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Aerobic exercise with the correct intensity can attenuate motor and non-motor symptoms of Parkinson's disease (PD) and improve the quality of life. However, a specific, validated, non-invasive, and outside the laboratory protocol that assesses physiological variables to prescribe optimal aerobic exercise intensity for people with PD is nonexistent. Therefore, this study aimed to propose a protocol, the Parkinson's critical heart rate test (Parkinson-CHR test), to determine the critical heart rate (CHR) in individuals with PD and verify its validity, reliability, and sensitivity. Fifteen people with idiopathic PD, who were able to practice exercises, were recruited to participate in the study (71.1 ± 6.6 years). The study consisted of two experiments: i) the first one aimed to assess the validity and reliability of the protocol, with participants performing the test twice at a one-week interval; ii) the second experiment aimed to investigate the protocol sensitivity, with individuals being evaluated before and after an 8-week training program according to Parkinson-CHR intensity. In experiment 1, no differences between test and retest were observed in the time to cover the distances (400, 800 and 1200 m), the total heart rate, the critical heart rate, and critical speed (p > 0.05). In experiment 2, there was a reduction in time to cover 400 and 800 m as well as in the total heart rate for all distances after the 8-week training program. The Parkinson-CHR test is a reliable, reproducible, inexpensive, and non-invasive protocol to assess, prescribe, and monitor aerobic exercise intensity in people with PD. [ABSTRACT FROM AUTHOR]

The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) is not available to Portuguese-Brazil. This study translates, cross-culturally adapts, and validates the PASIPD for Brazilian individuals with Parkinson's disease. The translation process followed guidelines: initial translation, synthesis, back translation, expert committee, and pretest. The validation and reliability processes were conducted with 40 individuals (15 men and 25 women) with Parkinson's disease. Concurrent validity was evaluated between PASIPD to Brazilian Portuguese, International Physical Activity Questionnaire, and Human Activity Profile. PASIPD to Brazilian Portuguese was found to be moderately correlated with International Physical Activity Questionnaire (r =.474, p <.05); however, there was no correlation with Human Activity Profile (r =.271, p <.05). We used the intrarater reliability with intraclass correlation coefficient and test–retest. Intrarater reliability was high (intraclass correlation coefficient =.80). Internal consistency was considered adequate by Cronbach's alpha (α =.70). PASIPD to Brazilian Portuguese is a valid and reliable instrument for evaluating physical activity levels in Brazilian individuals with Parkinson's disease. [ABSTRACT FROM AUTHOR]

A cardiopulmonary exercise test (CPET) is used to determine the ventilatory thresholds and to directly assess cardiorespiratory capacity. However, its reproducibility should be tested in people with stroke as sequelae imposed by the stroke may induce important variations among and within each subject, affecting the reproducibility of the physiological responses to CPET. This cross-sectional repeated measures study design aims to determine the reproducibility of anaerobic threshold (AT), respiratory compensation point (RCP), and maximal cardiorespiratory capacity assessed during a CPET in people with stroke. Twenty-eight subjects with hemiparesis after stroke aging 60 ± 13 years were submitted to two treadmill CPETs with identical protocols. The reproducibility of heart rate (HR) and oxygen consumption (VO2) obtained at AT, RCP, and peak effort was evaluated by systematic error (paired t-test); reliability (ICC and 95% confidence interval); and agreement (typical error and coefficient of variation). There were no systematic errors for HR and VO2assessed at AT, RCP, and peak effort (p > 0,05). Reliability was high for these variables during CPET (ICCs > 0.93). Agreement was good for all variables. Typical errors for HR and VO2 assessed at AT, RCP, and peak effort were, respectively, 7, 7, and 8 bpm, and 1.51, 1.44, and 1.57 ml.kg−1.min−1. Coefficients of variation assessed at AT, RCP, and peak effort were, respectively, 5.7, 5.1, and 6.0% for HR and 8.7, 7.3, and 7.5% for VO2. HR and VO2 measured at AT, RCP, and peak effort during a treadmill CPET present good reproducibility in people with stroke, showing high reliability and good agreement. [ABSTRACT FROM AUTHOR]

Objective: To analyze the feasibility, safety, and acceptability of immersive virtual tasks. Methods: The authors recruited 11 young adults and 10 older adults. The participants performed three virtual reaching tasks while walking on a virtual path. The descriptive analysis and comparison between participants were performed using the Mann–Whitney U test and chi-square test for nonparametric and nominal variables, respectively. The authors also used analysis of variance for a between-groups comparison for normal variables. Results: Twenty percent of older adults and 81.8% of young adults completed all three tasks (chi-square test; p =.005). Both groups reported minor symptoms, with no significant differences. The older adults were more motivated to practice the tasks (Mann–Whitney U test; p =.015) and would be more likely to suggest them to others (chi-square test; p =.034). Conclusion: All three tasks were feasible for young adults. All participants, except for one, had cybersickness. The symptoms were mostly mild and subsided once the interaction was complete. [ABSTRACT FROM AUTHOR]

