools for further conclusions. Objective: Compare the effect of resistance training with elastic (tubes and resistance band) and conventional (weight machines and dumbbells) devices on body composition. Method: This is a systematic review and meta-analysis. The PubMed/MEDLINE, Embase, PEDro and CENTRAL databases were searched from the earliest records to July 25, 2018. Data were described in standardized mean difference (SMD) with a 95% confidence interval (95% CI). Results: Four studies were included. The results of the meta-analysis did not show superiority among the analyzed methods for the variables investigated (SMD = -2.04, 95% CI -7.56, 3.48, p < 0.00001, lean mass: SMD = 0.28, 95% CI -0.29, 0.85, p = 0.97, body fat: SMD = 2.77, 95% CI -0.05, 5.59, p = 0.92, body mass: SMD = 1.22, 95% CI -0.29, 2.74, p = 0.11). Conclusion: The results of the meta-analysis showed superiority of outcome from training in conventional devices only for the variable fat mass. For the other variables, no statistically significant differences were found. Elastic resistance can promote similar outcomes to resistance in different population profiles and from various protocols on variables related to body composition.

Resumo Introdução: Tendo em vista a praticidade e o baixo custo dos dispositivos elásticos, uma comparação com dispositivos convencionais (halteres e máquinas de peso) pode ser capaz de quantificar os resultados observados para posteriores conclusões sobre eventual tendência de superioridade verificada entre os métodos investigados. Objetivo: Comparar o efeito do treinamento resistido em dispositivos elásticos (tubos e faixa elástica) e convencionais (máquinas de peso e halteres) sobre a composição corporal. Método: Trata-se de uma revisão sistemática e meta-análise. Foram pesquisadas as bases de dados PubMed/MEDLINE, Embase, PEDro e CENTRAL desde os registros mais antigos até 25 de julho de 2018. Os dados foram descritos em standardized mean difference (SMD) com intervalo de confiança de 95% (95% CI). Resultados: Quatro estudos foram incluídos. Os resultados da meta-análise não demonstraram superioridade entre os métodos analisados para as variáveis investigadas (massa gorda: SMD= -2.04; 95% CI 7.56, 3.48; p < 0.00001; massa magra: SMD = 0.28; 95% CI -0.29, 0.85; p = 0.97; gordura corporal: SMD = 2.77; 95% CI -0.05, 5.59; p = 0.92; massa corporal: SMD = 1.22; 95% CI -0.29, 2.74; p = 0.11). Conclusão: Houve superioridade de resultado apenas para a variável massa gorda, que demonstrou melhores resultados oriundos do treinamento em dispositivos convencionais. Para as demais variáveis, não foram identificadas diferenças estatisticamente significantes. A resistência elástica é capaz de promover desfechos similares a resistência convencional, em diferentes perfis de população e a partir de protocolos diversos sobre variáveis relacionadas a composição corporal.

Resumen Introducción: Debido a la practicidad y el bajo costo de los dispositivos elásticos, una comparación con los dispositivos convencionales (pesas y mancuernas) puede cuantificar los beneficios de ambas herramientas para obtener conclusiones adicionales. Objetivo: Comparar el efecto del entrenamiento de resistencia en dispositivos elásticos (tubos y banda elástica) y convencionales (pesas y mancuernas) en la composición corporal. Método: Esta es una revisión sistemática y metaanálisis. En las bases de datos PubMed/MEDLINE, Embase, PEDro y CENTRAL se buscaron desde los registros más antiguos hasta el 25 de julio de 2018. Los datos se describieron en la diferencia de medias estandarizada (DME) con un intervalo de confianza del 95% (IC del 95%). Resultados: Se incluyeron cuatro estudios. Los resultados del metaanálisis no mostraron una superioridad entre los métodos analizados para las variables investigadas (masa grasa, SMD=-2.04, IC 95% -7.56, 3.48, p < 0,00001, masa magra: SMD = 0.28, IC 95% -0.29, 0.85 , p = 0,97, grasa corporal: SMD = 2,77, IC 95% -0,05, 5,59, p = 0,92, masa corporal: SMD = 1,22, IC 95% -0,29, 2,74, p = 0,11). Conclusión: Hubo una superioridad de los resultados del entrenamiento en dispositivos convencionales solo para la variable masa grasa. Para las otras variables, no se encontraron diferencias estadísticamente significativas. La resistencia elástica es capaz de promover resultados similares a la resistencia convencional en diferentes perfiles de población y de varios protocolos sobre variables relacionadas con la composición corporal.

