Efeito placebo aplicado a ambientes clínicos e de desempenho físico

Introdução: Placebo é considerado uma substância ou um procedimento inerte que pode proporcionar um efeito positivo ou negativo dependendo da condição em que é aplicado. É bem documentado que o placebo promove resultados positivos em condições patológicas e em condições de desempenho físico. Objetivo: Sendo assim, objetivo desse estudo é revisar em duas sessões, trabalhos que tenham abordado: 1) o efeito placebo e nocebo aplicado à clínica no tratamento da doença de Parkinson, depressão e dor, e 2) o uso do placebo como recurso ergogênico no desempenho físico. Metodologia: Para tal, uma busca foi realizada na base de dados “Pubmed” e “Web of Science”. Resultados e discussão: Nesta revisão narrativa, discutimos como o efeito placebo atua em diversas condições como a dor, depressão, doença de Parkinson, e no desempenho físico, além disso, foram abordados possíveis mecanismos que possam atuar neste fenômeno. Conclusão: Podemos concluir que em condição clínica e de desempenho físico, o placebo compartilha regiões cerebrais semelhantes, que geram respostas positivas ao tratamento

Carbohydrate Mouth Rinse Mitigates Mental Fatigue Effects on Maximal Incremental Test Performance, but Not in Cortical Alterations

Detrimental mental fatigue effects on exercise performance have been documented in constant workload and time trial exercises, but effects on a maximal incremental test (MIT) remain poorly investigated. Mental fatigue-reduced exercise performance is related to an increased effort sensation, likely due to a reduced prefrontal cortex (PFC) activation and inhibited spontaneous behavior. Interestingly, only a few studies verified if centrally active compounds may mitigate such effects. For example, carbohydrate (CHO) mouth rinse potentiates exercise performance and reduces effort sensation, likely through its effects on PFC activation. However, it is unknown if this centrally mediated effect of CHO mouth rinse may mitigate mental fatigue-reduced exercise performance. After a proof-of-principle study, showing a mental fatigue-reduced MIT performance, we observed that CHO mouth rinse mitigated MIT performance reductions in mentally fatigued cyclists, regardless of PFC alterations. When compared to placebo, mentally fatigued cyclists improved MIT performance by 2.24–2.33 when rinsing their mouth with CHO during MIT. However, PFC and motor cortex activation during MIT in both CHO and placebo mouth rinses were greater than in mental fatigue. Results showed that CHO mouth rinse mitigated the mental fatigue-reduced MIT performance, but challenged the role of CHO mouth rinse on PFC and motor cortex activation

Commentaries on viewpoint : physiology and fast marathons

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Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Effects of caffeine intake on performance of mentally fatigued cyclists during a time-trial 20km

