Equações de referência para a predição da força de preensão manual em brasileiros de meia idade e idosos

A comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19

OBJECTIVE

To examine the physical function and respiratory muscle strength of patients - who recovered from critical COVID-19 - after intensive care unit discharge to the ward on Days one (D1) and seven (D7), and to investigate variables associated with functional impairment.

METHODS

This was a prospective cohort study of adult patients with COVID-19 who needed invasive mechanical ventilation, non-invasive ventilation or high-flow nasal cannula and were discharged from the intensive care unit to the ward. Participants were submitted to Medical Research Council sum-score, handgrip strength, maximal inspiratory pressure, maximal expiratory pressure, and short physical performance battery tests. Participants were grouped into two groups according to their need for invasive ventilation: the Invasive Mechanical Ventilation Group (IMV Group) and the Non-Invasive Mechanical Ventilation Group (Non-IMV Group).

RESULTS

Patients in the IMV Group (n = 31) were younger and had higher Sequential Organ Failure Assessment scores than those in the Non-IMV Group (n = 33). The short physical performance battery scores (range 0 - 12) on D1 and D7 were 6.1 ± 4.3 and 7.3 ± 3.8, respectively for the Non-Invasive Mechanical Ventilation Group, and 1.3 ± 2.5 and 2.6 ± 3.7, respectively for the IMV Group. The prevalence of intensive care unit-acquired weakness on D7 was 13% for the Non-IMV Group and 72% for the IMV Group. The maximal inspiratory pressure, maximal expiratory pressure, and handgrip strength increased on D7 in both groups, but the maximal expiratory pressure and handgrip strength were still weak. Only maximal inspiratory pressure was recovered (i.e., > 80% of the predicted value) in the Non-IMV Group. Female sex, and the need and duration of invasive mechanical were independently and negatively associated with the short physical performance battery score and handgrip strength.

CONCLUSION

Patients who recovered from critical COVID-19 and who received invasive mechanical ventilation presented greater disability than those who were not invasively ventilated. However, they both showed marginal functional improvement during early recovery, regardless of the need for invasive mechanical ventilation. This might highlight the severity of disability caused by SARS-CoV-2.

Cardiopulmonary responses during unsupported upper limb exercise tests and limitations in activities of daily living in individuals with chronic obstructive pulmonary disease

INTRODUCTION

Cardiopulmonary responses during unsupported upper limb function assessment may vary in chronic obstructive pulmonary disease (COPD).

OBJECTIVE

To compare the cardiopulmonary responses during the function assessment with the Six-Minute Pegboard and Ring Test (6PBRT) and the incremental Unsupported Upper Limb Exercise (UULEX) test in COPD and to investigate the correlations with muscle strength and the limitations on activity of daily living (ADLs).

METHODS

This was a cross-sectional study. Cardiopulmonary variables were recorded during tests using a breath-by-breath analyzer. Muscle strength was assessed using a hand-held dynamometer. Self-reported ADL was evaluated using the modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M). Paired t-test, Wilcoxon signed rank test, and Spearman correlation coefficients were used.

RESULTS

Fifteen individuals with moderate-to-severe COPD participated (66 ± 9 years old, forced expiratory volume in the first second [FEV1]: 48%±14% of predicted). The UULEX induced higher oxygen consumption (0.54 ± 0.20 vs. 0.44 ± 0.09 L/min, p = .01) and dyspnea (4.0 [2.6 to 6.9] vs. 0.5 [0.9 to 5.1], p < .01) than 6PBRT. The performance in both tests was correlated with self-reported ADL limitations on PFSDQ-M (6PBRT: r = -0.69, p < .01; UULEX: r = -0.62, p = .01).

CONCLUSION

The UULEX promoted greater cardiopulmonary responses than 6PBRT, and performance in 6PBRT and UULEX was correlated with ADL limitations in individuals with COPD.

Prevalence and impact of sarcopenia in individuals with heart failure with reduced ejection fraction (the SARC-HF study): A prospective observational study protocol

Sarcopenia, a clinical syndrome primarily associated with reduced muscle mass in the elderly, has a negative impact on quality of life and survival. It can occur secondarily to other diseases such as heart failure (HF), a complex clinical syndrome with high morbidity and mortality. The simultaneous occurrence of these two conditions can worsen the prognosis of their carriers, especially in the most severe cases of HF, as in patients with reduced left ventricular ejection fraction (LVEF). However, due to the heterogeneous diagnostic criteria for sarcopenia, estimates of its prevalence present a wide variation, leading to new criteria having been recently proposed for its diagnosis, emphasizing muscle strength and function rather than skeletal muscle mass. The primary objective of this study is to evaluate the prevalence of sarcopenia and/or dynapenia in individuals with HF with reduced LVEF according to the most recent criteria, and compare the gene and protein expression of those patients with and without sarcopenia. The secondary objectives are to evaluate the association of sarcopenia and/or dynapenia with the risk of clinical events and death, quality of life, cardiorespiratory capacity, ventilatory efficiency, and respiratory muscle strength. The participants will answer questionnaires to evaluate sarcopenia and quality of life, and will undergo the following tests: handgrip strength, gait speed, dual-energy X-ray absorptiometry, respiratory muscle strength, cardiopulmonary exercise, as well as genomic and proteomic analysis, and dosage of N-terminal pro-B-type natriuretic peptide and growth differentiation factor-15. An association between sarcopenia and/or dynapenia with unfavorable clinical evolution is expected to be found, in addition to reduced quality of life, cardiorespiratory capacity, ventilatory efficiency, and respiratory muscle strength.

Respiratory Oscillometry and Functional Performance in Different COPD Phenotypes

Purpose

Chronic obstructive pulmonary disease (COPD) phenotypes may introduce different characteristics that need to be known to improve treatment. Respiratory oscillometry provides a detailed analysis and may offer insight into the pathophysiology of COPD. In this paper, we used this method to evaluate the differences in respiratory mechanics of COPD phenotypes.

Patients and Methods

This study investigated a sample of 83 volunteers, being divided into control group (CG = 20), emphysema (n = 23), CB (n = 20) and asthma-COPD overlap syndrome (ACOS, n = 20). These analyses were performed before and after bronchodilator (BD) use. Functional capacity was evaluated using the Glittre‑ADL test, handgrip strength and respiratory pressures.

Results

Initially it was observed that oscillometry provided a detailed description of the COPD phenotypes, which was consistent with the involved pathophysiology. A correlation between oscillometry and functional capacity was observed (r=-0.541; p = 0.0001), particularly in the emphysema phenotype (r = -0.496, p = 0.031). BD response was different among the studied phenotypes. This resulted in an accurate discrimination of ACOS from CB [area under the receiver operating curve (AUC) = 0.84] and emphysema (AUC = 0.82).

Conclusion

These results offer evidence that oscillatory indices may enhance the comprehension and identification of COPD phenotypes, thereby potentially improving the support provided to these patients.

The phase angle cut-off point capable of discriminating hemodialysis patients with reduced exercise tolerance: a cross-sectional study

BACKGROUND

Phase angle (PhA) is a prognostic marker of all-cause mortality in chronic kidney disease. However, no study has investigated this marker as a predictor of exercise intolerance in hemodialysis (HD) patients. The aim of this study was to determine a cut-off point for the PhA capable of discriminating HD patients with reduced exercise tolerance.