Individuals with cognitive impairment may have motor learning deficits due to the high engagement of cognitive mechanisms during motor skill acquisition. We conducted a scoping review to address the quality of current research on the relationship between cognitive impairments (i.e., deficits in attention, memory, planning and executive functions) and motor learning among older adults with Alzheimer's Disease or Mild Cognitive Impairment. After screening thousands of articles, we selected 15 studies describing cognitive assessment tools, experimental designs, and the severity of cognitive impairment. Although seven studies reported that cognitive impairment impaired motor learning, most studies included a high risk of bias. We identified multiple assessment tools across these studies that make comparisons among findings difficult. Future research in this area should focus on the influence of increased practice days during motor learning acquisition and incorporate both retention and transfer tests. Cognitive assessments should target the specific cognitive skills or deficits most closely related to the motor learning process. [ABSTRACT FROM AUTHOR]

Self-efficacy has been shown to play an important role in rehabilitation outcomes of stroke patients. The Stroke Self-Efficacy Questionnaire Brazil (SSEQ-B) is designed to assess self-efficacy of functional performance after stroke. This research sought to address the structural validity of the SSEQ-B using exploratory and confirmatory factorial analyses. This is a cross-sectional study. We performed a reliability assessment and structural validation of the SSEQ-B in 115 Brazilian stroke survivors living in Rio Grande do Sul or São Paulo. Results: Sample mean age was 62.7 ± 14.2 years. Internal consistency presents a Cronbach's Alpha (αC) of 0.829. Exploratory factorial analysis using the scree plot method revealed a bifactorial structure, consisting of activity and self-management domains. While confirmatory factorial analysis suggested a trifactorial structure, the loading ranges between factors 1 and 3 were very similar, suggesting they could be collapsed – resulting in the same factors found in the scree plot analysis. Both structures with subscales showed good construct validity. SSEQ-B is a valid and reliable measure of stroke self-efficacy. The preferred structure of the SSEQ-B is bifactorial and includes the domains activity and self-management. [ABSTRACT FROM AUTHOR]

To investigate the feasibility, safety, and effects of dual task (DT) in a mixed physical exercise protocol on mobility under DT in stroke survivors. Twenty-six chronic mild-impaired stroke survivors (age 51.57 ± 12.55; men= 13, women= 13) were randomly assigned into Experimental Group participating in a 15-week mixed (aerobic and resistance exercises performing a cognitive DT condition simultaneously) physical exercise protocol (30 sessions, 2x/week, duration of 60–90 min), and Control Group engaged in the same protocol without DT. Feasibility and outcome measures were assessed before and after the intervention and in a 5-week follow-up. DT physical exercise protocol was viable and safe. This protocol also improved mobility and gait when performed under DT, which was not found in the control group. DT does not influence aerobic resistance, strength, and balance responsiveness. It does not present any improvement in cognition, self-efficacy for falls, and quality of life. The results indicate that mixed physical exercise under DT is feasible and safe for mild-impaired stroke survivors. Stroke survivors demonstrate more significant improvement in the mobility performance under DT when submitted to a DT mixed physical exercise protocol than the standard physical exercise intervention. Brazilian clinical trials registry (RBR-4mvzz6); WHO trial record (U1111-1198-7173) DT training can be prescribed by using clear and precise parameters for stroke survivors. Physical Exercise without DT requirements did not improve mobility performing and cognitive tasks simultaneously in stroke survivors. Clinicians are encouraged to incorporate DT requirements into the exercise routines to enhance mobility under DT to mild-moderate stroke survivors. [ABSTRACT FROM AUTHOR]

Introduction: Considering the reduction of physical activity performed daily in people with spinal cord injury, it is necessary to analyze the interventions based on physical exercises in order to provide recommendations based on evidence. Objectives: To review and evaluate the literature on physical exercise interventions for individuals with SCI, based on the International Classification of Functioning, Disability and Health, as well as physiological parameters for exercise prescription. Method: A systematic review of the literature produced from August 2016 to February 2017 within the PubMed, Embase, Cochrane Library, and MEDLINE databases. Results: Two independent examiners conducted a search in which 223 articles were initially found. A third evaluator verified possible divergences and generated a final list of 25 articles that strictly met the inclusion criteria, 5 of which investigated the effects of aerobic exercise, 2 of resistance training, 2 of balance training, 12 of gait training, and 4 evaluating the combined effect of 2 or more forms of training. Conclusion: Considering studies classified as of high and moderate quality of evidence, positive effects were observed in the domains of structures and functions, in aerobic, resistance training and combined exercises, and in some studies with gait training. In the domain of activities and participation, positive effects were observed in the studies with gait training, balance training, and combined interventions. [ABSTRACT FROM AUTHOR]

