Multifunctional training on subjects with amnestic mild cognitive impairment due to AD : effects on clinical parameters and functional and structural neuroimaging

Orientador: Marcio Luiz Figueredo BalthazarTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Comprometimento Cognitivo Leve amnéstico (CCLa) é um termo clínico que se aplica a pacientes com declínio objetivo da memória episódica, mas com desempenho sócio-funcional normal. Esses pacientes apresentam maior chance de desenvolverem demência da doença de Alzheimer (DA), a qual surge dependência para atividades de vida diária. Existem marcadores moleculares no líquido cefalorraquidiano (LCR), como o peptídeo beta-amiloide de 42 unidades Aß1-42 e as proteínas tau total e tau fosforilada (p-tau) que, quando alterados, evidenciam que o sujeito apresenta fisiopatologia da DA e maior chance de evoluir para demência. A prática de exercícios aeróbios e resistidos mostraram-se efetivos na melhora cognitiva e sócio-funcional de idosos. Outro tipo de exercício que tem ganhado destaque é o multifuncional (MEP), pois envolve várias capacidades físicas em um programa só. Existe uma relação positiva entre a prática de exercício físico e a estrutura e conectividade cerebral em idosos, mas até o momento não foram feitos estudos que comprovassem a eficácia dos exercícios físicos em idosos CCL com a fisiopatologia da DA. Assim o objetivo da presente tese foi verificar o efeito de 12 meses de um programa de exercício multifuncional aeróbio na memória episódica, atividades de vida diária e estrutura e conectividade cerebral de idosos com CCL amnéstico com evidência fisiopatológica da DA, esperando obter dados que subsidiem hipóteses sobre o real efeito da prática de exercícios aeróbios nesse grupo com risco aumentado. Além disso, procuramos relações entre integridade da estrutura cerebral e nível de condicionamento aeróbio desses sujeitos. Para tal foram realizados 3 estudos. Em todos, os sujeitos estudados eram idosos diagnosticados com CCLa com a fisiopatologia da DA, ou seja, apresentavam alteração pelo menos na concentração do peptídeo beta-amiloide e/ou na relação Aß1-42/ptau no LCR. No primeiro estudo verificamos a relação entre o condicionamento aeróbio e substância cinzenta de áreas frontais de idosos com CCLa e observamos também essa relação positiva com vários tratos da substância branca que ligam regiões frontais, temporais e parietais. Já nos estudos 2 e 3, analisamos o efeito da intervenção MEP. O estudo 2 mostrou que além de melhora em condicionamento aeróbio e memória, houve também um aumento do volume de hipocampo esquerdo e direito dos idosos que praticaram por 6 meses o MEP, enquanto os que não praticaram apresentaram uma piora significativa em funcionalidade e memória. O estudo 3 mostrou que 12 meses de prática do MEP beneficiou significativamente o condicionamento aeróbio, memória e funcionalidade de seus praticantes, mas sem alteração na conectividade da Default Mode Network. Nossos resultados sugerem que o condicionamento aeróbio tem relação positiva com o córtex frontal e tratos da substância branca que conectam áreas frontais, parietais e temporais. Além disso, o treinamento MEP não apenas contribuiu para a melhora do condicionamento aeróbio, performance na memória e funcionalidade, mas também teve influência positiva no volume de hipocampo desses idosos com CCLa e evidência fisiopatológica da DAAbstract: Amnestic Mild Cognitive Impairment (aMCI) is a clinical term applied to patients with memory decline but with normal social functional performance. These patients are more likely to develop the dementia in Alzheimer's disease (AD), in which there is a dependency on daily lining activities. There are molecular markers found in cerebrospinal fluid (CSF), such as amyloid- beta peptide (Aß1-42) and total tau and phosphorylated tau proteins that, when altered, show that the subject has pathophysiology of AD and a higher chance of developing dementia. The practice of aerobic and resistance exercises demonstrated to be effective improving the cognitive and socio-functional performance in elders. Another type of exercise is multicomponent (MEP), which involves several physical capabilities in one program. There is a positive relationship between physical exercise and brain in elders, but the literature showing physical exercise efficacy in elderly CCL patients with a pathophysiology of AD is scarce. Thus, the main objective of the present thesis was to evaluate the effects of 12 months of a multicomponent exercise program in episodic memory, daily life activities and brain structure and connectivity of elderly with aMCI due to AD. Besides that, we analyzed possible relation between brain structure integrity and aerobic fitness in those subjects. Three studies were carried out. In all, the subjects studied were old adults diagnosed with aMCI due to AD, that is, they presented alterations, at least, in the concentration of peptide beta-amyloid and/or in the ratio Aß1-42/ptau analyzed in the CSF. In the first study, we observed relationship between aerobic fitness and gray matter of frontal areas and also positive relationship with various white matter tracts that connect the frontal, temporal and parietal regions. In studies 2 and 3, we analyzed the effect of the MEP intervention. Study 2 showed that in addition to an improvement in aerobic fitness and memory, the left and right hippocampus volume of the elderly who practiced MEP for 6 months also increased, while the group that did not practice showed worsening in functional activities and memory. Study 3 showed that 12 months of MEP practice significantly increased aerobic fitness, memory and performance in social-functional activity of its practitioners, but without changes in Default mode network connectivity. Our results suggest that aerobic fitness is positively related to the frontal cortex and white matter tracts that connect frontal, parietal and temporal areas. In addition, MEP training not only contributed to an improvement in aerobic fitness, memory performance and functionality, but also had a positive influence on the hippocampi volume of elders with aMCI due to ADDoutoradoCiencias BiomedicasDoutora em Ciências Médicas01-P-3484/20142014/02359-9CAPESFAPES

