Nº de abstracts = 31

Modificado em 04 de Dezembro de 2011

Physical activity benefits and risks on the gastrointestinal system. Martin D

104(12):831-7, 2011 Dez From the Division of Medicine, Department of Internal Medicine, Landstuhl Regional Medical Center, Landstuhl/Kirchberg, Germany.

ABSTRACT: This review evaluates the current understanding of the benefits and risks of physical activity and exercise on the gastrointestinal system. A significant portion of endurance athletes are affected by gastrointestinal symptoms, but most symptoms are transient and do not have long-term consequences. Conversely, physical activity may have a protective effect on the gastrointestinal system. There is convincing evidence that physical activity reduces the risk of colon cancer. The evidence is less convincing for gastric and pancreatic cancers, gastroesophageal reflux disease, peptic ulcer disease, nonalcoholic fatty liver disease, cholelithiasis, diverticular disease, irritable bowel syndrome, and constipation. Physical activity may reduce the risk of gastrointestinal bleeding and inflammatory bowel disease, although this has not been proven unequivocally. This article provides a critical review of the evidence-based literature concerning exercise and physical activity effects on the gastrointestinal system and provides physicians with a better understanding of the evidence behind exercise prescriptions for patients with gastrointestinal disorders. Well-designed prospective randomized trials evaluating the risks and benefits of exercise and physical activity on gastrointestinal disorders are recommended for future research.

Exercise parameters in the management of breast cancer: A systematic review of randomized controlled trials. Pastakia K, Kumar S

Physiotherapy research international : the journal for researchers and clinicians in physical therapy 16(4):237-44, 2011, dez International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, South Australia. Este endereço de e-mail está protegido de spam bots, pelo que necessita do Javascript activado para o visualizar .

Aim. Previous systematic reviews have examined the efficacy of exercise in improving the quality of life for patients with, and survivors of, breast cancer. This review sets out to determine the parameters of exercise programmes used in randomized controlled trials. Methods. A systematic review of randomized controlled trials was conducted. Only trials that reported significant improvement on the quality of life outcome were included. Data relating to the parameters of exercise (mode, duration, frequency and intensity and delivery method) were analyzed. Results. Nine randomized controlled trials were included in this review. Overall quality of the trials was average. Aerobic exercise was featured in eight of the nine trials and was used in combination with resistance training in four trials. All the trials were gym-based, were under the supervision of a physiotherapist and included a warm-up and cool-down phase. Conclusions. This review concludes that aerobic exercise performed with or without weight training is a common feature of exercise programmes that report significant quality of life-related outcomes. The most commonly reported exercise parameters were three sessions per week, at moderate intensity being equivalent to 50% to 80% of the maximum heart rate for greater than 30 minutes

Effects of a structured weight-bearing exercise program on bone metabolism among breast cancer survivors: a feasibility trial.

Peppone LJ, Mustian KM, Janelsins MC, Palesh OG, Rosier RN, Piazza KM, Purnell JQ, Darling TV, Morrow GR.: Clinical Breast Cancer, 2010, 10(3):224-9. Department of Radiation Oncology, University of Rochester Medical Center, NY 14642, USA.

PURPOSE: Treatments for breast cancer, specifically hormonal therapy, accelerate bone loss (BL) among breast cancer survivors, leading to osteoporosis and an increase in fracture risk. Tai Chi Chuan (TCC) is a moderate form of weight-bearing exercise, equivalent to walking, and it has been shown to improve aerobic capacity and strength among breast cancer survivors and might also be effective in slowing bone loss in breast cancer survivors. This pilot study compared the influence of TCC with that of standard support therapy (ST; exercise control) on BL biomarkers among breast cancer survivors. PATIENTS AND METHODS: Randomly assigned breast cancer survivors (N = 16; median age, 53 years; < 30 months after treatment) completed 12 weeks (3 times per week, 60 minutes per session) of TCC or ST. Serum levels of N-telopeptides of type I collagen (NTx), a marker of bone resorption, and bone-specific alkaline phosphatase (BSAP), a marker of bone formation, were determined according to enzyme-linked immunosorbent assay at baseline and after the intervention. RESULTS: Using analysis of covariance, survivors in the TCC group experienced a greater increase in levels of bone formation (BSAP [microg/L]: before, 8.3; after, 10.2; change, 1.9 microg/L and 22.4%), compared with survivors in ST (BSAP [microg/L]: before, 7.6; after, 8.1; change, 0.5 microg/L [6.3%]). Survivors in the TCC group also experienced a significant decrease in bone resorption (NTx [nanomoles bone collagen equivalent; nmBCE]: before, 17.6; after, 11.1; change, -6.5 nmBCE; -36.9%), whereas women in the ST group did not (NTx [nmBCE]: before, 20.8; after, 18.8; change, -2.0 nmBCE; -9.6%). CONCLUSION: This pilot study suggests that weight-bearing exercise exerts positive effects on BL, through increased bone formation and decreased bone resorption. Further examinations of the influence of TCC on bone health are warranted.

The epidemiology of abnormal hemoglobins in Mediterranean high-level athletes.

