Effects of combined exercise training with sleep education in older adults with obstructive sleep apnea: protocol for a randomized clinical trial

Background

Obstructive sleep apnea (OSA) is a common disorder that affects approximately 1 billion people worldwide. Advanced age is a significant risk factor. Various treatment options have been explored to reduce the severity of OSA symptoms and physical exercise has emerged as a potential alternative therapy. Therefore, this study aims to investigate the effects of a combined exercise program with sleep education on sleep quality and on the severity of OSA in older adults.

Methods

This is a randomized clinical trial with two parallel groups that will involve individuals of both genders aged between 60 and 79 years who have an apnea-hypopnea index (AHI) of more than 15 events per hour and who have not received or are currently undergoing treatment for OSA. Older adults who have engaged in regular exercise in the last six months and individuals with contraindications to exercise will be excluded. The study will assess outcomes related to OSA, including AHI, oxygen desaturation index, minimum and mean oxyhemoglobin saturation, sleep efficiency, sleep latency, and the type of respiratory events. Additionally, sleep quality-related outcomes, daytime sleepiness, physical activity, physical fitness, aerobic capacity, cognitive status, anthropometric measures, and health-related quality of life will be analyzed. Participants will be randomized to two groups: a combined exercise group (involving both resistance and aerobic training) with sleep education, and a control group that will receive only educational recommendations for managing OSA. The intervention will last 12 weeks and will consist of three sessions per week, totaling 36 exercise sessions. Sample size calculation indicates a minimum number of 36 participants.

Discussion

If the hypothesis is confirmed, this clinical trial will indicate an effective non-pharmacological intervention for treating OSA in older adults. This intervention could be used as an adjunct to existing approaches designed to improve OSA management.

Clinical trail registration

Brazil Clinical Trials Registry (ReBEC), identifier RBR-9hk6pgz.

Knowledge of healthcare professionals about poliomyelitis and postpoliomyelitis: a cross-sectional study

BACKGROUND

Postpoliomyelitis syndrome is a clinical condition that can affect poliomyelitis survivors.

OBJECTIVE

Our aim was to evaluate knowledge of poliomyelitis and postpoliomyelitis syndrome among Brazilian healthcare professionals.

DESIGN AND SETTING

Cross-sectional study conducted at a Brazilian public higher education institution located in the state of Goiás.

METHODS

The participants (n = 578) were Brazilian physicians, physical therapists, nurses, nutritionists and psychologists. A self-administered questionnaire (30 questions) was designed to probe knowledge about poliomyelitis and postpoliomyelitis syndrome. From the questionnaire, we created a structured test to objectively evaluate the knowledge of these professionals. The test was composed of 20 questions and was scored over a range from 0 (totally ill-informed) to 20 (totally well-informed).

RESULTS

In general, the physicians, physical therapists and nurses demonstrated better understanding of poliomyelitis and postpoliomyelitis syndrome. The healthcare professionals who had received previous information about poliomyelitis and postpoliomyelitis syndrome had significantly higher scores than those who had never received information (P < 0.001). On average, this difference was approximately 28.6%.

CONCLUSIONS

The findings from the present study indicate that there is a critical need for improvement of knowledge about postpoliomyelitis syndrome among Brazilian healthcare professionals. The services provided by these professionals may therefore become compromised. Furthermore, public healthcare initiatives should be implemented to improve knowledge among healthcare professionals.

Presence of exercise physiology or similar coursework in the curricula of Brazilian health science undergraduate programs

Bolstered by evidence of the health benefits of exercise, health professionals advise their patients about it. Thus these professionals should have a basic knowledge of exercise physiology. In Brazil, a graduate degree is not mandatory, so for many health providers, the only opportunity to receive information on exercise physiology content is during their undergraduate study. Therefore, it is imperative that health science undergraduate programs include content on exercise physiology. The aim of the study was to verify the presence of exercise physiology (or similar coursework) in the curricula of seven health science undergraduate programs (biomedicine, physical education, nursing, physiotherapy, medicine, nutrition, and psychology). The study was divided into three phases: 1) a survey of the total number of undergraduate programs (n = 4,940) through an electronic system of the Brazilian Ministry of Education (e-MEC); 2) a random selection of 10% of the total undergraduate programs (n = 494) for further analysis of the curriculum; and 3) analysis of the curricula of the selected undergraduate programs. Of 494 undergraduate programs, we did not find curricula for 77 of them. Therefore, the final sample consisted of 417 undergraduate programs. In total, 65.9% of the undergraduate programs did not offer coursework in exercise physiology. The chi-square test revealed a significant association between undergraduate curricula in health science and the presence or absence of exercise physiology coursework [X²(6, n = 417) = 293.0, P < 0.0001]. We did not find exercise physiology coursework in most of the analyzed undergraduate programs. Alternatives to solve the lack of exercise physiology coursework would be the inclusion of content related to exercise physiology in professional/graduate education or in continuing education programs.

