INTRODUCTION: Amyotrophic Lateral Sclerosis (ALS) is an acquired, neurodegenerative and disabling disease of the nervous system, causing motor and extra-motor symptoms. It is described by a functional decline in affected people. In ALS, studies related to tDCS present consolidated results on the hypotheses of hyperexcitability in the corticomotor neural system, with some interesting aspects in its mechanisms of action that could minimize this hyperexcitability. According to the assembly in target areas, tDCS' main action is to act on the resting membrane potential and produce a prolonged suppression of neuronal excitability. This effect is determined by the modulation of dependent synaptic plasticity, which induces a return of the cell to its physiological conditions. The main objective of this study is to evaluate the effects of a HighDefinition Transcranial Direct Current Stimulation (HD-tDCS) protocol on the motor performance of the upper limbs of people with ALS.METHODOLOGY: This is a randomized controlled, parallel, double-blind clinical trial protocol with 2 arms, 1:1 allocation, following the recommendations of the Consolidated Standards of Reporting Trials (CONSORT), based on the Standard Protocol Items Recommendations for Interventional Trials (SPIRIT). Subjects will be included if they have been diagnosed with ALS according to the revised El Escorial criteria, are aged between 18 and 80, have a good cognitive level on the ALS Cgntv Bhvrl Srn sl (≥17 pnts), nd r able to understand and perform simple motor actions based on verbal commands. Participants will be recruited from the Neuromuscular Diseases Outpatient Clinic at the Onofre Lopes University Hospital (HUOL) and assessed before the intervention (PRE), one week after the intervention (POS1) and 2 weeks after the intervention (POS2). The experimental group will undergo an initial assessment, and if they meet the inclusion criteria, they will undergo five sessions of HD-TDCS on consecutive days (one session each day), which will last 20 minutes and have an intensity of 3mA. The Sham group will receive simulations of the application of high-definition tDCS, with the device providing an acceleration period of 30 s up to the full 3 mA, followed immediately by a 30 s reduction. In addition to describing the protocol, this study describes a case report of a participant diagnosed with ALS since September 2022 who underwent the HD-tDCS intervention protocol described. Results: It was found that in a functional activity protocol, most of the characteristics of the analyzed muscle activation signals were higher in POS1 and POS2 compared to PRE. Discussion: Changes were found in the electromyographic signals after the intervention was applied, which indicates that the protocol is viable; however, the clinical trial described above is necessary to validate the protocol's efficacy and safety.

Abstract: The effects of CBD and THC on the human body are due to the endocannabinoid system, which includes cannabinoid receptors type 1 (CB1) and type 2 (CB2), present in several types of cells throughout the body, including in the cardiovascular system, lungs and pulmonary vessels in animals and humans, however, little is known about the action on respiratory mechanics. Given the above, the objective of this study is to analyze the action of cannabis oil in removing full spectrum and THC on respiratory mechanics, muscular electrical activity and cardiovascular hemodynamics. This is a randomized, controlled, crossover, double-blind clinical trial. Therefore, individuals were allocated to a single group that participated in three phases with distinct interventions: Intervention-Full Spectrum (I-fs), Intervention-THC (I-THC) and Placebo Intervention (IP). The sample size and dosage used were defined based on pharmacological information available in the literature and finally confirmed in a pilot study with 10 subjects. The study included young men and women between 18 and 50 years old, who declared themselves healthy, with a body mass index (BMI) within the normal range, who did not present changes in respiratory function (confirmed in previous spirometry), did not present psychological or uncontrolled/treated psychiatric patients, do not use regular medications or have been exposed to cannabis in the last 6 months prior to the first day of assessment. The collection is carried out over three assessment days, and the team consists of a researcher responsible for randomization, and three others responsible for the baseline assessment with strength and lung function tests (spirometry), drug administration and evaluation of the intervention, which occurs in three stages: 1-Pre Intervention (Pre-IN); 2-Intervention (IN) and 3-Post-Intervention (Post-IN). All participants in the three assessment stages consist of: Assessment of respiratory mechanics using a Pneumotachograph, Electromyography of the Sternocleidomastoid, Scalenes, Parasternal and Rectus Abdominis muscles, and Assessment of cardiovascular hemodynamics (PhysioFlow) where 8 minutes will be recorded, with 2 minutes in Quiet breathing, 2 minutes of breathing with an inspiratory resistance of 30% of your MIP and an expiratory resistance of 10% of your MEP, and another 4 minutes of recovery in each stage for later analysis, in addition to the presence and severity of anxiety symptoms in the participant through Hamilton Anxiety Scale (HAM-A). The results of this research, carried out with 09 subjects, 04 women and 05 men, aged 24 ± 3.29 years, BMI 23.12 ± 2.11 kg/m2, declared an expected increase in ECOM muscular electrical activity, ESC, PARA and RA at the time of load pressure limits of 30% of the MIP and 10% of the MEP of the participants compared to the moment in Quiet breathing, with a difference between this increase in relation to the substances used, observing ΔQB/valve of ECOM of Δ=22.22 (placebo), Δ=17.94 (full spectrum) and Δ=23.04 (thc), ESC of Δ=11.33 (placebo), Δ=10.56 (full - spectrum) and Δ=16.25 (thc), TO of Δ=15.29 (placebo), Δ=10.67 (full spectrum) and Δ=17.05 (thc), and RA of Δ=1.34 (placebo), Δ=0.15 (full spectrum) and Δ=0.95 (thc). Despite the widespread use of full spectrum cannabis oil, safety studies regarding its administration are scarce, with a phase 1 study seeking to establish the effects of the substance on the respiratory and cardiovascular system as the first analysis for the safety of its use and enhancing rehabilitation techniques in respiratory and cardiovascular physiotherapy.

