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Iqbal A, Richardson C, Iqbal Z, O’Keefe H, Hanratty B, Matthews FE, Todd A. Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis. BMC Geriatr 2023; 23:149. [PMID: 36934249 PMCID: PMC10024437 DOI: 10.1186/s12877-023-03835-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/20/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual's socioeconomic status. METHODS A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. RESULTS Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. CONCLUSIONS There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.
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Affiliation(s)
- Anum Iqbal
- grid.1006.70000 0001 0462 7212School of Pharmacy, Population Health Sciences Institute, Newcastle University, King George VI Building, King’s Road, Newcastle Upon Tyne, NE1 7RU England
| | - Charlotte Richardson
- grid.1006.70000 0001 0462 7212School of Pharmacy, Newcastle University, Newcastle Upon Tyne, England
| | - Zain Iqbal
- grid.419481.10000 0001 1515 9979Novartis International, Basel, Switzerland
| | - Hannah O’Keefe
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Barbara Hanratty
- grid.1006.70000 0001 0462 7212Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Fiona E. Matthews
- grid.1006.70000 0001 0462 7212Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Adam Todd
- grid.1006.70000 0001 0462 7212School of Pharmacy, Newcastle University, Newcastle Upon Tyne, England
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Guttier MC, Silveira MPT, Tavares NUL, Krause MC, Bielemann RM, Gonzalez MC, Tomasi E, Demarco FF, Bertoldi AD. Difficulties in the use of medications by elderly people followed up in a cohort study in Southern Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230020. [PMCID: PMC10000017 DOI: 10.1590/1980-549720230020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Objective: This study aimed to assess the need for help by elderly people to take their medications, the difficulties related to this activity, the frequency of forgotten doses, and factors associated. Methods: Cross-sectional study conducted with a cohort of elderly people (60 years and over — “COMO VAI?” [How do you do?] study), where the need for help to properly take medication and the difficulties faced in using them were evaluated. The Poisson regression model was used to estimate the crude and adjusted prevalence ratios (PR) of the outcomes and respective 95% confidence intervals according to the characteristics of the sample. Results: In total, 1,161 elderly people were followed up. The prevalence of participants who reported requiring help with medication was 15.5% (95%CI 13.5–17.8), and the oldest subjects, with lower educational levels, in worse economic situations, on four or more medications and in bad self-rated health were the ones who needed help the most. Continuous use of medication was reported by 83.0% (95%CI 80.7–85.1) of the sample and most participants (74.9%; 95%CI 72.0–77.5) never forgot to take their medications. Conclusion: The need for help to use medications was shown to be influenced by social and economic determinants. Studies assessing the difficulties in medication use by the elderly are important to support policies and practices to improve adherence to treatment and the rational use of medications.
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Affiliation(s)
- Marília Cruz Guttier
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia –Pelotas (RS), Brasil
| | - Marysabel Pinto Telis Silveira
- Universidade Federal de Pelotas, Instituto de Biologia, Departamento de Fisiologia e Farmacologia, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas – Pelotas (RS), Brasil
| | | | | | - Renata Moraes Bielemann
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Nutrição e Alimentos – Pelotas (RS), Brasil
| | - Maria Cristina Gonzalez
- Universidade Católica de Pelotas, Programa de Pós-Graduação em Saúde e Comportamento – Pelotas (RS), Brasil
| | - Elaine Tomasi
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia –Pelotas (RS), Brasil
| | - Flavio Fernando Demarco
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia –Pelotas (RS), Brasil
| | - Andréa Dâmaso Bertoldi
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia –Pelotas (RS), Brasil
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Diferentes intervenções de fisioterapia na melhora da sensibilidade plantar e equilíbrio de idosas. PAJAR - PAN AMERICAN JOURNAL OF AGING RESEARCH 2022. [DOI: 10.15448/2357-9641.2022.1.42885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objetivo: comparar os efeitos de dois diferentes protocolos de fisioterapia no tratamento da sensibilidade plantar e equilíbrio em idosas da comunidade do município de Panambi. Métodos: ensaio clínico piloto, quantitativo e descritivo. As participantes responderam questionário sobre condições de saúde e autopercepção de sensibilidade plantar. Após, passaram por avaliação da sensibilidade plantar com estesiômetro Semmes-Weinstein. Foram selecionadas apenas idosas com sensibilidade diminuída. O equilíbrio foi avaliado através da Escala de Equilíbrio de Berg e teste Timed Up and Go. As 13 participantes selecionadas foram divididas em grupo sensibilidade plantar e grupo proprioceptivo, com a realização de 10 intervenções com cada grupo, com estímulo específico conforme alocação nos grupos. Após houve a reavaliação das participantes com estesiômetro, Escala de Equilíbrio de Berg e Timed Up and Go. As comparações das variáveis quantitativas foram realizadas através do teste t de Student, com nível de significância adotado de 5% (p<0,05). Resultados: 12 idosas concluíram o estudo, porém apenas cinco relataram perceber diminuição de sensibilidade plantar. As regiões plantares com maior perda de sensibilidade foram nos metatarsos, região lateral do pé e calcâneo. Já a região medial, apresentou menor perda sensorial. Após os treinos, ambos os grupos mostraram melhora estatisticamente significativa na sensibilidade plantar. Já no equilíbrio, o grupo sensibilidade plantar apresentou resultados estatisticamente significativos no teste Timed Up and Go e o grupo proprioceptivo na Escala de Equilíbrio de Berg. Conclusão: os treinos mostraram-se efetivos na sensibilidade plantar e equilíbrio das participantes, indicando que a combinação dessas intervenções no tratamento do controle postural é uma boa opção para fisioterapeutas.
