Exercício físico de baixa intensidade na dpoc: comparação dos programas solo e aquático

Physical Exercise (PE) is a necessary component in the management in COPD patients, where respiratory symptoms are associated with reduced functional capacity. Even with the increase in the number of studies that have been published and the therapeutics success using aquatic therapy approach, studies using PE in water in COPD patients are so few. Objective: the aim of this present study was to analyze the effects of low intensity water exercise in COPD patients, developed in two different places aquatic and ground. Methods: This is a randomized clinical trial study, 42 patients with moderate to very severe DPOC were recruited for the study, mean age of 63,2  10,9 years old. Randomized in 3 groups: Control Group (CG), Land Group (LG) and Water Group (WG). The PE protocol was performed in a period of 8 weeks, with frequency of 3 times per week. The CG participated in an educational program. All the patients were assessed twice through spirometry, respiratory muscular strength, the 6-min walk test, the quality of life (SF-36 and SGRQ), the LCADL, the MRC, the BODE index and the upper limbs (UP) incremental test. Results: There was a significant difference after the approaches in DP6 from the WG (p=0,02); in VEF1 in LG (p=0,00) and WG (p=0,01); in MIP in LG (p=0,01) and WG (p=0,02); in MEP in LG (p=0,02) and WG (p=0,01); the MRC decreases in WG (p=0,00). there was an increase of the weight supported by the UP in LG (p=0,00) and WG (p=0,01). The LG showed an increase of the quality of life represented by the SGRQ total score (p=0,00). The BODE index decreased in LG (p=0,00) and WG (p=0,01). In LCDAL, the LG showed a decrease. Conclusion: This data in this present study suggest that both approaches of low intensity exercise showed to be beneficial in moderate to very severe COPD patients. The WG showed additional benefits in physical function, pointing to a new therapeutic modality for COPD patients

Tradução, adaptação cultural e propriedades psicométricas da versão brasileira do Short-Form of the Mobility Assessment Tool (MAT-sf)

Objectives: to translate and assess the psychometric properties of the Brazilian short-form of the Mobility Assessment Tool (MAT-sf) in Brazilians community elderly. Methds: the 12 items MAT-sf went through the process of translation and back translation into Portuguese of the Brazil, considering the semantic and cultural adaptation. In a sample of 150 aged 65-74 years living in the community, the instrument's psychometric properties were evaluated by analysis of convergent and construct validity and test-retest reliability. The main outcomes measures used for validation included in the battery of tests of physical ability, self-repor measures of functional limitations, health, depression, cognitive and sex. The test-retest reliability of the instrument was assessed using the intra-class correlation coefficient (ICC), 40 subjects were reassessed after an interval of 14 days of assessment. Results: the concurrent validity for the MAT-sf was evidenced by significant correlations with SPPB (r = 0,53), number of functional limitations (r = -0,62) and depressive symptoms (r = -0,45). The construct validity of the instrument was measured by gradual and significant increase of the MAT-sf scores with high levels of physical performance and with positive self-reported health, also found that MAT-sf scores were statistically differents according to sex. The variation in MAT-sf scores (R2 = 0,41) was explained by SPPB, number of limitations for activities of daily life and depressive symptoms. High values for test-retest reliability was evidencend by ICC = 0,94, 95% CI = 0,90 0,97. Conclusions: the Brazilian version of the short-form of the Mobility Assessment Tool has values of validity and reliability to ensure its use in elderly populations living in communities

Avaliação das variáveis cardiovasculares, capacidade de caminhar e nível de atividade física de obesos mórbidos antes e depois da cirurgia bariátrica

Morbidly obese patients present an increase in heart rate, blood pressure and perceived exertion besides lower walking ability compared to normal weight people. However, little is known about how these variables are presented after bariatric surgery. Moreover, despite the distance walked during the six-minute walk (6MWT) improve after surgery is not well established if the level of physical activity influences this improvement. Objective: To evaluate cardiovascular performance, perceived effort, ability of walking and physical activity level of patients with morbid obesity before and after bariatric surgery. Methods: The cardiovascular performance, perception of effort, the ability to walk and level of physical activity were assessed in 22 patients before (BMI = 50.4 kg/m2) and after (BMI = 34.8 kg/m2) bariatric surgery through the 6MWT. The heart rate, blood pressure and perceived exertion were assessed at rest, at the end of the 6MWT and in the second minute post-test (HR recovery). The ability to walk was measured by total distance walked at the end of the test while the level of physical activity was estimated by applying the Baecke questionnaire, analyzing domains occupation, leisure and locomotion and leisure and physical activity. Results: The HR at rest and recovery decreased significantly (91.2 ± 15.8 bpm vs. 71.9 ± 9.8 bpm, 99.5 ± 15.3 bpm vs 82.5 ± 11.1 bpm, respectively), as well as all the arterial pressure and perceived exertion after surgery. The distance achieved by the patients increased by 58.4 m (p = 0.001) postoperatively. Time postoperatively had correlation with the percentage of excess weight lost (r = 0.48, p = 0.02), BMI (r =- 0.68, p = 0.001) and the Baecke (r = 0.52, p = 0.01) which did not happen with the distance walked (r = 0.37, p = 0.09). Despite weight loss, patients showed no difference in the level of physical activity in any of the areas before and after surgery. Conclusion: The cardiovascular performance, the perception of effort and ability to walk seem to improve after bariatric surgery. However, despite improvement in the ability to walk by the distance achieved in the 6MWT after weight loss, this is not reflected in an increase in physical activity level of obese patients after surgery