Touhami I, Fattoum S, Bibi A, Siala H, Messaoud T, Koubaa D, Mankai R, Bartagi Z, Le Gallais D.: European Journal of Applied Physiology, 2010, 108(6):1075-81. Dynamics of Cardiovascular Incoherencies, Montpellier 1 University, Montpellier, France.

The aim of this study was to determine the prevalence and nature of hemoglobin (Hb) defects in a Mediterranean high-level (HL) athlete population. Five hundred and ninety-four HL male and female athletes were recruited during the annual follow-up of the members of Tunisian national teams. Hematological data, Hb electrophoresis, and DNA analysis were assessed using conventional techniques. Sporting discipline, type of sport, and performance levels were assessed using a questionnaire. The results showed that 32 HL athletes had abnormal Hb (5.4%): beta-thalassemia (2.2%), alpha-thalassemia (0.5%), HbAS (1.5%), HbAC (0.5%), and rare Hb variants (0.7%). Of the 32 defect carriers, all but one (a alpha-thalassemia) were heterozygous. All the detected hemoglobinopathies but one (an Hb Hope) had already been reported in the country. The prevalence of Hb defect in the HL athletes was similar to that described in the general Tunisian population (P > 0.05). The percentage of Hb defect in the athletes was not dependent on gender, or performance level (P > 0.05). Within each type of sport the percentages of athletes with normal and abnormal Hb were similar (P > 0.05). The hematological data revealed the diversity of anemia, microcytosis, and hypochromia in thalassemic HL athletes. We concluded that HL athletes in Tunisia were a representative sample of the general Tunisian population regarding the prevalence and nature of benign abnormal Hb. The hematological data of the thalassemia carriers exhibited high variability and raised the question of genetic and sporting counseling, as well as biological follow-up for these carriers.

Acute mountain sickness: pathoPhysiology, prevention, and treatment.

Imray C, Wright A, Subudhi A, Roach R: Progress in Cardiovascular Diseases, 2010 May-Jun 52(6):467-84. Warwick Medical School, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.

Barometric pressure falls with increasing altitude and consequently there is a reduction in the partial pressure of oxygen resulting in a hypoxic challenge to any individual ascending to altitude. A spectrum of high altitude illnesses can occur when the hypoxic stress outstrips the subject's ability to acclimatize. Acute altitude-related problems consist of the common syndrome of acute mountain sickness, which is relatively benign and usually self-limiting, and the rarer, more serious syndromes of high-altitude cerebral edema and high-altitude pulmonary edema. A common feature of acute altitude illness is rapid ascent by otherwise fit individuals to altitudes above 3000 m without sufficient time to acclimatize. The susceptibility of an individual to high-altitude syndromes is variable but generally reproducible. Prevention of altitude-related illness by slow ascent is the best approach, but this is not always practical. The immediate management of serious illness requires oxygen (if available) and descent of more than 300 m as soon as possible. In this article, we describe the setting and clinical features of acute mountain sickness and high-altitude cerebral edema, including an overview of the known patho-physiology, and explain contemporary practices for both prevention and treatment exploring the comprehensive evidence base for the various interventions.

Use of the peak heart rate reached during six-minute walk test to predict individualized training intensity in patients with cystic fibrosis: validity and reliability.

Gruet M, Brisswalter J, Mely L, Vallier JM.: Archives of Physical Medicine and Rehabilitation, 201004 91(4):602-7. States Laboratoire HandiBio, Université du sud Toulon-Var, Toulon, France.

Objective: To determine whether the peak heart rate reached during a six-minute walk test (HR(6peak)) can be used to predict the heart rate determined at the gas exchange threshold (HR(GET)) during a maximal cardiopulmonary exercise test (CPET) in patients with cystic fibrosis (CF). To assess the test-retest reliability of HR(6peak). Design: Case-control and reliability study. Setting: CF unit. Participants: Adults with CF (n=23) and age-matched sedentary subjects (control group, n=17). Intervention : Not applicable. Main outcome measures: Six-minute walk test, HR(6peak), CPET, and HR(GET). Results: HR(GET) and HR(6peak) were not significantly different and were highly correlated in both groups (CF, r=.91, P<.01; controls, r=.81, P<.01). The mean differences (HR(6peak)-HR(GET)) for patients with CF and control subjects were, respectively, -0.9 beats.min(-1) (bpm) and -0.1 bpm, with neither significantly different from 0. The limits of agreements were +/-11 bpm and +/-18 bpm, respectively. HR(6peak) demonstrated excellent relative reliability (intraclass correlation coefficient=.93) and was associated with low variability (standard error of measurement=4.9 bpm) in patients with CF. Conclusions : HR(6peak) is valid and demonstrates satisfactory test-retest reliability in patients with CF. These results might suggest the use of HR(6peak) as a simple alternative method to individualize exercise prescriptions in this population. Further studies are needed in a larger cohort of patients to confirm these preliminary findings.

Differences in self-selected and fastest-comfortable walking in post-stroke hemiparetic persons.

Beaman CB, Peterson CL, Neptune RR, Kautz SA.: Gait & Posture, 201003 31(3):311-6. Department of Mechanical Engineering, The University of Texas, Austin, TX 78712, USA.

