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Abstract Background To describe the key findings and lessons learned from an international pilot study that surveyed spinal cord injury programs in acute and rehabilitation facilities to understand the status of spinal cord injury care. Methods An online survey with two questionnaires, a 74-item for acute care and a 51-item for rehabilitation, was used. A subset of survey items relevant to the themes of specialized care, timeliness, patient-centeredness, and evidence-based care were operationalized as structure or process indicators. Percentages of facilities reporting the structure or process to be present, and percentages of indicators met by each facility were calculated and reported separately for facilities from high-income countries (HIC) and from low and middle-income countries (LMIC) to identify “hard to meet” indicators defined as those met by less than two-thirds of facilities and to describe performance level. Results A total of 26 acute and 26 rehabilitation facilities from 25 countries participated in the study. The comparison of the facilities based on the country income level revealed three general observations: 1) some indicators were met equally well by both HIC and LMIC, such as 24-hour access to CT scanners in acute care and out-patient services at rehabilitation facilities; 2) some indicators were hard to meet for LMIC but not for HIC, such as having a multidisciplinary team for both acute and rehabilitation settings; and 3) some indicators were hard to meet by both HIC and LMIC, including having peer counselling programs. Variability was also observed for the same indicator between acute and rehabilitation facilities, and a wide range in the total number of indicators met among HIC facilities (acute 59–100%; rehabilitation 36–100%) and among LMIC facilities (acute: 41–82%; rehabilitation: 36–93%) was reported. Conclusions Results from this international pilot study found that the participating acute and rehabilitation facilities on average adhered to 74% of the selected indicators, suggesting that the structure and processes to provide ideal traumatic spinal cord injury care were broadly available. Recruiting a representative sample of SCI facilities and incorporating regional attributes in future surveys will be helpful to examine factors affecting adherence to indicators.

ABSTRACT Background: Postural instability affects Parkinson’s disease (PD) patients’ postural control right from the early stages of the disease. The benefits of resistance training (RT) for balance and functional capacity have been described in the literature, but few studies have been conducted showing its effects on PD patients’ postural control. Objective: To investigate the effects of a three-month RT intervention on static posturography (SP) measurements and clinical functional balance assessment among PD patients. Methods: Seventy-four patients were randomly assigned to a three-month RT intervention consisting of using weightlifting machines at a gym (gym group) or RT consisting of using free weights and elastic bands (freew group), or to a control group. The participants were evaluated at baseline, three months and six months. We evaluated changes of SP measurements under eyes-open, eyes-closed and dual-task conditions (primary endpoint), along with motor performance and balance effects by means of clinical scales, dynamic posturography and perceptions of quality of life (secondary endpoints). Results: There were no significant interactions in SP measurements among the groups. Unified Parkinson Disease Rating Scale (UPDRS-III) motor scores decreased in both RT groups (p

ABSTRACT Objective: To investigate the relationship between anthropometry and body composition with dynamic postural balance in elderly women with low bone mineral density (BMD). Methods: 45 older women (≥ 60 years), low BMD and nutritional diagnosis of low weight to overweight. For the assessment of body composition, Dual energy X-ray emission densitometry and anthropometric examination were used to measure: body mass (kg), height (cm) and BMI (k/m2). The assessment of dynamic postural balance was performed by the mini Balance Master Evaluation System clinical test and the computerized Balance Master® System test by the Sit to Stand and Step Up/Over tests. Results: There was a negative correlation between miniBESTest (r = − 0.566; p ≤ 0.001) and time to ascend and descend step (r = − 0.393; p ≤ 0.007) with fat mass, and positive correlation with miniBESTest (r = 0.526; p ≤0.001) and time to go up and down a step with muscle mass (r = 0.297; p ≤ 0.04). As for anthropometric variables, only height showed a positive correlation (r = 0.296; p ≤ 0.04) with the speed in the sit and stand test. Conclusion: Lean mass reduces postural oscillations; in contrast, fat mass negatively interfered with dynamic postural balance in women with low BMD. Height was related to dynamic postural balance, the taller the elderly, the worse their balance. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

O objetivo do estudo foi analisar o efeito do uso da palmilha customizada no equilibro postural dinâmico de idosos diabéticos em atividades funcionais. Trata-se de estudo experimental com 24 indivíduos idosos de ambos os sexos entre 60 e 79 anos, portadores de Diabetes Mellitus tipo 2 há mais de cinco anos, que possuíam independência funcional e apresentavam integridade da pele dos membros inferiores, especialmente dos pés. Foram realizadas avaliações do equilibro dinâmico, utilizando o equipamento NeuroCom Balance Master®: testes de sentar e levantar; andar e retornar e subir e descer degraus; antes e após oito semanas de uso de palmilhas customizada. Em todos os testes, não foram encontradas diferenças significativas no pré e pós-intervenção. Os resultados sugerem que o uso de palmilhas customizadas com apoio dos arcos longitudinais e neutralização da articulação subtalar durante o período de oito semanas não promoveu alterações no controle postural durante tarefas funcionais, como sentar e levantar; andar e retornar e subir e descer degraus em idosos diabéticos.