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Rezende GRD, Amaral TLM, Amaral CDA, Vasconcellos MTLD, Monteiro GTR. Prevalence of polypharmacy and associated factors in older adults living in Rio Branco, Acre, Brazil: a cross-sectional population-based study, 2014. ACTA ACUST UNITED AC 2021; 30:e2020386. [PMID: 34076227 DOI: 10.1590/s1679-49742021000200013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze polypharmacy prevalence and associated factors in older adults living in Rio Branco, Acre, Brazil, in 2014. METHODS This was a cross-sectional population-based study using complex sampling with older adults. Polypharmacy was defined as concomitant use of five or more medications. RESULTS Polypharmacy prevalence was 14.9% (95%CI 11.8;18.6), positively associated with females (OR=2.29 - 95%CI 1.41;3.74), white race/skin color (OR=1.61 - 95%CI 1.10;2.38), dependence (OR=1.65 - 95%CI 1.05;2.60), change in eating habits/dieting (OR=1.66 - 95%CI 1.16;2.36), hospitalization in the last 12 months (OR=1.61 - 95%CI 1.02;2.53) and presence of the following self-reported morbidities: systemic arterial hypertension (OR=2.40 - 95%CI 1.33;4.34), diabetes mellitus (OR=2.17 - 95%CI 1.23;3.84), osteoporosis (OR=2.92 - 95%CI 1.84;4.64) and heart problems (OR=2.94 - 95%CI 1.90;4.56). CONCLUSION This study found that polypharmacy in the older adults was associated with demographic and health conditions.
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Affiliation(s)
| | | | | | | | - Gina Torres Rego Monteiro
- Instituto Oswaldo Cruz, Escola Nacional de Saúde Pública Sérgio Arouca, Programa de Pós-Graduação em Saúde, Rio de Janeiro, RJ, Brasil
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de Araújo NC, Silveira EA, Mota BG, Neves Mota JP, de Camargo Silva AEB, Alves Guimarães R, Pagotto V. Potentially inappropriate medications for the elderly: Incidence and impact on mortality in a cohort ten-year follow-up. PLoS One 2020; 15:e0240104. [PMID: 33112864 PMCID: PMC7592782 DOI: 10.1371/journal.pone.0240104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/19/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Pharmacological therapy plays an important role in disease control in the elderly; unfortunately, this comes with a high prevalence in the use of medications classified as potentially inappropriate. OBJECTIVE To analyze the incidence, risk factors, and survival of elderly people using potentially inappropriate medications (PIM). METHOD A ten-year follow-up assessment of elderly participants residing in a capital of Central Brazil was conducted. The initial assessment (baseline) included 418 elderly people. Data were collected through home interviews guided by a questionnaire covering socioeconomic, demographic, living conditions, and health variables. The medication information obtained comprised active ingredient, dosage, route, and regimen for the medications. The PIMs were classified according to 2019 Beers Criteria. The analyses were performed using STATA 15.0. For survival analysis, a Cox Regression was performed with the respective Kaplan Meier curve. RESULTS The incidence of PIM was 44.1 cases (95% CI: 35.2-54.7) per 1,000 people a year. The most used PIMs were nifedipine, glibenclamide, and sodium diclofenac. The risk factors were polypharmacy (aRR: 3.00; 95% CI: 1.31-6.88) and diabetes mellitus (aRR: 1.57; 95% CI: 1.03-2.39). We identified no statistically significant association between survival and the use of PIM. CONCLUSION The study highlights the high consumption of PIM among the elderly causing polypharmacy risks. Health professionals working in drug treatment need to be alert to polypharmacy risks to ensure the rational use of medications to prevent adverse reactions and other health problems.