A importância da atividade física regular como estratégia complementar na promoção de resiliência de idosas e sua importância para suas vidas

O conceito de saúde, na concepção mais abrangente, é uma condição multidimensional de bem-estar físico, psicológico e social e não apenas a inexistência de enfermidades. Os benefícios da atividade física são tão relevantes quanto os benefícios psicológicos, porque ambos contribuem para a saúde. A literatura aponta um conjunto de ligações diretas e indiretas entre a atividade física e a qualidade de vida. Apesar destes benefícios, o processo de envelhecimento é caracterizado por grandes perdas biopsicossociais, que geram várias situações de adversidades que causam preocupação e podem colocar em risco a saúde do idoso. Deste modo, surge a resiliência como um conjunto de processos sociais e intrapsíquicos, que possibilitam o desenvolvimento saudável do idoso, mesmo diante de experiências negativas. Nesta direção, observou-se a necessidade de executar uma pesquisa de conhecimento multidisciplinar conciliando a Educação Física com a Psicologia, a Medicina, a Terapia Ocupacional e a Gerontologia, com o objetivo de investigar o efeito da atividade física sobre os níveis de resiliência em mulheres idosas, bem como conhecer a importância desta atividade para suas vidas. Para tanto, realizou-se um estudo comparativo descritivo, de caráter transversal. Assim sendo, 230 mulheres idosas foram divididas em dois grupos: ativas (n=115; 65,8±5,8 anos de idade), constituído por idosas matriculadas em um programa de atividade física orientada para idosos com período de prática igual ou superior a dois anos, e sedentárias (n=115; 69,2±7,2 anos de idade). Em seguida, foram submetidas à avaliação do nível de resiliência psicológica e da aptidão física (resistência muscular de membros superiores e inferiores, flexibilidade e resistência aeróbia). As idosas ativas apresentaram valores significativamente (p=0,001) maiores do fator 3 da resiliência psicológica quando comparados àqueles do grupo de idosas sedentárias, o qual está relacionado à autoconfiança e à capacidade de adaptação a situações diversas. Não foram observadas diferenças significativas (p>0,05) entre os grupos para os demais fatores (1 e 2). Quando comparados os testes de aptidão física com o nível de resiliência psicológica moderada (n=28) e alta (n=202) do fator 3, observou- se que idosas com nível de resiliência psicológica alta apresentaram maior flexibilidade (p=0,004). E para a avaliação da percepção da importância da atividade física para as idosas foi aplicado um questionário semiestruturado. A partir da Análise de Conteúdo proposto por Bardin (2009) os resultados foram: saúde/prevenção (85%), interação (47%), autonomia (40%), alegria/felicidade (33%), resiliência (33%), lazer (15%). E para avaliar a resiliência utilizou-se a Escala de resiliência de Wagnild e Young (1993). Quanto aos níveis de resiliência os resultados demonstraram que todas idosas apresentaram alto nível. Considerando os achados do presente estudo, sugere-se o emprego da atividade física como método de intervenção para melhora da saúde mental e, por conseguinte, da resiliência psicológica na população em questão, uma vez que os resultados apontam que idosas fisicamente ativas apresentam escores de resiliência psicológica superiores àquelas estratificadas como sedentárias. O resultado desse estudo possibilitou também concluir que a importância da atividade física parece estar relacionada, na sua maioria, às características de saúde/prevenção, interação social, autonomia, resiliência, alegria/felicidade e lazer. Além disso, as mulheres do presente estudo apresentaram um alto nível de resiliência quando comparado à tabela normativa

Força muscular respiratória e capacidade funcional em idosas hipertensas com sonolência diurna excessiva