METHODS

Thirty-one patients (80.6% men, median age 69 years) were included. The evaluations were performed on three different days, before the HD session. The outcomes evaluated were: biochemical markers, inflammatory and nutritional status, body composition, peripheral muscle strength and exercise tolerance. Performance ≤50% of the predicted value in the six-minute step test (6MST) was defined as reduced exercise tolerance.

RESULTS

Patients presented an average of 67.6 steps (50.5% of predicted) in the 6MST. Fifteen patients (48.4%) were classified with reduced exercise tolerance. The receiver operating characteristic curve indicated a cut-off point of 3.73° for the PhA (sensitivity = 87%, specificity = 81%, and area under the curve = 0.88 [95% CI: 0.76-1.00]; p < 0.001). Patients with reduced exercise tolerance had worse inflammatory and nutritional status, lower PhA and greater impairment of peripheral muscle strength.

CONCLUSION

The cut-off point of 3.73° for the PhA is sensitive and specific to discriminate HD patients with reduced exercise tolerance.

TRIAL REGISTRATION

This study was registered in the Clinical Trials database (no. NCT03779126, date of first registration 19/12/2018).

COVID-19 is more lethal in hemodialysis chronic kidney disease patients with low physical capacity

INTRODUCTION

The mortality rate in patients on maintenance hemodialysis (HD) is high and is associated with low functional capacity (FC). We analyzed the association of FC and COVID-19 lethality among HD patients.

METHODS

A cohort study that included evaluations of FC in patients on HD was underway, and the association between FC and lethality was included as an ad-hoc outcome.

RESULTS

One hundred and twelve patients were submitted to a physical, 31 patients contracted symptomatic COVID-19, 20 recovered and 11 died (lethality rate of 35.5%). There was a difference between survivors and non-survivors on six-minutes-walking-test (6MWT) 386.1 ± 112.8 versus 296.9 ± 103.3 meters (p = 0.04), 30 s sit-to-stand test (30CST) score 11.7 ± 3.1 versus 7.7 ± 4.1 (p = 0.006), and timed up and go test (TUG) 9.4 versus 13.6 s (p = 0.009). There was also an association between percentages of predicted 6MWT, 30CST, and TUG with COVID-19 lethality.

CONCLUSION

Patients on maintenance HD with poorer physical performance presented the worst prognosis from COVID-19 pandemic.

Melatonin supplementation enhances pulmonary rehabilitation outcomes in COPD: a randomized, double-blind, placebo-controlled study

Melatonin (MLT), the main product of the pineal gland, is involved in muscle tissue repair and regeneration, besides several other important physiologic functions. In COPD, MLT administration can improve lung oxidative stress and sleep quality, but its potential effects on the outcomes of pulmonary rehabilitation (PR) have not been previously investigated. A randomized controlled trial was undertaken to test the hypothesis that a combined approach of rehabilitative exercise training and MLT supplementation could maximize functional performance, health status and quality of life in patients with COPD. Thirty-nine individuals with COPD referred to a supervised PR program at the Federal University of Ceara, Brazil, were randomized to receive MLT (3 mg/day; n = 18) or placebo (n = 21). Exercise capacity (6-min walk test - 6MWT), health status (COPD assessment test), and quality of life (airways questionnaire 20) were investigated as primary outcomes. No differences were observed at baseline in demographic, anthropometric and clinical characteristics between MLT and placebo groups. At the end of PR, superiority of the MLT group was demonstrated in improvement in the distance covered in the 6MWT (71 ± 26 vs. 25 ± 36 m; p < 0.01), health status (-11 ± 6 vs. -3 ± 5; p < 0.01), and quality of life (-6.9 ± 3.0 vs. -1.9 ± 2.4; p < 0.01), compared to the placebo group. In conclusion, MLT supplementation during the course of 12 weeks of PR can improve functional capacity, health status and quality of life in patients with COPD. These findings may have significant implications for the management of this condition.

Reference value for the 6-min walking distance in women with systemic sclerosis considering the impact of muscle strength

BACKGROUND

Early triage, the search for new therapies, and closer monitoring of patients with systemic sclerosis before their lung function irreversibly deteriorates are urgent concerns. Because it is an independent predictor of systemic sclerosis-related mortality, the 6-min walk test is a potentially useful tool to evaluate outcomes, along with pulmonary function and computed tomography. This study aimed to establish a reference value for the 6-min walking distance in women with diffuse cutaneous systemic sclerosis-associated interstitial lung disease that takes into account the effects of muscle and lung function.

METHODS

This was a cross-sectional study in which 69 women with systemic sclerosis underwent the 6-min walk test, Health Assessment Questionnaire-Disability Index, pulmonary function, handgrip strength test, and quadriceps strength test.

FINDINGS

The mean 6-min walking distance was 447 ± 78 m, and 43.5% of the participants did not reach 80% of their predicted value. 6-min walking distance correlated positively with quadriceps strength (r = 0.418, P = 0.0004), forced vital capacity (r = 0.306, P = 0.011), pulmonary diffusion (r = 0.360, P = 0.002), maximum inspiratory pressure (r = 0.268, P = 0.029), and maximum expiratory pressure (r = 0.288, P = 0.019) and negatively with age (r = -0.378, P = 0.001), body mass index (r = -0.248, P = 0.039), and Health Assessment Questionnaire-Disability Index (r = -0.438, P = 0.0001). In the multiple linear regression analysis, quadriceps strength, body mass index, pulmonary diffusion, age, and maximum expiratory pressure explained 72% of the 6-min walking distance variability.

INTERPRETATION

Muscle function and, to a lesser extent, lung function are key contributors in determining the reference value for the 6-min walking distance in women with diffuse cutaneous systemic sclerosis-associated interstitial lung disease.

Assessment of Functional Capacity in Patients with Nondialysis-Dependent Chronic Kidney Disease with the Glittre Activities of Daily Living Test

This study evaluated the functional capacity measured by the Glittre-ADL test (TGlittre) in patients with nondialysis-dependent chronic kidney disease (NDD-CKD) and analyzed the test's associations with muscle strength, physical activity level (PAL), and quality of life. Methods: Thirty patients with NDD-CKD underwent the following evaluations: the TGlittre; the International Physical Activity Questionnaire (IPAQ); the Short Form-36 (SF-36); and handgrip strength (HGS). The absolute value and percentage of the theoretical TGlittre time were 4.3 (3.3-5.2) min and 143.3 ± 32.7%, respectively. The main difficulties in completing the TGlittre were squatting to perform shelving and manual tasks, which were reported by 20% and 16.7% of participants, respectively. The TGlittre time correlated negatively with HGS (r = -0.513, p = 0.003). The TGlittre time was significantly different between the PALs considered "sedentary", "irregularly active", and "active" (p = 0.038). There were no significant correlations between TGlittre time and the SF-36 dimensions. Patients with NDD-CKD had a reduced functional capacity to exercise with difficulties performing squatting and manual tasks. There was a relationship between TGlittre time and both HGS and PAL. Thus, the incorporation of the TGlittre in the evaluation of these patients may improve the risk stratification and individualization of therapeutic care.

Efficacy of home-based inspiratory muscle training in patients post-covid-19: Protocol for a randomized clinical trial

INTRODUCTION

Current evidence suggests the emergence of a novel syndrome (long COVID syndrome) due to sequels and persistent COVID-19 symptoms. Respiratory muscle training improves respiratory muscle strength, exercise capacity, diaphragm thickness, and dyspnea, especially in patients with decreased respiratory muscle strength. This study aims to evaluate the effectiveness of a protocol for home-based inspiratory muscle training to improve respiratory muscle strength, dyspnea, and quality of life of patients post-COVID-19.