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Affiliation(s)
| | - Erika Aparecida Silveira
- Faculty of Medicine, Postgraduate Program in Health Sciences, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Brenda Godoi Mota
- Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | | | - Rafael Alves Guimarães
- Faculty of Nursing, Postgraduate Program in Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Valéria Pagotto
- Faculty of Nursing, Postgraduate Program in Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
- * E-mail:
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Moreira T, Alvares-Teodoro J, Barbosa MM, Do Nascimento RCRM, Guerra Júnior AA, Acurcio FA. Polypharmacy among adult and older adult users of primary care services delivered through the Unified Health System in Minas Gerais, Brazil. Expert Rev Clin Pharmacol 2020; 13:1401-1409. [PMID: 33054470 DOI: 10.1080/17512433.2020.1836958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To estimate the prevalence of polypharmacy (≥5 drugs) among adults and to analyze related factors. METHODS Cross-sectional study with 1,159 interviewees distributed across 104 cities and 253 primary healthcare services delivered through the Brazilian Unified Health System. Polypharmacy-related factors were identified using logistic regression model. RESULTS 949 (81.8%) interviewees were using at least one medication and were included in this analysis. The prevalence of polypharmacy among them was 13.7% (95%CI:11.7-16.0%) in the general population and 33.3%(95%CI:26.1-41.4%) in older adults(≥65 years). Polypharmacy was positively associated with age (45 to 64 years, OR=2.02; 95%CI:1.03-3.94; ≥65 years, OR=4.17; 95%CI:1.92-9.17) and the following chronic diseases: stroke (OR=4.20; 95%CI:1.53-11.55); diabetes mellitus (OR=4.03; 95%CI:2.43-6.68); heart disease (OR=3.18; 95%CI:1.92-5.29); depression (OR=2.85; 95%CI:1.80-4.53); hypertension (OR=2.13; 95%CI:1.17-3.86); and dyslipidemia (OR=1.73; 95%CI:1.07-2.80). CONCLUSION This study revealed that polypharmacy is a real concern in primary health care and affects older and middle-aged adults alike. Groups of patients that are more likely to experience polypharmacy were identified. Our findings emphasize the relevance of an appropriate approach to polypharmacy driven by aging and multimorbidity.
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Affiliation(s)
- Thais Moreira
- Postgraduate Program in Public Health, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - J Alvares-Teodoro
- Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - M M Barbosa
- Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | | | - A A Guerra Júnior
- Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - F A Acurcio
- Postgraduate Program in Public Health, Federal University of Minas Gerais , Belo Horizonte, Brazil.,Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
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Castro TLB, Oliveira RH, Sousa JAG, Romano MCC, Guedes JVM, Otoni A. Alteración de la función renal: prevalencia y factores asociados en pacientes de riesgo. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.1019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: La enfermedad renal crónica (ERC) en sus primeras etapas no presenta manifestaciones clínicas y, por lo tanto, la mayoría de las personas solo se acercan a las unidades de salud cuando ya están en la fase terminal de la enfermedad, lo cual sigue siendo habitual en Brasil. Objetivo: Identificar la prevalencia de la tasa estimada de filtración glomerular (TFG) alterada y los factores asociados en usuarios del sistema de salud único que sufran de diabetes mellitus y/o hipertensión sistémica de alto riesgo de enfermedad cardiovascular. Materiales y métodos: Se realizó un estudio transversal con las historias clínicas de 331 usuarios del Centro Estatal de Atención Especializada ubicado en el centro oeste de Minas Gerais, Brasil entre septiembre de 2017 y junio de 2019. Se realizaron un análisis univariado descriptivo y una regresión logística multivariante. Resultados: Del total de participantes, 118 (35,6%) tenían la TFG alterada. Se identificó una asociación significativa entre la alteración de la TFG y la edad: los ancianos ≥ 60 años tenían 5,53 veces más posibilidades de tener la TFG alterada. Los participantes que utilizaron la polifarmacia tenían 2,64 veces más probabilidades de que se alterara la TFG. Discusión: En consonancia con estudios similares, se registró la falta de seguimiento del inicio y el desarrollo de la ERC en las primeras etapas, lo que implica un enfoque tardío y acciones limitadas para preservar las funciones renales. Conclusiones: Se identificó una alta prevalencia de TFG alterada (35,6%) sin registros en las tablas que pudieran conducir a un enfoque preventivo de la degeneración de la función renal. La edad avanzada y la polifarmacia se identificaron como variables independientes en la alteración de la función renal.