Individuals with stroke experience residual walking disabilities, as the inability to increase walking speed (walking speed reserve – WSR), and frequently present decreasing in functional capacity. The relation between functional capacity and walking ability may contribute to more specific functional management of stroke. To investigate the association between WSR and functional capacity in individuals with chronic stroke and compare functional capacity between individuals who can increase walking speed or not. Cross-sectional study, where functional capacity was assessed with the Duke Activity Status Index (DASI), in metabolic equivalent (METS). WSR was assessed through the difference between fast and self-selected speed (in m/s). The individuals were assigned into two groups: able (WSR ≥ 0.2 m/s) and unable (WSR<0.2 m/s) to increase speed. Pearson's correlation and t test were used for analysis. Fifty-five individuals (functional capacity 23 ± 13 METS and WSR 0.3 ± 0.2 m/s) were included. The association between functional capacity and WSR was positive and statistically significant, with moderate magnitude (r = 0.56) (p <.001). Individuals who were unable to increase their walking speed have less functional capacity (17.5 versus 31.3) (p =.003). Functional capacity has a positive association with WSR in individuals with chronic stroke. The individuals who are unable to increase walking speed present lower functional capacity. [ABSTRACT FROM AUTHOR]

We aimed to provide a critical review of measurement properties of mHealth technologies used for stroke survivors to measure the amount and intensity of functional skills, and to identify facilitators and barriers toward adoption in research and clinical practice. Using Arksey and O'Malley's framework, two independent reviewers determined eligibility and performed data extraction. We conducted an online consultation survey exercise with 37 experts. Sixty-four out of 1380 studies were included. A majority reported on lower limb behavior (n = 32), primarily step count (n = 21). Seventeen studies reported on arm-hand behaviors. Twenty-two studies reported metrics of intensity, 10 reported on energy expenditure. Reliability and validity were the most frequently reported properties, both for commercial and non-commercial devices. Facilitators and barriers included: resource costs, technical aspects, perceived usability, and ecological legitimacy. Two additional categories emerged from the survey: safety and knowledge, attitude, and clinical skill. This provides an initial foundation for a field experiencing rapid growth, new opportunities and the promise that mHealth technologies affords for envisioning a better future for stroke survivors. We synthesized findings into a set of recommendations for clinicians and clinician-scientists about how best to choose mHealth technologies for one's individual objective. Rehabilitation professionals are encouraged to consider the measurement properties of those technologies that are used to monitor functional locomotor and object-interaction skills in the stroke survivors they serve. Multi-modal knowledge translation strategies (research synthesis, educational courses or videos, mentorship from experts, etc.) are available to rehabilitation professionals to improve knowledge, attitude, and skills pertaining to mHealth technologies. Consider the selection of commercially available devices that are proven to be valid, reliable, accurate, and responsive to the targeted clinical population. Consider usability and privacy, confidentiality and safety when choosing a specific device or smartphone application. [ABSTRACT FROM AUTHOR]

Investigate the physiological responses to active video games (AVG) in individuals with spinal cord injury by comparing oxygen consumption (VO2) and heart rate (HR) during an AVG session and at the ventilatory thresholds (i.e., anaerobic threshold and respiratory compensation point); and by calculating the session energy expenditure (EE). Eight paraplegic individuals with spinal cord injury underwent cardiopulmonary exercise tests in an arm cycle ergometer to determine ventilatory thresholds. Then, they underwent three experimental sessions: two of AVG (4 sets of 3 min of Tennis and 4 min of Boxing) and one control (watching a movie). HR and VO2 were continuously measured, and the total energy expenditure was calculated from it. HR and VO2 were similar in both AVG sessions and higher than in the control session (p <.05). Mean HR and VO2 in Tennis and Boxing were, respectively, 100 ± 7 and 114 ± 9 bpm and 7.9 ± 1.2 and 10.3 ± 1.4 ml.kg−1.min−1.HR and VO2 during both games did not differ significantly from the anaerobic threshold (121 ± 2 bpm and 10.6 ± 1.0 ml.kg−1.min−1, p >.05). Mean energy expenditure during the AVG sessions was 2.4 METS, while the total was 136 kcal. The AVG generated an aerobic stimulus equivalent to the anaerobic threshold that increased basal metabolism 2.6 times, characterizing a low-intensity aerobic exercise. [ABSTRACT FROM AUTHOR]