Introduction: ischemic Preconditioning (IPC) is a method that has been widely used to improve physical performance acutely and to prevent muscle fatigue in different exercise modalities. However, evidence on the IPC effects is conflicting. Some studies suggest that IPC improves neuromuscular function and could alter perceptual responses while others suggest that IPC is not superior to sham. Objectives: This thesis aimed to investigate the effects of IPC on the subjective perception of effort and physical performance (functional and neuromuscular) of healthy individuals (athletes and non-athletes). Methods: For this thesis, the application of IPC locally and in healthy individuals (athletes and non-athletes) was considered. The thesis was divided into three parts: introduction, chapters (1 and 2) and final considerations. Each chapter consists of an article and its respective protocol, with chapter 1 comprising a clinical trial investigating the effects of IPC on physical performance (functional and neuromuscular) and perceptual responses (subjective perception of effort and affective responses) in football players. amateur football. Chapter 2 involves a systematic review with meta-analysis with its respective protocol that investigated the effects of IPC on the subjective perception of effort in different physical tests and sports modalities (subdivided into aerobic and anaerobic exercises). Results: Article 1 showed that there was no significant difference between the IPC and sham groups for any of the variables (p>0.05). Article 2 pointed out that there was no difference in RPE between the IPC group and the comparison. Conclusions: In general, the use of IPC was not superior to control (sham or no intervention) to improve the physical performance (functional or neuromuscular) of amateur football players or to attenuate the subjective perception of exertion in athletes and healthy individuals in different types of exercise.