OBJECTIVE: This study aimed to analyze the physical and pulmonary capacities of hospitalized patients with severe coronavirus disease and its correlation with the time of hospitalization and complications involved. METHODS: A total of 54 patients, aged ≥18 years of both sexes, were evaluated 2-4 months after hospital discharge in São Paulo, Brazil. The physical characteristics analyzed were muscle strength, balance, flexibility, and pulmonary function. The K-means cluster algorithm was used to identify patients with similar physical and pulmonary capacities, related to the time of hospitalization. RESULTS: Two clusters were derived using the K-means algorithm. Patients allocated in cluster 1 had fewer days of hospitalization, intensive care, and intubation than those in cluster 2, which reflected a better physical performance, strength, balance, and pulmonary condition, even 2-4 months after discharge. Days of hospitalization were inversely related to muscle strength, physical performance, and lung function: hand grip D (r=−0.28, p=0.04), Short Physical Performance Battery score (r=−0.28, p=0.03), and forced vital capacity (r=−0.29, p=0.03). CONCLUSION: Patients with a longer hospitalization time and complications progressed with greater loss of physical and pulmonary capacities.

ABSTRACT Objective: To compare the effects of different resistance training programs on measures of muscle strength and hypertrophy. Methods: Sixty-seven untrained subjects were randomized to one of two groups: Split Workout Routine (n=35), in which muscle groups were trained twice per week in an A/B split consisting of eight sets per session, or Full-Body Workout Routine (n=32), in which muscle groups were trained four times per week with four and eight sets per session. Both groups performed eight to 12 repetition maximum per set, with 60 seconds of rest between sets. Maximal strength and muscle thickness were assessed at baseline and after eight weeks of training. Results: A significant main effect of time (pre versus post) was observed for maximal strength in the bench press and squat exercises and thickness of the elbow extensor, elbow flexor and quadriceps femoris muscles. Selected variables did not differ significantly between groups. Conclusion: Resistance training twice or four times per week has similar effects on neuromuscular adaptation, provided weekly set volume is equal.

ABSTRACT The aging process can alter the organization of postural control causing instability; literature shows several equipment and clinical tests whose purpose is to measure postural balance, involving different protocols and methodologies. Objective: To evaluate postural balance during the task to walk over the force platform (turn and return) and its relationship with clinic balance test (BESTest) in older adults. Methods: 60 older people of both sexes, aged 60 to 79 years, were tested in the force platform (NeuroCom Balance) and BESTest to evaluate postural balance. Results: negative correlations were found when comparing domains of the clinical test with stabilometric parameters in time and velocity variables of the tests Step/Quick turn. The highest correlations were in the total score (time spent to perform the task − 0.41, and in the velocity left side − 0.33/right side − 0.43), as well as in the stability limit (time spent to perform the task left side − 0.34/right side − 0.37, and the equilibrium velocity left side − 0.37/right side − 0.43). Conclusion: There are slim correlations between the clinical test and force platform variables, showing that each test measures different parameters. Level of evidence II, Diagnostic study - investigating a diagnostic test.

Objective: To analyze the effects of whole body electrostimulation (WB-EMS) with body weight training on functional fitness and body composition of older men.Methods: Twenty physically inactive older men were randomized into: Control group (control), performed the body weight exercise training wearing electrostimulation clothing, but without receiving electrical current stimuli (n = 10), and body weight associated with whole body electrostimulation group (BW+WB-EMS), performed the body weight exercise training wearing electrostimulation clothing plus whole body electrostimulation (n = 10). The training sessions were performed twice a week for 6 weeks and included eight exercises using body weight, performed in two sets of eight repetitions. Physical function was assessed using a battery composed of seven tests, six derived from the Senior fitness test and a handgrip strength test. We also measured the muscle thickness (MT) of the biceps and triceps brachii and vastus lateralis.Results: The BW+WB-EMS group presented increased (p < 0.05) performance in the 30-s chair stand test (10.2 ± 3.3 vs. 13.8 ± 5.0 reps), arm curl (16.6 ± 3.9 vs. 19.9 ± 6.1 reps), 6-min walk test (402 ± 96 vs. 500 ± 104 m), and handgrip strength test (30 ± 11 vs. 32 ± 11 kgf). The BW+WB-EMS group also presented increased MT (p < 0.05) in the biceps brachii (17.7 ± 3.0 vs. 21.4 ± 3.4 mm), triceps brachial (14.7 ± 3.6 vs. 17.5 ± 4.1 mm), and vastus lateralis muscles (15.1 ± 2.6 vs. 18.6 ± 4.3 mm). Moderate correlations were found in arm curl (p = 0.011, r = 0.552) but not handgrip strength (p = 0.053, r = 0.439) with changes in the biceps MT. Moderate changes in the 6-min walk distance were significantly correlated with changes in vastus lateralis MT (p = 0.036, r = 0.471). There was a moderate correlation between the changes in the 30-s chair stand test (p = 0.006, r = 0.589) and changes in the vastus lateralis MT. Furthermore, although a moderate correlation (r = 0.438) was found between triceps MT and handgrip strength no significant difference (p = 0.053) was reported. Additionally, there were no statistical differences in any parameters for the control group.Conclusion: WB-EMS with body weight training increased functional fitness and MT in physically inactive older men.

ABSTRACT Parkinson's disease is the second most common neurodegenerative disorder in old age. Aging process for elders with Parkinson's disease can induce gait disturbances with more functional disabilities than for elders without the disease. Treadmill training as a therapy has resulted in notable effects on the gait of patients with Parkinson's disease and may be a resource for geriatric neurological rehabilitation. This review aimed to study the effects on gait after treadmill training in elderly patients with Parkinson's disease. The search was performed in the databases PubMed®, LILACS, PEDro and EMBASE, with the following keywords: “Parkinson's disease”, “elderly”, “treadmill training” and “gait evaluation”. The quality of the studies included was assessed by PEDro Scale. Eleven studies met the inclusion and exclusion criteria. Eight studies were randomized, and only one did a follow-up. One can observe in this review that treadmill training with or without weight support (at least 20 minutes, two to three times a week, with progressive increase of loads, for minimum of 6 weeks) in elderly patients with the Parkinson's disease was effective to improve gait. In addition, both were considered safe (since some studies described the use of belts, even in unsupported training) and can be associated with therapies complementary to gait, such as repetitive transcranial magnetic stimulation, visual cues or anodal transcranial direct current stimulation. Treadmill training in elderly patients with Parkinson's disease is an intervention that improves gait outcomes, but further studies are required for better proofs.

OBJECTIVES: Menopause marks the end of women’s reproductive period and can lead to sarcopenia and osteoporosis (OP), increasing the risk of falls and fractures. The aim of this study is to evaluate the influence of normal and low bone mineral density (BMD) on muscular activity, observed through inflammatory edema when mapping using magnetic resonance imaging (MRI) on the quadriceps muscle of postmenopausal women. METHODS: This was a cross-sectional study involving 16 older women, who were divided into two groups: osteoporosis group (OG), older women with OP, and control group (CG), older women without OP. The groups were evaluated in terms of nuclear MRI exam before and after carrying out fatigue protocol exercises using an isokinetic dynamometer and squatting exercises. RESULTS: The results of the present study showed that in intragroup comparisons, for both groups, there was a significant increase (p

ABSTRACT Objective: To evaluate bone mineral density (BMD) and body composition over a six-year period in elderly long-distance runners. Methods: We analyzed the medical records of elderly athletes who were long-distance runners, were participants of the IOT-HCFMUSP Orthogeriatric Group, and had their BMD evaluated between 2001 and 2007; of these athletes, 11 were included in the study. Inclusion criteria: athletes should be long-distance runners, should not stop long-distance running during the six-year period, and should have undergone BMD and body composition evaluations. Body composition was evaluated using bone densitometry with dual-energy X-ray absorptiometry with a Lunar-DPX device. Results: Over the six-year period, body composition remained stable, but there was a significant increase only in the fat percentage (p = 0.003). Conclusion: Long-distance running may maintain BMD but may lead to an increase in the fat percentage in elderly runners. Level of Evidence II; Prognostic Study - Investigating the Effect of Patient Characteristics on Disease Outcome.

ABSTRACT Objective: To evaluate the association between bone mineral density (BMD) and body composition in healthy older adults at different skeletal sites. Methods: We analyzed 87 medical records and BMD along with the body composition of men ranging from 60 to 87 years of age (mean: 68.5, standard deviation: 6.5). Inclusion criteria were normal BMD values (T-score greater than or equal to -1.0) and body mass index within normal or overweight range (18.5 to 29.5 kg/m2). Body composition was evaluated using bone densitometry with dual-energy X-ray absorptiometry (DEXA) in a LUNAR-DPX apparatus. Results: Greater lean mass, fat mass, and soft tissue was associated with better BMD values in older adults, and higher age was associated with poorer BMD. Conclusion: Body composition (lean and fat masses and soft tissue) in older men is positively associated with BMD at all body sites (arms, legs, and trunk). Level of Evidence II; Prognostic studies - Investigating the effect of a patient characteristic on the outcome of disease.

The objective of the study was to examine the association between handgrip strength (HGS), knee flexion and extension strength, and static and dynamic balance in older women. One hundred and ten women with a mean age of 67.4±5.9 years were assessed for dynamic postural balance using the Time Up & Go Test (TUG) with and without cognitive tasks. Semi-static balance was assessed by means of a force platform; knee flexor and extensor muscle strength was calculated using an isokinetic dynamometer; and HGS using a hand held dynamometer. Weaker HGS was significantly correlated with worse performance in dynamic postural balance, as well as performance with TUG with and without cognitive tasks; however, there was no correlation between HGS and static balance. There was a moderate positive correlation between knee flexion/extension strength and HGS. This suggests that HGS could be used as a proxy indicator of overall strength capacity for clinical screening among older women.

Assessing the driving abilities of individuals with disabilities is often a very challenging task because each medical condition is accompanied by physical impairments and because relative individual functional performance may vary depending on personal characteristics. We identified existing driving evaluation modalities for able-bodied and lower extremity-impaired subjects (spinal cord injury patients and amputees) and evaluated the potential relationships between driving performance and the motor component of driving. An extensive scoping review of the literature was conducted to identify driving assessment tools that are currently used for able-bodied individuals and for those with spinal cord injury or lower extremity amputation. The literature search focused on the assessment of the motor component of driving. References were electronically obtained via Medline from the PubMed, Ovid, Web of Science and Google Scholar databases. This article compares the current assessments of driving performance for those with lower extremity impairments with the assessments used for able-bodied persons. Very few articles were found concerning “Lower Extremity Disabilities,” thus confirming the need for further studies that can provide evidence and guidance for such assessments in the future. Little is known about the motor component of driving and its association with the other driving domains, such as vision and cognition. The available research demonstrates the need for a more evidenced-based understanding of how to best evaluate persons with lower extremity impairment.

OBJECTIVE: To validate an instrument to determine the graduate students' knowledge level of health care on the basic support of life procedures, risk factors, damage and disorders in elderly patients with hip fractures. METHOD: A group of experts was asked to analyze the instrument in two steps. Firstly, the procedure was done subjectively and according to objective analysis using the Likert scale proposed by the Delphi method. After adjustment according to the suggestions, the version of the instrument was applied to 179 undergraduate students in the health area. RESULT: The instrument has achieved in its entirety and in parts (risk factors), the minimum criteria established for the Cronbach's alpha (i.e., ≥0.70). There was no change in the Cronbach's alpha (0.551) for the maintenance of initial items of the instrument, as well as the deletion of seven assessment items. CONCLUSION: The instrument developed has sufficient internal validity to determine the level of knowledge of undergraduate students in the health area on basic life support, damage, injuries and risk factors in elderly patients with hip fractures from falls. Level of Evidence III, Diagnostic Study,

CONTEXT AND OBJECTIVE: Maintainance of postural balance requires detection of body movements, integration of sensory information in the central nervous system and an appropriate motor response. The purpose of this study was to evaluate whether lower-limb dominance has an influence on postural balance. DESIGN AND SETTING: This was a cross-sectional study conducted at Faculdade de Medicina da Universidade de São Paulo (FMUSP) and at Hospital do Coração (HCor). METHODS: Forty healthy sedentary males aged 20 to 40 years, without any injuries, were evaluated. A single-foot balance test was carried out using the Biodex Balance System equipment, comparing the dominant leg with the nondominant leg of the same individual. The instability protocols used were level 8 (more stable) and level 2 (less stable), and three instability indices were calculated: anteroposterior, mediolateral and general. RESULTS: The volunteers' mean age was 26 ± 5 years (range: 20-38), mean weight 72.3 ± 11 kg (range: 46-107) and mean height 176 ± 6 cm (range: 169-186). Thirty-four of them (85%) presented right-leg dominance (defined according to which leg they used for kicking) and six (15%) had left-leg dominance. There were no significant differences between the dominant and nondominant legs at the two levels of stability (eight and two), for any of the instability indices (general, anteroposterior and mediolateral). CONCLUSION: The lower-limb dominance did not influence single-foot balance among sedentary males.

OBJECTIVE: The aim of our study was to evaluate associations between maximum voluntary contraction torques of the lower limbs and body composition for subjects with severe obesity. METHODS: Body composition was evaluated by bioelectrical impedance analysis, and maximum voluntary contraction torques of the lower limbs were measured using an isokinetic dynamometer. One hundred thirty-two patients were enrolled (100 females and 32 males). Eighty-seven patients had a body mass index between 40 and 49.9 kg/m2 (the A group), and 45 patients had a body mass index between 50 and 59.9 kg/m2 (the B group). RESULTS: Absolute extension and flexion torques had weak associations with fat-free mass but a moderate association with absolute extension torque and fat-free mass of the lower limbs. There were no significant differences between the A and B groups with respect to absolute extension and flexion torques. For the A group, absolute extension and flexion torques were moderately associated with fat-free mass and with fat-free mass of the lower limbs. For the B group, there were only moderate associations between absolute extension and flexion torques with fat-free mass of the lower limbs. CONCLUSIONS: Our findings demonstrate that both groups exhibited similar absolute torque values. There were weak to moderate associations between absolute extension and flexion torques and fat-free mass but a moderate association with fat-free mass of the lower limbs. Individuals with severe obesity should strive for greater absolute torques, fat-free mass and especially fat-free mass of the lower limbs to prevent functional limitations and physical incapacity.

ABSTRACT Objective: After deep brain stimulation (DBS), patients with Parkinson’s disease (PD) typically still present significant gait and postural stability problems, and thus additional interventions are needed. In this way, our purpose was evaluate the comparative effectiveness of treadmill training, with and without body weight support, on balance outcomes among patients with PD after DBS. Methods: Eleven patients with PD that were using bilateral subthalamic nucleus DBS were evaluated using Time Up and Go test (TUG); Berg Balance Scale (BBS) and Static Posturography. In phase 1, all subjects participated in 8-weeks of treadmill training in conjunction with conventional physiotherapy. After six weeks (wash-out), each patient then participated in a subsequent 8-weeks of treadmill training with partial body weight support. Results: After the phase 1, there were improvements on the cognitive TUG performance (Before: 15.7 ± 1,8 sec; After: 13.7 ± 3.1 sec; p < 0.01) and an increase of anteroposterior and medio-lateral body oscillation with eyes closed. After the phase 2, there were improvements in conventional (Before: 12.3 ± 2.0 sec; After: 10.7 ± 1.7 sec; p < 0.01) and cognitive (Before: 14.6 ± 3.5 sec; After: 12.5 ± 1.6 sec; p < 0.05) TUG performances. There were no significant changes in the Berg Balance Scale following either training protocol. Conclusion: Both trainings improved static and dynamic balance and had similar results; however, supported treadmill training seemed to be a potentially superior option, as patients tended to feel safer. Level of Evidence II, therapeutic studies - investigation of treatment outcomes.

ABSTRACT Objective: To evaluate the correlation between blood alcohol levels and the severity of injuries assessed by the Injury Severity Score (ISS) in patients who were victims of traffic accidents admitted to the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP). Methods: Cross-sectional study carried out between July 2018 and June 2019, at the Central Emergency Room of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (PSC-HCFMUSP). A total of 172 hospitalized patients victims of traffic accidents were included in this study. Blood samples were analyzed by the FMUSP Toxicology Laboratory. Results: 36 patients (20.9%) had positive BAC (≥ 0.2 g/L) with a mean of 1.21 g/L. Overall, patients had a mean age of 37.2 years old, and 136 (79.1%) were men. The ISS of the total casuistry was 15.6; regarding the external cause, the motorcycle was ranked first with 100 cases (58.1%), and drivers were the majority with 57.4% of the sample. Conclusion: There was no correlation between the severity of the injuries and the blood alcohol levels of traffic accident victims admitted to a reference hospital. Level of Evidence II, Cross-Sectional Study.

ABSTRACT Objective: Evaluate and correlate the sagittal balance parameters with the postural of the pelvis and lumbar spine. Methods: 80 individuals of both sexes, aged between 20 and 35 years, were evaluated. Biophotogrammetry was done with the SAPO software program. Measurements of the sagittal balance parameters were obtained by analyzing a lateral view panoramic radiography of the vertebral column, in which the anatomical points of reference were digitally marked. The calculation of the angles was done automatically by the Keops program. Results: In Keops assessment, 17.5% of the sample had high pelvic incidence angles (> 60°), 31.5% had low pelvic incidence angles (< 45°), and 51.2% had medium pelvic incidence angles (between 46° and 59°). SAPO showed 12,5% lordosis, 40% retroversion, and 47,5% normal curvature. In the right lateral view, pelvic incidence angle had a moderate and positive correlation with vertical alignment of the trunk and with vertical alignment of the body, and a negative and moderate correlation with horizontal alignment of the pelvis. Conclusion: Differences were found between vertical alignment measurements from the postural evaluation system (SAPO). A positive correlation was found between PI from Keops and pelvic anteversion from SAPO. Level of Evidence II; Prospective Study.

Objectives. To assess the effectiveness of transcranial direct current stimulation (tDCS) for pain, fatigue, physical function, and health-related quality of life in patients with idiopathic inflammatory myopathy (IIM). Methods. This randomized, double-blind, sham-controlled, crossover clinical trial enrolled IIM patients with fatigue and pain who received tDCS (20 min, 2 mA) or sham stimulation for 10 daily sessions. Electrodes were placed according to the 10/20 EEG system. Both the groups underwent aerobic exercise training during the intervention period. The patients were evaluated for disease perception, pain, and fatigue using uni-multidimensional questionnaires and physical tests in the periods before and after the first and second interventions and after 12 weeks of follow-up. Results. After the tDCS intervention, a reduction in the general score of multidimensional pain of 32.0 (1.5-38.0) vs. 0.0 (0.0-13.4) with effect size (ES) of -0.78 was noted, and after sham intervention, a reduction of 26.0 (0.0-37.0) vs. 5.0 (0.0-19.2) with ES of -0.54 (P=0.047) was also noted. Similar results were evidenced with fatigue (22.5 (15.4-33.2) vs. 5.5 (0.0-14.6) with ES of -0.82) and sham intervention (21.0 (15.8-29.5) vs. 4.0 (4.0-17.5) with ES of -0.80 (P=0.012)). There were no differences in the domains of the fatigue and pain questionnaires. Adherence was observed in 88.8% of the patients without adverse events. Conclusion. The association of tDCS with aerobic training promoted additional effects in relation to the group subjected to placebo stimulation on general pain and fatigue scores, as well as on pain intensity, without changes in the subdomains of the pain and fatigue questionnaire. This trial is registered with NCT04678635.

Abstract Background Physical exercise (PE) is a recommended lifestyle intervention for different mental disorders and has shown specific positive therapeutic effects in unipolar depressive disorder. Considering the similar symptomatology of the depressive phase in patients with bipolar disorder (BD) and unipolar depressive disorder, it is reasonable to suggest that PE may also be beneficial for bipolar depression. However, there is an absence of studies evaluating the antidepressant effect of a structured PE intervention in BD. Methods This is an open-label, single-arm study trial. Fifteen patients with a diagnosis of BD Type I or Type II, presenting a depressive episode were included in the study. After physical and functional evaluation, patients participated in supervised training sessions with aerobics followed by strength exercises, three times per week, for 12 weeks (36 training sessions). Depressive and manic symptoms were assessed at baseline and 2, 4, 8, and 12 weeks. Additionally, quality of Life and functioning were assessed at baseline and 4, 8, and 12 weeks). Finally, we tested cardiorespiratory fitness, muscle strength and body composition at baseline and week-12. Results The mean (± SD) Montgomery Asberg Depression Rating Scale (MADRS) score at baseline was 23.6 ± 8.3 points and after 12 weeks of PE the mean score was 10.2 ± 4.8 points. Nine patients (82%) presented an antidepressant response defined as a reduction of more than 50% of depressive symptoms at week 12 with five of those patients (45%) presenting criteria for full remission. A large and significant Cohen’s D Effect Size (pre-post) was verified for MADRS reduction [1.98 (95% Confidence interval = 0.88 to 3.08)]. We did not detect a significant change in manic symptoms, functioning, and quality of life during the 12-week follow-up. At week-12, all patients increased their muscular strength (one repetition maximal test − 1RM) and reduced the percentage of body fat (spectral bioelectrical impedance analysis). Conclusions This study, using rigorous criteria and a structured intervention, provides valid pilot data, showing the feasibility of a structured PE intervention for the treatment of depressive symptoms in BD, and suggesting a potential adjunctive antidepressant effect. Moreover, PE showed a positive impact on muscle strength and body composition. This should be further verified by randomized controlled studies.

ABSTRACT Objective: To analyze the impact of the Peripheral Diabetic Neuropathy (PDN) on the postural and functional balance and quality of life of Brazilian older adults. Methods: A cross-sectional study. Sixty older men and women (60-79 years) were divided into three groups: control, DM without and with PDN. The following parameters were evaluated: anthropometry; quality of life; postural balance (BESTest); functional balance in force plate (NeuroCom Balance). Results: PDN group presented significant differences compared with the other groups, with the worst performance in quality of life than DM2 without PDN in: sensory functioning (p = 0.030); past and future (p = 0.036); death and dying (p = 0.035). Postural balance deficit in the total score (p = 0.025) and biomedical constraints section (p = 0.043) of the BESTest, compared with DM2 without PDN (p = 0.007). In the functional balance (Neurocom), PDN group presented a worse performance in the time spent on the left side (p = 0.030) than the control group. During step up over test, the control group performed the task faster than the group with PDN (p = 0.004). Conclusion: This study showed that neuropaths presented worse physical performance and postural balance deficits, sensorial limitations, affecting the daily tasks and, as a consequence, decreasing the quality of life in Brazilian older adults. Level of Evidence II, Cross-sectional observational study.

ABSTRACT Objective: Fatigue of the ankle’s stabilizing muscles may influence the performance of functional activities and postural control. The purpose of this study was to evaluate the performance of healthy young adults using functional jump tests and static posturography control under pre- and post-fatigue conditions of the ankle invertor and evertor muscles. Methods: Thirty physically active healthy male and female (15 male and 15 female) volunteers (24.3 years) were enrolled in this prospective cross-sectional study. Participants performed tests on one day under a non-fatigued state of invertor and evertor muscles and on the second day in a fatigued state. Tests included static posturography on a force platform in a bipedal stance with eyes open and closed and in one-legged support with eyes open and functional jump tests (figure-of-8, side hop, 6-m crossover hop, and square hop). Fatigue of the ankle invertor and evertor muscles was induced using isokinetic dynamometry with 30 repetitions at 120°/s. Results: Participants had an average age of 24.3 years (SD ± 2.08), the height of 1.73 m (SD ± 0.08), and a weight of 68.63 kg (SD ± 10.29). The average Body Mass Index (BMI) was 22.88 (SD ± 2.46). A decrease in performance was observed in functional activities and postural control under all conditions after the induction of muscle fatigue, except for the speed at a bipedal stance with eyes open. Conclusions: Functional jump tests are low cost and useful for clinical practice and evaluation of the effects of muscle fatigue and could be used in clinical practice.

OBJECTIVES: To evaluate the clinical characteristics, ground reaction force (GRF), and function of the plantar muscles and dorsiflexors of the ankle in runners with and without Achilles tendinopathy (AT) and in non-runners. METHODS: Seventy-two participants (42 men, 30 women; mean age: 37.3±9.9 years) were enrolled in this cross-sectional study and divided into three groups: AT group (ATG, n=24), healthy runners’ group (HRG, n=24), and non-runners’ group (NRG, n=24). Both ankles were evaluated in each group. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for clinical and functional evaluation. GRF was evaluated using force plates and muscle strength was evaluated using an isokinetic dynamometer. RESULTS: The AOFAS scores were lower in the ATG. The strike impulse was higher in the ATG than in the HRG and NRG. However, GRF was similar among the groups. The ATG exhibited lower total work at 120°/s speed than the HRG. The peak torque in concentric dorsiflexion was lower in the NRG than in the ATG and HRG. The peak torque and total work in concentric plantar flexion were lower in the NRG than in the ATG. The peak torque and total work in eccentric plantar flexion were lower in the NRG than in the ATG and HRG. CONCLUSION: Runners with AT showed higher strike impulse, lower muscle strength of the plantar flexors, and higher clinical and functional damage.

OBJECTIVE: This study aimed to evaluate if posturography can be considered a recurrent fall predictor in elderly individuals. METHODS: This was a cross-sectional study. A total of 124 subjects aged 60 to 88 years were evaluated and divided into two groups—the recurrent fallers (89) and single fallers (35) groups. Patients’ sociodemographic characteristics were assessed, and clinical testing was performed. The functional test assessment instruments used were timed up and go test (TUGT), Berg Balance Scale (BBS), five times sit-to-stand test, and Falls Efficacy Scale (to measure fear of falling). Static posturography was performed in a force platform in the following three different situations—eyes open (EO), eyes closed (EC), and EO dual task. RESULTS: There were significant differences between the single and recurrent fallers groups regarding the fear of falling, the Geriatric Depression Scale score, the mean speed calculated from the total displacement of the center point of pressure (COP) in all directions with EO, and the root mean square of the displacement from the COP in the mediolateral axis with EC. Based on the hierarchical logistic regression model, none of the studied posturographic variables was capable of significantly increasing the power of differentiation between the recurrent and single fallers groups. Only TUGT with a cognitive distractor (p

Abstract Background Physical exercise and educational programs promote several benefits for patients with knee osteoarthritis (OA). However, little is known about the effects of educational programs promoting the regular practice of physical exercise. The purpose of the present study was to assess the effect of an interdisciplinary educational program, emphasizing the recommendation for regular practice of physical exercise, on functional capacity and daily living physical activity in individuals with knee OA. Methods Two hundred and thirty-nine individuals (50 men) with an established diagnosis of knee OA (degree I to IV in the Kelgreen and Lawrence scale) were randomly allocated into a multidisciplinary educational program (EDU; n = 112) or control group (CON; n = 127). Functional capacity (sit and reach, 6-min walking test (6MWT), timed up and down stairs test, timed up and go test (TUGT), and five times sit-to-stand test (FTSST)) and daily living physical activity (IPAQ, short version) were measured before, during (6 months) and after 12 months of follow-up. Results Body mass index reduced significantly (P

Abstract Trunk muscle strength affects trunk controlling playing an important role in performance and to define the classes of wheelchair basketball players. Trunk control capacity differs among players and quantitative assessments of trunk muscle strength have not been investigated. The aim of this study was to identify and correlate quantitative measures of trunk muscle strength with the wheelchair basketball players' classification. Forty-two male wheelchair basketball players with spinal cord injury, amputation, post-poliomyelitis sequelae, and cerebral palsy had their trunk extension and flexion strength evaluated with isokinetic dynamometer. The classes 1.0, 2.0, 3.0, and 4.0 were considered for statistical analysis. Comparison of trunk muscle strength differed significantly between classes: 1.0 and 3.0; 1.0 and 4.0; 2.0 and 3.0; and 2.0 and 4.0. High correlation was found between the trunk muscle strength and players' classes. The findings of the present study showed a strong correlation of trunk muscle strength and wheelchair basketball classes being able to distinguish players in their classes. However, this quantitative method of evaluation of the trunk muscle strength cannot be solely used to make a decision on the full trunk control.

OBJECTIVE: To assess the postural control and flexibility of obese subjects before and both six and 12 months after bariatric surgery. To verify whether postural control is related to flexibility following weight reductions resulting from bariatric surgery. METHODS: The sample consisted of 16 subjects who had undergone bariatric surgery. All assessments were performed before and six and 12 months after bariatric surgery. Postural balance was assessed using an Accusuway¯ portable force platform, and flexibility was assessed using a standard chair sit and reach test (Wells’ chair). RESULTS: With the force platform, no differences were observed in the displacement area or velocity from the center of pressure in the mediolateral and anteroposterior directions. The displacement speed from the center of pressure was decreased at the six month after the surgery; however, unchanged from baseline at 12 months post-surgery. Flexibility increased over time according to the three measurements tested. CONCLUSIONS: Static postural balance did not change. The velocity of postural adjustment responses were increased at six months after surgery. Therefore, weight loss promotes increased flexibility. Yet, improvements in flexibility are not related to improvements in balance.

OBJECTIVES: This study sought to analyze the extent of motor adaptation in ankle plantar flexors and dorsiflexors among older drivers during clinical isokinetic testing. METHODS: One hundred older adults (70.4±5.7 years) participated in two bilateral ankle plantar flexor and dorsiflexor isokinetic assessments at 30°/sec. Peak torque (PTQ), PTQ adjusted for body weight (PTQ/BW), and total work (TW) were analyzed. RESULTS: On the dominant side, PTQ/BW and TW were significantly greater for the second plantar flexion test than were those for the first such test (p

ABSTRACTObjectives To estimate the impact of a sensory-motor- cognitive task on postural balance, in Parkinson disease patients (Hoehn and Yahr 2-3) and to investigate possible relationships between posturography and functional balance clinical scales.Method Parkinson disease patients (n = 40) and healthy controls (n = 27) were evaluated with fluency tests, Berg Balance scale, Mini Best test and static posturography on the conditions eyes open, eyes closed and dual-task (simultaneous balance and fluency tasks).Results Posturographic data showed that Parkinson disease patients performed worse than controls in all evaluations. In general, balance on dual-task was significantly poorer than balance with eyes closed. Posturographic data were weakly correlated to clinical balance scales.Conclusion In clinical practice, Parkinson disease patients are commonly assessed with eyes closed, to sensitize balance. Our study showed that adding a cognitive task is even more effective. Static posturographic data should be carefully overgeneralized to infer functional balance impairments.

OBJECTIVE: The aim of this study was to evaluate the vertical component of the ground reaction force, plantar pressure, contact area of the feet and double-support time using static and dynamic (gait) baropodometry before and after bariatric surgery. METHODS: Sixteen individuals with a body mass index of between 35 and 55 were evaluated before and after bariatric surgery. Thirteen patients (81.3%) were female and three (18.8%) male and their average age was 46±10 (21-60) years. An FSCAN system (version 3848) was used for baropodometric analyses (1 km/h and 3 km/h). The peak plantar pressure and ground reaction force were measured for the rear foot and forefoot. The double-support time and foot contact area were measured during gait. RESULTS: There were reductions in the ground reaction force in the forefoot and rear foot and in the foot contact area in all evaluations and of the double-support time at 3 km/h, as well as a significant reduction in the body mass index at six months post-surgery. The peak pressure did not vary at 1 km/h and at 3 km/h, reductions in peak pressure were observed in the left and right rear feet and left forefoot. CONCLUSIONS: Weight loss after bariatric surgery resulted in decreases in the ground reaction force and contact area of the foot. Plantar pressure was decreased at 3 km/h, especially in the forefoot. There was an increase in rhythm because of a reduction in the double-support time at 3 km/h.

OBJECTIVE: To determine whether Tai Chi Chuan or ballroom dancing promotes better performance with respect to postural balance, gait, and postural transfer among elderly people. METHODS: We evaluated 76 elderly individuals who were divided into two groups: the Tai Chi Chuan Group and the Dance Group. The subjects were tested using the NeuroCom Balance Master¯ force platform system with the following protocols: static balance tests (the Modified Clinical Tests of Sensory Interaction on Balance and Unilateral Stance) and dynamic balance tests (the Walk Across Test and Sit-to-stand Transfer Test). RESULTS: In the Modified Clinical Test of Sensory Interaction on Balance, the Tai Chi Chuan Group presented a lower sway velocity on a firm surface with open and closed eyes, as well as on a foam surface with closed eyes. In the Modified Clinical Test of Sensory Interaction on Unilateral Stance, the Tai Chi Chuan Group presented a lower sway velocity with open eyes, whereas the Dance Group presented a lower sway velocity with closed eyes. In the Walk Across Test, the Tai Chi Chuan Group presented faster walking speeds than those of the Dance Group. In the Sit-to-stand Transfer Test, the Tai Chi Chuan Group presented shorter transfer times from the sitting to the standing position, with less sway in the final standing position. CONCLUSION: The elderly individuals who practiced Tai Chi Chuan had better bilateral balance with eyes open on both types of surfaces compared with the Dance Group. The Dance Group had better unilateral postural balance with eyes closed. The Tai Chi Chuan Group had faster walking speeds, shorter transfer times, and better postural balance in the final standing position during the Sit-to-stand Test.

