Relationship between the ability to walk long distances and to climb up and down stairs with the health-related quality of life of older adults with symptomatic knee osteoarthritis

Objective: To investigate the relationship between physical capacity and health-related quality of life (HRQoL) in older patients with symptomatic knee osteoarthritis (KOA). Method: A cross-sectional study was carried out, in which 67 older people (55 women and 12 men) diagnosed with KOA completed the physical function tests: Timed Up and Go (TUG); 30-second Chair Stand Test (30CST); Stair Climb Test (SCT); 40m Fast-Paced Walk Test (40FPWT); and Six-Minute Walk Test (6MWT). HRQoL was measured using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Univariate and multivariate linear regression analyzes were used to explore the relationship between the variables. Results: Patients were predominantly female, overweight, inactive, nondepressed, with bilateral KOA and in severe pain. In HRQoL, the domains showed low performance compared to healthy individuals. An association was observed between 30CST, SCT, 40FPWT and 6MWT with pain and physical function and an association of 30CTS, 6MWT with stiffness (R² = 0.064 to 0.304, p<0.05). In the multivariate analysis, BMI, sex and bilateral impairment were also considered as independent variables, resulting in significant associations of the 6MWT and BMI with pain (ß[6MWT]=0.121, 95%CI 0.005 to 0.237; ß[BMI]=0.022, 95CI and sex (ß=10.724, 95%CI 2.985 to 18.463) with physical function. Conclusion: The results suggests positive association between TSDE and physical function and negative associations between physical capacity on 6MWT on pain and stifness

Aplicação da técnica de eletrodiagnóstico em pacientes críticos: Uma revisão sistemática

O ambiente de terapia intensiva está evoluindo em tecnologias para avaliação e tratamento sendo uma das técnicas mais atuais aplicadas neste ambiente o eletrodiagnóstico. Esta é uma revisão sistemática desenvolvida com base nos resultados de pesquisa das principais bases de dados, seguindo o PRISMA. Neste foram incluídos somente artigos observacionais que utilizaram a técnica de eletrodiagnóstico em pacientes críticos, para os mais diferentes objetivos e desfechos. As bases de dados consultadas foram: MEDLINE (acessado via PubMed), Fisioterapia Evidence banco de dados (Pedro), Registro de Ensaios Controlados (CENTRAL Cochrane) e EMBASE além de uma busca manual de referências adicionais. Um total de 10 artigos foram encontrados, sendo que dois apresentaram-se repetidos e outros seis foram excluídos por não contemplarem os critérios de inclusão obtendo-se ao final um total de dois artigos totalizando 33 pacientes. Um dos artigos apresentou resultados seguros, sem lesão muscular e o protocolo foi viável para ser aplicado em terapia intensiva. O outro artigo que após lesão cerebral traumática os pacientes podem apresentar distúrbios eletrofisiológicos, além de atrofia muscular generalizada sendo evidenciados pela técnica de eletrodiagnóstico.Palavras-chave: Unidade de terapia intensiva; ventilação mecânica; eletrodiagnóstico cronaxia; músculo esquelético; respiração artificia

The effect of intermittent cryotherapy on the activities of citrate synthase and lactate dehydrogenase in regenerating skeletal muscle

This study examined the effect of three sessions of cryotherapy (three sessions of 30 minutes applied each 2 h) and muscle compression in the regenerating skeletal muscle of the rats. The middle belly of tibialis anterior muscle was injured by a frozen iron bar and received one of the following intervention: injury + cryotherapy (treated with cryotherapy); injury + placebo (sand pack), and injury (I).The enzymatic activities of citrate synthase (CS) and lactate dehydrogenase (LDH) were measured in the presence of 1mM or 10mM pyruvate. The ANOVA and Tukey’s test (p£0.05) were performed for the statistical analysis. In summary, the intermittent sessions of cryotherapy, associated to muscle compression and applied immediately after the primary muscle injury minimized the CS and LDH activity at 4h30 and 24h periods post-lesion, which could be related to the reduction in the secondary muscle injury inherent to cryotherapy treatment

Adipose tissue extracellular matrix remodeling in response to dietary patterns and exercise : molecular landscape, mechanistic insights, and therapeutic approaches