Como citar este artículo: Castro, Tássia Lima Bernardino; Oliveira, Rayane Hellen; Sousa, João Antônio Gomides; Romano, Márcia Christina Caetano; Guedes,Guedes, João Victor Marques; Otoni, Alba. Função renal alterada: prevalência e fatores associados em pacientes de risco. Revista Cuidarte. 2020; 11(2): e1019. http://dx.doi.org/10.15649/cuidarte.1019
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Oliveira-Rosado J, Duarte JP, Sousa-E-Silva P, Costa DC, Martinho DV, Sarmento H, Valente-Dos-Santos J, Rama LM, Tavares ÓM, Conde J, Castanheira J, Soles-Gonçalves R, Agostinete RR, Coelho-E-Silva MJ. Physiological profile of adult male long-distance trail runners: variations according to competitive level (national or regional). EINSTEIN-SAO PAULO 2020; 18:eAO5256. [PMID: 32267367 PMCID: PMC7108817 DOI: 10.31744/einstein_journal/2020ao5256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022] Open
Abstract
Objective To describe and identify the importance of different indicators of the aerobic and anaerobic fitness of male ultra-trail runners according to their level of participation (regional or national). Methods Forty-four male ultra-trail runners were assessed (36.5±7.2 years). They were classified as regional (n=25) and national (n=19). Wingate test was used to assess the anaerobic pathway. A progressive incremental running test was performed and ventilatory thresholds registered, in parallel to heart rate and lactate concentration at the end of the protocol. Comparison between groups was performed using independent samples t-test. Results No significant differences were found between outputs derived from Wingate test. For aerobic fitness, while examining absolute values, differences were uniquely significant for the second ventilatory threshold (ultra-trail regional runners: 3.78±0.32L.min-1; ultra-trail national runners: 4.03±0.40L.min-1 p<0.05). Meantime, when aerobic fitness was expressed per unit of body mass, differences were significant for the second ventilatory threshold (ultra-trail regional runners: 50.75±6.23mL.kg-1.min-1; ultra-trail national runners: 57.88±4.64mL.kg-1.min-1 p<0.05) and also maximum volume of oxygen (ultra-trail regional runners: 57.33±7.66mL.kg-1.min-1; ultra-trail national runners: 63.39±4.26mL.kg-1.min-1 p<0.05). Conclusion This study emphasized the importance of expressing physiological variables derived from running protocols per unit of body mass. Also, the second ventilatory threshold appears to be the best and the only aerobic fitness variable to distinguish between trail runners according to competitive level. Maximal oxygen uptake seems of relative interest to distinguish between long distance runners according to competitive level.
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Affiliation(s)
- Joana Oliveira-Rosado
- Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, Coimbra, Portugal.,Faculdade de Desporto, Universidade do Porto, Porto, Portugal
| | - João P Duarte
- Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra, Coimbra, Portugal.,Centro de Investigação do Desporto e da Atividade Física, Universidade de Coimbra, Coimbra, Portugal
| | - Paulo Sousa-E-Silva
- Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra, Coimbra, Portugal.,Centro de Investigação do Desporto e da Atividade Física, Universidade de Coimbra, Coimbra, Portugal.,Fundação para a Ciência e a Tecnologia, Lisboa, Portugal
| | - Daniela C Costa
- Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra, Coimbra, Portugal.,Centro de Investigação do Desporto e da Atividade Física, Universidade de Coimbra, Coimbra, Portugal.,Fundação para a Ciência e a Tecnologia, Lisboa, Portugal
| | - Diogo V Martinho
- Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra, Coimbra, Portugal.,Centro de Investigação do Desporto e da Atividade Física, Universidade de Coimbra, Coimbra, Portugal.,Fundação para a Ciência e a Tecnologia, Lisboa, Portugal
| | - Hugo Sarmento
- Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra, Coimbra, Portugal.,Centro de Investigação do Desporto e da Atividade Física, Universidade de Coimbra, Coimbra, Portugal
| | - João Valente-Dos-Santos
- Centro de Investigação do Desporto e da Atividade Física, Universidade de Coimbra, Coimbra, Portugal.,Faculdade de Educação Física e Desporto, Universidade Lusófona de Humanidades e Tecnologia, Lisboa, Portugal
| | - Luís M Rama
- Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra, Coimbra, Portugal.,Centro de Investigação do Desporto e da Atividade Física, Universidade de Coimbra, Coimbra, Portugal
| | - Óscar M Tavares
- Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Jorge Conde
- Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Joaquim Castanheira
- Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, Coimbra, Portugal.,Centro de Investigação do Desporto e da Atividade Física, Universidade de Coimbra, Coimbra, Portugal
| | - Rui Soles-Gonçalves
- Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Ricardo R Agostinete
- Laboratório de Investigação em Exercício, Departamento de Educação Física, Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, SP, Brazil.,Programa de Pós-graduação em Ciências da Motricidade, Departamento de Educação Física, Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, SP, Brazil
| | - Manuel J Coelho-E-Silva
- Faculdade de Ciências do Desporto e Educação Física, Universidade de Coimbra, Coimbra, Portugal.,Centro de Investigação do Desporto e da Atividade Física, Universidade de Coimbra, Coimbra, Portugal
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