Post-stroke hemiparetic walking is typically asymmetric. Assessment of symmetry is often performed at either self-selected or fastest-comfortable walking speeds to gain insight into coordination deficits and compensatory mechanisms. However, how walking speed influences the level of asymmetry is unclear. This study analyzed relative changes in paretic and non-paretic leg symmetry to assess whether one speed is more effective at highlighting asymmetries in hemiparetic walking and whether there is a systematic effect of speed on asymmetry. Forty-six subjects with chronic hemiparesis walked at their self-selected and fastest-comfortable speeds on an instrumented split-belt treadmill. Relative proportions (paretic leg value/(paretic+non-paretic leg value)) were computed at each speed for step length (PSR), propulsion (PP), and joint moment impulses at the ankle and hip. Thirty-six subjects did not change their step length symmetry with speed, while three subjects changed their step length values toward increased asymmetry and seven changed toward increased symmetry. Propulsion symmetry did not change uniformly with speed for the group, with 15 subjects changing their propulsion values toward increased asymmetry while increasing speed from their self-selected to fastest-comfortable and 11 decreasing the asymmetry. Both step length and propulsion symmetry were correlated with ankle impulse proportion at self-selected and fastest-comfortable speed (cf., hip impulse proportion), but ratios (self-selected value/fastest-comfortable value) of the proportion measures (PSR and PP) showed that neither step length nor propulsion symmetry correlated with the ankle impulse proportions. Thus, the individual kinetic mechanisms used to increase speed could not be predicted from PSR or PP.

First therapy of decompression injuries

Castan J, Wirtz S, Moecke H, Schmidbauer W, Ahlers O, Kerner T.: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS, 201002 45(2):80-6. Klinik für Anästhesiologie und operative Intensivmedizin, Asklepios Klinik Harburg, Hamburg.

The diving accident is a rare incident for an emergency physician which requires special physical and patho-physiological knowledge. With increasing recreational activities and the fascination of diving also for older persons diving accidents are expected to occur more often. There can be several reasons for diving accidents such as the ignorance of the physics of diving, a trauma under water as well as internistical illnesses like heart attach, stroke or hypoglycaemia. The therapy of the underlying illness should not be left aside while dealing with the patient. The careful rescue and the immobilisation are most important for the initial therapy. The patient should receive oxygen, if possible via a demand valve, until a hyperbaric chamber is reached. There is no specific medical therapy for decompression illness. It is very important that a pre-information is sent to the closest hyperbaric chamber as soon as possible since often the chamber needs some time to be properly prepared for usage. In order to receive information regarding the depth where the diving incident occured, the duration of the diving trip and the decompression stops, it is important to secure the diving computer of the victim for the hyperbaric chamber. Also outside diving, decompression illness can occur, for example working in a tunnel under hyperbaric conditions. These accidents have to be treated according to the same guidelines.

Sportsman hernia: what can we do?

Garvey JF, Read JW, Turner A.: Hernia : the Journal of hernias and abdominal wall surgery, 201002 14(1):17-25 Language: eng Country: France Groin Pain Clinic, Sydney, NSW 2000, Australia.

Introduction: Sportsman (sports) hernia is a medially located bulge in the posterior wall of the inguinal canal that is common in football players. About 90% of cases occur in males. The injury is also found in the general population. Clinical presentation: The presenting symptom is chronic groin pain which develops during exercise, aggravated by sudden movements, accompanied by subtle physical examination findings and a medial inguinal bulge on ultrasound. Pain persists after a game, abates during a period of lay-off, but returns on the resumption of sport. Frequently, sports hernia is one component of a more extensive pattern of injury known as 'groin disruption injury' consisting of osteitis pubis, conjoint tendinopathy, adductor tendinopathy and obturator nerve entrapment. Risk factors: Certain risk factors have been identified, including reduced hip range of motion and poor muscle balance around the pelvis, limb length discrepancy and pelvic instability. The suggested aetiology of the injury is repetitive athletic loading of the symphysis pubis disc, leading to accelerated disc degeneration with consequent pelvic instability and vulnerability to micro-fracturing along the pubic osteochondral junction, periosteal stripping of the pubic ligaments and para-symphyseal tendon tears, causing tendon dysfunction. Radiology: Diagnostic imaging includes an erect pelvic radiograph (X-ray) with flamingo stress views of the symphysis pubis, real-time ultrasound and, occasionally, computed tomography (CT) scanning and magnetic resonance imaging (MRI), but seldom contrast herniography. Other imaging tests occasionally performed can include nuclear bone scan, limb leg measurement and test injections of local anaesthetic/corticosteroid. Prevention and treatment: The injury may be prevented by the detection and monitoring of players at risk and by correcting significant limb length inequality. Groin reconstruction operation consists of a Maloney darn hernia repair technique, repair of the conjoint tendon, transverse adductor tenotomy and obturator nerve release. Rehabilitation involves core stabilisation exercises and the maintenance of muscle control and Strength around the pelvis. Outcome: Using this regimen of groin reconstruction and post-operative rehabilitation, a player would be anticipated to return to their pre-injury level of activity approximately 3 months after surgery.

Minimal Repair technique of sportsmen's groin: an innovative open-suture repair to treat chronic inguinal pain.

