Percepção de fisioterapeutas sobre facilitadores e barreiras no uso de diferentes ferramentas para treinamento resistido em pacientes com DPOC: estudo de método mistos

O objetivo do estudo foi quantificar e analisar qualitativamente a percepção de fisioterapeutas sobre facilitadores e barreiras no uso de diferentes ferramentas para treinamento resistido em pacientes com doença pulmonar obstrutiva crônica (DPOC). O método utilizado foi desenvolvido em um centro de reabilitação. Seis fisioterapeutas que participaram como terapeutas de um ensaio clínico randomizado foram entrevistados. O protocolo consistiu na avaliação de três ferramentas para treinamento resistido: tubos elásticos, bandas elásticas e treinamento convencional com equipamentos de musculação. Depois da finalização do ensaio clínico randomizado, os fisioterapeutas foram convidados a participar de um grupo focal para análise qualitativa e responder questionário fechado para análise quantitativa. Os profissionais opinaram sobre vantagens e desvantagens de cada uma das três ferramentas na prática clínica. A análise do grupo focal resultou em oito temas: insegurança em relação à carga e manuseio das ferramentas; implementação de tratamento domiciliar; melhorias para ferramentas; vantagens e desvantagens das ferramentas; incidência de lesões com ferramentas elásticas; preferência dos pacientes; e particularidades de cada ferramenta. Fisioterapeutas apontaram diferentes barreiras e facilitadores para o treinamento resistido. Características das ferramentas – como custo, portabilidade, manuseio, praticidade e percepção do paciente e fisioterapeuta – foram citadas como fatores que influenciam a prática clínica. Na análise quantitativa, nenhuma diferença foi observada quando comparados os escores para cada instrumento. As três ferramentas são aplicáveis na prática clínica do fisioterapeuta. Adicionalmente, as características e particularidades de cada uma delas devem ser consideradas.This study sought to quantify and qualitatively analyze the perception of physical therapists about facilitators and the challenges in the use of different types of tools for resistance training in chronic obstructive pulmonary disease (COPD) patients. This was a mixed-model study with qualitative analysis developed in a rehabilitation center. Six physical therapists who performed a randomized clinical trial were interviewed. The protocol consisted of the evaluation of three types of resistance training: elastic tubes, elastic bands, and training with conventional weight machines. After completion of the randomized trial, therapists were invited to participate in a focus group to collect qualitative data. Physical therapists also answered a quantitative questionnaire containing closed questions. The main outcome measures were the opinion of physical therapists about the advantages and disadvantages in clinical practice of each of the analyzed tools. The focus group analysis resulted in eight themes: Insecurities regarding load and handling tools, implementation of home-based treatment, improvements of tools, advantages and disadvantages of tools, incidence of injuries with elastic tools, patient’s preferences, and particularities of the tools. Physical therapists pointed out different challenges and facilitators for resistance training. Characteristics of the tools such as costs, portability, handling and practicality were cited as factors that influence clinical practice. In the quantitative analysis, no differences were observed when comparing the scores of each instrument. The three tools analyzed are applicable and feasible in the clinical practice of physical therapists; moreover, they present different characteristics and particularities that should be considered, such as cost, clinical applicability, portability and perception of the patient and therapists.El objetivo del estudio fue cuantificar y analizar cualitativamente la percepción de fisioterapeutas sobre facilitadores y barreras en el uso de diferentes herramientas de entrenamiento de resistencia en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). El método utilizado fue desarrollado en un centro de rehabilitación. Seis profesionales que participaron como terapeutas en un ensayo clínico aleatorizado fueron entrevistados. El protocolo consistió en la evaluación de tres herramientas de entrenamiento de resistencia: tubos elásticos, bandas elásticas y entrenamiento convencional con equipo de entrenamiento con pesas. Después del ensayo clínico aleatorizado, se invitó a los fisioterapeutas a participar en un grupo focal para análisis cualitativo y a responder un cuestionario cerrado para análisis cuantitativo. Los profesionales opinaron sobre las ventajas y desventajas de cada una de las tres herramientas en la práctica clínica. El análisis del grupo resultó en ocho temas: falta de fiabilidad en lo referente a la carga y al manejo de las herramientas; puesta en práctica del tratamiento domiciliario; mejoras en las herramientas; ventajas y desventajas de las herramientas; incidencia de lesiones con las herramientas elásticas; preferencia de los pacientes; particularidades de cada herramienta. Los fisioterapeutas señalaron diferentes barreras y facilitadores para el entrenamiento de resistencia. Características de la herramienta – como costo, portabilidad, manejo, practicidad y percepción del paciente y del fisioterapeuta – fueron mencionadas como factores que influyen en la práctica clínica. En el análisis cuantitativo no se observaron diferencias de puntaje entre los instrumentos. Las tres herramientas son aplicables en la práctica clínica del fisioterapeuta. Además, se deben considerar las características y particularidades de cada una de ellas

