[Manifestation and course of coronary heart disease in men and women--consequences for diagnosis and treatment]

Gender related issues in manifestation, diagnosis and treatment of coronary artery disease are important but still not well recognized. Women are more likely to present late after first symptoms of myocardial infarction. Myocardial infarction is more often unrecognized. In regard to complications after myocardial infarctions ventricular tachycardia and cardiac arrest are more frequent and women are also more likely to develop heart failure or cardiogenic shock. The reason for this is most probably the fact that women presenting with myocardial infarction are of older age and have a higher incidence of co-morbidities. Thrombolysis and coronary angioplasty are less often performed in women in the setting of myocardial infarction. However there is a clear trend toward improvement of this situation during the last years. The reopening rate of occluded coronary arteries with thrombolysis and with coronary angioplasty is similar in women compared to men. Perioperative risk with aorto-coronary bypass surgery is higher in women, which can not be fully explained by higher age and co-morbidities. However 10 years survival rate after aorto-coronary bypass-surgery is similar for men and women, although occlusion of venous grafts is seen more often in women. The benefit of structured cardiac rehabilitation after an acute event is similar for younger and older women and as good as in men. Positive effects of cardiac rehabilitation include increased physical performance, reduction of body fat, improvement of lipid-profiles and an improvement of the psychosocial situation and quality of life.

Intermediate results of health related quality of life after vertical banded gastroplasty

OBJECTIVES: The purpose of this study is to evaluate (a) health-related quality of life (HRQL) after vertical banded gastroplasty (VBG) (Mason) and (b) predictors of HRQL. SUBJECTS: Eighty-two consecutive patients were assessed preoperatively and then after 6, 12 and 24 months. Patients filled out questionnaires for subjective appraisal of HRQL (physical well-being, mood, physical performance, perceived health, social support and coping/adjustment). RESULTS: The greatest improvement in weight and HRQL was seen within 6 months of surgery. Twenty-four months after VBG weight reduction (P<0.05), perceived health (P<0.05), physical well-being (P<0.05), physical performance (P<0.05), mood (P<0.05), coping/adjustment (P<0.05) continued to be better than before surgery. Preoperative binge eating was the most important predictor of HRQL. CONCLUSION: Two years after VBG weight loss and a significant improvement of HRQL can be found. HRQL and weight loss are not associated in terms of outcome, indicating that weight loss alone may not be enough to improve HRQL.

The relationship between pain intensity and severity and depression in older people: exploratory study

BACKGROUND: Pain and depression are known to be associated in later life, and both have a negative effect on physical performance both separately and in combination. The nature of the relationships between pain intensity and depression in elderly persons experiencing pain is less clear. The objectives of this study were to explore which factors are associated with depressed mood in older people experiencing pain, and to test the hypothesis that older people experiencing pain are at risk of depressed mood according to the severity or frequency of their pain. In addition we explored whether other potentially modifiable factors might increase the risk of depressed mood in these persons. METHODS: The study is a secondary analysis of baseline data for four hundred and six community-dwelling non-disabled people aged 65 and over registered with three group practices in suburban London who had experienced pain in the past 4 weeks. Intensity and frequency of pain was measured using 24 item Geriatric Pain Measure (GPM) and the presence of depressive symptoms using the 5 item Mental Health Inventory. Risk for social isolation was measured using the 6 item Lubben Social Network scale and instrumental activities of daily living (IADL) were also measured. RESULTS: Overall 76 (19%) had depressed mood. Pain frequency and severity were not statistically significantly associated with depressed mood in this population. In multivariate analyses, significant predictors of the presence of depressive symptoms were difficulties with basic ADLs (OR 2.8, 95% CI 1.1.7.8), risk for social isolation (OR 4.1, 95% CI 1.8-9.3), and basic education only (OR 2.2, 95% CI 1.1-4.4). CONCLUSION: Older people experiencing pain are also likely to experience depression. Among those experiencing pain, social network and functional status seem to be more important predictors of depressive symptoms than the severity of pain. Further studies should evaluate whether improvement of social network and functional status might reduce depressive symptoms in older patients.