Muschaweck U, Berger L.:Hernia : the Journal of Hernias and Abdominal Wall Surgery, 201002 14(1):27-33. Hernia Center Dr. Muschaweck, München, Germany.

Background: Sportsmen's groin, also known as sportsman's hernia, sports hernia, (athletic) pubalgia or athletic hernia, especially in professional sportsmen, is a difficult clinical problem, and may place an athlete's career at risk. It presents with acute or chronic inguinal pain exacerbated with physical activity. So far, the diagnostic criteria and treatment modalities are inconsistently described and there is no evidence-based consensus available to guide decision-making. Objectives: We developed an innovative open suture repair, called the "Minimal Repair" technique. With this technique, the defect of the posterior wall of the inguinal canal is not enlarged, the suture is nearly tension-free and the patient can, therefore, return to full training and athletic activity within the shortest time. Methods: In September 2008, we started a prospective cohort study to evaluate the outcome of patients undergoing operations under the Minimal Repair technique for sportsmen's groin. Between September 2008 and May 2009, 129 patients were included in the study and were questioned at entry and 4 weeks after the operation. The primary endpoints were time to complete freedom of pain and time to resumption of exercise and sport. Here, we present the results observed 4 weeks after operation under the Minimal Repair technique. Results: At enrollment, all but three patients reported a significant restriction of physical activities due to severe groin pain (median duration of pain 142 days, interquartile range [IQR] 57-330 days). Four weeks after operation under the Minimal Repair technique, 96.1% had resumed training (median 7 days, IQR 5-14 days). At this time, there was a full return to pre-injury sports activity levels in 75.8% (median 18.5 days, IQR 11.75-28 days). Focusing on the group of professional athletes, 83.7% had returned to unrestricted sports activities (median 14 days, IQR 10-28 days). In this subgroup, the median time to complete pain relief was 14 days (IQR 6-28 days). Discussion: The surgical treatment of sportsmen's groin is common practice when non-surgical treatment has failed over a period of 6 weeks or more. However, there is no evidence-based data on the type of treatment. A wide variety of techniques with and without mesh are being performed. So far, laparoscopic repair is believed to enable a faster recovery and return to unrestricted sports activities. Our results, however, show that the outcome after operation under the Minimal Repair technique is very fast, without exposing the patient to possible risks related to mesh insertion or laparoscopic procedures. Conclusions: The Minimal Repair technique is an effective and safe way to treat sportsmen's groin.

Feet dermatophytosis in soccer players.

Purim KS, de Freitas CF, Leite N.: Anais Brasileiros de Dermatologia, 200910 84(5):550-2. Servico de Dermatologia do Hospital de Clinicas da Universidade Federal do Parana (UFPR), Curitiba (PR), Brasil.

Athletes present risk of cutaneous mycosis. A study was carried out with 23 soccer players using clinical and mycological examination (direct microscopic examination and culture) and nail clipping. Eighteen (78.26%) did not present mycosis; two (8.70%) presented tinea pedis, and three (13.04%) presented onychomycosis associated to tinea pedis, mainly for Trichophyton mentagrophytes. Infected tinea pedis has produced cellulitis in one of the athletes. It is necessary to create an educative program of skin care during sports practice.

Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity: findings from NHANES (2003-2006).

Lynch BM, Dunstan DW, Healy GN, Winkler E, Eakin E, Owen N.: Cancer Causes & Control : CCC.:

2010, 21(2):283-8. Cancer Prevention Research Centre, School of Population Health, The University of Queensland, Brisbane, QLD, Australia.

Objective: Obesity and physical inactivity are poor prognostic indicators for breast cancer. Studies to date have relied on self-report measures of physical activity, which tend mainly to assess moderate-to-vigorous intensity leisure-time physical activity. We report the cross-sectional associations of objectively assessed physical activity and sedentary time with adiposity in a sample of breast cancer survivors from the United States. Methods: One hundred and eleven women from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2005-2006 reported a history of breast cancer. Participants wore an accelerometer for 7 days, and activity levels were summarized as moderate-to-vigorous intensity (accelerometer counts/min > or =1,952), light intensity (counts/min 100-1,951), and sedentary time (counts/min <100). Anthropometric measures were taken by study staff at examination centers. Results: Participants spent the majority of their day in sedentary time (66%) or in light intensity activities (33%). Log moderate-to-vigorous intensity physical activity was negatively associated with adiposity (waist circumference beta = -9.805 [95% CI: -15.836, -3.775]; BMI beta = -3.576 [95% CI: -6.687, -0.464]). Light intensity physical activity was negatively associated with adiposity; however, the fully adjusted models did not retain statistical significance. Similarly, sedentary time was positively associated with adiposity, but the fully adjusted models were not statistically significant. Conclusions: This is the first study to describe the objectively assessed physical activity and sedentary time of breast cancer survivors. Increasing moderate-to-vigorous and light intensity physical activity, and decreasing sedentary time, may assist with weight management and improve other metabolic health outcomes for breast cancer survivors.

Cardiorespiratory fitness, lifestyle factors and cancer risk and mortality in Finnish men.

Laukkanen JA, Pukkala E, Rauramaa R, Mäkikallio TH, Toriola AT, Kurl S.: European Journal of Cancer, 2010, 46(2):355-63. Research Institute of Public Health, School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland.