The effects of a physical activity program on quality of life of women

Studies show the beneficial influence of the physical activity on women quality of life. The aim of this study was to analyze the effects of a physical activity program on the quality of life (QV) of women, initially sedentary, employees of UNICAMP, 47.4±8 years (n=16). The training program was performed 3 times/week, for 4 months, consisting of general coordination exercises, such as: jogging, dancing and games with alternative materials. The evaluation protocol used was WHOQOL-26, which analyzes the physical, psychological, personal and environmental domains. The Student “t” test was used to analyze the domains before and after the application of the training program (α=0.05). There was a significant improvement in the physical, psychological and environmental domains. Physical exercise is beneficial for the apprentices\u27 QV, because it influences positively the psychological and physical domains

SQUARE STEPPING EXERCISE E EXERCÍCIOS BÁSICOS NA COGNIÇÃO DE IDOSOS

http://dx.doi.org/10.5902/010283085719O objetivo do presente estudo foi comparar as funções cognitivas de idosos antes e após dois protocolos de intervenção: exercícios básicos combinados com o Square Stepping Exercise (COM) e apenas exercícios básicos (EB). Todos foram avaliados antes e depois dos 4 meses de intervenção por meio do Montreal Cognitive Assessment (MoCA) e do Teste Winsconsin de Classificação de Cartas (TWCC). Os resultados mostraram que ambos os grupos melhoraram o estado cognitivo global, mas que apenas o COM apresentou melhora específica em abstração e flexibilidade mental. Assim, o treinamento combinado de exercícios básicos e SSE parece ser mais efetivo para a cognição quando comparado com um treinamento exclusivamente com exercícios básicos.Palavras-Chave: Idosos. Cognição. Exercício físico

Relação entre nível de atividade física e realização de atividades instrumentais em frequentadores de centro dia geriátrico

Objetivo: Analisar a associação entre nível de atividade física e a realização de atividades instrumentais de idosos frequentadores de Centro-Dia Geriátrico. Métodos: Estudo de delineamento transversal, com amostra constituída por 31 idosos frequentadores de Centro-Dia Geriátrico. Foram utilizados o Questionário de Baeck Modificado para Idosos (QBMI) e o Questionário de Atividades Instrumentais de Pfeffer (Pfeffer), para avaliar o nível de atividade física e realização de atividades instrumentais, respectivamente. E para caracterização da amostra, foi utilizado o Mini Exame do Estado Mental. Para análise dos dados foi utilizada a estatística descritiva e Correlação de Spearman. Resultados: A análise mostrou correlação moderada e negativa entre o QBMI e o Pfeffer (r=-0,04), podendo essa relação ser extrapolada para quanto maior o nível de atividade física, maior a independência na realização de atividades instrumentais. Conclusões: O nível de atividade física tem relação com a realização de atividades instrumentais. Assim, o incentivo à prática de atividade física é de extrema importância para a população idosa, para que a mesma se mantenha independente

Cognitive Reserve Relates to Functional Network Efficiency in Alzheimer’s Disease