METHODS AND ANALYSES

This randomized, controlled, double-blind clinical trial will be conducted at the Instituto de Medicina Tropical of Universidade Federal do Rio Grande do Norte (Brazil). Sample size will be determined using maximal inspiratory pressure after a pilot study with five patients per group (total of 10 patients). Patients included in the study will be evaluated in three moments: pre-training (initial), post-training (three weeks), and retention (24 weeks). The sample will be randomized in two groups: active (IMT using 30% of IMT and load increase of 10% of initial IMT every week. Patients will perform 30 repetitions, twice a day (morning and afternoon), for seven consecutive days, and six weeks) and SHAM (IMT without load). The following measurements will be assessed: anthropometry, respiratory muscle strength, pulmonary volume and capacity, dyspnea, perception of effort and lower limb fatigue, handgrip strength, functional capacity, anxiety, depression, and functional status. After initial evaluation, all patients will receive a POWERbreathe® (POWERbreathe®, HaB Ltd, Southam, UK) device to perform the training. Normality will be verified using Shapiro-Wilk or Kolmogorov-Smirnov, according to the number of patients included. Variables presenting nonparametric distribution will be compared using Wilcoxon (intragroup analysis) and Mann-Whitney test (intergroup analysis), whereas repeated measures two-way ANOVA will be performed in case of parametric distribution. Dunn's post hoc test will be used to identify significant differences in the two-way ANOVA test.

PRIMARY OUTCOMES

Respiratory muscle strength, dyspnea, and quality of life of post-COVID-19 patients.

SECOND OUTCOMES

Pulmonary function, dyspnea, exercise tolerance, handgrip strength, anxiety, depression, and functional status.

TRIAL REGISTRATION

Trial register number NCT05077241.

Respiratory Oscillometry in Chronic Obstructive Pulmonary Disease: Association with Functional Capacity as Evaluated by Adl Glittre Test and Hand Grip Strength Test

Purpose

Respiratory oscillometry has emerged as a powerful method for detecting respiratory abnormalities in COPD. However, this method has not been widely introduced into clinical practice. This limitation arises, at least in part, because the clinical meaning of the oscillometric parameters is not clear. In this paper, we evaluated the association of oscillometry with functional capacity and its ability to predict abnormal functional capacity in COPD.

Patients and Methods

This cross-sectional study investigated a control group formed by 30 healthy subjects and 30 outpatients with COPD. The subjects were classified by the Glittre‑ADL test and handgrip strength according to the functional capacity.

Results

This study has shown initially that subjects with abnormal functional capacity had a higher value for resistance (p < 0.05), reactance area (Ax, p < 0.01), impedance modulus (Z4, p < 0.05), and reduced dynamic compliance (Cdyn, p < 0.05) when compared with subjects with normal functional capacity. This resulted in significant and consistent correlations among resistive oscillometric parameters (R=−0.43), Cdyn (R=−0.40), Ax (R = 0.42), and Z4 (R = 0.41) with exercise performance. Additionally, the effects of exercise limitation in COPD were adequately predicted, as evaluated by the area under the curve (AUC) obtained by receiver operating characteristic analysis. The best parameters for this task were R4-R20 (AUC = 0.779) and Ax (AUC = 0.752).

Conclusion

Respiratory oscillometry provides information related to functional capacity in COPD. This method is also able to predict low exercise tolerance in these patients. These findings elucidate the physiological and clinical meaning of the oscillometric parameters, improving the interpretation of these parameters in COPD patients.

Intensive Care Unit-Acquired Weakness in Patients With COVID-19: Occurrence and Associated Factors

OBJECTIVE

The primary objective of this study was to identify the occurrence and factors associated with intensive care unit (ICU)-acquired weakness (ICUAW) in patients with COVID-19. Secondarily, we monitored the evolution of muscle strength and mobility among individuals with ICUAW and those without ICUAW and the association of these variables with length of stay, mechanical ventilation (MV), and other clinical variables.

METHODS

In this prospective observational study, individuals admitted to the ICU for >72 hours with COVID-19 were evaluated for muscle strength and mobility at 3 times: when being weaned from ventilatory support, discharged from the ICU, and discharged from the hospital. Risk factors for ICUAW were monitored.

RESULTS

The occurrences of ICUAW at the 3 times evaluated among the 75 patients included were 52%, 38%, and 13%. The length of the ICU stay (29.5 [IQR = 16.3-42.5] vs 11 [IQR = 6.5-16] days), the length of the hospital stay (43.5 [IQR = 22.8-55.3] vs 16 [IQR = 12.5-24] days), and time on MV (25.5 [IQR = 13.8-41.3] vs 10 [IQR = 5-22.5] days) were greater in patients with ICUAW. Muscle strength and mobility were lower at all times assessed in patients with ICUAW. Bed rest time for all patients (relative risk = 1.14; 95% CI = 1.02 to 1.28) and use of corticosteroids (relative risk = 1.01; 95% CI = 1.00 to 1.03) for those who required MV were factors independently associated with ICUAW. Muscle strength was found to have a positive correlation with mobility and a negative correlation with lengths of stay in the ICU and hospital and time on MV.

CONCLUSION

The occurrence of ICUAW was high on patients' awakening in the ICU but decreased throughout hospitalization; however, strength and mobility remained compromised at hospital discharge. Bed rest time and use of corticosteroids (for those who needed MV) were factors independently associated with ICUAW in patients with COVID-19.

IMPACT

Patients who had COVID-19 and developed ICUAW had longer periods of ICU stay, hospital stay, and MV. Bed rest time and use of corticosteroids (for those who required MV) were factors independently associated with ICUAW.

Influence of handgrip strength on pharyngeal transit time in individuals with chronic obstructive pulmonary disease

OBJECTIVE

To investigate the relationship between Handgrip Strength (HGS), dysphagia classification, nutritional aspects, and Pharyngeal Transit Time (PTT) in subjects with Chronic Obstructive Pulmonary Disease (COPD).

METHODS

Study based on the analysis of secondary data from a database. The sample comprised 15 COPD patients of both sexes and a mean age of 65.7 years. We collected information on HGS, videofluoroscopic swallowing study, Volume-Viscosity Swallow Test (V-VST), and Body Mass Index (BMI). We applied correlation, effect size, and logistic regression tests at the 5% significance level.

RESULTS

Most individuals had severe COPD (66.7%), mean dominant HGS of 28.2, and non-dominant HGS of 25.3. Five subjects were malnourished, five were well-nourished, and five were obese. Most of them had normal swallowing (40%), normal V-VST results (60%), and PTT of 0.89 s (liquid) and 0.81 s (pudding-thick). There was no significant correlation between the swallowing classification and the other variables. We obtained a significant correlation (p = 0.015), though weak (r = -0.611), between non-dominant HGS and PTT. Regarding the binary logistic regression, HGS variables and HGS asymmetry were not enough to be considered a risk to clinically abnormal swallowing (V-VST).

CONCLUSION

Subjects with COPD in this study had a longer PTT than reported in the literature for normal subjects and a weak correlation between PTT and non-dominant HGS. The variables related to muscle condition were not considered predictors for abnormal swallowing.