Background: Physical fitness along with lifestyle factors may have important roles in the prevention of cancer. We examined the relationship between common lifestyle factors such as energy expenditure, physical activity and maximal oxygen uptake (VO₂max)), nutrition and smoking habits and the risk of cancer. Methods: A population-based cohort study was carried out in 2268 men from Eastern Finland with no history of cancer. They were followed up for an average of 16.7 years. The outcome measures were cancer incidence (n=387) and cancer mortality (n=159). Results: Men with VO(2max) of more than 33.2 mL/kg/min (highest tertile) had 27% (95% confidence interval (CI) 0.56-0.97) decreased cancer incidence and 37% (95% CI 0.40-0.97) reduced cancer mortality than men with VO(2max) of less than 26.9 mL/kg/min (lowest tertile) after adjustment for age, examination year, alcohol, smoking, socioeconomic status, waist-to-hip ratio and energy, fibre and fat intake. The risk reduction was mainly due to decreased risk of lung cancer in fit men. The adjusted risk of cancer was 0.73 (95% CI 0.55-0.98) among fit (VO₂max)> or =26.9 mL/kg/min) men with the total energy expenditure of physical activity over 2500 kcal/week. A total of 290 active (energy expenditure >2500 kcal and at least 2h of physical activity per week) men with a favourable lifestyle (good fitness, balanced diet and non-smoking) had an adjusted relative risk of 0.63 (95% CI 0.46-0.87) for cancer. Conclusion: Favourable lifestyle including good cardiorespiratory fitness and healthy dietary habits with active and non-smoking lifestyle considerably reduces the risk of cancer.

Perceived functional disabilities among rheumatoid arthritis patients.

Tuominen R, Tuominen S, Suominen C, Möttönen T, Azbel M, Hemmilä J.: Rheumatology International

2010, 30(5):643-9. Department of Public Health, University of Turku, 20014, Turku, Finland.

The aim of this study was to determine from patient perspective the most relevant physical functions when estimating the functional disabilities, and to estimate the perceived relative influence of them. Structured telephone interviews were conducted among 143 RA patients. The subjects were asked to name functions and activities in their everyday life, which were affected by RA. After this, they were asked to score each of the named item with a scale from 0 to 100. These were combined with earlier collected data on sociodemographic background and clinical status. Listed activities were grouped to functional disabilities and further categorized according to joints, limbs and body areas. One or more functional disabilities affecting everyday life because of RA was mentioned by 87.4%, altogether 354 mentions. The most commonly mentioned disabilities were walking and opening jars. However, the most commonly mentioned disabilities were not those with highest perceived disabilities. Of the 59 different types of disabilities mentioned, 25 were connected with movements of the shoulder, 30 with elbow, 40 with wrist, and 37 with fingers. Movements of the back were involved in 20 mentioned disabilities, hip and knee both in 8, and ankles in 6. Disabilities related to lower extremity functions were considered most disabling. In conclusion, to describe RA patients' functional disability, the measured functions should be those which the patients themselves consider relevant and causing disability. Furthermore, the studied functional measures ought to be weighted according to the relative influence of each function to the patients.

Physical fitness predicts functional tasks in individuals with Down syndrome.

Cowley PM, Ploutz-Snyder LL, Baynard T, Heffernan K, Jae SY, Hsu S, Lee M, Pitetti KH, Reiman MP, Fernhall B.: Medicine and Science in Sports and Exercise, 2010, 42(2):388-93. Department of Exercise Science, Syracuse University, Syracuse, NY 13244, USA.

Individuals with Down syndrome (DS) exhibit reduced strength and aerobic capacity, which may limit their ability to perform functional tasks of daily living. Purpose: This study was conducted to examine the relationship between timed performance on functional tasks of daily living and age, knee isometric strength, and peak aerobic capacity in a group of individuals with DS. Methods: This was a cross-sectional study involving 35 individuals (27 +/- 7.5 yr) with DS. Participants completed an isometric test of knee extensor and flexor strength, an individualized exercise test to measure peak aerobic capacity, and three timed functional tasks of daily living, which included chair rise, gait speed, and stair ascent and descent. Multiple regression analyses were performed to examine the relationship between timed task performance and age, knee isometric strength, and peak aerobic capacity. Results: The multiple regression models explained 11-29% of the variance in timed task performance. Knee extensor strength was the most influential variable in predicting timed task performance (squared semipartial correlation coefficient [sr2] = 0.11-0.20), followed by aerobic capacity (sr2 = 0.10-0.14). Age was not a significant predictor of timed task performance. Conclusion: These findings suggest that physical fitness (defined here as aerobic capacity and knee extensor strength) limits the ability of adults with DS to perform functional tasks of daily living. Randomized controlled trials should be performed to test the probable causal relationship between exercises designed to improve physical fitness and functional tasks of daily living.

Dose-response curve to exercise in hypertensive individuals: analysis of the number of sessions to the hypotensive effect.