Níveis de ansiedade, depressão e estresse em funcionários de uma instituição de ensino superior pública do interior do estado de São Paulo / Anxiety, depression and stress among employees of a public higher education institution in São Paulo, Brazil

Introdução: A saúde do trabalhador ganha destaque em âmbito científico, sendo tema de pesquisas e debates internacionais, apresentando o estresse laboral como potencial agente estressor. Objetivo: Caracterizar a incidência de sintomatologia referente à ansiedade e à depressão correlacionada aos níveis socioeconômicos em servidores técnico-administrativos de uma universidade estadual do estado de São Paulo. Métodos: A amostra foi composta de 89 participantes. Os dados foram obtidos por meio do inventário de sintomas de estresse para adultos de Lipp, para detectar o nível de estresse; da escala hospitalar de ansiedade e depressão, para análise de ansiedade e depressão; e de um questionário informativo para detectar o nível educacional e sociodemográfico. Resultados: Verificou-se que 47% dos participantes apresentaram sintomas de ansiedade e 39% de depressão, não havendo relação direta com o nível socioeconômico. Além disso, observou-se que, entre os indivíduos que apresentavam ansiedade, 50% eram docentes, e, do total de indivíduos com depressão, 38,4% eram do setor administrativo. O estresse encontra-se em maior escala nas categorias ensino superior (29,6%) e pós-graduados (33,3%). Conclusões: Os achados demonstraram elevada prevalência de ansiedade e depressão em todas as classes socioeconômicas investigadas. Ademais, indivíduos de nível educacional elevado são mais estressados que os de nível educacional inferior.

Background: Occupational health is increasing in visibility within the scientific community and has become a field of international research and discussions in which occupational stress is described as a possible stressor. Objective: To analyze the relationship between anxiety and depression symptoms and socioeconomic level among technical-administrative employees of a public university in the state of São Paulo, Brazil. Methods: The sample comprised 89 participants. Data were obtained through Lipp's Inventory of Stress Symptoms for adults to identify levels of stress and the Hospital Anxiety and Depression scale. An additional questionnaire was administered to gather information on educational and socioeconomic levels. Results: About 45% of the participants exhibited symptoms of anxiety and 39% of depression, however, without direct relationship with their socioeconomic level. Among the participants with depression 50% were professors, and among those with depression 38.4% were administrative employees. Stress was more frequent among the participants who had attended higher education (29.6%) and graduate studies (33.3%). Conclusion: The study results indicate a high prevalence of anxiety and depression regardless of the socioeconomic level of the participants. Stress was more frequent among the participants with higher educational level.

Kinetics of Muscle Damage Biomarkers at Moments Subsequent to a Fight in Brazilian Jiu-Jitsu Practice by Disabled Athletes.

Purpose: Evidence indicates that muscle injury caused by exercise can lead to functional, biochemical, and clinical damage. These outcomes encompass an intrinsic potential to understand the real magnitude of interpretation of classic signs in sport environments and to monitor athletes, contributing to specific actions. However, little or no research has explored the general behavior of the variables presented in response to paradesportivo Brazilian jiu-jitsu. The objective of this study was to investigate the physiological behavior through clinical, functional, and metabolic outcomes in the moments following a simulated fight. Methods: Six disabled athletes, male Brazilian jiu-jitsu practitioners (34-44 years old), were included. The participants had their outcomes analyzed individually and the variables studied were correlated. It is noteworthy that participants I and II are professional athletes with world titles. The ethics committee involving human beings of the Federal University of Mato Grosso (register no. 2.997.241) accepted the study. The participants attended the collection site four times, with a 24-h interval between sessions, characterizing the following moments: pre-exertion, and post-exertion, 24, 48, and 72 h after the simulated fight. Data collected were muscle pain, perception of recovery, muscle strength, and blood samples for creatine kinase (CK) and lactate dehydrogenase (LDH) analysis. The variables described were measured at all collection moments. The data were presented in individual raw values of each participant, with Spearman correlation analysis to verify the relationship between variables and moments. Results: The outcomes demonstrated that the CK and LDH activity was higher of high-performance parathletes (I and II) and the reported muscle pain was lower. The fight did not influence maximal isometric strength levels in either participant. In addition, regarding delayed effects, the participants reported peak pain, CK, LDH, and decreased perception of recovery within 24 h. However, it was found that, at 72 h, all values had recovered, close to baseline levels. Conclusion: The presented outcomes provide parameters and suggest a safe scenario based on the intensity and volume commonly adopted in this sports parade modality where the level of effort recommended during combat does not seem to cause deleterious damage.

Effects of training with elastic resistance versus conventional resistance on muscular strength: A systematic review and meta-analysis.

Given the practicality and low cost of using elastic resistance in training for different populations and its effectiveness in a range of outcomes, a comparison with conventional devices could clarify and quantify the benefits provided by both mode. To compare the effects of resistance training with elastic devices (tubes and Thera-Bands) and conventional devices (weight machines and dumbbells) on the outcome muscular strength. A search was performed in the databases PubMed/MEDLINE, EMBASE, PEDro (Physiotherapy Evidence Database), and CENTRAL (Cochrane Central Register of Controlled Trials) from the earliest records up to 20 December 2017. Data were pooled into a meta-analysis and described as standardized mean difference with a 95% confidence interval (registration number: CRD42016042152). Eight studies were included. The results of the meta-analysis demonstrated no superiority between the methods analyzed for lower limb (SMD = -0.11, 95% CI -0.40, 0.19, p = 0.48) or upper limb muscular strength (SMD=0.09; 95% CI -0.18, 0.35; p = 0.52) [corrected]. Elastic resistance training is able to promote similar strength gains to conventional resistance training, in different population profiles and using diverse protocols.

Association of Appendicular Lean Mass, and Subcutaneous and Visceral Adipose Tissue With Mortality in Older Brazilians: The São Paulo Ageing & Health Study.

Body composition changes as a result of ageing may impact the survival of older adults. However, its influence on mortality risk is uncertain. Currently, the best method for body composition analysis in clinical practice is DXA. Nonetheless, the few studies on body composition by DXA and mortality risk in the elderly have some limitations. We investigated the association between body composition by DXA and mortality in a cohort of elderly subjects. Eight hundred thirty-nine community-dwelling subjects (516 women, 323 men) ≥ 65 years of age were assessed by a questionnaire, clinical data, laboratory exams, and body composition by DXA at baseline. Total fat and its components (eg, visceral adipose tissue [VAT]) were estimated. Appendicular lean mass (ALM) adjusted for fat and ALM divided by height² was used to ascertain the presence of low muscle mass (LMM). Mortality was recorded during follow-up. Multivariate logistic regression was used to compute ORs for all-cause and cardiovascular mortality. Over a mean follow-up of 4.06 ± 1.07 years, there were 132 (15.7%) deaths. In men, after adjustment for relevant variables, the presence of LMM (OR, 11.36, 95% CI, 2.21 to 58.37, P = 0.004) and VAT (OR, 1.99, 95% CI, 1.38 to 2.87, P < 0.001, for each 100-g increase) significantly increased all-cause mortality risk, whereas total fat, measured by the fat mass index, was associated with decreased mortality risk (OR, 0.48, 95% CI, 0.33 to 0.71, P < 0.001). Similar results were observed for cardiovascular mortality. In women, only LMM was a predictor of all-cause (OR, 62.88, 95% CI, 22.59 to 175.0, P < 0.001) and cardiovascular death (OR, 74.54, 95% CI, 9.72 to 571.46, P < 0.001). LMM ascertained by ALM adjusted for fat and fat mass by itself are associated with all-cause and cardiovascular mortality risk in the elderly. Visceral and subcutaneous fat have opposite roles on mortality risk in elderly men. Thus, DXA is a promising tool to estimate risk of mortality in the elderly. © 2019 American Society for Bone and Mineral Research.

Anxiety, depression and stress among employees of a public higher education institution in São Paulo, Brazil.

BACKGROUND: Occupational health is increasing in visibility within the scientific community and has become a field of international research and discussions in which occupational stress is described as a possible stressor. OBJECTIVE: To analyze the relationship between anxiety and depression symptoms and socioeconomic level among technical-administrative employees of a public university in the state of São Paulo, Brazil. METHODS: The sample comprised 89 participants. Data were obtained through Lipp's Inventory of Stress Symptoms for adults to identify levels of stress and the Hospital Anxiety and Depression scale. An additional questionnaire was administered to gather information on educational and socioeconomic levels. RESULTS: About 45% of the participants exhibited symptoms of anxiety and 39% of depression, however, without direct relationship with their socioeconomic level. Among the participants with depression 50% were professors, and among those with depression 38.4% were administrative employees. Stress was more frequent among the participants who had attended higher education (29.6%) and graduate studies (33.3%). CONCLUSION: The study results indicate a high prevalence of anxiety and depression regardless of the socioeconomic level of the participants. Stress was more frequent among the participants with higher educational level.

INTRODUÇÃO: A saúde do trabalhador ganha destaque em âmbito científico, sendo tema de pesquisas e debates internacionais, apresentando o estresse laboral como potencial agente estressor. OBJETIVO: Caracterizar a incidência de sintomatologia referente à ansiedade e à depressão correlacionada aos níveis socioeconômicos em servidores técnico-administrativos de uma universidade estadual do estado de São Paulo. MÉTODOS: A amostra foi composta de 89 participantes. Os dados foram obtidos por meio do inventário de sintomas de estresse para adultos de Lipp, para detectar o nível de estresse; da escala hospitalar de ansiedade e depressão, para análise de ansiedade e depressão; e de um questionário informativo para detectar o nível educacional e sociodemográfico. RESULTADOS: Verificou-se que 47% dos participantes apresentaram sintomas de ansiedade e 39% de depressão, não havendo relação direta com o nível socioeconômico. Além disso, observou-se que, entre os indivíduos que apresentavam ansiedade, 50% eram docentes, e, do total de indivíduos com depressão, 38,4% eram do setor administrativo. O estresse encontra-se em maior escala nas categorias ensino superior (29,6%) e pós-graduados (33,3%). CONCLUSÕES: Os achados demonstraram elevada prevalência de ansiedade e depressão em todas as classes socioeconômicas investigadas. Ademais, indivíduos de nível educacional elevado são mais estressados que os de nível educacional inferior.