Frailty and risk for heart failure in older adults: the health, aging, and body composition study

OBJECTIVE The aim of this study was to assess the association between frailty and risk for heart failure (HF) in older adults. BACKGROUND Frailty is common in the elderly and is associated with adverse health outcomes. Impact of frailty on HF risk is not known. METHODS We assessed the association between frailty, using the Health ABC Short Physical Performance Battery (HABC Battery) and the Gill index, and incident HF in 2825 participants aged 70 to 79 years. RESULTS Mean age of participants was 74 ± 3 years; 48% were men and 59% were white. During a median follow up of 11.4 (7.1-11.7) years, 466 participants developed HF. Compared to non-frail participants, moderate (HR 1.36, 95% CI 1.08-1.71) and severe frailty (HR 1.88, 95% CI 1.02-3.47) by Gill index was associated with a higher risk for HF. HABC Battery score was linearly associated with HF risk after adjusting for the Health ABC HF Model (HR 1.24, 95% CI 1.13-1.36 per SD decrease in score) and remained significant when controlled for death as a competing risk (HR 1.30; 95% CI 1.00-1.55). Results were comparable across age, sex, and race, and in sub-groups based on diabetes mellitus or cardiovascular disease at baseline. Addition of HABC Battery scores to the Health ABC HF Risk Model improved discrimination (change in C-index, 0.014; 95% CI 0.018-0.010) and appropriately reclassified 13.4% (net-reclassification-improvement 0.073, 95% CI 0.021-0.125; P = .006) of participants (8.3% who developed HF and 5.1% who did not). CONCLUSIONS Frailty is independently associated with risk of HF in older adults.

[Health Status of Young Men in Switzerland: Monitoring Results from Conscription].

Abstract Due to their representativeness and consistent measurement standards the medical und sports data of the Swiss conscripts provide a valuable basis for a continuous health monitoring of young Swiss men. During three to four years, the prevalence of overweight and obesity seems to stabilise on a high level. After a longer period of decreasing performance at the endurance test between the 1980s and 2002, the level of physical performance in the fitness test does no longer decrease since 2006. However, health and health behaviour show significant regional and socioeconomic inequalities among young Swiss men. Besides economic resources and education, major driving factors behind these inequalities can be identified in health knowledge, values, and attitudes.

Percepción de la educación física en docentes universitarios

El objetivo del trabajo es conocer la percepción epistemológica de docentes universitarios sobre la educación física, para contrastar esta postura contra la literatura actual y las necesidades para esta asignatura. La metodología se realizó desde una revisión sobre las reformas, normas/estándares, políticas y premisas de educación física, para la construcción de una encuesta como instrumento de medición, se encuestaron a 41 docentes que imparten clases en un programa de Licenciatura en Educación Física. Resultados: La confiabilidad del instrumento muestra un Alfa de Conbrach (.611), un 64.3 de los docentes opinan que es muy importante el dominio de habilidades motoras y formas de movimiento necesarias, para participar en una gran variedad de actividades físicas; un 54.8 considera muy importante la evaluación de los componentes de la condición física, para mejorar el rendimiento físico y la salud; un 45.2 considera muy importante la participación regular en una gran variedad de actividades físicas. Conclusiones: la percepción epistemológica de los docentes encuestados no es totalmente consistente con la postura epistemológica que se plantea a nivel internacional, por lo que se debería trabajar en la formación y actualización del docente universitario para tener una postura epistemológica adecuada hacia la educación física actual

Percepción de la educación física en docentes universitarios

El objetivo del trabajo es conocer la percepción epistemológica de docentes universitarios sobre la educación física, para contrastar esta postura contra la literatura actual y las necesidades para esta asignatura. La metodología se realizó desde una revisión sobre las reformas, normas/estándares, políticas y premisas de educación física, para la construcción de una encuesta como instrumento de medición, se encuestaron a 41 docentes que imparten clases en un programa de Licenciatura en Educación Física. Resultados: La confiabilidad del instrumento muestra un Alfa de Conbrach (.611), un 64.3 de los docentes opinan que es muy importante el dominio de habilidades motoras y formas de movimiento necesarias, para participar en una gran variedad de actividades físicas; un 54.8 considera muy importante la evaluación de los componentes de la condición física, para mejorar el rendimiento físico y la salud; un 45.2 considera muy importante la participación regular en una gran variedad de actividades físicas. Conclusiones: la percepción epistemológica de los docentes encuestados no es totalmente consistente con la postura epistemológica que se plantea a nivel internacional, por lo que se debería trabajar en la formación y actualización del docente universitario para tener una postura epistemológica adecuada hacia la educación física actual

