Reabilitação física na síndrome de fragilidade do idoso

São considerados idosos frágeis aqueles com vulnerabilidade intrínseca a desenvolver incapacidades e eventos adversos relacionados à saúde. A prevalência de fragilidade aumenta com a idade e a Associação Médica Americana estima que 40% das pessoas com mais de 80 anos são frágeis. Objetivo: Demonstrar os resultados obtidos com o protocolo de reabilitação para idosos frágeis, implementado no Hospital Israelita Albert Einstein-Unidade Vila Mariana. Metódo: Estudo do tipo série de casos, descritivo, retrospectivo, com 12 idosos que cumpriram o programa de reabilitação física, do ambulatório de geriatria, da Unidade Vila Mariana, do Hospital Israelita Albert Einstein. Resultados: A média de idade foi de 77 anos, 75% dos participantes eram do sexo feminino e apresentavam em média 7,5 diagnósticos. Houve melhora em todos os domínios avaliados: equilíbrio (p = 0,02), velocidade de marcha (p < 0,01), força de membros inferiores (p < 0,01) e força de preensão (p < 0,01) na população estudada. Os idosos com 80 anos ou mais apresentaram melhora de 83% enquanto aqueles com menos de 80 anos mostraram melhora de 41%. Verificou-se que 8 dos 10 idosos que encontravam se na faixa de alto risco para incapacidade, hospitalização e morte (SPPB igual ou menor que 9) conseguiram sair da faixa de risco. Todos demonstraram melhora em pelo menos um domínio. Nenhuma piora ou complicação foi verificada. Conclusão: O protocolo de reabilitação para síndrome de fragilidade do idoso, utilizado no ambulatório da Unidade Vila Marina, do Hospital Israelita Albert Einstein, foi capaz de melhorar os domínios equilíbrio, velocidade de marcha, força de membros inferiores e força de preensão palmar na população estudada.Frail elderly are those who have intrinsic vulnerability to develop disabilities and adverse events related to health. The prevalence of frailty increases with age. The American Medical Association estimates that 40% of those over 80 years old are fragile. Objective: To demonstrate the results obtained with the rehabilitation protocol for the frailty syndrome at Vila Mariana Geriatric Outpatient Unit of the Israelita Albert Einstein Hospital. Method: Series of cases study, descriptive and retrospective of 12 elderly who have accomplish the physical rehabilitation program at Vila Mariana geriatric outpatient unit in the Israelita Albert Einstein Hospital. Results: The average age was 77 years, 75% of the participants were female with an average of 7,5 diagnoses. There was improvement in all areas evaluated: balance (p = 0.02), gait speed (p < 0.01), lower limb strength (p < 0.01) and grip strength (p < 0.01). Those who aged 80 or more showed improvement of 83% while those with less than 80 years old, showed an improvement of 41%. It was found that 8 of 10 seniors who met on the track at high risk for disability, hospitalization and death (SPPB equal or less than 9) was able to leave the risk range. It was showed improvement in at least one domain. No deterioration or complication was observed. Conclusion: The rehabilitation protocol for the frailty syndrome that was used at Vila Mariana geriatric outpatient unit was able to improve the balance, gait speed, lower limb strength and grip strength in the population studied

Association between respiratory capacity, quality of life and cognitive function in elderly individuals

OBJECTIVE: To investigate associations between respiratory capacity, quality of life and cognitive function in elderly individuals. METHODS: The sample included 386 elderly individuals (232 women). Respiratory capacity assessment was based on maximal expiratory pressure measured at peak expiratory flow. Subjects were classified according to peak expiratory flow values adjusted for sex, age and height of individuals with normal (peak expiratory flow curve 60%) or reduced (peak expiratory flow curve < 60%) respiratory capacity. The World Health Organization Quality of Life Questionnaire and the Mini-Mental State Examination were used to assess quality of life and cognitive function, respectively. RESULTS: Elderly women with reduced respiratory capacity scored lower on the Mini-Mental State Examination (p=0.048) and quality of life questionnaire (p=0.040) compared to those with normal respiratory capacity. These differences were not observed in men (p>0.05). CONCLUSION: Reduced respiratory capacity was associated with poorer quality of life and cognitive function in elderly women. These associations were not observed in elderly men