Introduction: Wearable technologies have been widely used in the context of monitoring chronic health conditions. However, its applicability in monitoring sarcopenia is still a gap in the literature. Objective: Investigate how wearable devices can help monitor sarcopenia. Methods: This thesis is composed of three studies: Article 1 – This is a Systematic Review (RS) protocol, whose design seeks to support the identification of studies that suggest how wearable devices have been used to monitor sarcopenia, identify which parameters of physical performance are best used to monitor sarcopenia and which sensors and body location have been used. Article 2 – RS study, conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), which included observational studies that used wearable devices to monitor sarcopenia, searched in the databases PubMed, CINHAL, Embase, Web of Science and SciELO. Article 3 – Observational and methodological study developed with community-dwelling elderly people, who were assessed for the presence of probable sarcopenia and the level of Physical Activity (PA) using a smartwatch-type wearable device, with the aim of establishing points of reference cutoff to discriminate probable sarcopenia, using the ROC Curve (Receiver Operating Characteristic). Results: Articles 1 and 2: The RS study included 6 studies, whose summary of results suggests that PA intensity, measured using triaxial accelerometers, is the most commonly used parameter, demonstrating an association between PA level and sarcopenia. The body segments to position the sensors with the greatest potential to be explored are the hip and wrist. Article 3: 169 elderly people were evaluated, of which 69 had probable sarcopenia, with an average of 75.8 ±56.2 active minutes involved in light PA per week and an average of 80.8 ±56.9 minutes involved in moderate PA per week. The best accuracy cutoff points were 109 minutes (AUC: 61%) for mild AF; 56 minutes (AUC: 65%) for moderate PA; 8,417 (AUC: 67%) for number of steps per day; 2,707 (AUC: 65%) for calories; and 5,439 meters for distance traveled per day. Conclusions: The RS suggests that measuring the level of PA and mobility using triaxial accelerometers shows promise in monitoring the physical performance of individuals with probable sarcopenia. Furthermore, it contributes to the understanding of how PA and mobility measures can be explored in the context of monitoring and presents recommendations for new research in the area. Article 3 demonstrates that the PA construct, assessed by a wearable device, is a good classifier for discriminating probable sarcopenia. In this way, technology can be seen as a viable tool that can contribute to the monitoring of sarcopenia, allowing identification and planning of early interventions.

Purpose: To compare the parameters of postural balance in different sensory conditions of individuals without and with vestibular dysfunction submitted to posturographic evaluation. Method: This is a cross-sectional and analytical study. Individuals aged 40 to 79 years, distributed in Group 1 (G1) - complaining of dizziness and/or postural imbalance and diagnosed with vestibular dysfunction, and Group 2 (G2) without the above-mentioned complaints and vestibular diagnosis were included. Sociodemographic, clinical-functional data (International Physical Activity Questionnaire; Vestibular Disorders Activities of Daily Living Scale), and the parameters ratio of The Confidence/Stability Limit Elipse (CE/SL), Anteroposterior Speed (APS) and Mid-lateral Speed (MLS) through the posturographic examination composed of seven tests: C1 and C2 (eyes open and closed on firm surface); C3 and C4 (eyes open and closed); C5, C6 and C7 (optokinetic visual stimulus for right and left, and tunnel), these on unstable surface. For data analysis, the tests used were Student's t or Mann-Whitney. Results: the sample consisted of 100 individuals, 62 from G1 and 38 from G2. The CE/SL ratio and MLS were higher in the seven sensory conditions in G1. The APS of G1 was higher in the progression of conditions 1 to 3. Conclusion: Individuals with vestibular dysfunction presented higher MLS postural oscillations when reduced sensory aferences. The APS oscillations of the groups were similar in conditions that provided somatosensory reduction, deprivation and suppression of dynamic visual stimuli.

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a multisystemic neurodegenerative disease with clinical, genetic and neuropathological heterogeneity, with cerebral impairment, characterized by reduced lung volumes and ineffective cough, its main cause of morbidity and mortality. Mechanical insufflation-exsufflation (I-EM) consists of increasing the expiratory air flow and, thus, promoting an increase in the peak cough flow (PCF) and the removal of secretions. Objective: To analyze and describe the acute effects of applying the I-EM technique on PCF and operating volumes of the chest wall (CW) in individuals with ALS versus healthy peers. Methodology: This is an analytical cross-sectional study, where subjects with ALS were allocated to the experimental group (EG) and healthy subjects matched for age, gender and body mass index were allocated to the control group (CG). After collecting sociodemographic and clinical data, the subjects were assessed for lung function (spirometry) and respiratory muscle strength (maximum respiratory pressures). Then, the PT and PCF volumes were evaluated before (Pre I-EM) during (I-EM) and after the application of the I-EM technique (Post I-EM), through Optoelectronic Plethysmography (OEP). Results: Nine individuals with ALS were evaluated, of which 6 had spinal onset ALS. An increase of 0.73±1.4 L/s was observed in the PCF of holders with Spinal-onset ALS, while holders with bulbar-onset ALS showed a reduction of 0.82±1.2 L/s immediately after the application of the I-EM technique. As for the analysis parameters of the controlled pattern, the rapid and shallow breathing index (RSBI) at the Pre I-EM moment was 71.46 (38.53-122.40) and changed to 55.41 (29.42- 159.43) at the time Post I-EM. Conclusion: The results demonstrated that the I-EM technique led to an acute increase in the PCF value in spinal-onset ALS, as well as improved the pattern followed by the population followed, by reducing the RSBI.