The extracellular matrix (ECM) is a 3-dimensional network of molecules that play a central role in differentiation, migration, and survival for maintaining normal homeostasis. It seems that ECM remodeling is required for adipose tissue expansion. Despite evidence indicating that ECM is an essential component of tissue physiology, adipose tissue ECM has received limited attention. Hence, there is great interest in approaches to neutralize the harmful effects of ECM enlargement. This review compiles and discusses the current literature on adipose tissue ECM remodeling in response to different dietary patterns and exercise training. High-calorie diets result in substantial adipose tissue ECM remodeling, which in turn could lead to fibrosis (excess deposition of collagens, elastin, and fibronectin), inflammation, and the onset of metabolic dysfunction. However, combining a nutritionally balanced diet with exercise is a remarkable potential strategy for lipolytic activity, preventing rapid ECM expansion in different adipose tissue depots. Despite the distinct exercise modalities (aerobic or resistance exercise) reversing adipose tissue fibrosis in animal models, the beneficial effect on humans remains controversial. Defining molecular pathways and specific mechanisms that mediate the positive effects on adipose tissue, ECM is essential in developing optimized interventions to improve health and clinical outcomes

Estimulação elétrica minimiza alterações metabólicas musculares durante e após a imobilização de membro posterior de ratos

This study aimed at assessing the effect of electrical stimulation (ES) in muscles metabolic profile and weight of rats hindlimb during the limb immobilization period and after casts were removed. Thirty-six Wistar rats were divided into 6 groups: control (C); control but receiving ES (CES); immobilized (Im); immobilized receiving ES during immobilization (ImEE); immobilized and observed during recuperation for seven days after cast removal (ImR); and immobilized and receiving ES during recuperation for seven days after cast removal (ImREE). After the experimental period the soleus (S), white gastrocnemius (WG), red gastrocnemius (RG), anterior tibial (AT) and extensor digitorum longus (EDL) muscles were collected for analysis of glycogen reserves (GR), besides S and EDL weight evaluation. Results show that, in the Im group, immobilization caused significant GR and muscle weight reduction. Inversely, ES produced significant GR increase in CEE and ImEE groups, but did not interfere in muscle weight. During recuperation after cast removal, the group that did not receive ES (ImR) showed significant reductions in muscle GR and weight, while in the ImREE group there was significant increase in RG (257.9% S, 308.1% WG, 343.3% RG, 312% AT, 240.7% EDL) and in EDL weight (12%). ES thus minimized deleterious effects both during and after immobilization, pointing to its great efficiency in clinical treatment situations of muscle disuse.O objetivo do estudo foi avaliar o efeito da estimulação elétrica (EE) no perfil metabólico e no peso muscular de membro posterior de ratos durante a imobilização e após a retirada da órtese. Trinta e seis ratos Wistar foram divididos em controle (C), controle associado à estimulaçãoelétrica (CEE), imobilizado (Im), imobilizado associado à estimulação elétrica (ImEE), imobilizado e mais sete dias de recuperação pós-retirada da órtese (ImR), e imobilizado com estimulação elétrica durante a recuperação pós-retirada da órtese (ImREE). Após o período experimental, os músculos sóleo (S), gastrocnêmio branco (GB) e vermelho (GV), tibial anterior (TA) e extensor longo dos dedos (ELD) foram coletados para análise das reservas de glicogênio (RG) e avaliação do peso do S e ELD. Pôde-se observar, no grupo apenas imobilizado, que a imobilização promoveu redução significativa nas reservas de glicogênio em todos os músculos e no peso muscular do S e ELD. A EE aumentou significativamente as RG dos grupos CEE e ImEE, porém não interferiu no peso. No período de recuperação, no grupo que não recebeu EE houve redução significativa nas RG e no peso muscular, enquanto no grupo que recebeu EE aumentaram significativamente as RG (257,9% S, 308,1% GB, 343,3% GV, 312% TA, 240,7% ELD) e o peso do ELD (12%). A EE minimizou pois os efeitos deletérios durante a imobilização e no período de remobilização, mostrando-se de grande eficácia no tratamento clínico de situações que levam ao desuso muscular

Efeitos da imobilização articular aguda nos músculos do membro posterior de ratos: análise metabólica e morfométrica