Effects of a home-based exercise training on the benefits of quality of life, physical capacity and neurovascular control in patients with heart failure

INTRODUÇÃO: O benefício de um programa de treinamento físico em pacientes com insuficiência cardíaca tem sido bastante documentado. Contudo, pouco se conhece a respeito dos benefícios de um programa de treinamento fisco nãosupervisionado na qualidade de vida, capacidade física e no controle neurovascular, após uma fase inicial de treinamento físico supervisionado. Foi ainda objetivo deste estudo, analisar a efetividade de um programa de atividade física na redução dos níveis de catecolaminas plasmáticas, NT-ProBNP e Interleucina 6 em pacientes com disfunção ventricular na vigência de betabloqueadores. MÉTODOS: Trinta pacientes (idade 54±1,7 anos) com disfunção ventricular esquerda acentuada foram inicialmente selecionados para o estudo. Os pacientes foram divididos em 2 grupos: o grupo controle (n=12); e o grupo treinamento físico (n=18). No início do estudo todos tiveram a qualidade de vida avaliada pelo questionário de Minnesota, e foram dosados os níveis de Interleucina 6, NT-ProBNP, e catecolamina plasmática. A atividade nervosa simpática muscular foi registrada diretamente no nervo fibular através da técnica da microneurografia. O fluxo sangüíneo muscular em antebraço foi avaliado pela técnica da pletismografia de oclusão venosa. Ambos os procedimentos foram registrados em repouso e durante o exercício isométrico a 30% da contração voluntária máxima. A capacidade física foi avaliada por meio da ergoespirometria. O grupo treinamento foi submetido inicialmente a quatro meses de treinamento físico supervisionado composto por 3 sessões de 60 minutos por semana, mantendo uma freqüência cardíaca correspondente a 10% abaixo do ponto de descompensação respiratória determinado pela ergoespirometria. Após a fase de treinamento físico supervisionado, os pacientes foram orientados a realizar quatro meses adicionais de treinamento físico de forma não-supervisionada, na mesma freqüência e intensidade determinadas durante a fase de treinamento supervisionado. A medida da qualidade de vida, atividade nervosa simpática muscular, fluxo sangüíneo muscular e análise laboratorial foram repetidas em 4 meses em ambos os grupos e no oitavo mês apenas no grupo submetido ao treinamento físico. RESULTADOS: Após os quatro primeiros meses, o grupo treinado apresentou melhora na qualidade de vida comparado ao grupo controle (39±6 vs 42±5 pontos; p=0,014). A atividade nervosa simpática muscular em repouso e durante o exercício isométrico a 30% da contração voluntária máxima também apresentaram melhora (47±5 vs 73±6 impulsos/ 100 bat; p=0,0052) e (61±5 vs 77±6 impulsos/ 100 bat; p=0,034), respectivamente. O fluxo sangüíneo muscular em antebraço em repouso aumentou no grupo treinado (1,96±0,11 vs 1,51±0,12 ml/min/100 ml tecido; p=0,015). Quatro meses de treinamento físico não-supervisionado foram efetivos na manutenção dos benefícios na qualidade de vida (52±6 vs 36±6 vs 33±5 pontos; p=0,0001), no fluxo sangüíneo muscular em antebraço, tanto em repouso (1,62±0,47 vs 1,93±0,56 vs 2,18±0,63 ml/min/100 ml tecido; p=0,03) como durante o exercício isométrico (2,04±0,11 vs 2,69±0,18 vs 2,74 ±0,2 ml/min/100 ml tecido; p=0,0016) e na capacidade física (71±9 vs 84±9 vs 88±9 Watts; p=0,0073). Não houve diferença nas medidas seriadas de NTProBNP, Interleucina 6 e de catecolaminas plasmáticas. CONCLUSÕES: O treinamento físico não-supervisionado por quatro meses, após uma fase de treinamento físico supervisionado, foi efetivo na manutenção dos benefícios na qualidade de vida, capacidade física e no fluxo sangüíneo muscular em antebraço. Não houve diferença nas medidas laboratoriais dos pacientes com disfunção ventricular esquerda treinados por oito mesesINTRODUCTION: The benefits of a physical training program in patients with heart dysfunction have been well described. However little is know about the response of a home-based exercise training in quality of life, physical capacity and neurovascular control in patients with heart failure, after a initial four months supervised training. The second objective of this study was to analyze the effectiveness of a exercise program on catecholamine, NT-ProBNP and Interleukin 6 in patients with heart dysfunction receiving beta-blockers. METHODS: Thirty patients (age 54±1,7 years) with severe heart dysfunction were initially enrolled in the protocol. They were divided in two groups; a control group (n=12) and a exercise group (n=18). Initially, both group had the measuring of quality of life by Minnesota questionnaire, Interleukin 6, NT-ProBNP and catecholamine. Muscle sympathetic nerve activity was recorded directly from fibular nerve using the technique of microneurography. Forearm blood flow was measured by venous plethysmography. Both procedures were recorded at rest and during 30% of maximal isometric contraction. The exercise group was submitted initially to fourmonths supervised exercise training program consisted of three 60 min exercise XXIX sessions per week, at heart rate levels that corresponded up to 10% below the respiratory compensation point. After the supervised period, the exercise group was instructed to perform an additional four-months home-based exercise training in the same frequency and intensity they had usually done. The quality of life, muscle sympathetic nerve activity, forearm blood flow and laboratory analysis were repeated at four months in both groups and only in the exercise group at eight months. RESULTS: After the initial 4 months the exercise group improved the quality of life compared to the control group (39±6 vs 42±5 units; p=0,014). The muscle sympathetic nerve activity at rest and during 30% of the maximum isometric contraction was also improved (47±5 vs 73±6 bursts/100 heart beat; p=0,0052) and (61±5 vs 77±6 bursts/100 heart beat; p=0,0276), respectively. The forearm blood flow at rest reduced in the exercise group (1,96±0,11 vs 1,51±0,11ml/min/100 ml tissue; p=0,015). An additional 4 month home-based exercise training was effective on the maintenance of the benefits on quality of life ( 52±6 vs 36±6 vs 33±5 points; p=0,0001), forearm blood flow at rest (1,62±0,47 vs 1,93±0,56 vs 2,18±0,63 ml/min/100 ml tissue; p=0,03), and during 30% of the maximum isometric contraction (2,04±0,11 vs 2,69±0,18 vs 2,74 ±0,2 ml/min/100 ml tissue; p=0,0016) and on physical capacity (71±9 vs 84±9 vs 88±9 Watts; p=0,0073). There was no difference on the measurements of NT-ProBNP, Interleukin 6 and catecholamine. CONCLUSIONS: A home-based exercise training for four months, after a supervised phase, was effective on the maintenance of the benefits of quality of life, physical capacity and forearm blood flow. There was no difference on the laboratorial measurements after an eight months physical training on patients with heart dysfunctio

Effects of a home-based exercise training on the benefits of quality of life, physical capacity and neurovascular control in patients with heart failure

INTRODUÇÃO: O benefício de um programa de treinamento físico em pacientes com insuficiência cardíaca tem sido bastante documentado. Contudo, pouco se conhece a respeito dos benefícios de um programa de treinamento fisco nãosupervisionado na qualidade de vida, capacidade física e no controle neurovascular, após uma fase inicial de treinamento físico supervisionado. Foi ainda objetivo deste estudo, analisar a efetividade de um programa de atividade física na redução dos níveis de catecolaminas plasmáticas, NT-ProBNP e Interleucina 6 em pacientes com disfunção ventricular na vigência de betabloqueadores. MÉTODOS: Trinta pacientes (idade 54±1,7 anos) com disfunção ventricular esquerda acentuada foram inicialmente selecionados para o estudo. Os pacientes foram divididos em 2 grupos: o grupo controle (n=12); e o grupo treinamento físico (n=18). No início do estudo todos tiveram a qualidade de vida avaliada pelo questionário de Minnesota, e foram dosados os níveis de Interleucina 6, NT-ProBNP, e catecolamina plasmática. A atividade nervosa simpática muscular foi registrada diretamente no nervo fibular através da técnica da microneurografia. O fluxo sangüíneo muscular em antebraço foi avaliado pela técnica da pletismografia de oclusão venosa. Ambos os procedimentos foram registrados em repouso e durante o exercício isométrico a 30% da contração voluntária máxima. A capacidade física foi avaliada por meio da ergoespirometria. O grupo treinamento foi submetido inicialmente a quatro meses de treinamento físico supervisionado composto por 3 sessões de 60 minutos por semana, mantendo uma freqüência cardíaca correspondente a 10% abaixo do ponto de descompensação respiratória determinado pela ergoespirometria. Após a fase de treinamento físico supervisionado, os pacientes foram orientados a realizar quatro meses adicionais de treinamento físico de forma não-supervisionada, na mesma freqüência e intensidade determinadas durante a fase de treinamento supervisionado. A medida da qualidade de vida, atividade nervosa simpática muscular, fluxo sangüíneo muscular e análise laboratorial foram repetidas em 4 meses em ambos os grupos e no oitavo mês apenas no grupo submetido ao treinamento físico. RESULTADOS: Após os quatro primeiros meses, o grupo treinado apresentou melhora na qualidade de vida comparado ao grupo controle (39±6 vs 42±5 pontos; p=0,014). A atividade nervosa simpática muscular em repouso e durante o exercício isométrico a 30% da contração voluntária máxima também apresentaram melhora (47±5 vs 73±6 impulsos/ 100 bat; p=0,0052) e (61±5 vs 77±6 impulsos/ 100 bat; p=0,034), respectivamente. O fluxo sangüíneo muscular em antebraço em repouso aumentou no grupo treinado (1,96±0,11 vs 1,51±0,12 ml/min/100 ml tecido; p=0,015). Quatro meses de treinamento físico não-supervisionado foram efetivos na manutenção dos benefícios na qualidade de vida (52±6 vs 36±6 vs 33±5 pontos; p=0,0001), no fluxo sangüíneo muscular em antebraço, tanto em repouso (1,62±0,47 vs 1,93±0,56 vs 2,18±0,63 ml/min/100 ml tecido; p=0,03) como durante o exercício isométrico (2,04±0,11 vs 2,69±0,18 vs 2,74 ±0,2 ml/min/100 ml tecido; p=0,0016) e na capacidade física (71±9 vs 84±9 vs 88±9 Watts; p=0,0073). Não houve diferença nas medidas seriadas de NTProBNP, Interleucina 6 e de catecolaminas plasmáticas. CONCLUSÕES: O treinamento físico não-supervisionado por quatro meses, após uma fase de treinamento físico supervisionado, foi efetivo na manutenção dos benefícios na qualidade de vida, capacidade física e no fluxo sangüíneo muscular em antebraço. Não houve diferença nas medidas laboratoriais dos pacientes com disfunção ventricular esquerda treinados por oito mesesINTRODUCTION: The benefits of a physical training program in patients with heart dysfunction have been well described. However little is know about the response of a home-based exercise training in quality of life, physical capacity and neurovascular control in patients with heart failure, after a initial four months supervised training. The second objective of this study was to analyze the effectiveness of a exercise program on catecholamine, NT-ProBNP and Interleukin 6 in patients with heart dysfunction receiving beta-blockers. METHODS: Thirty patients (age 54±1,7 years) with severe heart dysfunction were initially enrolled in the protocol. They were divided in two groups; a control group (n=12) and a exercise group (n=18). Initially, both group had the measuring of quality of life by Minnesota questionnaire, Interleukin 6, NT-ProBNP and catecholamine. Muscle sympathetic nerve activity was recorded directly from fibular nerve using the technique of microneurography. Forearm blood flow was measured by venous plethysmography. Both procedures were recorded at rest and during 30% of maximal isometric contraction. The exercise group was submitted initially to fourmonths supervised exercise training program consisted of three 60 min exercise XXIX sessions per week, at heart rate levels that corresponded up to 10% below the respiratory compensation point. After the supervised period, the exercise group was instructed to perform an additional four-months home-based exercise training in the same frequency and intensity they had usually done. The quality of life, muscle sympathetic nerve activity, forearm blood flow and laboratory analysis were repeated at four months in both groups and only in the exercise group at eight months. RESULTS: After the initial 4 months the exercise group improved the quality of life compared to the control group (39±6 vs 42±5 units; p=0,014). The muscle sympathetic nerve activity at rest and during 30% of the maximum isometric contraction was also improved (47±5 vs 73±6 bursts/100 heart beat; p=0,0052) and (61±5 vs 77±6 bursts/100 heart beat; p=0,0276), respectively. The forearm blood flow at rest reduced in the exercise group (1,96±0,11 vs 1,51±0,11ml/min/100 ml tissue; p=0,015). An additional 4 month home-based exercise training was effective on the maintenance of the benefits on quality of life ( 52±6 vs 36±6 vs 33±5 points; p=0,0001), forearm blood flow at rest (1,62±0,47 vs 1,93±0,56 vs 2,18±0,63 ml/min/100 ml tissue; p=0,03), and during 30% of the maximum isometric contraction (2,04±0,11 vs 2,69±0,18 vs 2,74 ±0,2 ml/min/100 ml tissue; p=0,0016) and on physical capacity (71±9 vs 84±9 vs 88±9 Watts; p=0,0073). There was no difference on the measurements of NT-ProBNP, Interleukin 6 and catecholamine. CONCLUSIONS: A home-based exercise training for four months, after a supervised phase, was effective on the maintenance of the benefits of quality of life, physical capacity and forearm blood flow. There was no difference on the laboratorial measurements after an eight months physical training on patients with heart dysfunctio