LEVEL OF EVIDENCE: 3

Acute Whole-Body Vibration Exercise Promotes Favorable Handgrip Neuromuscular Modifications in Rheumatoid Arthritis: A Cross-Over Randomized Clinical

Objective

Rheumatoid arthritis (RA) causes progressive changes in the musculoskeletal system compromising neuromuscular control especially in the hands. Whole-body vibration (WBV) could be an alternative for the rehabilitation in this population. This study investigated the immediate effect of WBV while in the modified push-up position on neural ratio (NR) in a single session during handgrip strength (HS) in women with stable RA.

Methods

Twenty-one women with RA (diagnosis of disease: ±8 years, erythrocyte sedimentation rate: ±24.8, age: 54± 11 years, BMI: 28 ± 4 kg·m⁻²) received three experimental interventions for five minutes in a randomized and balanced cross-over order: (1) control—seated with hands at rest, (2) sham—push-up position with hands on the vibration platform that remained disconnected, and (3) vibration—push-up position with hands on the vibration platform turned on (45 Hz, 2 mm, 159.73 m·s⁻²). At the baseline and immediately after the three experimental interventions, the HS, the electromyographic records (EMGrms), and range of motion (ROM) of the dominant hand were measured. The NR, i.e., the ratio between EMGrms of the flexor digitorum superficialis (FDS) muscle and HS, was also determined. The lower NR represented the greater neuromuscular efficiency (NE).

Results

The NR was similar at baseline in the three experimental interventions. Despite the nonsignificance of within-interventions (p = 0.0611) and interaction effect (p = 0.1907), WBV exercise reduced the NR compared with the sham and control (p = 0.0003, F = 8.86, η² = 0.85, power = 1.00).

Conclusion

Acute WBV exercise under the hands promotes neuromuscular modifications during the handgrip of women with stable RA. Thus, acute WBV exercise may be used as a preparatory exercise for the rehabilitation of the hands in this population. This trial is registered with trial registration 2.544.850 (ReBEC-RBR-2n932c).

Social Participation and Associated Factors in Individuals with Chronic Obstructive Pulmonary Disease on Long-Term Oxygen Therapy

Long-term oxygen therapy (LTOT) reduces hypoxaemia and mitigate systemic alterations in chronic obstructive pulmonary disease (COPD), however, it is related to inactivity and social isolation. Social participation and its related factors remain underexplored in individuals on LTOT. This study investigated social participation in individuals with COPD on LTOT and its association with dyspnoea, exercise capacity, muscle strength, symptoms of anxiety and depression, and quality of life. The Assessment of Life Habits (LIFE-H) assessed social participation. The modified Medical Research Council dyspnoea scale, the 6-Minute Step test (6MST) and handgrip dynamometry were used for assessments. In addition, participants responded to the Hospital Anxiety and Depression Scale (HADS) and the Chronic Respiratory Questionnaire (CRQ). Correlation coefficients and multivariate linear regression analyses were applied. Fifty-seven participants with moderate to very severe COPD on LTOT were included (71 ± 8 years, FEV₁: 40 ± 17%predicted). Social participation was associated with dyspnoea (r_s=-0.46, p < 0.01), exercise capacity (r = 0.32, p = 0.03) and muscle strength (r = 0.25, p = 0.05). Better participation was also associated with fewer depression symptoms (r_s=-0.40, p < 0.01) and a better quality of life (r = 0.32, p = 0.01). Dyspnoea was an independent predictor of social participation (p < 0.01) on regression models. Restricted social participation is associated with increased dyspnoea, reduced muscle strength and exercise capacity. Better participation is associated with fewer depression symptoms and better quality of life in individuals with COPD on LTOT.

Relationship between quadriceps thickness and 60-second sit-to-stand test in patients with chronic kidney disease

Background:

This study aimed to evaluate the relationship between quadriceps muscle thickness and functional performance on the 60s sit-to-stand test (60s-STS), the six-minute walk test (6MWT), and handgrip strength in non-dialytic stage 4 and 5 chronic kidney disease (CKD) patients.

Methods:

This was a cross-sectional study that evaluated 40 CKD patients aged between 30-70 years. Participants were submitted to an assessment that included quadriceps muscle thickness evaluated by a portable ultrasound. Functional performance tests included the 60s-STS, distance walked in the 6MWT, and handgrip strength. Also, body composition evaluated using electrical bioimpedance analysis and physical activity level through the short version of International Physical Activity were measured. Multiple linear regression was used to investigate the relationship between the quadriceps thickness and functional performance.

Results:

Quadriceps muscle thickness was correlated to 60s-STS (R2 = 43.6%; 95% CI = 0.022 - 0.665; β = 0.34; p = 0.037). Also, a moderate correlation between this muscle thickness and appendicular skeletal muscle (ALM) was found in CKD patients (r = 0.603, p <0.001). No relationship was found between quadriceps muscle thickness with the 6MWT and handgrip strength.

Conclusion:

Quadriceps muscle thickness is associated to 60s-STS, thus our results demonstrate the repercussions of the disease on the musculoskeletal system.

Association between muscle strength, upper extremity fatigue resistance, work ability and upper extremity dysfunction in a sample of workers at a tertiary hospital

Background

Upper extremity musculoskeletal disorders negatively affect ability to perform activities of daily living, self-care and work. Therefore, outcome measurements that address muscle strength, fatigue resistance, functionality and work physical capacity must be defined to assess and plan specific actions to minimize them.

Objective

To investigate the association of upper extremity muscle strength with upper extremity fatigue resistance, work ability and upper extremity dysfunction in a sample of workers from a tertiary hospital.

Methods

Shoulder and elbow isokinetic strength were assessed by Biodex System 4™, isometric hand grip by JAMAR™, upper extremity fatigue resistance by Functional Impairment Test Hand and Neck/Shoulder/Arm (FIT-HaNSA), ability to work by the Work Ability Index and upper extremity dysfunction by the Quick-Disabilities of the Arm, Shoulder and Hand QuickDASH-Br questionnaire. The Nordic questionnaire and Numeric Pain Rating Scale (NPRS) were used for pain description. The associations were analysed by Spearman’s correlation coefficient (rho) (p < 0.05).

Results

Twenty-seven participants: 59.2% women; mean age 46 years old; 70.3% obese/overweight; 62.9% active with predominantly dynamic muscle contraction work. Besides predominance of good to moderate work ability (81.4%) and comorbidities (37%), all participants had symptoms of the upper extremities for at least 12 months, with a predominance of low-intensity in the shoulder (55.5%). In addition, 88.8% reported pain in other segments. Muscle strength of abduction (rho = 0.49), adduction (rho = 0.40), internal rotation (rho = 0.44) and hand grip (rho = 0.68) presented moderate correlation with FIT-HaNSA. Hand grip (rho = − 0.52) showed moderate correlation with upper extremity dysfunction.

Conclusions

The results of this preliminary study suggested the association of shoulder strength with fatigue resistance. Also, hand grip strength was associated with upper extremity dysfunction and fatigue resistance. No association was found with the Work Ability Index in this sample. So, it is suggested that hand grip and shoulder strength could be outcome measurements used for future interventions focused on upper extremity preventive exercises to improve strength and fatigue resistance of workers at risk for the development of musculoskeletal disorders. Other individual, psychosocial and organizational risk factors must also be considered as influences on upper extremity function.