The aim of this work was to evaluate the effect of acute (three-day) immobilization in rats hindlimb muscles onto the metabolic and morphologic profile. Ten Wistar rats were divided into two groups (n=5 each): control group and that of immobilized limb with acrylic resin orthosis in ankle neutral position during three days. After this period, analyses made were: glycogen reserves of the soleus muscle (S), extensor digitorum longus (EDL), white gastrocnemius (WB), red gastrocnemius (RG) and tibialis anterior (TA), soleus weight, fiber area, and intramuscular connective tissue. Data were statistically treated, with significance set at p&lt;0,05. Immobilization did not promote significant alterations in S glycogen reserves and in RG; however, there was significant reduction (of 26%) in the WG, 40% in ELD and 36% in TA. Moreover, immobilization did not promote significant reduction in S weight. The morphometric analysis showed significant reduction of the S fiber area in 31%, as well as significant increase (of 279%) in intramuscular connective tissue. It may thus be said that morphologic alterations take place during the immobilization acute phase, preceding S weight and metabolic changes. These data highlight the importance of early physical therapy intervention during the shortterm immobilization phase, aiming at minimizing skeletal muscle alterations also observed in the long term.Este estudo visou avaliar o efeito da imobilização aguda (três dias) dos músculos da pata posterior de ratos sobre o perfil metabólico e morfométrico. Dez ratos Wistar foram divididos em dois grupos (n=5 cada), controle e o grupo dos que tiveram uma pata posterior imobilizada com órtese de resina acrílica em posição neutra de tornozelo durante três dias. Após esse prazo, foram avaliados: conteúdo de glicogênio dos músculos sóleo (S), extensor longo dos dedos (ELD), gastrocnêmio branco (GB), gastrocnêmio vermelho (GV) e tibial anterior (TA), peso, área dasfibras e tecido conjuntivo intramuscular do sóleo. Os dados coletados foram submetidos a análise estatística com índice de significância fixado em p&lt;0,05. A imobilização não promoveu alterações significativas (p&gt;0,05) nas reservas de glicogênio do músculo sóleo e no GV; houve porém redução significativa de 26% no GB, 40% no ELD e 36% no TA. Além disso, a imobilização não promoveu redução significativa do peso muscular do sóleo. A análise morfométrica mostrou redução significativa de 31% na área das fibras do sóleo e aumento significativo de 279% nadensidade do tecido conjuntivo intramuscular. Conclui-se que as alterações morfométricas são evidenciadas já na fase aguda da imobilização, antecedendo as metabólicas e a do peso do sóleo. Isso leva a ressaltar a importância da intervenção fisioterapêutica durante a fase aguda da imobilização, para minimizar alterações musculoesqueléticas também observadas a longo prazo

Diacutaneous fibrolysis versus passive stretching after articular immobilisation : muscle recovery and extracellular matrix remodelling

Introduction Atrophy and muscle shortening due to articular immobilisation are common problems in musculoskeletal rehabilitation. Muscle stretching mechanical stimuli might be considered as the golden standard procedure to improve muscle flexibility in rehabilitation. Muscle stretching generates mechanotransduction, potentiating specific gene expression and promotes sarcomerogenesis and extracellular matrix remodelling on shortened and atrophied muscles. Hypothesis Diacutaneous fibrolysis, like stretching, uses an external force to stress connective and muscle tissues mechanically to treat muscle shortening; thus, it is widely used in clinical practice even if there is no evidence to support it. Considering this subject, we have hypothesised that diacutaneous fibrolysis can generate mechanotransduction, affecting muscle hypertrophy and extracellular matrix remodelling after immobilisation. Evaluation of hypothesis We have designed a laboratory experimental study with a sample of 50 rats. The sample was randomly divided into five groups: Control group (n = 10) with non–immobilised rats; 3–week immobilisation group (n = 10); 3–week immobilisation/3–week non–immobilisation group (n = 10);3–week immobilisation/3–week stretching group (n = 10); and 3–week immobilisation/3–week diacutaneous fibrolysis group (n = 10). All rats had their left tibiotarsal joint immobilised in maximum plantar flexion with the orthotics for 3 consecutive weeks. After the immobilisation period, the intervention groups received their respective intervention on their left triceps suralis for 3 weeks. Dependent variables of the study were sarcomere analysis, polymerase chain reaction, connective tissue density, collagen birefringence and matrix metalloproteinases. Statistical analysis was performed using analysis of variance and Duncan post hoc test was applied for differences between groups. For all calculations, a 5% (p < 0.05) significance level was established. Conclusion If the hypothesis is confirmed, the present study might provide evidence to support the use of this physical therapy resource widely used to treat muscle dysfunctions