The restriction of physical fitness is directly related with hypertension and sleep disorders, while the respiratory muscle strength is associated with hypertension, but the literature is scarce regarding its relationship with sleep disorders and particularly with excessive daytime sleepiness. Objectives: To compare physical fitness and strength of respiratory muscles between people with hypertension with excessive daytime sleepiness (EDS) and non EDS people, those who do not feel excessive daytime sleepiness, in addition to relate aerobics resistance and functional mobility of patients. Methods: An observational, analytical and transversal study, evaluated 32 elderly with hypertension, divided into two groups (EDS and non EDS), in which the following topics were measured; respiratory muscular strength, functional fitness, level of physical activity, level of excessive daytime sleepiness, quality of sleep and intensity of the patients snoring. Results: There was a significant difference in the level of EDS (P=0,00) and quality of sleep (p=0,03), however, the data related to snoring intensity (p=0,18), maximum inspiratory pressure PImax (p=0,39) and maximum expiratory pressure PEmax (p=0,98) did not show any difference. Also, no significant difference was observed concerning physical fitness, presenting p=0,08 for the sitting and getting up test on the chair in 30 ; p=0,54 for the extension and flexing of the elbow test in 30 ; p=0,38 for the walking test 6 ; p=0,38 for the parking gear test 2 , p=0,08 for the sitting and reaching test; p=0,42 for the scratching the back test; p=0,49 for the getting up and walking test; and p=0,62 for the global rate of activity limitation. There was moderate positive correlation between 6MWT and 2MST, r=0,54 (p=0,01) and negative moderate correlation between 6MWT and TUG, r=-0,61 (p=0,000) and between 2MST and TUG, r=-0,60 (p=0,000). Conclusion: The presence of EDS in the hypertension people studied, showed a bad quality of sleep, however this sleepiness did not influence the strength of the respiratory muscles. The physical fitness came out diminished in all hypertension people, regardless of the presence or non presence of sleep disturbance; and there is a close relationship between cardiovascular resistance and physical mobility, since when there is less cardiovascular resistance, there is precarious physical mobility and vice-versa

Avaliação da capacidade de caminhar do portador de obesidade mórbida utilizando teste de caminhada de 6 minutos

Introduction: The ability to walk is impaired in obese by anthropometric factors (BMI and height), musculoskeletal pain and level of inactivity. Little is known about the influence of body adiposity and the acute response of the cardiovascular system during whole the 6-minute walk test (6mWT). Objective: To evaluate the effect of anthropometric measures (BMI and WHR waist-to-hip ratio), the effort heart and inactivity in ability to walk the morbidly obese. Materials and Methods: a total 36 morbidly obese (36.23 + 11.82 years old, BMI 49.16 kg/m2) were recruited from outpatient department of treatment of obesity and bariatric surgery in University Hospital Onofre Lopes and anthropometric measurements of obesity (BMI and WHR), pulmonary function, pattern habitual physical activity (Baecke Questionnaire) and walking capacity (6mWT). The patient was checking to measure: heart rate (HR), breathing frequency (BF), peripheral oxygen saturation, level of perceived exertion, systemic arterial pressure and duplo-produto (DP), moreover the average speed development and total distance walking. The data were analysed between gender and pattern of body adiposity, measuring the behavior minute by minute of walking. The Pearson and Spearmam correlation coefficients were calculated, and stepwise multiple Regression examined the predictors of walking capacity. All analyses were performed en software Statistic 6.0. Results: 20 obese patients had abdominal adiposity (WHR = 1.01), waist circumference was 135.8 cm in women (25) and 139.8 cm in men (10). Walked to the end of 6mWT 412.43 m, with no differences between gender and adiposity. The total distance walked by obesity alone was explained by BMI (45%), HR in the sixth minute (43%), the Baecke (24%) and fatigue (-23%). 88.6% of obese (31) performed the test above 60% of maximal HR, while the peak HR achieved at 5-minute of 6mWT. Systemic arterial pressure and DP rised after walking, but with no differences between gender and adiposity. Conclusion: The walk of obese didn´t suffers influence of gender or the pattern of body adiposity. The final distance walked is attributed to excess body weight, stress heart, the feeling of effort required by physical activity and level of sedentary to obese. With a minute of walking, the obeses achieved a range of intensity cardiovascular trainning

Concepções de mulheres com deficiência física sobre a maternidade

The study aimed to understand the concept of women with physical disabilities about their ability to gestate, give birth or care a child. This is an exploratory, descriptive study with qualitative approach developed in three non-governmental organizations in Natal, Rio Grande do Norte, Brazil. The data collection occurred in the period from April to June, 2014, through semi-structured interviews, using a script composed by sociodemographic questions and a guiding one. It was obtained a priori the permission from the association’s directors, the approval from the Research Ethics Committee, of the Federal University of Rio Grande do Norte, CAAE nº 27442814.7.0000.5537 and the assent n° 618.045, as well as the participant’s formal authorization by signing the Informed Consent Statement. Participated in the study 12 women, selected according to the following inclusion criteria: to have physical disability, to be aged 18 to 49 years old, and to affirm the existence of limiting characteristics from early childhood (0-3 years). The information obtained in the interviews were subjected to the precepts of Content Analysis according to Bardin, under the thematic analysis technique. From this process, three categories emerged: Conceiving motherhood in front of disability; Conceiving the capacity to be mother with disability; and Conceiving the support during pregnancy and puerperium period. As the theoretical framework we adopted the principles of symbolic interactionism proposed by Blumer. The discussion was supported by literature findings on women's health care in the context of reproduction. The interviewees conceive motherhood as an accomplishment and believe in their own ability to gestate, give birth and care a child. However, the desire for the maternal role tends to be influenced by adverse feelings and limitations raised by disability, social barriers and prejudices. They also referred the importance of support from partner, family and health professionals in the care of child. Upon these findings, it is understood that although there are barriers to the realization of their desire, these barriers were not enough to make them give up on becoming a mother. Therefore, it is necessary that health professionals, highlighted the nurse, be trained to care for women with disabilities in the context of reproductive health care in order to offer adequate support to their needs