Introduction: Population aging in Brazil has been growing very quickly. The practice of physical activity provides multiple health benefits, including better cognition, regulation of cardiorespiratory and vascular fitness, in addition to the reduction of chronic diseases. However, there is a shortage of validated questionnaires in Portuguese to assess the level of physical activity in the elderly. Thus, the current study aimed to translate into Brazilian Portuguese, cross-culturally adapt and evaluate the psychometric properties of the Rapid Assessment of Physical Activity (RAPA) instrument for use in the Brazilian elderly population. Materials and methods: Exploratory and psychometric methodological study, which involves the process of translation and cross-cultural adaptation, through translation, reverse translation, review by a multidisciplinary committee of experts and pre-test. The concurrent validity of the Rapid Assessment of Physical Activity (RAPA), International Physical Activity Questionnaire (IPAQ) and objective monitoring of physical activity using a bracelet was evaluated. Reliability and test-retest was assessed using two visits one week apart. Results: The RAPA was translated and transculturally adapted for Brazilian elderly. There was a moderate correlation between RAPA and IPAQ for participants with high education through Spearman's correlation coefficient (r=0.60, p<0.003) and (r=0.51, p<0.0001) respectively. The test-retest reliability assessed using the Kappa test showed strong intra-rater (k=0.89, p<0.0001, 80% agreement) and inter-examiner (k=0.71, p<0.0001, 84-agreement) reliability. %). Sensitivity and specificity reached minimum values without statistical significance, compared to objective measures of physical activity in the elderly. Conclusion: The data from the present study demonstrated that the translated version of the RAPA into Brazilian Portuguese is a valid and reliable measure for measuring physical activity in elderly people with a high level of education in Brazil, and can be used in clinical practice due to its cost-effectiveness and short time. of application. The current study also showed considerable evidence about test-retest and reliability. Taking into account sensitivity and specificity, objective measures of physical activity are better able to measure the number of active minutes in elderly Brazilians.

Introduction: Treadmill gait training has been recommended in the rehabilitation of people with stroke. As with any treatment in the health area, treadmill training is a potential source of adverse events, and it is important that the evaluation, reporting and quality of information on these events are clear, reliable and expected. Objective: To analyze the report of adverse events in clinical trials involving treadmill gait training for individuals with stroke. Methods: The article constitutes a systematic review of intervention studies, in which randomized or quasi-randomized crossover clinical trials were considered; and before-after studies. Primary studies should include treadmill gait training in subjects with stroke in at least one of the study groups. Studies with full text, in English, Portuguese and Spanish and without data restrictions were considered. The searches were carried out in the period of October and November 2019 and updated in May and June 2021, as well as in November and December 2022 in the PsyINFO, MEDLINE, CENTRAL, CINAHL, SportDISCUS, LILACS and PEDro databases. Among the studies that met the criteria, studies that mentioned some type of adverse event observed or evaluated/monitored in the study were included. In the article, the results related to adverse events were analyzed regarding the occurrence and types of events evaluated and observed, and the data were analyzed using descriptive statistics. Data regarding the type and severity of the event were analyzed in relation to an adverse event tree. Results: The Article included 51 studies, of which 36 were randomized clinical trials. The most frequently evaluated adverse events in the studies were pain and imbalances in heart rate and pressure, while the most observed events were new strokes, medical complications and pain. Although less serious when compared to physiological and pharmacological reactions, adverse events associated with physical exercise need attention regarding the severity, type and frequency in which they occur. Adverse events for participants in groups who received treadmill training were reported in a greater number of studies compared to participants who did not train on a treadmill. Few studies used an event assessment strategy, failing to inform event details, how they were assessed and the time of assessment. Conclusion: From this review, we concluded that the reporting of adverse events in studies that built treadmill training in individuals with stroke is inconsistent and not systematic. Even though it is considered safe, our results indicate that treadmill training in individuals with stroke seems to be related to the occurrence of adverse events.

