Analysis of Plantar Tactile Sensitivity in Older Women after Conventional Proprioceptive Training and Exergame.

OBJECTIVE: To evaluate and compare the effects of conventional proprioceptive training and games with motion monitoring on plantar tactile sensitivity in older women. METHODS: A randomized controlled clinical trial, with 50 older women randomized into three groups: conventional proprioception (n = 17), games with motion monitoring (n = 16), and the control (n = 17). They underwent 24 intervention sessions, three times a week, for eight weeks. The conventional proprioception group performed exercises involving gait, balance, and proprioception. The games performed by the motion monitoring group included exercises using the Xbox Kinect One video game from Microsoft®. The evaluation of tactile pressure sensitivity was performed using Semmes-Weinstein monofilaments. Intragroup comparisons between the two paired samples were performed using paired Student's t-test or Wilcoxon test. Intergroup comparisons between the three independent samples were performed using the Kruskal-Wallis test and Dunn's post hoc test, with p ≤ 0.05. RESULTS: The older women submitted to conventional games with motion monitoring training and showed improvement in plantar tactile sensitivity in the right and left feet. When comparing the intergroup results, the two training modalities obtained an improvement in the plantar tactile sensitivity of the older women when compared to the control group. CONCLUSIONS: We conclude that both training modalities may favor the improvement of plantar tactile sensitivity in older women, with no significant differences between conventional and virtual training.

Factors influencing gait speed in community-dwelling older women: A Bayesian approach.

BACKGROUND: Human gait is a complex task resulting from the interaction of sensory perception, muscle force output, and sensory-motor integration, which declines with the aging process and impacts gait speed in older women. RESEARCH QUESTION: What are the separate and combined impacts of sensory-motor factors on gait speed of older women? METHODS: Sixty healthy older women (69.3 ±â€¯5.9 years) volunteered for this study. A previous screening using Pearson's correlation selected variables significantly correlated with gait speed: age, plantar tactile perception, lower limb explosive force, and mean velocity (MV) of the center of pressure (CoP). Simple and multivariate regression models were performed with selected variables. The magnitude of evidence was obtained using Bayesian inference, determining posterior probabilities based on our data. RESULTS: Gait speed was negatively correlated with age and positively correlated with plantar tactile perception, MV (Romberg index), and lower limb explosive force. The coefficient of determination (R2) varied between 0.06 for plantar tactile perception and 0.22 for explosive force (p < 0.05). The multivariate model, including age, MV (Romberg index), and lower limb explosive force, explained 44% (R2 = 0.44) of the variance in gait speed, with a small standard error of estimate (0.14 m/s). Bayesian inference confirmed the good posterior probability of the model. SIGNIFICANCE: Age, plantar tactile perception, MV (Romberg index), and lower limb explosive force impact gait speed, whereas the combination of the first three factors has an excellent posterior probability of predicting or affecting gait speed.

Hyperuricemia is associated with sympathovagal imbalance in older adults.

PURPOSE: This study aimed to compare heart rate variability (HRV) parameters obtained through symbolic analysis (SA), between older adults with and without hyperuricemia. METHODS: This is a cross-sectional study including 202 community-dwelling old adults, which was clinically stratified as with or without hyperuricemia, according to the cutoff point of serum uric acid ≥ 6 mg/dL for women and ≥ 7 mg/dL for men. Successive RR intervals were recorded along 5 min and analyzed with SA method. 0 V%, 1 V% and 2 V% patterns were quantified and compared between groups. Comparisons were carried out through parametric or nonparametric tests, according to the data distribution characteristics, evaluated by Kolmogorov-Smirnov test. The significance level was set as p ≤ 0.05 for all statistical procedures. RESULTS: The prevalence of hyperuricemia was 67.8 %, and the hyperuricemic older adults exhibited significant higher values for V0% and lower values for V2% parameters when compared to normouricemic older adults. CONCLUSION: These results suggesting a sympathovagal imbalance in hyperuricemic older adults, characterized by greater sympathetic predominance (0 V%) and lower vagal modulation (2 V%) at rest conditions.