Efeitos de um programa domiciliar de exercícios após um treinamento resistido supervisionado em pacientes com doença pulmonar obstrutiva crônica

Design of the study: clinical Trial. Objective: This study aimed to evaluate the effects of a homebased resistance exercise program with elastic tubing after supervised resistance training on peripheral muscle strength and quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods: The study included 22 COPD patients, aged 55-70 years. Peripheral muscle strength and quality of life were evaluated through digital dynamometer and Chronic Respiratory Disease Questionnaire (CRDQ) respectively after supervised resistance training program, and then the patients were divided into two groups: home-based treatment (n = 10) and control (n = 12). After 16 weeks the assessments were repeated. Results: The home resistance training showed no significant increase in peripheral muscle strength and quality of life, however, was able to maintain the gains made in the previous supervised training. Conclusion: The continuity of home-based treatment did not promote additional improvements to supervised training after the protocol, since the gains were maintained in both assessed groups after 4 monthsDesenho do estudo: ensaio clínico. Objetivo: Avaliar os efeitos de um programa de exercícios resistidos em domicílio, com tubos elásticos, após o treinamento resistido supervisionado sobre a força muscular periférica e qualidade de vida de pacientes com doença pulmonar obstrutiva crônica (DPOC). Métodos: O estudo incluiu 22 pacientes com DPOC, com idade entre 55-70 anos. A força muscular periférica e a qualidade de vida foram avaliados por meio da dinamometria e do questionário Chronic Respiratory Questionare (CRQ), respectivamente, após o programa de treinamento de resistência supervisionado, e, em seguida, os pacientes foram divididos em dois grupos: tratamento domiciliar (n = 10) e controle (n = 12). Após 16 semanas, as avaliações foram repetidas. Resultados: O treinamento resistido em domicílio não mostrou aumento significativo sobre a força muscular periférica e qualidade de vida, no entanto, foi capaz de manter os ganhos obtidos após o programa de treinamento supervisionado. Conclusão: A continuidade do tratamento em domicílio não promoveu melhorias adicionais após o protocolo, uma vez que os ganhos foram mantidos nos dois grupos avaliados após 4 mese

Autonomic function recovery and physical activity levels in post-COVID-19 young adults after immunization: an observational follow-up case-control study