Alzheimer’s disease (AD) is the most common form of dementia, with no means of cure or prevention. The presence of abnormal disease-related proteins in the population is, in turn, much more common than the incidence of dementia. In this context, the cognitive reserve (CR) hypothesis has been proposed to explain the discontinuity between pathophysiological and clinical expression of AD, suggesting that CR mitigates the effects of pathology on clinical expression and cognition. fMRI studies of the human connectome have recently reported that AD patients present diminished functional efficiency in resting-state networks, leading to a loss in information flow and cognitive processing. No study has investigated, however, whether CR modifies the effects of the pathology in functional network efficiency in AD patients. We analyzed the relationship between CR, pathophysiology and network efficiency, and whether CR modifies the relationship between them. Fourteen mild AD, 28 amnestic mild cognitive impairment (aMCI) due to AD, and 28 controls were enrolled. We used education to measure CR, cerebrospinal fluid (CSF) biomarkers to evaluate pathophysiology, and graph metrics to measure network efficiency. We found no relationship between CR and CSF biomarkers; CR was related to higher network efficiency in all groups; and abnormal levels of CSF protein biomarkers were related to more efficient networks in the AD group. Education modified the effects of tau-related pathology in the aMCI and mild AD groups. Although higher CR might not protect individuals from developing AD pathophysiology, AD patients with higher CR are better able to cope with the effects of pathology—presenting more efficient networks despite pathology burden. The present study highlights that interventions focusing on cognitive stimulation might be useful to slow age-related cognitive decline or dementia and lengthen healthy aging

Surface-based correlates of cognition along the Alzheimer's continuum in a memory clinic population

Composite cognitive measures in large-scale studies with biomarker data for amyloid and tau have been widely used to characterize Alzheimer's disease (AD). However, little is known about how the findings from these studies translate to memory clinic populations without biomarker data, using single measures of cognition. Additionally, most studies have utilized voxel-based morphometry or limited surface-based morphometry such as cortical thickness, to measure the neurodegeneration associated with cognitive deficits. In this study, we aimed to replicate and extend the biomarker, composite study relationships using expanded surface-based morphometry and single measures of cognition in a memory clinic population. We examined 271 clinically diagnosed symptomatic individuals with mild cognitive impairment (N = 93) and Alzheimer's disease dementia (N = 178), as well as healthy controls (N = 29). Surface-based morphometry measures included cortical thickness, sulcal depth, and gyrification index within the “signature areas” of Alzheimer's disease. The cognitive variables pertained to hallmark features of Alzheimer's disease including verbal learning, verbal memory retention, and language, as well as executive function. The results demonstrated that verbal learning, language, and executive function correlated with the cortical thickness of the temporal, frontal, and parietal areas. Verbal memory retention was correlated to the thickness of temporal regions and gyrification of the inferior temporal gyrus. Language was related to the temporal regions and the supramarginal gyrus' sulcal depth and gyrification index. Executive function was correlated with the medial temporal gyrus and supramarginal gyrus sulcal depth, and the gyrification index of temporal regions and supramarginal gyrus, but not with the frontal areas. Predictions of each of these cognitive measures were dependent on a combination of structures and each of the morphometry measurements, and often included medial temporal gyrus thickness and sulcal depth. Overall, the results demonstrated that the relationships between cortical thinning and cognition are widespread and can be observed using single measures of cognition in a clinically diagnosed AD population. The utility of sulcal depth and gyrification index measures may be more focal to certain brain areas and cognitive measures. The relative importance of temporal, frontal, and parietal regions in verbal learning, language, and executive function, but not verbal memory retention, was replicated in this clinic cohort

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Estudo da influencia fisiologica e antropometrica de 12 semanas da pratica de aulas de jump fit em mulheres entre 18 e 26 anos

Atualmente as academias licenciadas pelo grupo FIT PRO Fitness Programs® têm suas aulas de JUMP FIT® sempre lotadas, resultados de muito empenho do grupo FIT PRO®. A literatura é escassa em relação aos ajustes e adaptações proporcionadas com este tipo de atividade. Dessa forma, esta pesquisa avaliou as alterações na composição corporal, antropométrica e sistema cardiorrespiratório de 20 mulheres sedentárias com idade entre 18 e 25 anos. Para tal recorremos à avaliação da porcentagem de gordura utilizando três dobras cutâneas, peso, altura, IMC, perimetria dos membros e avaliação do V02 máximo (protocolo de Astrand, 1960). O programa teve duração de 12 semanas (não ininterruptas), este que foi desenvolvido pelo grupo FIT PRO®. Todas as voluntárias seguiram o mesmo programa. As aulas práticas aconteceram 3 vezes por semana no Salão de Danças da Faculdade de Educação Física da UNICAMP. As voluntárias foram avaliadas igualmente no inicio (INI) e finai (FTN) do programa de treinamento, para comparar o comportamento das variáveis analisadas. O programa de treinamento foi eficaz na redução da porcentagem de gordura e aumento do V02 máximo, mas não houve diferença significativa no peso corporal e IMC do grupo, além da avaliação perimétrica não ter apresentado resultado aparente. O objetivo que o programa apresenta (redução na porcentagem de gordura e melhora na aptidão cardiorrespiratória) foi alcançado, mas, ainda, seria importante uma continuidade no treinamento e outros testes adaptados para o tipo de treinamento que comprovem a eficácia do programa.Nowadays the Fitness Centers, which are graduated by FIT.PRO Fitness Programs®, have the JUMP FIT® classes always full. There is a lack of literature related to this kind of activity. Thereby, this research evaluated the alterations in body composition, anthropometric measures and cardio respiratory system of 1.8 to 26 year-old sedentary women. For that we used the body fat test (3 skin folds), perimetric measurements, weight, height, IMC (body mass rate) and V02 max evaluation (Astrand protocol 1960| The training program took 12 weeks (non-interrupts), which was developed by FIT.PRO group. Ali the volunteers followed the same program. The classes happened 3 times a week. The volunteers were evaluated equally at the beginning and at the end of the training program, to compare the variables analyzed. The training program was effective in body fat reduction and V02 max. growth, but there wasn\u27t significative reduction in weight and IMC, and more, the perimetric evaluation didn\u27t show conclusive results. The program7s objectives (body fat reduction and improvement in cardio respiratory system) were achieved, but yet, it would be important to those volunteers if they continue the training. And also, to prove the efficiency of this program, adapted test to this kind of activity are necessary