Percepción de la educación física en docentes universitarios

El objetivo del trabajo es conocer la percepción epistemológica de docentes universitarios sobre la educación física, para contrastar esta postura contra la literatura actual y las necesidades para esta asignatura. La metodología se realizó desde una revisión sobre las reformas, normas/estándares, políticas y premisas de educación física, para la construcción de una encuesta como instrumento de medición, se encuestaron a 41 docentes que imparten clases en un programa de Licenciatura en Educación Física. Resultados: La confiabilidad del instrumento muestra un Alfa de Conbrach (.611), un 64.3 de los docentes opinan que es muy importante el dominio de habilidades motoras y formas de movimiento necesarias, para participar en una gran variedad de actividades físicas; un 54.8 considera muy importante la evaluación de los componentes de la condición física, para mejorar el rendimiento físico y la salud; un 45.2 considera muy importante la participación regular en una gran variedad de actividades físicas. Conclusiones: la percepción epistemológica de los docentes encuestados no es totalmente consistente con la postura epistemológica que se plantea a nivel internacional, por lo que se debería trabajar en la formación y actualización del docente universitario para tener una postura epistemológica adecuada hacia la educación física actual

Análisis biomecánico zancada a zancada de la prueba "60 metros vallas" durante los campeonatos del mundo y de España de pista cubierta Valencia 2008

El principal objetivo del presente trabajo de investigación fue determinar las diferencias en distintas variables relacionadas con el rendimiento físico entre atletas de distinto nivel durante la prueba de los 60 metros vallas. Un total de 59 vallistas masculinos (los 31 participantes en el Campeonato del Mundo Absoluto de Pista Cubierta y los 28 participantes en el Campeonato de España Absoluto de Pista Cubierta, ambos celebrados en Valencia en el año 2008) formaron la muestra del estudio. El análisis biomecánico se realizó mediante un sistema fotogramétrico en dos dimensiones que permitió calcular, aplicando algoritmos basados en el procedimiento de la DLT (Abdel-Aziz y Karara, 1971), las coordenadas (x, y) de los sucesivos apoyos de los pies de los atletas sobre toda la superficie de competición. La filmación de las pruebas se llevó a cabo con seis cámaras de vídeo, ubicadas sobre la gradas, con una frecuencia de muestreo para el tratamiento de los datos de 50 Hz. En la fase de salida, los atletas de nivel superior mostraron una menor longitud (p<0,05) y tiempo de zancada (p<0,001), debido a un menor tiempo de vuelo (p<0,05). En la fase de vallas, los atletas de nivel más elevado presentaron mayores distancia de ataque a la valla (p<0,001), así como menores distancias de caída de la valla (p<0,001), tiempos de zancada (p<0,01-0,001) y de apoyo (p<0,01-0,001 ) en los cuatro pasos que conforman cada ciclo de vallas, así como un menor tiempo de vuelo en el paso de valla (p<0,001) y en el paso de transición (p<0,001). De manera adicional, se encontraron importantes diferencias en el reparto de los pasos entre vallas entre la primera y tercera valla y el resto de obstáculos. En la fase final, se observó una mayor longitud de zancada en los atletas de nivel superior (p<0,001), así como un menor tiempo de zancada (p<0,01) y de apoyo (p<0,01). Los resultados obtenidos en el presente estudio de investigación avalan la utilización de la fotogrametría en dos dimensiones para el análisis biomecánico de la prueba de 60 metros vallas en competición. Su aplicación en competiciones del máximo nivel internacional ha posibilitado conocer las características de los vallistas a lo largo de toda la prueba y determinar posibles implicaciones de cara al proceso de entrenamiento. ABSTRACT The aim of this research was to determine the differences in different variables related to physical performance among athletes of different levels during the race of 60 meter hurdles. A total of 59 male hurdlers (the 31 participants in the World Indoor Championship and the 28 participants in the Spanish Indoor Championship, both held in Valencia in 2008) formed the sample of the study. The biomechanical analysis of athletes was performed using a two-dimensional photogrammetric system which enabled calculation, applying algorithms based on the DLT method (Abdel -Aziz y Karara , 1971), the coordinates (x , y) of the successive supports of the feet on the entire competition surface. Filming test was conducted with six video cameras, located on the bleachers, with a sampling frequency for data processing of 50 Hz. In the approach run phase, the top-level athletes showed a smaller length step (p<0.05), and shorter step time (p<0.001), due to a shorter step flight time (p<0.05). In the hurdle unit phase, the higher level athletes had greater take-off distances (p<0.001), shorter landing distances (p<0.001), smaller step times (p<0.01-0.001), and support times (p<0.01- 0.001) in the four steps that comprised each hurdle unit, and smaller flight times in the hurdle step (p < 0.001), and the recovery step (p<0.001). Additionally, differences in the distribution of hurdle unit steps between the first and third hurdle, and other hurdles were found. In the run-in phase, a greater step length in top-level athletes (p<0.001), and a shorter step time (p<0.01) and contact time (p<0.01) was observed. The results obtained in this study support the use of photogrammetry in two dimensions for biomechanical analysis in 60 meter hurdles competition events. Its application at the highest international level competitions has allowed to know the characteristics of the hurdlers over the entire race and identify possible implications for the training process.

The Assessment of Total Energy Expenditure During a 14-day 'In-Season' Period of Professional Rugby League Players Using the Doubly Labelled Water Method

Peer reviewed

Prevalência e incidência de obesidade sarcopênica em coorte de idosos domiciliados no município de São Paulo

Introdução: Evidências epidemiológicas mostram que a obesidade sarcopênica (OS) em idosos está associada a um acelerado declínio funcional e alto risco de morbimortalidade, sendo que seu impacto tem se tornado grande preocupação dos profissionais de saúde. Objetivo: Estimar a prevalência e a incidência de obesidade sarcopênica, em coorte de idosos domiciliados no município de São Paulo/Brasil 2000 e 2010. Casuística e Métodos: Foram utilizados dados do Estudo SABE (Saúde, Bem-estar e Envelhecimento), realizado no município de São Paulo em 2000 (2.143 idosos), e em 2010 (795 idosos). A população deste estudo foi constituída por idosos ( 70 anos), de ambos os sexos, que apresentaram todos os dados necessários para este estudo e que concordaram em participar, totalizando 871 idosos analisados em 2000 e 656 idosos em 2010. As variáveis de estudo foram: 1. Dependente - obesidade sarcopênica, identificada segundo: obesidade, diagnosticada pelo valor da circunferência da cintura (CC 94 cm e CC 80 cm para homens e mulheres, respectivamente); sarcopenia, identificada por: 1- força muscular, pelo teste de preensão manual (FPM - kg) (baixa P25; normal > P25, da mesma população), 2- massa muscular (MM), obtida pelo índice de massa muscular (IMM=MM/altura²) (baixa P20; normal > P20, da mesma população) e 3- desempenho físico, identificado pelo teste (tempo dependente segundos) de sentar e levantar 5 vezes de uma cadeira (SeL) , com os braços cruzados sobre o peito (baixo P75; normal < P75); 2. Explanatórias - sexo e grupos etários (70 79 e 80). Foram classificados com OS idosos que apresentaram, simultaneamente, valores de CC adotados e baixo desempenho e baixa MM, ou então, desempenho normal, mas baixas FPM e MM. A prevalência de obesidade sarcopênica em 2000 e em 2010 foi estimada pelo número de casos de OS identificados nos dois momentos, onde foram realizadas comparações entre os intervalos de confiança, para verificar diferença estatística em idosos ( por cento ) com OS, segundo variáveis explanatórias, com nível de significância de 5 por cento . Para o cálculo do coeficiente de incidência de OS, em 2010, foi considerado o tempo de observação de cada indivíduo, determinado de maneira específica para cada caso. Para os cálculos foi utilizado o programa: Stata/SE ® 10.0 for Windows. Resultados: Dos 871 idosos analisados em 2000, 85 (7,4 por cento ) foram identificados com OS [6,5 por cento mulheres (IC 5,08,4) e 4,8 por cento 80 anos (IC 3,6-6,4)] (p 5 por cento ), e, em 2010, (n=656), 73 (9,2 por cento ) foram identificados com OS [7,2 por cento mulheres (IC 5,5-9,4) e 5,3 por cento 80 anos (IC 4,0-7,0)] (p 5 por cento ). Em 10 anos, foram identificados 43 novos casos de OS. O coeficiente de incidência foi 15,29/1000 pessoas/ano entre 2000 e 2010. Conclusões: A prevalência de OS em 2000 e 2010 foi maior nas mulheres e nos idosos mais longevos, sendo que, em ambos os casos, foi maior em 2010, quando comparada a 2000. Não houve diferença significativa entre os coeficientes de incidência, segundo as variáveis explanatórias.

Reproducibilidad de la batería EPESE de desempeño físico en atención primaria

Objetivo. Estimar la reproducibilidad de tres medidas objetivas de desempeño físico de personas mayores en atención primaria. Diseño. Estudio descriptivo y prospectivo con observación directa de la función física por parte de profesionales de la salud de acuerdo a un protocolo estandarizado. Emplazamiento. Tres centros de atención primaria de las provincias de Alicante y Valencia. Participantes. Muestra de 66 personas de 70 y más años, evaluadas en dos ocasiones por el mismo profesional al objeto de replicar idénticas condiciones del estudio, en un intervalo temporal de dos semanas (mediana de 14 días). Mediciones principales. Se evaluó el funcionamiento físico a través de tres pruebas objetivas de desempeño: el test de equilibrio, el de velocidad de la marcha, y la capacidad para levantarse y sentarse de una silla. Estas medidas provienen de los estudios E PESE (Established Populations for Epidemiologic Studies of the Elderly). Se ha calculado la fiabilidad test-retest mediante el coeficiente de correlación intraclase. Resultados. Los coeficientes de correlación intraclase (CCI) fueron de 0,55 para el test de equilibrio, de 0,69 para el test de levantarse de la silla, y de O, 79 para el de velocidad de la marcha. El valor para la puntuación total de la batería EPESE fue de 0,80. Conclusiones. La reproducibilidad de estas medidas de desempeño es tan aceptable como las aportadas por la bibliografía de referencia. Estas pruebas de desempeño permiten evaluar con rigor cambios importantes en funcionamiento y salud que se producen con el tiempo.

Single- vs. multiple-set resistance training: Recent developments in the controversy

Galvao, D.A., and D.R. Taaffe. Single- vs. multiple-set resistance training: recent developments in the controversy. J. Strength Cond. Res. 18(3):660-667. 2004.-The number of sets in a resistance training program remains a major point of discussion and controversy. Studies prior to 1998 demonstrated inconsistent findings between single-set and multiple-set programs; however, recent evidence suggests that multiple sets promote additional benefits following short- and long-term training. The rationale supporting multiple sets is that the number of sets is part of the exercise volume equation, and the volume of exercise is crucial in producing the stimulus necessary to elicit specific physiological adaptations. The purpose of this paper is to present an overview of recent resistance training studies comparing single and multiple sets. However, it should be noted that studies to date have been conducted in young and middle-aged adults, and it remains to be determined if the additional benefits accrued with multiple-set training also occurs for older adults, especially the frail elderly.

A randomized controlled trial of intensive neurophysiology education in chronic low back pain

Objectives: Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance. Methods: This study was a blinded randomized controlled trial. Individual education sessions on neurophysiology of pain (experimental group) and back anatomy and physiology (control group) were conducted by trained physical therapist educators. Cognitions were evaluated using the Survey of Pain Attitudes (revised) (SOPA(R)), and the Pain Catastrophizing Scale (PCS). Behavioral measures included the Roland Morris Disability Questionnaire (RMDQ), and 3 physical performance tasks; (1) straight leg raise (SLR), (2) forward bending range, and (3) an abdominal drawing-in task, which provides a measure of voluntary activation of the deep abdominal muscles. Methodological checks evaluated non-specific effects of intervention. Results: There was a significant treatment effect on the SOPA(R), PCS, SLR, and forward bending. There was a statistically significant effect on RMDQ; however, the size of this effect was small and probably not clinically meaningful. Discussion: Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.

Resistance training for the older adult: Manipulating training variables to enhance muscle strength

Resistance training has been shown to reliably and substantially enhance muscle function in older adults and these improvements can be accompanied by improved functional performance. Training variables should be manipulated to enhance muscle strength and minimize injury risks in this population.