Intra- and inter-rater reproducibility of ultrasound imaging of patellar and quadriceps tendons in critically ill patients

Since the outset of body image reconstruction for diagnosis purposes, ultrasound has been used to investigate structural changes located in tendons. Ultrasound has clinical applications in the intensive care unit, but its utility for tendon imaging remains unknown. Thus, we aimed to determine intra- and inter-rater reproducibility of measures obtained by images generated through morphological tendon sonographic analysis recorded from critically ill patients. We designed a cross-sectional study to assess thickness, cross-sectional area, and echogenicity of patellar and quadriceps tendons in a convenience sample formed with 20 critically ill patients. Two independent raters (experienced and novice) recorded repeated measures, checking for agreement (Kappa statistics) and reliability (Intraclass coefficient Correlation-ICC and Bland-Altman). The quality of images acquired by the two independent raters substantially agreed (k = 0.571–1.000), regardless of the region on the patellar tendon or the studied tendon (patellar or quadriceps). Regardless of how much experience the rater had, their repeated records (intra-rater reliability) always demonstrated almost complete correlation, ICC ranging from 0.89 to 0.98 for both tendons in all outcomes. At the same way, the statistically significant inter-rater ICC ranging from 0.87 to 0.97. Both repeated measures by the raters (intra-rater) and the repeated single and double measures between the raters (inter-rater) presented a minimum measurement error constituting a predominant pattern of random variability. We conclude that ultrasound imaging acquisition performed by independent raters for tendon thickness, CSA, and echogenicity monitoring of critically ill patients are acceptable and are not influenced by rater experience

The effect of quadriceps muscle length on maximum neuromuscular electrical stimulation evoked contraction, muscle rchitecture, and tendon-aponeurosis stiffness

Muscle-tendon unit length plays a crucial role in quadriceps femoris muscle (QF) physiological adaptation, but the influence of hip and knee angles during QF neuromuscular electrical stimulation (NMES) is poorly investigated. We investigated the effect of muscle length on maximum electrically induced contraction (MEIC) and current efficiency. We secondarily assessed the architecture of all QF constituents and their tendon-aponeurosis complex (TAC) displacement to calculate a stiffness index. This study was a randomized, repeated measure, blinded design with a sample of twenty healthy men aged 24.0 ± 4.6. The MEIC was assessed in four different positions: supine with knee flexion of 60◦ (SUP60); seated with knee flexion of 60◦ (SIT60); supine with knee flexion of 20◦ (SUP20), and seated with knee flexion of 20◦ (SIT20). The current efficiency (MEIC/maximum tolerated current amplitude) was calculated. Ultrasonography of the QF was performed at rest and during NMES to measure pennation angle (θp) and fascicle length (Lf ), and the TAC stiffness index. MEIC and current efficiency were greater for SUP60 and SIT60 compared to SUP20 and SIT20. The vastus lateralis and medialis showed lower θp and higher Lf at SUP60 and SIT60, while for the rectus femoris, in SUP60 there were lower θp and higher Lf than in all positions. The vastus intermedius had a similar pattern to the other vastii, except for lack of difference in θp between SIT60 compared to SUP20 and SIT20. The TAC stiffness index was greater for SUP60. We concluded that NMES generate greater torque and current efficiency at 60◦ of knee flexion, compared to 20◦ . For these knee angles, lengthening the QF at the hip did not promote significant change. Each QF constituent demonstrated muscle physiology patterns according to hip and/or knee angles, even though a greater Lf and lower θp were predominant in SUP60 and SIT60. QF TAC index stiffened in more elongated positions, which probably contributed to enhanced force transmission and slightly higher torque in SUP60. Our findings may help exercise physiologist better understand the impact of hip and knee angles on designing more rational NMES stimulation strategies