Different anthropometric indicators of central obesity can predict hypertension in older adults

Abstract Objective: to investigate the association between hypertension and anthropometric indicators of central obesity, obtained from two anatomical sites in old adults. Methodology: a cross-sectional study including 145 elderly people, from whom socioeconomic and demographic data and anthropometric indicators of central obesity (Waist Circumference [CC] and Abdominal Circumferency [CA]) were obtained, which were considered independent variables. A logistic regression model was used to analyze the associations, and for the discriminatory power of the cutoff points of the anthropometric indicators for hypertension, a Receiver Operating Characteristic (ROC) curve was performed. Comparisons between ROC curves were performed, aiming to identify a significant difference in the discriminatory power of the anthropometric indicators studied. Results: among the 145 individuals, 79 were female (54%) and 66 were male (46%). The results showed a high prevalence of hypertension among men (69.7%) and women (73.4%). Both WC and AC were significantly associated to hypertension in both sexes. The ROC curve parameters indicated that both anthropometric indicators of central obesity exhibit a good discriminatory power for hypertension in this studie. For the studied population, the WC cutoff point for hypertension was > 83.2 cm for men and > 82.6 cm in women, while for CA it was > 85.1 cm and > 85.4 cm in men and women, respectively. Conclusion: AC and WC are significantly associated with hypertension in both sexes, and there is no superiority among them to predict hypertension in the elderly population.

Resumen Objetivo: investigar la asociación entre hipertensión e indicadores antropométricos de obesidad central, obtenidos de dos sitios anatómicos en adultos mayores. Metodología: estudio transversal que incluyó a 145 adultos mayores, de los cuales se obtuvieron datos socioeconómicos y demográficos e indicadores antropométricos de obesidad central (circunferencia de cintura [CC] y circunferencia abdominal [CA]), que fueron considerados variables independientes. Se utilizó un modelo de regresión logística para analizar las asociaciones, además del poder discriminatorio y los puntos de corte para la hipertensión de los indicadores antropométricos, que se obtuvieron a partir de los parámetros de la curva Receiver Operating Characteristic (ROC). Se hicieron comparaciones entre las curvas ROC, con el objetivo de identificar diferencias significativas en el poder discriminatorio de los indicadores antropométricos estudiados. Resultados: de los 145 individuos 79 eran del sexo femenino (54 %) y 66 del masculino (46 %). Los resultados mostraron una alta prevalencia de hipertensión arterial en hombres (69,7 %) y mujeres (734 %). Tanto CC como CA se asociaron significativamente a la hipertensión en ambos sexos. Los parámetros de la curva ROC revelaron que ambos indicadores antropométricos de obesidad central exhiben un buen poder discriminatorio para la hipertensión en la población estudiada. El punto de corte para la CC fue > 83,2 cm para hombres y de > 82,6 cm para mujeres; mientras que para CA fue > 85,1 cm y > 85,4 cm para hombres y mujeres, respectivamente. Conclusión: CA y CC están significativamente asociadas a la hipertensión en ambos sexos, y no hay superioridad entre ellas para predecir la hipertensión en la población anciana.

Resumo Objetivo: investigar a associação entre hipertensão e indicadores antropométricos de obesidade central obtidos de dois sítios anatômicos em idosos. Metodologia: estudo transversal incluindo 145 idosos, dos quais foram obtidos dados socioeconô-micos e demográficos e indicadores antropométricos de obesidade central (circunferência de cintura [CC] e cirfunferência abdominal [CA]), que foram considerados como variáveis independentes. Um modelo de regressão logística foi utilizado para analisar as associações, além do poder discriminatório e os pontos de corte para a hipertensão dos indicadores antropométricos, que foram obtidos a partir dos parâmetros da curva Receiver Operating Characteristic (ROC). Comparações entre as curvas ROC foram realizadas, objetivando identificar diferença significativa no poder discriminatório dos indicadores antropométricos estudados. Resultados: entre os 145 indivíduos, 79 eram do sexo feminino (54 %) e 66 do masculino (46 %). Os resultados mostraram uma alta prevalência de hipertensão arterial entre homens (69,7 %) e mulheres (73,4 %). Tanto a CA quanto a CC foram associadas à hipertensão em ambos os sexos de maneira significativa. Os parâmetros da curva ROC indicaram que ambos os indicadores antropométricos da obesidade central exibiram um bom poder discriminatório para a hipertensão na população estudada. O ponto de corte para a CC foi > 83,2 cm para homens e > 82,6 cm para mulheres, enquanto para CA foi > 85,1 cm e > 85,4 cm para homens e mulheres, respectivamente. Conclusão: as CA e CC estão significativamente associadas à hipertensão em ambos os sexos e não há superioridade entre elas para prever a hipertensão na população idosa.

Sarcopenia is associated to an impaired autonomic heart rate modulation in community-dwelling old adults.

PURPOSE: The aims of this study were to compare the autonomic heart control parameters from sarcopenic and non-sarcopenic community-dwelling elders. METHODS: This is a cross-sectional study including 76 community-dwelling old adults, which was clinically stratified as sarcopenic or non-sarcopenic, according to the current recommendations. They were submitted to 5-min recordings of successive RR intervals. The analysis of the RR intervals variability was carried out in time (mean RR, RMSSD, pNN50, SDNN and triangular index) and frequency domains (LFnu, HFnu and LF/HF ratio), and with nonlinear methods (SD1, SD2, and D2). The parameters of autonomic heart rate modulation (AHRM) were adjusted for potential confounders: sex, diabetes, beta-blockers use, cardiovascular disease, body mass index and physical activity level, smoking habit. Normality of the data was tested by Kolmogorov-Smirnov test and, since most variables did not exhibit a normal distribution the Mann-Whitney test was used to compare the parameters of AHRM. The significance level was set as p ≤ 0.05 and all statistical procedures were performed with SPSS®. RESULTS: Adjusted parameters of AHRM obtained from time domain and nonlinear methods were significantly different between sarcopenic and non-sarcopenic elders (p < 0.05), while parameters obtained from frequency domain analysis did not were different between groups (p > 0.05). CONCLUSION: Sarcopenic old adults exhibited lower parasympathetic-associated modulation, suggesting a poor cardioprotection associated to this condition.

Lower limb strength, but not sensorial integration, explains the age-associated postural control impairment.

INTRODUCTION: The aging process leads to functional decline of sensorial organs, muscle mass and strength, as well as the sensorimotor integration, culminating in age-associated postural control impairments. The purpose of this study was to compare the balance, the sensorial integration process and the lower limb strength among three old aged groups. METHODS: Eighty-one community-dwelling healthy old people (58% women), assigned into three age groups [60-69 years (n=30), 70-79 years (n=40), and ≥80 years (n=11)], participated in this study. All participants were submitted to anthropometric and stabilometric evaluation, and carried out a Chair stand test. Stabilometric parameters obtained from time [amplitude displacement of center of pressure (CoP)] and frequency (oscillations of CoP at sub 0.3 Hz and 1-3 Hz bands) domain analysis were used as the indicators of balance performance and sensorial integration, respectively. RESULTS: Our results revealed that the CoP amplitude displacement was significantly greater in the older aged group, without differences in spectral bands, while the performance in the Chair stand test was smaller in the older aged group. CONCLUSION: These data indicate that the age-associated postural control impairment is explained by the lower limb strength declines, but not by the age-associated changes in sensorial integration. LEVEL OF EVIDENCE: III.

Handgrip explosive force is correlated with mobility in the elderly women.

The analysis of explosive force, through rate of force development (RFD) and contractile impulse (CI), from handgrip strength data seems to be useful and promising information to study the aging of musculoskeletal system and health status. We aimed to test the hypothesis that, in elderly women, the handgrip explosive force could be better associated to the functional mobility than maximum handgrip strength. Handgrip strength and the performance of Timed Up & Go Test (TUG) were measured from sixty-five community-dwelling healthy elderly women. The average slope of the moment-time curve (Δ moment/Δ time) over the time interval of 0-200 ms relative to the onset of contraction was calculated to provide the RFD and CI. The highest strength achieved during the isometric contraction was used as maximum handgrip strength. Pearson correlations were used to assess the strength of the relationship between the handgrip strength parameters (Maximum strength and explosive force from 0-200 ms) and TUG test performance from older women. The correlation analysis showed that the TUG test performance was inversely correlated to the handgrip strength parameters, with better relationship with explosive force parameters. The handgrip explosive force seems to be a promising predictor of functional mobility of elderly women, since it showed a better relationship with functional mobility than maximum handgrip strength.

Nutritional status and handgrip strength in elderly living at low human development index community / Estado nutricional e força de preensão manual em idosos residentes em comunidade com baixo índice de desenvolvimento humano

Design of the study: Epidemiological cross-sectional population-based household study. Objective: To investigate the relationship between anthropometric indicators of nutritional status and muscular strength in community-dwelling elderly with low human development index. Methodology: Elderly (N = 316) residents of a city in Brazil’s Northeast Region were submitted to an interview and a physical evaluation. The dependent variable assessed was handgrip strength. The independent variables were body mass index and arm muscle area. The control variables were age, smoking, physical activity, hospitalization and hyperglycemia. Simple and multiple linear regression models were used for statistical analyses. Results: Following control by adjustment variables, there was significant positive correlation of handgrip strength with body mass index (βadjusted = 0.439; p = 0.010; r2adjusted = 0.062) and arm muscle area (βadjusted= 0.046; p = 0.003; r2 adjusted = 0.087) for male individuals, but not for female individuals. Conclusions: Anthropometric indicators of nutritional status have been positively related to handgrip strength in elderly men, but not in women.

Modelo do estudo: Estudo epidemiológico transversal, populacional de base domiciliar. Objetivo: Verificar a relação entre indicadores antropométricos de estado nutricional e força muscular em idosos residentes em comunidade com baixo índice de desenvolvimento humano. Metodologia: Idosos (N =316) de uma cidade do Nordeste do Brasil foram submetidos a entrevista e avaliação física. A variável dependente analisada foi a força de preensão manual. As variáveis independentes foram o índice de massa corporal e a área muscular do braço. As variáveis de controle foram a idade, tabagismo, atividade física, hospitalização e hiperglicemia. Foram usados modelos de regressão linear simples e múltipla para as análises estatísticas. Resultados: Após controle pelas variáveis de ajuste, houve correlação positiva significante da força de preensão manual com o índice de massa corporal (βajustado = 0,439;p = 0,010; r2 ajustado = 0,062) e a área muscular do braço (βajustado = 0,046; p = 0,003; r2ajustado = 0,087) para os exo masculino, mas não para o sexo feminino. Conclusões: Indicadores antropométricos de estado nutricional foram relacionados a força de preensão manual em homens idosos, mas não em mulheres.

Comparison of explosive force between young and elderly women: evidence of an earlier decline from explosive force.

The aging process causes many changes in muscle strength, and analysis of explosive force from handgrip strength seems to be useful and promising in studying the aging musculoskeletal system. Therefore, the purpose of this study was to investigate if explosive force parameters [rate of force development (RFD) and contractile impulse (CI) over the time interval of 0-200 ms from the onset of contraction] during handgrip efforts decline differently than maximum handgrip strength with increasing age. Twenty healthy young women (20-27 years) and 65 healthy elderly women, assigned into three age groups (50-64, 65-74, and 75-86 years), participated in this study. All participants performed two maximal grip attempts. Handgrip data were recorded as force-time curves, peak force, and explosive force parameters. Our results revealed that peak force decreased significantly (p < 0.05) for those who are 65 years old, while explosive force parameters decreased significantly (p < 0.05) for those aged 50 years. These data indicate that the decline in explosive grip force-generating capacity may begin earlier (i.e., for those aged 50 years old) than peak force during the aging process. Our findings suggest that the aging process reduces the explosive grip force-generating capacity before affecting peak force.

Aspectos bioéticos da autonomia do idoso / Aspectos bioéticos de la autonomía del anciano / Bioethical aspects of the autonomy of the elderly

Com base em uma revisão narrativa, este estudo visa descrever os aspectos bioéticos envolvidos na autonomia de idosos. O levantamento bibliográfico foi realizado a partir da produção registrada nas bases Biblioteca Cochrane, SciELO, Medline, Ibecs, Lilacs e em livros voltados ao tema. Considera-se significativa esta reflexão, haja vista que o número de idosos tem crescido aceleradamente nos últimos anos e os estudos têm demonstrado que este aumento associa-se, concomitantemente, à ausência do respeito à autonomia dessa população. Conclui-se que este princípio deve estar pautado em atitudes bioéticas e no respeito ao idoso como um ser autocapaz. Sugere-se que novos estudos possam ampliar a discussão acerca do tema, a fim de garantir uma vida mais digna ao idoso, em uma sociedade que envelhece rapidamente.

Con base en una revisión narrativa, este estudio tiene como objetivo describir los aspectos bioéticos involucrados en la autonomía de los ancianos. Fue efectuado a partir de la producción registrada en las bases de datos: Biblioteca Cochrane, SciELO, Medline, Ibecs, Lilacs; además de libros dirigidos para el tema en cuestión. Se considera significativa esta reflexión visto que el número de ancianos ha crecido aceleradamente en los últimos años y los estudios han demostrado que este aumento se asocia concomitantemente a la ausencia del respeto a la autonomía de esa población. Se concluye que este principio debe estar pautado en actitudes bioéticas y al respeto del anciano como un ser autónomo. Se sugiere que nuevos estudios puedan ampliar la discusión acerca del tema, con la finalidad de garantizar una vida más digna al anciano, en una sociedad que envejece rápidamente.

This study was performed through a review of literature and it aims to describe bioethical issues involved in the autonomy of the elderly. This bibliographical survey was carried out through the recorded production of the following databases: Ibecs, Lilacs, Medline, Cochrane Library, and SciELO; besides of books that focus on the topic. This reflection is considered significant because the number of elderly has grown rapidly in recent years and studies have shown that this increase is concomitantly associated with a lack of respect for this population's autonomy. It can be concluded that such principle should be founded on bioethical attitudes and respect for the elderly as autonomous people. It is therefore suggested that further studies should broaden the discussion about this subject, in order to guarantee a better quality of life for the elderly in a rapidly aging society.

Task failure during standing heel raises is associated with increased power from 13 to 50 Hz in the activation of triceps surae.

The goal of this paper was to investigate the amplitude and sub-100 Hz frequency content of surface electromyography (EMG) signals obtained from agonist, antagonist and synergist muscles during a heel-raise task sustained to failure. Twenty-two healthy adults, 14 men and 8 women participated in the study. Surface EMG data from the raising and lowering phases of the movement were studied in the time (EMG amplitude) and frequency (wavelet transform) domains. For the raising phase, we found a significant increase in the EMG amplitude of all muscles studied throughout the task (P < 0.02); however, for the lowering phase, we found a decrease in overall muscle activation for the medial gastrocnemius and tibialis anterior. Additionally, we found higher 13-30 and 30-50 Hz normalized power during the raising phase for the triceps surae prior to task failure and at task failure compared with the beginning and midway of the task (P < 0.05); during the lowering phase, however, we found higher normalized power from 30 to 50 Hz for the triceps surae (P < 0.01) and higher 13-30 Hz normalized power for the tibialis anterior (P < 0.01) at task failure compared with the beginning and midway of the task. Finally, we showed that a dynamic task performed until failure can induce different activation strategies for agonist, antagonist and synergist muscles, and that the frequency content below 100 Hz contains useful information about the neural activation of these muscles in relation to task failure that is not evident from the EMG amplitude.

Análise eletromiográfica dos músculos masseter, temporal e trapézio em diferentes condições da lordose cervical / Electromyographic analysis of masseter, temporalis and trapezius muscles in different conditions of the cervical lordosis