Viecili PR, Bündchen DC, Richter CM, Dipp T, Lamberti DB, Pereira AM, Barbosa Lde C, Rubin AC, Barbosa EG, Panigas TF.: Arquivos Brasileiros de Cardiologia, 2009, 92(5):361-7, 378-84, 393-9. Instituto de Cardiologia de Cruz Alta, Universidade de Cruz Alta, Cruz Alta, RS, Brazil.

Background: The effect of exercise on blood pressure (BP) is already known; however, the dose-response curve of the hypotensive effect of exercise in hypertensive individuals is yet to be clarified. Objective: To evaluate the dose-response curve of the number of sessions that are necessary to cause a hypotensive effect in hypertensive individuals. Methods: 88 individuals, aged 58 +/- 11 years, divided in Experimental group (EG), with 48 that participated in a physical exercise program (PEP), which consisted of 40 minutes of aerobic exercises performed 3x/week, for 3 months, at 70% of the VO2max, and muscular exercises at 40% of the maximal voluntary contraction (MVC) and Control Group (CG) with 40 individuals that did not participate in the PEP. The systolic (SAP) and diastolic (DAP) arterial pressures were measured before each of the 36 sessions in the EG and assessed by ambulatory blood pressure monitoring (ABPM) in the CG. Differences in BP, the variation rate (D%) and the maximum hypotensive effect (MHE%) were observed between sessions. The data were expressed as means +/- SD; the t test and correlation were used, with p<0.05 being considered significant. Results: There was no difference regarding BP values in the CG. The EG showed an important decrease of 15 mmHg in SAP and 7 mmHg in DAP, with a large part of this effect occurring as early as the first session and the majority up to the 5th session. There was a strong inverse correlation (R:-0.66) with the number of sessions. Conclusion: An important hypotensive effect was observed from the 1st session on and it was observed that the dose-response curve can be abrupt and decrescent, instead of flat.

Modificado em 23 de Maio de 2010, Domingo

Efficacy of home-based exercise programmes for people with chronic heart failure: a meta-analysis.

Hwang R, Marwick T.: European Journal of Cardiovascular Prevention and Rehabilitation, 2009, 16(5):527-35. Princess Alexandra Hospital, Brisbane, Queensland, Australia

Home-based programmes may offer an alternative to conventional programmes or as a means of maintaining physical fitness after graduating from centre-based programmes. We sought to examine the effectiveness of home-based exercise programmes on exercise capacity in patients with heart failure compared with usual medical care. Electronic databases were searched to identify randomized controlled trials. Protocols included an initial period of centre-based exercise followed by exercise at home, home-based exercise only and concurrent centre and home-based exercise. Outcome measures included peak oxygen consumption, exercise duration and the six-minute walk test. Nineteen relevant studies were identified for review. The mean improvement in peak oxygen consumption was 2.86 ml/kg per min [95% confidence interval (CI): 1.43-4.29]. Exercise duration increased by 1.94 min (95% CI: 0.89-2.98) and distance on the six-minute walk test was increased by 30.41 m (95% CI: 6.13-54.68). Other reported benefits of home-based programmes include increased quality of life and lowered hospital admission rates. In conclusion, home-based exercise programmes have been shown to benefit people with heart failure in the short term. Further research is required to investigate the long-term effects of home exercise and to determine the optimal strategies for improving exercise adherence in patients with heart failure.

Does the use of TENS increase the effectiveness of exercise for improving walking after stroke? A randomized controlled clinical trial.

Ng SS, Hui-Chan CW.: Clinical Rehabilitation, 2009, 23(12):1093-10 . Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.

Objective: To investigate whether surface electrical stimulation can increase the effectiveness of task-related exercises for improving the walking capacity of patients with chronic stroke. Design: Randomized, placebo-controlled clinical trial. Setting: Home-based programme. Subjects: One hundred and nine hemiparetic stroke survivors were assigned randomly to: (1) transcutaneous electrical nerve stimulation (TENS), (2) TENS + exercise, (3) placebo stimulation + exercise, or (4) control group. Interventions: The TENS group received 60 minutes of electrical stimulation. Both the TENS + exercise group and placebo stimulation + exercise group did 60 minutes of exercises, followed respectively by 60 minutes of electrical and placebo stimulation. Treatment was given five days a week for four weeks. The control group had no active treatment. Outcome measures: Comfortable gait speed was measured using a GAITRite II walkway system. Walking endurance and functional mobility were measured by the distance covered during a 6-minute walk test (6MWT) and by timed up and go test scores before treatment, after two weeks and after four weeks of treatment, and at follow-up four weeks after treatment ended. Results: When compared with the other three groups, only the combined TENS + exercise group showed significantly greater absolute and percentage increases in gait velocity (by 37.1-57.5%, all P<0.01) and reduction in timed up and go scores (by -14.9 to -23.3%, P<0.01) from week 2 onwards. When compared with the control and TENS groups, only the combined TENS + exercise group covered significantly more distance in the 6MWT (by 22.2-34.7%, P<0.01) from week 2 onwards. Conclusion: TENS can improve the effectiveness of task-related exercise for increasing walking capacity in hemiparetic stroke survivors.

Can strength training predictably improve gait kinematics? A pilot study on the effects of hip and knee extensor strengthening on lower-extremity alignment in cerebral palsy.