Physical fitness and quality of life in adolescents with asthma and fixed airflow obstruction

Asthma is a disease characterized by reversible bronchoconstriction, but some subjects develop fixed airflow obstruction (FAO). Subjects with FAO present more asthma symptoms and may have increased sedentary behavior; however, the effect of FAO on aerobic fitness and physical activity levels (PAL) remains poorly understood.

AIM

To compare adolescents with asthma and FAO and adolescents with asthma without FAO in terms of aerobic fitness, PAL, muscle strength, and health-related quality of life (HRQoL).

METHODS

This cross-sectional study included adolescents with asthma, both sexes, and aged 12-18 years. They were divided into two groups: FAO and non-FAO groups. The adolescents were diagnosed with asthma according to the Global Initiative for Asthma guidelines and underwent optimal pharmacological treatment for at least 12 months. FAO was diagnosed when the forced expiratory volume in the first second/forced vital capacity ratio was below the lower limit of the normal range after optimal treatment. Aerobic fitness, PAL, peripheral and respiratory muscle strength, and HRQoL were evaluated.

RESULTS

No significant differences were observed between FAO and non-FAO groups regarding the peak oxygen uptake (34.6 ± 8.5 vs. 36.0 ± 8.4 mLO₂ /min/kg), sedentary time (578 ± 126 vs. 563 ± 90 min/day), upper limb muscle strength (29.1 ± 5.9 vs. 28.1 ± 5.7 kilograms of force [kgf]), lower limb muscle strength (42.8 ± 8.6 vs. 47.6 ± 9.6 kgf), or HRQoL (5.1 ± 1.3 vs. 4.7 ± 1.4 score; p > .05). However, the FAO group exhibited a higher maximal expiratory pressure than the non-FAO group (111.5 ± 15.5 vs. 101.5 ± 15.0 cmH₂ O, respectively).

CONCLUSION

Our results suggest that FAO does not impair aerobic fitness, PAL, peripheral muscle strength, or HRQoL in adolescents with asthma. Furthermore, adolescents with asthma were physically deconditioned.

Força de preensão, capacidade funcional e qualidade de vida de indivíduos com câncer

RESUMO O objetivo deste estudo foi avaliar a força, capacidade funcional e qualidade de vida de indivíduos com câncer em comparação com valores preditos em indivíduos saudáveis, bem como determinar se força e capacidade funcional são capazes de predizer a qualidade de vida dessa população. Foram avaliados 50 indivíduos com câncer, de acordo com força (dinamômetro Crown), capacidade funcional (teste de AVD-Glittre) e qualidade de vida (SF-36). Os resultados foram comparados aos valores de referência preditos em indivíduos saudáveis, pareados por idade e sexo, pelo teste two-sample Kolmogorov-Smirnov. O coeficiente de correlação de Spearman foi utilizado para avaliar as relações entre as variáveis, e a regressão linear múltipla foi utilizada para avaliar se força e capacidade funcional são capazes de predizer a qualidade de vida. Houve diferença significativa (p<0,01) para força, capacidade funcional e qualidade de vida entre indivíduos com câncer e o predito em indivíduos saudáveis. Bem como, uma correlação significativa entre força e capacidade funcional (ρ=-0,58; p<0,01), entre força e qualidade de vida (ρ=0,46; p<0,01), e qualidade de vida e capacidade funcional (ρ=-0,51; p<0,01). A análise de regressão demonstrou que a capacidade funcional é preditora da qualidade de vida, sendo capaz, sozinha, de explicar 20% (R2=0,195) dessa variável. Assim, indivíduos com câncer apresentaram diminuição significativa na força, capacidade funcional e qualidade de vida se comparados ao predito. Além disso, todas essas variáveis estão correlacionadas em indivíduos com câncer, principalmente, a capacidade funcional e a qualidade de vida.

Association Between the Predictors of Functional Capacity and Heart Rate Off-Kinetics in Patients with Chronic Obstructive Pulmonary Disease

Background

The heart rate (HR) kinetics as well as other predictors of functional capacity such as the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT), the Duke Activity Status Index (DASI) and the handgrip strength (HGS) represent important tools in assessing the impact of COPD on exercise performance and health status of individuals with COPD.

Purpose

To verify the relationship between functional capacity, measured using the six-minute walking test (6MWT), with the HR off-kinetics, HGS and the DASI and CAT scores.

Methods

For this cross-sectional study, 29 subjects with COPD underwent body composition, pulmonary function and cardiac function tests. Subsequently, the DASI and CAT questionnaires and HGS test were performed. The beat-to-beat R-R intervals (IRR) were collected in rest, during the test and in recovery after the 6MWT. The HR off-kinetics was obtained during a 360-second period in post-exercise recovery through the HR mono-exponential decay.

Results

Moderate correlations were observed between: 1) walked distance (WD) in the 6MWT and the CAT and DASI scores (r= −0.58, p=0.001 and r= 0.58, p=0.001, respectively); 2) WD and HGS (r=0.37, p=0.05); 3) and WD and HR off-kinetics (τ; r= −0.54, p=0.002 and MRT; r= −0.55, p=0.002, respectively).

Conclusion

The 6MWT performance is a direct measurement to evaluate functional capacity. Additionally, it is related to other direct and indirect markers for functional evaluation in patients with COPD. These results suggest the application of these tools in clinical practice, based on the accessibility, non-invasive character and easy applicability of these methods.

Physiotherapist advice to older inpatients about the importance of staying physically active during hospitalisation reduces sedentary time, increases daily steps and preserves mobility: a randomised trial

QUESTIONS

Does advice from a physiotherapist about the importance of staying physically active during hospitalisation improve activity, mobility, strength, length of stay, and complications in older inpatients? What barriers to physical activity during hospitalisation do older inpatients perceive?

DESIGN

Randomised controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessment.

PARTICIPANTS

Sixty-eight people who were aged > 60 years and admitted to a university hospital ward.

INTERVENTION

In addition to usual hospital care, the experimental group received a booklet with content about the deleterious effects of hospitalisation and the importance of staying active during hospitalisation. The control group received usual hospital care only.

OUTCOME MEASURES

The amount of physical activity was measured via accelerometry during the hospital admission. Mobility was assessed using the de Morton Mobility Index (DEMMI), and muscle strength was assessed using a handgrip dynamometer. Length of stay and complications were extracted from hospital records. The barriers to staying active during hospitalisation were investigated via a questionnaire.

RESULTS

Accelerometry showed a mean between-group difference of 974 steps/day (95% CI 28 to 1919) in favour of the experimental group. The intervention also increased moderate-intensity physical activity and reduced sedentary time, although these effects might be trivially small. Experimental group participants were about one-fifth as likely to lose mobility during their hospital admission (two of 33) than control group participants (10 of 35), relative risk 0.21 (95% CI 0.05 to 0.90). Effects of the intervention were unclear regarding muscle strength, length of stay and incidence of complications between the groups. Patients reported that the main barriers to remaining active during hospitalisation were dyspnoea, lack of space, and fear of contracting infection.

CONCLUSION

In older inpatients, the addition of advice from a physiotherapist about maintaining activity during hospitalisation increases the level of physical activity and prevents loss of mobility.

REGISTRATION

ClinicalTrials.govNCT03297567.