Coronavirus disease 2019 (COVID-19) has detrimental multi-system consequences. Symptoms may appear during the acute phase of infection, but the literature on long-term recovery of young adults after mild to moderate infection is lacking. Heart rate variability (HRV) allows for the observation of autonomic nervous system (ANS) modulation post-SARS-CoV-2 infection. Since physical activity (PA) can help improve ANS modulation, investigating factors that can influence HRV outcomes after COVID-19 is essential to advancements in care and intervention strategies. Clinicians may use this research to aid in the development of non-medication interventions. At baseline, 18 control (CT) and 20 post-COVID-19 (PCOV) participants were observed where general anamnesis was performed, followed by HRV and PA assessment. Thus, 10 CT and 7 PCOV subjects returned for follow-up (FU) evaluation 6 weeks after complete immunization (two doses) and assessments were repeated. Over the follow-up period, a decrease in sympathetic (SNS) activity (mean heart rate: p = 0.0024, CI = −24.67–−3.26; SNS index: p = 0.0068, CI = −2.50–−0.32) and increase in parasympathetic (PNS) activity (mean RR:p = 0.0097, CI = 33.72–225.51; PNS index: p = 0.0091, CI = −0.20–1.47) were observed. At follow-up, HRV was not different between groups (p > 0.05). Additionally, no differences were observed in PA between moments and groups. This study provides evidence of ANS recovery after SARS-CoV-2 insult in young adults over a follow-up period, independent of changes in PA.info:eu-repo/semantics/publishedVersio

Role of body mass and physical activity in autonomic function modulation on Post-COVID-19 condition: an observational subanalysis of Fit-COVID study

The harmful effects of coronavirus disease 2019 (COVID-19) can reach the autonomic nervous system (ANS) and endothelial function. Therefore, the detrimental multiorgan effects of COVID-19 could be induced by deregulations in ANS that may persist after the acute SARS-CoV-2 infection. Additionally, investigating the differences in ANS response in overweight/obese, and physically inactive participants who had COVID-19 compared to those who did not have the disease is necessary. The aim of the study was to analyze the autonomic function of young adults after mild-to-moderate infection with SARS-CoV-2 and to assess whether body mass index (BMI) and levels of physical activity modulates autonomic function in participants with and without COVID-19. Patients previously infected with SARS-CoV-2 and healthy controls were recruited for this cross-sectional observational study. A general anamnesis was taken, and BMI and physical activity levels were assessed. The ANS was evaluated through heart rate variability. A total of 57 subjects were evaluated. Sympathetic nervous system activity in the post-COVID-19 group was increased (stress index; p = 0.0273). They also presented lower values of parasympathetic activity (p < 0.05). Overweight/obese subjects in the post-COVID-19 group presented significantly lower parasympathetic activity and reduced global variability compared to non-obese in control group (p < 0.05). Physically inactive subjects in the post-COVID-19 group presented significantly higher sympathetic activity than active subjects in the control group. Parasympathetic activity was significantly increased in physically active subjects in the control group compared to the physically inactive post-COVID-19 group (p < 0.05). COVID-19 promotes changes in the ANS of young adults, and these changes are modulated by overweight/obesity and physical activity levels.info:eu-repo/semantics/publishedVersio

Autonomic Function Recovery and Physical Activity Levels in Post-COVID-19 Young Adults after Immunization: An Observational Follow-Up Case-Control Study

Coronavirus disease 2019 (COVID-19) has detrimental multi-system consequences. Symptoms may appear during the acute phase of infection, but the literature on long-term recovery of young adults after mild to moderate infection is lacking. Heart rate variability (HRV) allows for the observation of autonomic nervous system (ANS) modulation post-SARS-CoV-2 infection. Since physical activity (PA) can help improve ANS modulation, investigating factors that can influence HRV outcomes after COVID-19 is essential to advancements in care and intervention strategies. Clinicians may use this research to aid in the development of non-medication interventions. At baseline, 18 control (CT) and 20 post-COVID-19 (PCOV) participants were observed where general anamnesis was performed, followed by HRV and PA assessment. Thus, 10 CT and 7 PCOV subjects returned for follow-up (FU) evaluation 6 weeks after complete immunization (two doses) and assessments were repeated. Over the follow-up period, a decrease in sympathetic (SNS) activity (mean heart rate: p = 0.0024, CI = −24.67–−3.26; SNS index: p = 0.0068, CI = −2.50–−0.32) and increase in parasympathetic (PNS) activity (mean RR: p = 0.0097, CI = 33.72–225.51; PNS index: p = 0.0091, CI = −0.20–1.47) were observed. At follow-up, HRV was not different between groups (p \u3e 0.05). Additionally, no differences were observed in PA between moments and groups. This study provides evidence of ANS recovery after SARS-CoV-2 insult in young adults over a follow-up period, independent of changes in PA