A literatura recente sugere que a fadiga mental piora o desempenho de atletas durante testes contrarrelógio (TT) de ciclismo. Assim o objetivo deste estudo foi verificar se a cafeína poderia reverter ou bloquear os efeitos negativos da fadiga mental em um contrarrelógio de 20km (TT20km). Métodos: Doze ciclistas treinados, com experiência em TT há pelo menos 2 anos, e nível de performance > 3 (34.3 ± 6.2 anos; 179.3 ± 5.1 cm; 77.6 ± 6.8 kg; 13.8 ± 4.5 % de gordura corporal; 58.9 ± 6.2 ml.kg-1.min-1; 367.0 ± 32.5 WPEAK), realizaram cinco visitas ao laboratório: 1) PRELIMINAR: para seleção dos sujeitos e familiarização com os instrumentos; 2) CONTROLE: foram realizadas três contrações voluntárias isométrica máxima (CVM), cujo maior torque encontrado entre elas definirá o valor de 70% para contração voluntária isométrica submáxima (CVIS) nas sessões seguintes. Posteriormente a CVIS, foi realizado o TT20km sem manipulação cognitiva ou suplementação; 3) FADIGA MENTAL (FM): execução do teste de atenção sustentada (RVIP), CVIS e TT20km respectivamente; 4) PLACEBO: ingestão da cápsula de placebo (FM + PLA) em seguida teste de RVIP, CVIS e TT20km; 5) CAFEÍNA: ingestão de cafeína (FM + CAF), consequentemente realizaram o teste de RVIP, CVIS e o TT20km). A atividade cerebral do córtex pré-frontal e córtex motor primário foi analisada por meio de eletroencefalografia (EEG) registrada antes e depois do teste RVIP. Igualmente, EEG do córtex pré-frontal e motor primário foi registrada durante uma contração voluntária isométrica submáxima, realizada antes do TT20km. Para as análises de comparações entre pré e pós tarefa cognitiva de atenção sustentada utilizou-se um teste T-student. Para as comparações múltiplas analisou-se por modelo misto entre a condição e a distância no TT20km, quando necessário o teste de Bonferroni foi utilizado. Resultados: CAF melhorou o desempenho em ciclistas mentalmente fatigados em ~ 1.8 % para FM e ~ 1.7 % para PLA (p = 0.00) e aumentou ~ 4.4 % para FM e ~ 3.6 % do que o placebo de WMEAN em FM + CAF (p = 0,00). A ativação cortical aumentou em ~ 4.8 % nas ondas teta de EEG após teste RVIP em FM e reduziu em FM + CAF ~ 8.8 % e FM + PLA ~ 4.8%. A razão entre PSE e WMEAN foi menor em FM + CAF do que nas outras condições (p = 0.01). Os ciclistas apresentaram maior motivação nos primeiros 2 km em FM + CAF comparado a FM e FM + PLA (p = 0.02) e maior afeto nos últimos 2 km em FM e FM + CAF do que FM + PLA (p = 0.01). Uma menor ativação cortical durante a CVIS e uma maior eficiência neuromuscular foi identificada na condição FM + CAF (p = 0.03). Conclusão: A CAF bloqueou os efeitos negativos da fadiga mental no CPF, melhorou o desempenho, diminuiu a PSE durante TT20km e aumentou a eficiência neuromuscularRecent literature suggests that mental fatigue worsens the performance of athletes during time trial (TT) cycling tests. Thus, the aim of this study was to verify if caffeine could reverse or block the negative effects of mental fatigue in a TT of 20km (TT20km). Methods: Twelve trained cyclists with experience in TT for at least 2 years, and performance level > 3 (34.3 ± 6.2 years, 179.3 ± 5.1 cm, 77.6 ± 6.8 kg, 13.8 ± 4.5 % body fat 58.9 ± 6.2 ml .kg-1.min-1; 367.0 ± 32.5 WPEAK), carried out five visits at laboratory: 1) PRELIMINARY: for selection of subjects and familiarization with the instruments; 2) CONTROL: three maximal isometric voluntary contractions (CVM) were performed, the highest torque found between them will define the value of 70% for voluntary isometric submaximal contraction (CVIS) in the following sessions. After the CVIS, the TT20km will be performed without cognitive manipulation or supplementation; 3) MENTAL FATIGUE (FM): execution of the sustained attention test (RVIP), CVIS and TT20km respectively; 4) PLACEBO: placebo capsule intake (FM + PLA) then RVIP, CVIS and TT20km test; 5) CAFFEINE: caffeine intake (FM + CAF), consequently performed the RVIP, CVIS and TT20km tests). Brain activity of the prefrontal cortex and primary motor cortex will be analyzed by electroencephalography (EEG) recorded before and after the RVIP test. Likewise, EEG of the prefrontal cortex and primary motor will be recorded during a submaximal isometric voluntary contraction, performed before TT20km. For the analysis of comparisons between pre and post cognitive task of sustained attention was used a T-student test. For the multiple comparisons, the mixed model was analyzed for the condition and the distance in the TT20km, and the best matrix was identified for each case, when necessary the Bonferroni test was used. Results: CAF improved performance in mentally fatigued cyclists at ~ 1.8 % for FM and ~ 1.7 % for PLA (p = 0.00) and increased ~ 4.4% for FM and ~ 3.6% than WMEAN on FM + CAF (p = 0.00). Cortical activation increased by ~ 4.8 % in the theta EEG waves after RVIP test in FM and reduced in FM + CAF ~ 8.8 % and FM + PLA ~ 4.8 %. The ratio of RPE to WMEAN was lower in FM + CAF than in other conditions (p = 0.01). The ciclists started the TT20km more motivated in first 2 km (p = 0.02) and finished with more pleasure in the last 2km in FM and FM + CAF than in FM + PLA (p = 0.01). Lower cortical activation during CVIS and greater neuromuscular efficiency was identified in the FM + CAF condition (p = 0.03). Conclusion: CAF blocked the negative effects of mental fatigue on CPF, improved performance, decreased PSE over TT20km and increased neuromuscular efficienc

Caffeine improved cycling trial performance in mentally fatigued cyclists, regardless of alterations in prefrontal cortex activation

Purpose: To verify whether caffeine (CAF) could increase the prefrontal cortex (PFC) activation and improve 20 km cycling time trial (TT20km) performance in mentally fatigued cyclists. Methods: After preliminary TT20km, twelve recreational cyclists (VO2MAX of 58.9 ± 6.2 mL∙kg∙min-1 ) performed a familiarization with a cognitive test to induce mental fatigue (MF) and psychological scales. Thereafter, they performed: 2) a baseline TT20km; 3) a mentally fatigued TT20km (MF); 4 and 5) a mentally fatigued TT20km after CAF (MF+CAF) or placebo (MF+PLA) ingestion, in a doubleblind, counterbalanced design. Performance and psychological responses were obtained throughout the TT20km, while PFC electroencephalography (EEG) theta wave was obtained before and after the mental fatigue test. Results: The mental fatigue-induced increase in EEG theta wave (↑ ~ 4.8 %) was reverted with CAF (↓ 8.8 %) and PLA ingestion (↓ 4.8 %). CAF improved TT20km performance in mentally fatigued cyclists by reducing time (p = 0.00; ↓ ~1.7 %) and increasing WMEAN (p = 0.00; ↑ ~3.6%), when compared to MF+PLA. The RPE-power output ratio was lower (p = 0.01), but affect (p = 0.018), motivation (p = 0.033) and emotional arousal (p = 0.001) were greater throughout the TT20km in MF+CAF than in MF+PLA. Conclusions: CAF ingestion improved TT20km performance and psychological responses in mentally fatigued cyclists, despite the unaltered PFC activation