Effects of different modalities of inspiratory muscle training as an add-on to conventional treatment of patients with chronic obstructive pulmonary disease (COPD): study protocol for a randomized controlled trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) leads to peripheral and respiratory muscle dysfunctions. Nowadays, inspiratory muscle training can be geared toward strength or endurance gains. This study aims to investigate the effects of an inspiratory muscle training (IMT) protocol using different therapeutic modalities to be implemented in pulmonary rehabilitation programs. The effects of IMT on exercise capacity were considered as the primary endpoint, and the effects of IMT on inspiratory muscle function, health-related quality of life, and daily physical activity level were considered as the secondary outcomes.

METHODS

This study is a blinded-investigator randomized controlled clinical trial. Sixty subjects will be randomly allocated into three groups: (1) pulmonary rehabilitation (PR) associated with inspiratory muscle training without any load (PRWIMT), (2) PR associated with inspiratory muscle training with a linear load (PRIMTLL), and (3) PR associated with inspiratory muscle training with isocapnic voluntary hyperpnea (PRIMTIVH). The protocol will be performed 5 days a week (3 days with supervision) for 10 weeks. The study will assess anthropometric data, lung function, respiratory muscle strength, and functional capacity by the Incremental Shuttle Walking Test and the Six-Minute Walk Test, lung volumes during the submaximal endurance test, peripheral muscle strength of the upper and lower limbs, dyspnea, and quality of life related to health, before and after the training protocol. Normality will be tested using the Kolmogorov-Smirnov test, and variables will be compared by two-way analysis of variance. The significance level was set at p < 0.05. Ethics approval was obtained from the Institutional Ethics Committee in Research (1.663.411). The study results will be disseminated through presentation at specific scientific conferences and publication in peer-reviewed journals.

DISCUSSION

The different IMT protocols used in our study will be able to guide respiratory therapists to understand and to include in conventional PR programs the most effective respiratory muscle training type in subjects with COPD.

TRIAL REGISTRATION

Brazilian Clinical Trials Registry, RBR-94v6kd . Registered on 11 March 2017.

Hand grip strength as a physical biomarker of aging from the perspective of a Fibonacci mathematical modeling

Background

The Golden Ratio (GR) and the Fibonacci sequence have wide applications in biodiversity research, and recent studies indicate that the GR can be highlighted in the organization and physiological functioning of many body systems. The aim of this cross-sectional descriptive study is to determine the applicability of a mathematical model derived from the Fibonacci sequence to investigate the changes in hand grip strength (HGS) induced by the aging process.

Methods

We assessed the HGS for both hands, using a Saehan hydraulic hand dynamometer in a group of autonomous elderly subjects. One hundred twenty 55-year-old subjects (58 males and 62 females) and seventy 89-year-old subjects (31 men and 39 women) were included in the study group. All subjects were completely independent or independent with minimal assistance in activities of daily living (ADL), as determined after applying the Barthel index of ADL. The data series were statistically processed using descriptive statistics (univariate analysis) and inferential statistical methods (the t test for unpaired groups, with effect size measure – Cohen’s d and the ratio of the means method).

Results

The decline of the relative HGS between the two age groups can be expressed by values close to the GR value (p < 0.001), both in relation to body symmetry (left hand/right hand evaluation) and laterality (dominant hand/non-dominant hand evaluation), for both sexes. For the whole group of men and women, the rhythm of HGS decline may be expressed by a value (1.61) notably close to the GR, regardless of body symmetry or laterality.

Conclusions

The common pattern of the relative HGS reduction between 55 and 89 years, as expressed by a value notably close to GR, can be considered to be an expression of a specific and predictable manifestation of the aging process, in the absence of disability.

Impact of Heart Transplantation on the Recovery of Peripheral and Respiratory Muscle Mass and Strength in Patients With Chronic Heart Failure

BACKGROUND

To assess the impact of heart transplantation (HT) on the recovery of peripheral and respiratory muscle mass and strength in patients with congestive heart failure.

METHODS

The study included 23 patients with an indication for HT (patients in the waiting list [WL] group). These patients were monitored for 1.5 to 3 years after HT; 8 died before 6 months of follow-up, 15 patients completed the early follow-up period of 6 months after HT (FU6m group), 4 died between 6 months and 3 years after HT, and 11 patients completed the late follow-up period 1.5 to 3 years after HT (FU1.5-3y group). Twenty-three healthy subjects were included in the control group. The study variables included inspiratory muscle strength, expressed as the maximum inspiratory pressure (MIP); expiratory muscle strength, expressed as the maximum expiratory pressure (MEP); peripheral muscle strength, expressed as bilateral handgrip strength (bHGS); and the cross-sectional area of the bilateral psoas major muscle (CSAbPm).

RESULTS

The results showed a reduction in the CSAbPm (1238.9 ± 312.3 mm2), a reduction in the bHGS (27.0 ± 5.7 kg/f), a reduction in the MIP (60.2 ± 29.8 cmH2O), and a reduction in the MEP (75.2 ± 33.4 cmH2O) in patients in the WL group compared with the healthy controls. In the time series comparison, for patients in the WL, FU6m, and FU1.5-3y groups, increases were found in the CSAbPm (1305.4 vs 1458.1 vs 1431.3 mm2, respectively), bHGS (27.3 vs 30.2 vs 34.7 kg/f, respectively), MIP (59.5 vs 85.5 vs 90.9 cmH2O, respectively), and MEP (79.5 vs 93.2 vs 101.8 cmH2O, respectively) (P < 0.00).

CONCLUSIONS

Sarcopenia was observed in patients in the WL group. Patients recovered peripheral and respiratory muscle mass and strength at 3 years after HT.

Whole body vibration training increases physical measures and quality of life without altering inflammatory-oxidative biomarkers in patients with moderate COPD

Whole body vibration training (WBVT) has been identified as an alternative intervention to improve exercise capacity and quality of life of patients with chronic obstructive pulmonary disease (COPD). However, the effect of WBVT on inflammatory-oxidative biomarkers remains unknown. The aim of this trial was to investigate the effects of WBVT on quality of life and physical and inflammatory-oxidative parameters in patients with COPD. Twenty patients were equally divided into 1) an intervention group (IG) that performed the WBVT, and 2) a control group (CG) that did not receive any intervention. Intervention consisted in performing static squatting on a vibrating platform, in six series of 30 s, 3 days/wk, for 12 wk. Patients were evaluated for plasma levels of IL-6, IL-8, IFN-γ, soluble receptors of TNF-α; white cell count; plasma levels of oxidant and antioxidant markers; 6-min walking distance (6MWD); peak oxygen uptake (V̇o2peak); handgrip strength; quality of life; timed 5-chair sit-to-stand (5STS); and timed get-up and go test (TUG). After WBVT, patients from IG showed a significant increase in the 6MWD, V̇o2peak, and handgrip strength ( P < 0.05). Furthermore, patients from the IG reached minimal clinically important difference regarding quality of life. No significant differences were found in 5STS, TUG, inflammatory-oxidative biomarkers, and white cell count in the IG. The CG did not show significant improvement in all assessments ( P > 0.05). Taken together, our results demonstrated that the WBVT induced clinically significant benefits regarding exercise capacity, muscle strength, and quality of life in patients with COPD that were not related to inflammatory-oxidative biomarker changes.

NEW & NOTEWORTHY Whole body vibration training is a new option for nonpharmacological treatment of chronic obstructive pulmonary disease (COPD). This study showed the potential of this training to improve exercise capacity, quality of life, and muscle strength in patients with COPD. Furthermore, to our knowledge this was the first study showing that vibration exercise does not modify the plasma levels of inflammatory-oxidative biomarkers, suggesting that the beneficial effects on physical measures and quality of life are independent of changes in biomarkers.