Cognitive assessment in an elderly population with metabolic syndrome in Brazil

ABSTRACT Chronic degenerative conditions are very common in the elderly. According to medical literature, there is a correlation between cognitive impairment among elders and arterial hypertension/hyperglycemia which in turn are common diseases among the elderly population worldwide. Nonetheless, data on the association between cognitive impairment and Metabolic Syndrome (MetS) remains controversial. Objective: To compare the cognitive status of Brazilian elderly outpatients with and without MetS. Methods: A cross-sectional case-control study with 49 subjects (25 MetS and 24 controls) who underwent a global geriatric and neuropsychological assessment was carried out. The scores for cognitive abilities (sustained attention, alternating attention, immediate memory, working memory, memory - immediate recall, memory - delayed recall, memory - recognition, executive function, ideomotor praxis, constructive praxis, naming ability, verbal fluency) were compared with the data for the normal population and differences between case and control groups were analyzed using Student's t-test or the Mann-Whitney test. Results: Forty-five patients (91.8%) were female, with a mean age of 73.9±5.9 years, and 3.0±1.0 years of schooling. A significant difference (p<0.01) was found between case and control groups regarding the MetS components. For cognitive abilities, no statistically significant difference was detected between the groups and all subjects presented low cognitive scores. Conclusion: The results obtained in the present study showed that MetS was not associated with cognitive impairment in this population. Further prospective studies are necessary to investigate the influence of well-controlled MetS on cognitive performance among elders

The pros and cons of early diagnosis of dementia

Universidade Federal de São Paulo, Dept Psychiat, BR-01333000 São Paulo, BrazilUniv São Paulo, Dept Neurol, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, BR-01333000 São Paulo, BrazilWeb of Scienc

Depression and cancer were independently associated with quality of life in Brazilian older people

OBJECTIVE: To analyse the factors associated with low health-related quality of life (HRQoL) in older people living in Brazil. METHODS: In this cross-sectional study of the Jewish community residing in Sao Paulo, Brazil, we extensively evaluated the characteristics - including clinical, functional and sociodemographic - of 496 older people. Quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF), while the Geriatric Depression Scale (GDS) was used to measure depressive symptoms. RESULTS: After adjusting for potential confounders, we found that GDS score (β = -0.07; P = 0.04) and cancer (β = -0.47; P = 0.05) were associated with a low WHOQOL-BREF score. CONCLUSION: Depressive symptoms and cancer were independently associated with low HRQoL among older people living in Brazil