Damiano DL, Arnold AS, Steele KM, Delp SL.: Physical Therapy, 2010, 90(2):269-79. Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, NIH Clinical Center, Bldg 10, Room 1-1469, Bethesda, MD 20892, USA.

Background: Computer simulations have demonstrated that excessive hip and knee flexion during gait, as frequently seen in ambulatory children with cerebral palsy (CP), can reduce the ability of muscles to provide antigravity support and increase the tendency of hip muscles to internally rotate the thigh. These findings suggest that therapies for improving upright posture during gait also may reduce excessive internal rotation. Objective: The goal of this study was to determine whether strength training can diminish the degree of crouched, internally rotated gait in children with spastic diplegic CP. Design: This was a pilot prospective clinical trial. Methods: Eight children with CP participated in an 8-week progressive resistance exercise program, with 3-dimensional gait analysis and isokinetic testing performed before and after the program. Secondary measures included passive range of motion, the Ashworth Scale, and the PedsQL CP Module. To identify factors that may have influenced outcome, individual and subgroup data were examined for patterns of change within and across variables. Results: Strength (force-generating capacity) increased significantly in the left hip extensors, with smaller, nonsignificant mean increases in the other 3 extensor muscle groups, yet kinematic and functional outcomes were inconsistent. The first reported subject-specific computer simulations of crouch gait were created for one child who showed substantial benefit to examine the factors that may have contributed to this outcome. Limitations: The sample was small, with wide variability in outcomes. Conclusions: Strength training may improve walking function and alignment in some patients for whom weakness is a major contributor to their gait deficits. However, in other patients, it may produce no change or even undesired outcomes. Given the variability of outcomes in this and other strengthening studies in CP, analytical approaches to determine the sources of variability are needed to better identify those individuals who are most likely to benefit from strengthening.

Participation and risk-taking behaviour in sports in children with haemophilia.

Köiter J, van Genderen FR, Brons PP, Nijhuis-van der Sanden MW.: Haemophilia, 2009, 15(3):686-94. Department of Paediatric Physiotherapy, Radboud University Nijmegen Medical Centre, and Research Centre for Allied Health Care, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands. The aim of this study was to investigate participation in sports activities and risk-taking behaviour in children with haemophilia and the relationship to personal and health related factors. Ninety-nine children (mean age 12.6 years) completed questionnaires regarding participation in sports and physical education, medication, health related quality of life, and perceived motor competence. Furthermore, weight, height, active range of motion, pain, and muscle strength were assessed. Based on a risk exposure factor (REF) we defined subgroups with low, medium, and high risk when participating in sport. Most children participate in sport five times a week (mean 140 min per week), and little absence during school sports was reported. In general, prophylaxis was not tailored to sport activities. Boys with haemophilia preferred other sports than their Dutch contemporaries. The top-5 being soccer, swimming, tennis, gymnastics, and cardio-fitness for the former; soccer, gymnastics, tennis, hockey, and swimming for the latter. Significant differences between the low risk group and both other groups were found for sport intensity, total energy expenditure (EE) and average risk factor (ARF), however the medium and high-risk groups did not differ in ARF. REF and sport participation increased associated with increasing interest in athletic and motor activities. No significant differences were found between REF groups regarding age, Z-BMI, Z-AROM, Z-Muscle force, and the presence of painful joints. As in normal peers motivation to participate in sport depends upon the enthusiasm and interest, in children with haemophilia choice of sports differs, probably related to sport advice.

Physical activity participation and bleeding characteristics in young patients with severe haemophilia.

Tiktinsky R, Kenet G, Dvir Z, Falk B, Heim M, Martinowitz U, Katz-Leurer M.: Haemophilia, 2009, 15(3):695-700. Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel.

Patients with haemophilia are now widely advised to participate in sport activities. However, no extensive data are available about their actual participation. The aim of this study was to describe the type; intensity and duration of leisure time physical activity (PA) among young patients with severe hemophilia and to assess whether there are differences in bleeding profile and muscle strength in related to activity intensity. Forty-four boys (ages 12-25 years) with severe haemophilia were studied. PA was assessed by the Godin and Shephard (G&S) questionnaire. Bleeding profile was determined based on a one month diary filled by each patient. Muscle strength of the lower limbs muscles was assessed using a hand held dynamometer. Only three subjects did not perform any PA. Twenty-five of the participants performed strenuous PA at least once a week. An inverse, moderate association (r(p) =-0.45, P < 0.002) was found between the G&S score and age. There were no significant differences in bleeding frequency or pain but a significant difference in the cause of bleed was found: those who exercised strenuously showed a higher proportion of bleeds due to traumatic reasons (P < 0.01). No differences in muscle strength values were noted in related to activity intensity also no linear association was noted between muscle strength and bleeding profile. Further investigation, including prospective studies, is needed in order to assess the temporal sequencing between training and the occurrence of bleeds and bleeds cause.

Sickle cell trait and fatal rhabdomyolysis in football training: a case study.

Anzalone ML, Green VS, Buja M, Sanchez LA, Harrykissoon RI, Eichner ER.: Medicine and Science in Sports and Exercise, 2010, 42(1):3-7. Office of the Medical Examiner of Harris County, Houston, TX, USA.

