Preditor de qualidade de vida em indivíduos com doença de Parkinson moderada

The purpose of this study was to verify among the motor and nonmotor dysfunctions and the fear of falling the main predictors for poor quality of life in individuals in stages 2 and 3 of Parkinson ́s disease (PD). Thirty-nine individuals with PD (64.1±9.1 years, 10.3±4.7 duration of disease) evaluated in “on” state (fully medicated) participated of the study. Motor dysfunctions were assessed using the following tests: Unifi ed Parkinson’s Disease Rating Scale part III motor subscale score (UPDRS-III), timed up and go  test,  Balance  Evaluation  System  Test  (BESTest),  one-repetition  maximum  (1RM)  in  the  leg  press.  Nomotor dysfunctions were assessed using the following tests: Montreal Cognitive Assessment (MoCA), Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI). The fear of falling was as-sessed by Falls Effi cacy Scale-International (FES-I). Quality of life was assessed using the Parkinson ́s Disease Questionnaire- 39 (PDQ-39). A multiple regression linear, stepwise method was employed. Only the FES-I score entered into multiple linear regression model and showed a high ability to explain the quality of life score of individual with PD (R2 adjusted = 0.73, p<0.0001). Thus, as clinical implication, it is possible to suggest that physical training strategies that promote a decrease in fear of falling can positively impact on the quality of life of individuals with PD.O objetivo deste estudo foi verificar dentre os sintomas motores, sintomas não motores e o medo de cair quais seriam os principais preditores de qualidade de vida em indivíduos nos estágios 2 e 3 da doença de Parkinson (DP). Trinta e nove indivíduos com DP (64,1±9,1 anos, 10,3±4,7 duração da DP) avaliados no estado on da medicação participaram do estudo. A disfunção motora foi avaliada por meio dos seguintes testes: parte III da Escala Unificada de Avaliação da Doença de Parkinson (UPDRS-III), teste Timed up and Go (TUG), Teste de Sistema de Avaliação do Equilíbrio (BESTest) e uma repetição máxima dos membros inferiores (1RM no leg press). A disfunção não motora foi avaliada por meio dos seguintes testes: Avaliação Cognitiva de Montreal (MoCA), Inventário de Depressão de Beck (IDB) e o Índice de Qualidade do Sono de Pittsburgh (PSQI). O medo de cair foi avaliado por meio da Escala Internacional de Eficácia de Quedas (FES-I). A qualidade de vida foi avaliada por meio do teste Questionário da Doença de Parkinson (PDQ-39). Uma regressão múltipla linear, método stepwise foi empregada para verificar o principal preditor do escore da PDQ-39. A única variável independente que entrou no modelo de regressão múltipla linear (stepwise) e mostrou uma alta capacidade para explicar o escore de qualidade de vida de indivíduos com DP foi a FES-I (R2 ajustado = 0,73, P<0,0001). Assim, como implicação clínica, é possível sugerir que estratégias de treinamento físico que promovam diminuição no medo de cair podem impactar positivamente na qualidade de vida de indivíduos com DP moderada

Aerobic exercise program with or without motor complexity as an add-on to the pharmacological treatment of depression – study protocol for a randomized controlled trial

Abstract Background Patients with major depression disorder presents increased rates of cognitive decline, reduced hippocampal volume, poor sleep quality, hypertension, obesity, suicidal ideation and behavior, and decreased functionality. Although continuous aerobic exercise (CAE) improves some of the aforementioned symptoms, comorbidities, and conditions, recent studies have suggested that performing aerobic exercise with motor complexity (AEMC) may be more beneficial for cognitive decline, hippocampal volume, and functionality. Therefore, this randomized controlled trial will compare the effects of CAE and AEMC on depression score, cognitive function, hippocampal volume, brain-derived neurotrophic factor expression, sleep parameters, cardiovascular risk parameters, suicidal behavior, functionality, and treatment costs in patients with depression. Methods/design Seventy-five medicated patients with depression will be recruited from a Basic Healthcare Unit to participate in this prospective, parallel group, single blinded, superiority, randomized controlled trial. Patients with depression according to DSM-V criteria will be balanced and randomly assigned (based on depression scores and number of depressive episodes) to a non-exercising control (C), CAE, and AEMC groups. The CAE and AEMC groups will exercise for 60 min, twice a week for 24 weeks (on non-consecutive days). Exercise intensity will be maintained between 12 and 14 points of the rating of perceived exertion scale (~ 70–80% of the maximum heart rate). The CAE group will perform a continuous aerobic exercise while the AEMC group will perform exercises with progressively increased motor complexity. Blinded raters will assess patients before and after the intervention period. The primary outcome measure will be the change in depression score measured by the Montgomery-Asberg Depression Rating Scale. Secondary outcomes will include measures of cognitive function, hippocampal volume, brain-derived neurotrophic factor expression, sleep parameters, cardiovascular risk parameters, suicidal behavior, functionality, and treatment costs. Discussion This study was selected in the call of public policy programs for the Brazilian Unified National Health System – “PPSUS 2015”. To our knowledge, this is the first pragmatic trial to test the effect of adding AEMC to the pharmacological treatment of patients with depression and to evaluate the possible reductions in depression symptoms and healthcare costs. Trial registration Brazilian Clinical Trials Registry (ReBec) - RBR-9zgxzd - Registered on 4 Jan. 2017