OBJECTIVES: This study sought to analyze the effects of resistance training on functional performance, lower-limb loading distribution and balance in older women with total knee arthroplasty (TKA) and osteoarthritis (OA) in the contralateral knee. In addition, this older knee OA and TKA group (OKG) was compared to older (OG) and young women (YG) without musculoskeletal diseases who underwent the same resistance training program. METHODS: Twenty-three women divided into OKG (N = 7), OG (N = 8) and YG (N = 8) had their functional performance, lower-limb loading distribution and balance compared before and after 13 weeks of a twice-weekly progressive resistance training program. RESULTS: At baseline, the OKG showed lower functional performance and unilateral balance, and impaired lower-limb loading distribution compared to the OG and the YG (p

OBJECTIVE: The aims of this study were to evaluate the anteroposterior displacement behavior of the center of pressure without any visual reference and determine its relationship with knee muscle strength and reports of falls in postmenopausal women. Among those with osteoporosis, the specific objective was to evaluate the correlation of thoracic kyphosis and vitamin D with center of pressure displacement. METHODS: This was a cross-sectional observational study without intervention. The assessments were performed on 126 postmenopausal women (aged 55-65 years) who were grouped according to their lumbar bone density into osteoporosis and control groups. Center of pressure was evaluated on a force platform (100 Hz frequency and 10 Hz filter), with the subjects standing on both feet with eyes closed for 60 seconds. Knee muscle strength was evaluated using an isokinetic dynamometer in concentric/concentric mode at a velocity of 60°/s. In the osteoporosis group, vitamin D was assayed, and the thoracic spine was radiographed. RESULTS: In the control group, there was a correlation between the center of pressure and knee strength (r = 0.37; p

OBJECTIVE: To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD: This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6 ±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS: At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION: Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment.

OBJECTIVE: The purpose of this study was to compare aerobic function [anaerobic threshold (%VO2-AT), respiratory compensation point (%VO2-RCP) and peak oxygen uptake (VO2peak)] between physically active patients with HIV/AIDS and matched controls and to examine associations between disease status, poor muscle strength, depression (as estimated by the profile of mood states questionnaire) and the aerobic performance of patients. METHODS: Progressive treadmill test data for %VO2-AT (V-slope method), RCP and (VO2peak) were compared between 39 male patients with HIV/AIDS (age 40.6±1.4 years) and 28 male controls (age 44.4±2.1 years) drawn from the same community and matched for habitual physical activity. Within-patient data were also examined in relation to CD4+ counts (nadir and current data) and peak isokinetic knee torque. RESULTS: AT, RCP and (VO2peak) values were generally similar for patients and controls.Within the patient sample, binary classification suggested that AT, RCP and (VO2peak) values were not associated with either the nadir or current CD4+ count, but treadmill test variables were positively associated with peak isokinetic knee torque. CONCLUSION: The aerobic performance of physically active patients with HIV/AIDS is generally well conserved. Nevertheless, poor muscle strength is observed in some HIV/AIDS patients, which is associated with lower anaerobic power and (VO2peak), suggesting the possibility of enhancing the aerobic performance of patients with weak muscles through appropriate muscle-strengthening activities.

Considering the growth of the aging population, and the increasing risk for falls and related morbidity, it is vital to seek efficient, comprehensive, and culturally relevant prevention programs for elderly people to reduce risks for falls. The aim of the present study was to evaluate the postural balance and muscle strength among women participating in the "Wing of Baianas" in the carnival parades. One hundred and ten women, with an average age of 67.4±5.9 years, were divided into two groups: Baianas group-elderly participants of the carnival parades in the "Wing of Baianas", and a Control group of women who do not dance samba. Assessments included a physical activity questionnaire, isokinetic muscle strength testing for the knee extensors and flexors, and a postural balance assessment completed on a force platform. There were no differences between groups, for postural balance outcomes, during the eyes open condition; however, with eyes closed, there was a significant effect between groups (Baianas vs Control) in all variables. The Baianas group showed less medio-lateral displacement (p < 0.04); and anteroposterior displacement (p < 0.007); larger amplitudes of medio-lateral displacement (p < 0.001); and anteroposterior displacement (p < 0.001); increased mean velocity (p < 0.01); and elliptical area (p < 0.01) There were no differences in the isokinetic peak torque corrected by body weight, total work and flexor/extensor ratio. Participation in the Wing of Baianas is associated with better balance with closed eyes, but there were no differences between dancers and non-dancers for muscle strength.

OBJECTIVE: To analyze and compare the vertical component of ground reaction forces and isokinetic muscle parameters for plantar flexion and dorsiflexion of the ankle between long-distance runners, triathletes, and nonathletes. METHODS: Seventy-five males with a mean age of 30.26 (±6.5) years were divided into three groups: a triathlete group (n=26), a long-distance runner group (n = 23), and a non-athlete control group. The kinetic parameters were measured during running using a force platform, and the isokinetic parameters were measured using an isokinetic dynamometer. RESULTS: The non-athlete control group and the triathlete group exhibited smaller vertical forces, a greater ground contact time, and a greater application of force during maximum vertical acceleration than the long-distance runner group. The total work (180º/s) was greater in eccentric dorsiflexion and concentric plantar flexion for the non-athlete control group and the triathlete group than the long-distance runner group. The peak torque (60º/s) was greater in eccentric plantar flexion and concentric dorsiflexion for the control group than the athlete groups. CONCLUSIONS: The athlete groups exhibited less muscle strength and resistance than the control group, and the triathletes exhibited less impact and better endurance performance than the runners.