We report the athletic, the clinical, and the pathological details of a case of fatal rhabdomyolysis during training in a college football player with sickle cell trait (SCT) who collapsed minutes after running 16 successive sprints of 100 yd each. The player, 19 yr old, African American, was apparently healthy when he took the field for the conditioning run. No exertional heat illness was present. After collapsing on-field, the player soon went into coma and developed fulminant rhabdomyolysis, profound lactic acidosis, acute myoglobinuric renal failure, refractory hyperkalemia, and disseminated intravascular coagulation. Despite intensive care in the hospital, he died about 15 h after admission, likely from a hyperkalemic cardiac arrhythmia; the terminal rhythm was pulseless electrical activity. The forensic autopsy confirmed that the cause of death was acute exertional rhabdomyolysis associated with SCT. Counting this case, at least 15 college football players with SCT have died from complications of exertional sickling, as have younger football players and other athletes. In SCT, maximal, sustained exercise evokes four forces that can foster sickling: hypoxemia, acidosis, hyperthermia, and red cell dehydration. The setting, the clinical and laboratory features, and the clinicopathological correlation here suggest that the fulminant rhabdomyolysis and its fatal sequelae were from exertional sickling. These data suggest that screening and simple precautions for SCT may be warranted to prevent tragedies like this and enable all athletes with SCT to thrive in their sports.

Subclinical hyperthyroidism and sport eligibility: an exploratory study on cardiovascular pre-participation screening in subjects treated with levothyroxine for multinodular goiter.

Di Luigi L, Parisi A, Quaranta F, Romanelli F, Tranchita E, Sgrò P, Nardi P, Fattorini G, Cavaliere R, Pigozzi F, D'Armiento M, Lenzi A.: Journal of Endocrinological Investigation, 2009, 32(10):825-31. Unit of Endocrinology, Department of Health Sciences, University of Rome Foro Italico, piazza Lauro de Bosis, 15, 00135, Rome, Italy.

Background: Subclinical hyperthyroidism (sHT) affects cardiovascular (CV) morphology and function; whether such changes can impact on sport eligibility is unclear. AIM: This exploratory study evaluated the CV system and sport eligibility in athletes with levothyroxine-induced sHT, in the setting of mandatory pre-participation screening. Subjects and methods: A full, non-invasive CV screening (history and physical examination, 12-lead ECG, echocardiography, 24-hour Holter ECG, exercise stress test) was performed in two groups of untrained female athletes affected by non-toxic multinodular goiter. One group was taking levothyroxine at mildly suppressive doses (TG) whereas the other was untreated (UG). There was also a group of healthy controls (HC). Results: In TG the following characteristics were observed: a) a higher resting heart rate (HR; p<0.01 and p<0.05, vs HC and UG respectively), b) a thicker left ventricular posterior wall (p<0.05 vs HC, and p<0.05 vs HC and UG, respectively), c) a higher mean HR during the 24-hour Holter ECG (p<0.01 and p<0.05, vs HC and UG respectively), and d) a lower achieved maximum work load (p<0.05, vs HC). No differences in the prevalence of cardiac arrhythmias among groups were observed. Sport eligibility was granted to all except one subject in the TG. Concusions: Although some alterations were found in athletes with levothyroxine-induced mild sHT, these are probably of limited clinical relevance and they did not contraindicate sport participation in the majority of cases. Future research to address both health risks and the need for specific evaluations (e.g. free thyroxine, TSH, echocardiography) during the preparticipation screening of athletes with sHT is warranted.

Effect of progressive resistance training on muscle performance after chronic stroke.

Lee MJ, Kilbreath SL, Singh MF, Zeman B, Davis GM.: Medicine and Science in Sports and Exercise, 2010 42(1):23-34. Faculty of Health Sciences, The University of Sydney, Sydney, Australia.

Purpose: This study investigated the effects of high-intensity progressive resistance training (PRT) and high-intensity cycling (cycling) on muscle performance and the time course of strength gains in a chronic stroke population. Metods: Forty-eight individuals with chronic stroke sequelae (mean +/- SD; age = 63 +/- 9 yr, time since stroke = 57 +/- 54 months) were randomly allocated to one of four treatment groups: PRT + cycling, PRT + sham cycling, sham PRT + cycling, or sham PRT + sham cycling groups in a fully factorial clinical trial. Thirty exercise sessions were conducted over a 10- to 12-wk period. The main outcomes investigated were measures of unilateral muscle strength, peak power, and muscle endurance. Results: Those undergoing PRT improved their lower limb muscle strength, peak power, and endurance compared with participants receiving sham PRT or cycling only (P < 0.05), and combined exercise was not superior to PRT alone. Strength improvements occurred primarily during the first 6 to 8 wk (98%-100% of total gain) and then reached a plateau during the final 2 to 4 wk. Conclusion: We have shown for the first time in a direct comparison study that high-intensity PRT, but not cycling or sham exercise, can improve muscle strength, peak power, and muscle endurance in both affected and unaffected lower limbs after chronic stroke by a significant and clinically meaningful amount. Although strength gains plateaued earlier than anticipated, adherence to the intended continuous high-intensity progressive overload protocol was largely achieved (average load of 84% +/- 4% of one repetition maximum).