Capacidade funcional, força muscular e qualidade de vida na insuficiência cardíaca

RESUMO Introdução: Pacientes com insuficiência cardíaca (IC) podem apresentar redução da força muscular periférica e da musculatura respiratória que leva à redução da capacidade funcional (CF), avaliada pela distância percorrida no teste de caminhada de seis minutos (TC6M) e no teste graduado de caminhada (TGC), podendo interferir na qualidade de vida (QV) desses indivíduos. Objetivo: Mensurar a força muscular respiratória e periférica, bem como analisar a correlação existente entre tais variáveis, a CF e a qualidade de vida em pacientes ambulatoriais com IC, bem como compará-las às encontradas nos indivíduos saudáveis. Métodos: Utilizou-se a dinamometria manual para avaliar a força de preensão manual (FPM), manovacuometria para avaliação das pressões respiratórias máximas (PRM), TC6M e TGC para avaliação da CF, além do questionário para avaliar a qualidade de vida SF-36. Resultados: Foram avaliados 72 indivíduos. No entanto, participaram do estudo 23 indivíduos com IC (Grupo de estudo - G1) e 11 saudáveis (Grupo controle - G2). As PRM, bem como a FPM não apresentaram diferença significativa entre os grupos. Observou-se diferença significativa ao comparar os grupos quanto às distâncias do TC6M e do TGC. No G1, observou-se correlação significativa entre as distâncias do TC6M e do TGC com o domínio CF do SF-36 (r = 0,52 e p = 0,01; r = 0,41 e p = 0,05, respectivamente). Conclusão: A população estudada apresentou redução da CF e, no entanto, ausência de fraquezas musculares respiratória e periférica. Evidenciou-se correlação entre as distâncias do TC6M e do TGC com o domínio CF.

Reference equations for handgrip strength: Normative values in young adult and middle-aged subjects

BACKGROUND & AIMS

Handgrip strength (HS) has been widely used as a functionality parameter of the upper limbs (UL) and general health. The measurement of HS by dynamometry is a low cost, non-invasive method of simple applicability, widely used in pulmonary rehabilitation and in critical care units. However, there are no reports in the literature of reference equations for the Brazilian population involving young and middle-aged adults. The aim of this study was to establish reference equations to predict normal HS for young and middle-aged adults through demographic and anthropometric data.

METHODS

This is a cross-sectional study with a sample of 80 healthy subjects (40 men and 40 women), aged 20-60 years. Inclusion criteria were: 1) BMI between 18.5 and 30 kg/m²; 2) presence of dominant hand; 3) no cardiac, pulmonary, metabolic, or neurologic diseases; 4) lack of musculoskeletal disorders; 5) no history of fractures or trauma of the UL. Anthropometric measurements of the UL were obtained by a tape (hand length and width, forearm circumference and length). The dominance of hands was defined by the Dutch Handedness Questionnaire. HS measures were obtained by a manual hydraulic dynamometer, according to the recommendations of the American Association of Hand Therapists. Data were analyzed with SPSS for Windows, version 17.0, and treated with descriptive and inferential analysis. Normality was evaluated by Kolmogorov-Smirnov. Pearson or Spearman coefficients and multiple regression analysis were also used.

RESULTS

HS was significantly higher for men compared to women, and also higher for the dominant hand (HSD) compared to the non-dominant hand (HSND) (p < 0.05). No significant differences were found for HS between the age groups 20-30, 30-40, 40-50 and 50-60 years (p > 0.05). No correlation was found between HS and age. A weak correlation was found between HS and BMI. A moderate correlation of HS was observed with weight and height. Finally, moderate and high correlations were found between HS and anthropometric variables of UL. The best reference equations with R², adjusted to 0.71 and 0.70, were respectively: HSD_kg = -15.490 + (10.787 × Gender _{male=1; female=0}) + (0.558 × Forearm circumference) + (1.763 × Hand Length); HSND_kg = -9.887 + (12.832 × Gender _{male=1; female=0}) + (2.028 × Hand Length).

CONCLUSION

The variability of HS is largely explained by gender, forearm circumference, and hand length.

Associação de força e nível de atividade física à densidade mineral óssea na pós-menopausa

INTRODUÇÃO: o exercício físico atua melhorando a densidade mineral óssea DMO por gerar deformidades nesse tecido e estimular remodelação.OBJETIVO: verificar a associação entre força muscular e nível de atividade física à densidade mineral óssea DMO utilizando testes de força de bíceps, de sentar e levantar, dinamometria de mãos, história pregressa de atividade física e nível de atividade física, avaliado pelo pedômetro com a DMO em mulheres na pós-menopausa.MÉTODOS: estudo transversal, descritivo que mensurou a densidade mineral óssea pela absorção de dupla energia de raios X DXA da coluna lombar L1-L4, fêmur e antebraços em 62 mulheres saudáveis no pós-menopausa, com média de 56,82 ± 4,02 anos de idade. Foi aplicado questionário para atividade física pregressa e realizada contagem diária de passos pedômetro. A força muscular foi medida pelos testes de dinamometria de mãos, de 30 segundos de bíceps bilateral e de sentar e levantar da cadeira em 30 segundos. Realizou-se registro alimentar de três dias para mensuração da ingestão diária de cálcio e vitamina D.RESULTADOS: os indivíduos apresentaram altos níveis de atividade física, porém baixa ingestão diária de cálcio e vitamina D. Não foi verificada diferença estatisticamente significativa entre força muscular nos dois grupos estudados, com DMO diminuída e DMO normal. O grupo com DMO diminuída apresentou maior número de passos diários e menor peso quando comparado com o grupo com DMO normal. Foram observadas várias correlações positivas de baixa magnitude, embora significantes, entre a densitometria e a força muscular p < 0,50.CONCLUSÃO: os autores descreveram risco cinco vezes e meia maior em mulheres não praticantes de atividade física da adolescência até a idade adulta e de apresentarem redução da DMO em comparação com as mulheres que apresentaram DMO normal.

Effect of peripheral muscle fatigue during the testing of handgrip strength

Introduction Muscle fatigue is a phenomenon associated with physical work. It is common in endurance sports, physical fitness tests and daily activities. Some tests can be directly affected by the effect of peripheral muscle fatigue, including the handgrip strength (HGS) test, which is considered baseline measure for assessing the functionality of the hand. Objectives a) verify the effect of peripheral muscle fatigue (between trials) during the testing of HGS, with a 60-second recovery interval; b) to analyze whether there is a difference in considering the mean value obtained in three trials or the best result as the final result. Materials and methods The final sample comprised 1,279 men. We followed the standard methodology and used a hydraulic hand dynamometer. Results There were statistically significant differences (P < 0.05) in the dominant hand among all the trials: first (46.5 ± 8.6 Kgf), second (46.4 ± 8.5 Kgf) and third (46.1 ± 8.6 Kgf); and also in the non-dominant hand: first (44.9 ± 8.4 Kgf), second (44.5 ± 8.3 Kgf) and third (44.0 ± 8.3 Kgf). We also found statistically significant differences (P < 0.05) between the two ways of considering the final result. For the dominant hand, the mean of the three attempts was 46.3 ± 8.3 Kgf and the best result was 48.1 ± 8.5 Kgf, whereas for the non-dominant hand, these results were 44.5 ± 8.2 Kgf and 46.0 ± 8.2 kgf, respectively. Conclusion Peripheral muscle fatigue directly interferes in the final result. A significant reduction in strength levels occurs in course of the assessment. The best result is frequently obtained at the first trial, which indicates that the highest value obtained should be considered as the final result.