Analysis of type 2 diabetes mellitus and arterial hypertension content in exercise physiology textbooks

The textbook is a pedagogical tool that provides students and professionals with scientific information. As exercise is an important strategy for the prevention and treatment of noncommunicable diseases, such as type 2 diabetes mellitus (T2DM) and arterial hypertension, the presence of correct and up-to-date scientific information in exercise physiology textbooks is important. Our aim was to analyze T2DM and arterial hypertension content in exercise physiology textbooks and compare this content with the American College of Sports Medicine (ACSM) position stands. Comparative descriptions were made between information regarding T2DM and arterial hypertension found in textbooks (n = 10) and similar information contained in the official ACSM position stands. The quality of the content was compared with current scientific information present in the ACSM position stands. In regards to T2DM, eight textbooks provided information regarding the purpose and benefits of exercise, two provided information regarding exercise prescription, seven provided information regarding the type of exercise, six provided information regarding general care and recommendations, and five provided information regarding the mechanisms involved. In regards to arterial hypertension, all textbooks provided information regarding the purpose and benefit of exercise, six provided information regarding exercise prescription, nine provided information regarding the type of exercise, two provided information regarding general care and recommendations, and seven provided information regarding the mechanisms involved. All textbooks analyzed contained information related to physical exercise for patients with T2DM and arterial hypertension. However, the textbooks differed in terms of the quality of the contents, especially in regard to exercise prescription.

The influence of physical exercise and leisure activity on neuropsychological functioning in older adults

It has been suggested that leisure activity and physical exercise can be a protective factor for neuropsychological functions and are associated with a reduced risk of dementia. Thus, the purpose of this study was to investigate the influence of physical exercise and leisure on the neuropsychological functions of healthy older adults. The sample was composed of 51 sedentary female volunteers who were 60-70 years old and were distributed into three groups: A-control, B-leisure, and C-training. Volunteers were submitted to a physical and neuropsychological assessment at baseline and after 6 months. Groups A and B were monitored longitudinally three times a week. Group C improved their neuropsychological functioning and oxygen consumption compared to groups A and B (p = <0.05). The neuropsychological functions of groups A and B were significantly worse after 6 months of monitoring (p = <0.05). The data suggest that physical exercise improves neuropsychological functioning, although leisure activities may also improve this functioning. Thus, an aerobic physical fitness program can partially serve as a non-medication alternative for maintaining and improving these functions in older adults; however, leisure activities should also be considered.

Knowledge among physical education professionals about poliomyelitis and post-poliomyelitis syndrome: a cross-sectional study in Brazil

BACKGROUND

Post-poliomyelitis syndrome is a clinical condition that can affect poliomyelitis survivors with the onset of new symptoms several years after the acute disease. These symptoms include new muscular weakness, fatigue, pain, onset or aggravation of muscle atrophy, muscle cramps, onset or aggravation of pre-existing difficulties in accomplishing daily life activities, cold intolerance, sleep disorders, dysphonia or dysphagia, and respiratory deficiency. The treatment of post-poliomyelitis syndrome requires a multiprofessional health team because the rehabilitation procedures include lifestyle changes, physiotherapy, avoidance of secondary complications, and physical exercise. As physical exercise is prescribed by physical education professionals, the assessment of knowledge about post-poliomyelitis syndrome among these professionals is very relevant. The aim of this study was to evaluate poliomyelitis and post-poliomyelitis syndrome knowledge among physical education professionals in Brazil.

METHODS

We invited participants with an academic degree in physical education (n = 217) to participate in this study. A self-administered survey (30 questions) was designed to probe knowledge about poliomyelitis and post-poliomyelitis syndrome. From the survey, we created a questionnaire to evaluate the performance of the professionals. The questionnaire was composed of 20 questions and a score was provided, varying from 0 (totally uninformed) to 20 (well informed).

RESULTS

Approximately 73% of surveyed participants had never heard of post-poliomyelitis syndrome, and only 19.4% had received information about the disease. Among those surveyed, 61.8% did not know whether restriction of physical activities was warranted for people with poliomyelitis sequelae, and only 32.3% knew that physical exercise (especially intense exercise) should be limited for patients with sequelae of paralytic poliomyelitis.

CONCLUSION

The findings of the present study indicate a critical need for improvement of knowledge about post-poliomyelitis syndrome among Brazilian physical education professionals.

Tratamento não farmacológico para a insônia crônica

O objetivo deste artigo é descrever, resumidamente, quais são as terapias não farmacológicas e também a atualização do uso destas para o tratamento da insônia crônica. Além da insônia ser o mais prevalente distúrbio do sono, ela está diretamente associada aos transtornos psiquiátricos. Embora o tratamento farmacológico seja o mais comumente utilizado, as terapias não farmacológicas vêm sendo amplamente estudadas, em particular as relacionadas às mudanças de comportamento. Entre estas estão a cognitiva; a higiene do sono; a do controle de estímulos; a de restrição do sono; a do relaxamento muscular; a da intenção paradoxal e, mais recentemente, a prática regular de exercícios físicos. Inicialmente, o principal objetivo dos estudos realizados com as intervenções comportamentais foi o de melhorar a qualidade do sono dos pacientes. No entanto, alguns estudos recentes têm sido desenvolvidos com o objetivo de avaliar o efeito de tais terapias auxiliando à redução da dose e da freqüência de uso de medicamentos utilizados, bem como à melhora da qualidade de vida dos pacientes. Como a insônia é um problema crônico, os tratamentos de longo prazo têm sido alvos de estudos e de uso comum entre os clínicos.