Role of Body Mass and Physical Activity in Autonomic Function Modulation on Post-COVID-19 Condition: An Observational Subanalysis of Fit-COVID Study

The harmful effects of coronavirus disease 2019 (COVID-19) can reach the autonomic nervous system (ANS) and endothelial function. Therefore, the detrimental multiorgan effects of COVID-19 could be induced by deregulations in ANS that may persist after the acute SARS-CoV-2 infection. Additionally, investigating the differences in ANS response in overweight/obese, and physically inactive participants who had COVID-19 compared to those who did not have the disease is necessary. The aim of the study was to analyze the autonomic function of young adults after mild-to-moderate infection with SARS-CoV-2 and to assess whether body mass index (BMI) and levels of physical activity modulates autonomic function in participants with and without COVID-19. Patients previously infected with SARS-CoV-2 and healthy controls were recruited for this cross-sectional observational study. A general anamnesis was taken, and BMI and physical activity levels were assessed. The ANS was evaluated through heart rate variability. A total of 57 subjects were evaluated. Sympathetic nervous system activity in the post-COVID-19 group was increased (stress index; p = 0.0273). They also presented lower values of parasympathetic activity (p \u3c 0.05). Overweight/obese subjects in the post-COVID-19 group presented significantly lower parasympathetic activity and reduced global variability compared to non-obese in control group (p \u3c 0.05). Physically inactive subjects in the post-COVID-19 group presented significantly higher sympathetic activity than active subjects in the control group. Parasympathetic activity was significantly increased in physically active subjects in the control group compared to the physically inactive post-COVID-19 group (p \u3c 0.05). COVID-19 promotes changes in the ANS of young adults, and these changes are modulated by overweight/obesity and physical activity levels

Avaliação da força, estresse muscular e marcadores inflamatórios de indivíduos com doença pulmonar obstrutiva crônica submetidos a treinamento resistido com tubos elásticos

It is known that physical exercise is effective in the rehabilitation process of patients with chronic obstructive pulmonary disease (COPD), but the behavior of functional variables and inflammatory expression from resistance training with elastic tubing are not yet clear in the literature in these patients. Objective: To evaluate the strength, functional capacity, muscle stress and inflammatory expression between a resistance training performed with elastic tubing and weight machines in pacients with COPD. Methods: We evaluated 19 patients with COPD randomized into 2 groups: resistance training with elastic tubing (GR1: n: 9) and resistance training with weight machines (GR2: n: 10). The training was performed 3 times weekly for 12 weeks, with initial intensity of 2x15 RM progressive to 4x6RM. Initially we performed initial assessment and evaluation of lung function.The measurement of muscle strength test were performed using a digital dynamometer; blood sampling for analysis of expression of inflammatory TNF-α, IL-6 and PAI-I and the metabolic variables glucose, triacylglycerol (TAG) and total cholesterol were performed at baseline, 6 weeks and 12 weeks (48 hours after the last training session); the functional capacity was done through the Six-minute walk test (6MWT) (baseline and 12 weeks) and the muscle stress through the measurement of creatine kinase (CK) (baseline, 24, 48 and 72 hours after protocol) Results: There were significant gains in muscle strength and functional capacity in both groups, with similar gain deltas. Significant peak in CK levels was observed 24 hours after the end of training on the GR2 (p = 0.027), but with value within the normal range...É conhecido que o exercício físico é eficaz no processo de reabilitação de pacientes com doença pulmonar obstrutiva crônica (DPOC), porém o comportamento de variáveis funcionais e expressão inflamatória a partir de treinamento resistido com tubos elásticos com estes pacientes ainda não estão claros na literatura. Objetivos: Avaliar o comportamento da força, capacidade funcional, estresse muscular e expressão inflamatória entre um treinamento resistido realizado com tubos elásticos e em aparelhos de musculação em indivíduos com DPOC. Métodos: Foram avaliados 19 pacientes com DPOC, randomizados em dois grupos: treinamento resistido com tubos elásticos (GR1:n:9) e treinamento resistido com aparelhos de musculação (GR2:n:10). O treinamento foi realizado três vezes semana durante 12 semanas, com intensidade inicial de 2x15 repetições máximas(RM) progressiva até 4x6RM. Inicialmente foi realizada avaliação inicial e avaliação da função pulmonar. A mensuração da força muscular foi realizada por meio de dinamômetro digital; as coletas sanguíneas para análise da expressão inflamatória de TNF-α, IL-6 e PAI-I e das variáveis metabólicas glicose, triacilglicerol (TAG) e colesterol total foram realizadas nos momentos basal, seis semanas e 12 semanas ( 48 horas após a ultima sessão de treinamento); a capacidade funcional foi realizada por meio do Teste de Caminhada de Seis minutos (TC6) (basal e 12 semanas)e o estresse muscular por meio da mensuração de creatina quinase (CK) (basal, 24, 48 e 72 horas após protocolo) Resultados:Houveram ganhos significativos de força muscular e capacidade funcional em ambos os grupos, com ganhos relativos semelhantes..