Desequilíbrios osteomioarticulares da região cervical e craniomandibular têm sido referenciados como fontes potenciais de disfunções da articulação temporomandibular. O presente estudo objetivou analisar a atividade eletromiográfica (EMG) dos músculos masseter, temporal anterior e trapézio, bilateralmente, com a coluna cervical em posição lordose fisiológica (LF) e em posição de hiperlordose ( HL), induzida através da colocação de um rolo de espuma com raio de 5 cm, nas condições de repouso e durante oclusão dentária com força máxima. 10 indivíduos saudáveis (5 homens e 5 mulheres), sem acometimento da articulação temporomandibular ou da coluna cervical foram voluntários no estudo, sendo observado que em condição de repouso o músculo masseter direito apresentou maior atividade EMG na postura de LF (7.0+-1.uV) em relação à postura de HL ( 6.1+-1.ouV) (p<0.05), já o músculo trapézio esquerdo apresentou maior atividade EMG na postura de HL (9.2+-1.O uV) se comparada à postura de LF (7.0+-O.6uV)(p<0.05), durante o ato de oclusão dentária com força máxima houve maior ativação do músculo trapézio direito na postura de HL (9.6+-1.8uV) se comparada à postura de LF (6.6+-1.3.uV) (p<0.05). Os dados deste estudo apontam para uma potencial influência do input sensorial da região cervical na ativação do músculo masseter e trapézio, sendo recomendada a realização de estudos que reproduzam a metodologia aqui aplicada a amostras de indivíduos portadores de disfunção da articulação temporomandibular.

Unbalance in the skeletal system of the cervical and craniomandibular regions have benn indicated as potentials sources of temporomandibular dysfunctions. This study aims to analysis the electromyographical activity(EMG) of masseter, anterior temporal and upper trapezius muscles, bilaterally, with the cervical spine in physiological lordosis (PL) and in hiperlordosis (HL) positions, induced by roll placement with 5 cm of ray. In both positions the EMG was recorded during rest and dental occlusion with maximal effort. 10 health subjects (5 men and 5 women) without history of temnporomandibular or cervical spine disease participated in the estudy. In rest condition the EMG activity of right masseter muscle in PL posture ((7.0+-1.uV) was greater than HL ( 6.1+-1.ouV) (p<0.05), the left trapezius muscle showed greater EMG activity in the HL (9.2+-1.O uV) in relation to the PL posture (7.0+-O.6uV)(p<0.05), the EMG activity of the right trapezius muscle in the posture (9.6+-1.8uV) was greater than the PL (6.6+-1.3.uV) (p<0.05) during the occlusion acts. The results obtained indicate the potential influence of the sensorial input of the cervical region in the masseter and trapezius muscle activities. We recommend that more studies are made reproducing this methodology, applying to the subjects with temporomandibular disorders.

Estudo comparativo da força e autonomia em idosas-sedentárias versus ativas / Comparative study of strength and autonomy in eldery women-sedentery versus activen

O objetivo deste trabalho foi de avaliar e comparar o desempenho físico de indivíduos idosos ativos (praticantes regulares de atividade física) e sedentários (não praticantes de atividade física) em testes funcionais de autonomia e na capacidade de produção de força membro inferior. Foram selecionados 33 indivíduos do gênero feminino, divididos em dois grupos: ATIVOS (n=17) e SEDENTÁRIOS (n=16), sendo submetidos inicialmente a uma anamnese, avaliação biométrica (estatura, massa corporal total (MCT) e perimetria de quadril, abdômem e membros inferiores). Posteriormente realizaram a contração isométrica voluntária máxima unilateral de membro inferior por seis segundos em cadeira extensora com joelhos a 90º, seguindo-se os testes de "levantar da cadeira em 30 segundos" e "levantar-se e andar". Os grupos apresentaram perfil homogêneo nos parâmetros biométricos (p>0,05). Observou-se a diferença significativa (p<0,05) no desempenho dos testes "levantar da cadeira em 30 s" (ATIVOS 14+2; SEDENTÁRIOS 11+2 movimentos completos), "levantar-se e andar" (ATIVOS 9,37+0,99; SEDENTÁRIOS 11,48+2,27) e na força gerada do 2º ao 5º segundo (ATIVOS 214,83+40,84; SEDENTÁRIOS 184,88+49,37 N). Os resultados obtidos neste trabalho permitem concluir que a participação em um programa de atividade física regular e bem orientada é uma modalidade efetiva em minimizar/previnir o declínio funcional do sistema do sistema músculoesquelético associado ao envelhecimento, possibilitando um envelhecimento saudável.