Declínio de atividades instrumentais de vida diária associado à perda de força de preensão palmar em idosos internados em enfermaria geriátrica

OBJETIVO: Verificar a associação entre a capacidade de executar as atividades instrumentais de vida diária (AIVDs) e a força de preensão palmar em idosos sem comprometimento cognitivo internados em enfermaria geriátrica. MÉTODOS: Estudo transversal. Foram incluídos pacientes idosos, com idade igual ou superior a 60 anos, de ambos os gêneros, admitidos em enfermaria de Geriatria. Foram excluídos indivíduos com doenças neurológicas, osteomusculares agudas e respiratórias exacerbadas; com indicação médica de repouso ou com uso de algum aparato clínico, bem como aqueles com déficits cognitivos e/ou delirium. Os dados foram coletados do prontuário e foi realizada a avaliação da capacidade de realizar atividades instrumentais de vida diária, por meio da Escala de Lawton, e a avaliação da força de preensão palmar, por meio da dinamometria do membro superior dominante. Os dados foram descritos em média e desvio- padrão. O teste de correlação de Pearson foi aplicado para verificar associação entre a capacidade de realizar AIVDs e a força de preensão palmar. RESULTADOS: Participaram do estudo 12 idosos (75% mulheres) com idade média de 80,67±6,35 anos. As médias da força de preensão palmar e pontuação total da Escala de Lawton foram 11,96±6,71 quilogramas-força (kgf) e 22,58±1,67 pontos, respectivamente. Verificou-se associação moderada e positiva entre a força de preensão palmar e a pontuação na Escala de Lawton (r=0,640; p=0,025). CONCLUSÃO: A capacidade de realizar AIVDs e a força de preensão palmar apresentaram associação na amostra estudada.

Capacidade de exercício e seu valor prognóstico no pós-operatório de cirurgia cardíaca

INTRODUÇÃO: O valor prognóstico da capacidade de exercício em pacientes submetidos à cirurgia de revascularização miocárdica (CRM) necessita de esclarecimentos. OBJETIVOS: Avaliar a capacidade de exercício e o seu valor prognóstico em pacientes com doença arterial coronariana, submetidos à cirurgia de revascularização miocárdica eletiva. MATERIAIS E MÉTODOS: Foram avaliados 21 pacientes e 29 controles. Dois incremental shuttle walk test (ISWT) e dois testes de caminhada de 6 min (TC6) foram realizados randomicamente em dias alternados. A força de preensão manual (FPM) foi também avaliada. RESULTADOS: A FPM em valores percentuais (78,4 ± 16 vs. 97,2 ± 15%), o TC6 em metros (412 ± 79 vs. 601 ± 7 m) e em valores percentuais (72 ± 13 vs. 110 ± 11%) e o ISWT em metros (257 ± 90 vs. 517 ± 138 m) e em valores percentuais (53 ± 16 vs. 108 ± 16%) foram significativamente (p < 0,05) inferiores nos pacientes. Onze pacientes apresentaram complicações pós-operatórias (grupo C) e dez evoluíram bem (grupo SC). O grupo C apresentou idade mais avançada (57 ± 6 vs. 71 ± 7 anos; p < 0,05), FPM inferior (33 ± 6 vs. 41 ± 9 kgf) e ISWT inferior (208 ± 81 vs. 311 ± 66 m). Não houve diferenças significativas para o TC6. A regressão logística selecionou o ISWT como determinante do prognóstico dos pacientes (p = 0,04). CONCLUSÃO: Os pacientes à espera de CRM eletiva apresentam significativa redução da capacidade de exercício e o ISWT apresentou valor prognóstico significativo discriminando os pacientes com complicações pós-operatórias.

Validade preditiva de equações de referência para força de preensão manual em homens brasileiros de meia idade e idosos

O objetivo deste estudo foi verificar a validade preditiva das equações de referência para predição da força de preensão manual (FPM) em homens brasileiros de meia idade e idosos. Foram avaliados 60 homens com idade de 58,7±8,6 anos (50-84 anos), estatura 168,7±8,0 cm, massa corporal 67,9±13,0 kg e índice de massa corporal 23,7±4,0 kg/m², utilizando equipamento 'padrão-ouro' na avaliação da FPM e seguindo todas as recomendações metodológicas preconizadas pela American Society of Hand Therapists (ASHT). Os resultados do diagrama de Bland-Altman para mão dominante (MD) apresentam um erro médio (viés) de -8,4% (IC95% -51,6-34,7). Já o diagrama de Bland-Altman para mão não dominante (MND) apresenta um erro médio (viés) de 1,4% (IC95% -47,1-49,8). O cálculo de Cronbach's alpha para a MD foi de 0,69 e 0,59 para MND. O coeficiente de correlação intraclasse para MD foi 0,52 (IC95% 31-68) e de 0,42 (IC95% 20-60) para a MND. Concluímos que as equações para predição analisadas neste estudo, para uma população de homens brasileiros de meia idade e idosos, apresentou baixa validade preditiva, o que pode gerar erros de interpretação dos resultados.

Força muscular como determinante da eficiência do consumo de oxigênio e da máxima resposta metabólica ao exercício em pacientes com DPOC leve/moderada

OBJETIVO: Comparar o comportamento de oxygen uptake efficiency slope (OUES, inclinação da eficiência do consumo de oxigênio) com o do consumo de oxigênio no pico do exercício (VO2pico). MÉTODOS: Estudo prospectivo transversal envolvendo 21 pacientes (15 homens) com DPOC leve/moderada que foram submetidos a espirometria, dinamometria de preensão palmar (DIN), teste cardiopulmonar de exercício e medida de lactato no pico do exercício (LACpico). RESULTADOS: A média de peso foi 66,7 ± 13,6 kg, e a de idade foi 60,7 ± 7,8 anos. Com exceção de VEF1 e relação VEF1/CVF (75,8 ± 18,6 do previsto e 56,6 ± 8,8, respectivamente), as demais variáveis espirométricas foram normais, assim como DIN. As médias, em % do previsto, para VO2pico (93,1 ± 15,4), FC máxima (92,5 ± 10,4) e OUES (99,4 ± 24,4), assim como a da taxa de troca respiratória (1,2 ± 0,1), indicaram estresse metabólico e hemodinâmico importante. A correlação entre o VO2pico e a OUES foi elevada (r = 0,747; p < 0,0001). A correlação entre DIN e VO2pico (r = 0,734; p < 0,0001) foi mais expressiva do que com aquela entre DIN e OUES (r = 0,453; p < 0,05). Resultados semelhantes ocorreram em relação às correlações de VO2pico e OUES com PImáx. Houve correlação significativa entre VO2pico e LACpico (r = -0,731; p < 0,0001), mas essa só ocorreu entre OUES e LACpico/potência máxima (r = -0,605; p = 0,004). CONCLUSÕES: Nossos resultados sugerem que, na DPOC leve/moderada, determinantes do VO2, além da força muscular global, têm um maior impacto na OUES do que no VO2pico.