Exercise as a Peripheral Circadian Clock Resynchronizer in Vascular and Skeletal Muscle Aging

Aging is characterized by several progressive physiological changes, including changes in the circadian rhythm. Circadian rhythms influence behavior, physiology, and metabolic processes in order to maintain homeostasis; they also influence the function of endothelial cells, smooth muscle cells, and immune cells in the vessel wall. A clock misalignment could favor vascular damage and indirectly also affect skeletal muscle function. In this review, we focus on the dysregulation of circadian rhythm due to aging and its relationship with skeletal muscle changes and vascular health as possible risk factors for the development of sarcopenia, as well as the role of physical exercise as a potential modulator of these processes. © 2021 by the authors. Licensee MDPI, Basel, Switzerlan

Predictive equation for assessing appendicular lean soft tissue mass using bioelectric impedance analysis in older adults: Effect of body fat distribution

Background: Low muscle mass is associated with sarcopenia and increased mortality. Muscle mass, especially that of the limbs, is commonly estimated by dual-energy X-ray absorptiometry (DXA) or bioimpedance analysis (BIA). However, BIA-based predictive equations for estimating lean appendicular soft tissue mass (ALST) do not take into account body fat distribution, an important factor influencing DXA and BIA measurements.Objectives: To develop and cross-validate a BIA-based equation for estimating ALST with DXA as criterion, and to compare our new formula to three previously published models.Methods: One-hundred eighty-four older adults (140 women and 44 men) (age 71.5 +/- 7.3 years, body mass index 27.9 +/- 5.3 kg/m2) were recruited. Participants were randomly split into validation (n = 118) and crossvalidation groups (n = 66). Bioelectrical resistance was obtained with a phase-sensitive 50 kHz BIA device. Results: A BIA-based model was developed for appendicular lean soft tissue mass [ALST (kg) = 5.982 + (0.188 x S2 / resistance) + (0.014 x waist circumference) + (0.046 x Wt) + (3.881 x sex) - (0.053 x age), where sex is 0 if female or 1 if male, Wt is weight (kg), and S is stature (cm) (R2 = 0.86, SEE = 1.35 kg)]. Cross validation revealed r2 of 0.91 and no mean bias. Two of three previously published models showed a trend to significantly overestimate ALST in our sample (p < 0.01).Conclusions: The new equation can be considered valid, with no observed bias and trend, thus affording practical means to quantify ALST mass in older adults