Influência do square stepping exercise nos componentes da capacidade funcional e funções cognitivas de idosos

Acompanhando a tendência mundial de envelhecimento populacional, a população idosa brasileira também tem aumentado. As consequências do envelhecimento da mundial são importantes sob o ponto de vista social, da saúde e de políticas publicas. O processo de envelhecimento promove uma redução das reservas de vários sistemas orgânicos. Esses sistemas ficam mais vulneráveis, tornando as pessoas idosas mais suscetíveis ao aparecimento de doenças, diminuindo a independência das mesmas. Intervenções não farmacológicas que promovam a manutenção ou até a melhora das funções físicas e cognitivas dos idosos têm sido alvo de muitos estudos. Por isso o objetivo do presente estudo foi analisar os efeitos da prática do Square Stepping Exercise (SSE) na capacidade funcional e funções cognitivas de pessoas idosas. Para tal foram selecionados 86 idosos (60 anos ou mais), subdivididos em 4 grupos: GSSE(praticavam apenas as sequências do SSE, n=21), GSSE+EB (praticavam as sequências do SSE e exercícios básicos, n=25), GEB (praticavam exercícios básicos, n=20), e controle (n=20). Esta pesquisa apresentou delineamento longitudinal, com duração de 4 meses E as sessões de treinamento aconteceram 3x/semana, com duração de 40 minutos cada. Todos foram avaliados cognitivamente antes e depois dos 4 meses de intervenção através do Mini Exame do Estado Mental (MEEM), Montreal Cognitive Assessment (MoCA), Teste de Atenção Concentrada Tolouse-Pierón, teste Dígitos Direto e Indireto, Teste Modificado de Classificação de Cartas (TMCC), e foram avaliados motoramente através da bateria de testes AAHPERD, Escala de Equilíbrio de Berg (EEFB) e Timed Up and Go TUG). Os dados paramétricos foram analisados utilizando ANOVA One Way e Anova Two Way, e os não paramétricos através do...The world is aging, so is Brazil, where the elderly population has also increased. The consequences of world population aging are important from the social, health and public policy point of view. Aging process promotes a depletion of many organ systems. These systems are more vulnerable, which makes old people more susceptible to disease onset, reducing their independence. Non-pharmacological interventions that promote the maintenance or even improvement of cognition and functional fitness in elderly have been the subject of many studies. Therefore, the aim of the present study was to analyze the effects of the practice of Square Stepping Exercise (SSE) on cognition and functional fitness of older people. There were selected 86 elderly (60 years old or more), divided into four groups: GSSE (who practiced only the sequences of the SSE, n=21), GSSE+EB (who practiced SSE sequences and basic exercises, n=25), GEB (who practiced basic exercises n=20) and control (n=20). The training lasted 4 months, with 40 minutes and 3x/week sessions. All participants were cognitively evaluated before and after 4 months of intervention using the Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Toulouse-Pierón Attention test, Digit Span, Modified Sorting Card test (TMCC). In addition, motor skills were evaluated through the battery of tests AAHPERD, Berg Balance Scale (EEFB) and Timed Up and Go (TUG). The parametric data was analyzed using One Way Anova and Two Way ANOVA, and the for nonparametric data was used U-Mann Whitney and Wilcoxon tests. The significance level adopted was p<0.05. The U-Mann Whitney and One way Anova tests showed that the groups were equal in all the variables at baseline. The results showed that the three groups that received some... (Complete abstract click electronic access)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES