Electromyographic and magnetic resonance imaging evaluations of individuals with patellofemoral pain syndrome

OBJETIVOS: Analisar a atividade elétrica (EMG) dos músculos vasto medial oblíquo (VMO), vasto lateral longo (VLL) e vasto lateral oblíquo (VLO) de indivíduos com síndrome da dor femoropatelar (SDFP) durante contração isométrica voluntária máxima (CIVM) de extensão da perna com o joelho a 30(0), a dor por meio da Escala Visual Analógica (EVA) e o posicionamento da patela por meio da ressonância magnética nuclear por imagem (RMNI). MÉTODOS: Avaliaram-se 12 mulheres com SDFP e 12 clinicamente normais, que realizaram cinco CIVM de extensão da perna no ângulo de 30(0) para análise da EMG. Avaliou-se o ângulo do sulco (AS), ângulo de congruência (AC), ângulo de inclinação patelar (AIP) e deslocamento patelar (DP) pela RMNI. Utilizaram-se testes estatísticos: ANOVA, análise de variância de medidas repetidas para EMG; o teste Mann-Whitney U para análise da RMNI; o teste de correlação de Pearson (r) entre EMG e RMNI e análise de variância one-way para avaliação da dor (p<0,05). RESULTADOS: Verificou-se maior atividade elétrica do músculo VLL em relação ao VMO no grupo com SDFP. Em ambos os grupos, os músculos VMO e VLL apresentaram maior atividade elétrica que o VLO. Para o grupo SDFP, a RMNI revelou maiores valores do AS e menores do AC, e verificou-se uma correlação negativa entre VMO e AIP. CONCLUSÃO: Os dados sugerem que maior atividade elétrica do VLL, juntamente com o aumento do AS e diminuição do AC, possam ser fatores favorecedores da instabilidade patelar nos indivíduos com SDFP.OBJECTIVES: To analyze the electrical activity of the vastus medialis obliquus (VMO), vastus lateralis longus (VLL) and vastus lateralis obliquus (VLO) muscles of individuals with patellofemoral pain syndrome (PFPS) during maximum voluntary isometric contraction (MVIC) of lower leg extension with the knee at 30°; to assess pain using a visual analogue scale (VAS); and to assess patellar positioning using magnetic resonance imaging (MRI). METHODS: Twelve women with PFPS and 12 clinically normal women were evaluated. They performed five MVICs of lower leg extension at 30° for electromyographic (EMG) analysis. Using MRI, the sulcus angle (SA), congruence angle (CA), patellar tilt angle (PTA) and patellar displacement (PD) were obtained. The following statistical tests were used: analysis of variance (ANOVA) for repeated measurements to assess EMGs; Mann-Whitney U test to analyze MRIs; Pearson's (r) correlation test between EMGs and MRIs; and one-way ANOVA to evaluate pain (p<0.05). RESULTS: In the PFPS group, there was greater electrical activity in the VLL than in the VMO. In both groups, there was greater electrical activity in the VMO and VLL than in the VLO. In the PFPS group, the MRI showed higher SA and lower CA values, and there was a negative correlation between the VMO and the PTA. CONCLUSION: The data suggest that, in individuals with PFPS, greater electrical activity in the VLL combined with an increased SA and a decreased CA may contribute to patellar instability.Conselho Nacional de Pesquisa (CNPq

Exacerbation and functional capacity of patients with COPD undergoing an exercise training program: longitudinal study

Objective: To analyze if there is influence of body weight, body mass index (BMI), body composition, dyspnoea, grip strength and tolerance to exertion in the occurrence of exacerbation during a 12-month follow up of patients with COPD who underwent a physical training program. Material and methods: Sixty three patients were distributed in two groups, (Exacerbation Group EG, n = 29e#894; Non-Exacerbated Group NEG, n = 34). The MannWhitney test was used for the comparison between groups, the Friedman test (posthoc Dunn) to compare the assessments and the logistic regression analysis, with a significance level of p elt; 0.05. Results: There is a significant difference between the groups in age and walked distance (WD) in the sixminute walk test (6MWT). The WD was reduced in 6th, 9th and 12th month revaluation compared to baseline and 3 months for the EG. Logistic regression analysis showed a significant interaction between the lean body mass and the WD, BMI with the lean body mass and the BMI with the WD, this and the isolated dyspnoea, and lean body mass with body weight. Conclusion: Involving several variables along the follow up of patients with COPD in physical therapy programs is important, since it may prevent or reduce the chance of the occurrence of exacerbations. In addition, older patients with less tolerance to physical activity had a higher number of episodes of exacerbation, even when participating in a physiotherapy program associated to exercise training

Determination of exacerbation predictors in patients with COPD in physical therapy - a longitudinal study

Background: Chronic obstructive pulmonary disease (COPD) typically presents the characteristic clinical condition of exacerbation, with more intense symptoms associated with greater functional loss and consequently lower chances of patient survival. Objectives: This study sought to determine the predictors of exacerbation, alone or in combination, in patients with chronic obstructive pulmonary disease (COPD) who received physical therapeutic treatment over 6 months. Method: This was an observational, longitudinal and prospective study in which 63 COPD patients residing within the municipality of São Carlos, SP, Brazil were evaluated. These patients had COPD stages II and III and were entered into a physical therapy program, consisting of 3 periods of assessment over 6 months. We evaluated the occurrence of acute exacerbation as well as the patients' body mass index (BMI), fat-free mass (FFM), fat-free mass index, forced expiratory volume in 1 second (FEV1), dyspnea, distance walked (DW) in the 6-minute walk test (6MWT) and handgrip strength. Results: When applying Cox settings with each covariate separately, the results revealed 5% significance only for the DW in the 6MWT, which demonstrated an interaction between BMI and FFM. Comparison of the 3 periods of assessment across the covariates measured showed a significant difference only for the DW between evaluations in the 3rd and 6th months. Conclusion: Upon analyzing the predictors of risk over 6 months of follow-up in patients with COPD, we found that the DW in the 6MWT was associated with the risk of exacerbation, although this risk also depended on the covariates BMI and FFM

Exacerbation and functional capacity of patients with COPD undergoing an exercise training program: longitudinal study

Objective To analyze if there is influence of body weight, body mass index (BMI), body composition, dyspnoea, grip strength and tolerance to exertion in the occurrence of exacerbation during a 12-month follow up of patients with COPD who underwent a physical training program. Material and methods Sixty three patients were distributed in two groups, (Exacerbation Group — EG, n = 29; Non-Exacerbated Group — NEG, n = 34). The Mann Whitney test was used for the comparison between groups, the Friedman test (posthoc Dunn) to compare the assessments and the logistic regression analysis, with a significance level of p < 0.05. Results There is a significant difference between the groups in age and walked distance (WD) in the sixminute walk test (6MWT). The WD was reduced in 6th, 9th and 12th month revaluation compared to baseline and 3 months for the EG. Logistic regression analysis showed a significant interaction between the lean body mass and the WD, BMI with the lean body mass and the BMI with the WD, this and the isolated dyspnoea, and lean body mass with body weight. Conclusion Involving several variables along the follow up of patients with COPD in physical therapy programs is important, since it may prevent or reduce the chance of the occurrence of exacerbations. In addition, older patients with less tolerance to physical activity had a higher number of episodes of exacerbation, even when participating in a physiotherapy program associated to exercise training