During the COVID-19 pandemic, there was an increase in the use of Personal Protective Equipment (PPE), increased working hours and high rates of psychological disorders in health professionals, which together can lead to acute and chronic health problems. psychic and physical, such as craniocervical complaints, headache, orofacial pain, neck pain and otological symptoms, which can also be influenced due to the anatomical interconnections and nervous communication of the craniocervical structures. Objective: to identify factors associated with craniocervical and otological symptoms in health professionals who worked in the COVID-19 pandemic. Methods:cross-sectional study carried out with health professionals of both sexes, aged 18 years or older, who worked in providing assistance to patients infected or suspected of having COVID-19, without restrictions on their work in department or level of care. Data were collected on sociodemographic characteristics, presence of craniocervical symptoms (headache, orofacial pain and neck pain) and otological symptoms (tinnitus, ear fullness, hypoacusis, dizziness and vertigo), pattern of PPE use before and during the pandemic. In addition to medical history, working conditions, life habits, sleep quality and depressive symptoms, through a self-administered online questionnaire. Results: 147 subjects answered the questionnaire, with 79.6% women, mean age 35 ± 9.7 years. The presence of craniocervical symptoms before the pandemic was 32% for headache, 15.6% for orofacial pain, 21.1% for neck pain and 11.6% for otological symptoms. Regarding the worsening of pre-existing symptoms during the pandemic, headaches were identified in 22%, orofacial pain in 8.8%, neck pain in 9.4% and otological symptoms in 6.8%. As for the emergence of new craniocervical symptoms during the pandemic, headache was present in 50.8%, orofacial pain occurred in 39.7%, neck pain in 43.8% and otological symptoms in 54.4%. Headache was the most prevalent symptom before the pandemic and in the worsening of pre-existing symptoms; already the otological symptoms for the emergence of new symptoms. Factors associated with the worsening of pre-existing headache symptoms were: being female (OR = 5.09), not practicing physical activity during the pandemic (OR = 4.48), and using the PFF2 mask during the pandemic (OR = 4.07). As for orofacial pain, it was just working in a ward (OR = 4.74). Regarding the factors associated with the onset of craniocervical symptoms, with regard to headache, we found depressive symptoms present (OR = 3.15) and for the onset of orofacial pain, the presence of neck pain during the pandemic (OR = 2.42 ) and having otological symptoms during the pandemic (OR = 3.14). Regarding neck pain, having associated symptoms during the pandemic (OR = 3.99) and presenting orofacial pain during the pandemic (OR = 2.45). With regard to the factors associated with the onset of otological symptoms, the use of a surgical mask before the pandemic for more than 4 hours a day (OR = 3.06), use of a face shield during the pandemic for more than 4 hours a day (OR = 2.98, 95% CI 1.07 – 8.24, p = 0.035) and presence of orofacial pain during the pandemic (OR = 3.89). Conclusion: an increase in the frequency of craniocervical and otological symptoms in health professionals during the pandemic was evidenced, with headache being the most prevalent before the pandemic and in the worsening of pre-existing symptoms. It is suggested to carry out epidemiological, longitudinal studies, with the largest sample size, to improve knowledge and repercussions regarding craniocervical and otological complaints, ways to prevent and treat them.

Introduction: As the world population ages, one of the important challenges for the health area is to intervene in the decline of the musculoskeletal system. This decline mainly consists of a reduction in muscle mass and function, which is called sarcopenia and is associated with adverse health outcomes. Although the number of studies on sarcopenia has increased, the reported prevalence varies greatly, since it depends on the characteristics of the population studied and the cutoff points adopted in the consensus. The different reference values have a critical impact on the epidemiology of sarcopenia as the cutoffs are not consistent. In this sense, defining the best cut-off point and the best way to measure the muscle mass and strength of individuals, considering not only ethnic heterogeneities, but also the practicality and cost of instruments aimed at this type of measurement, makes it if necessary. Objective: To verify the prevalence of sarcopenia using different forms of assessment proposed by the EWGSOP2. Methods: 778 community-dwelling elderly people living in a city in Rio Grande do Norte, Brazil were evaluated. Cut-off points were defined for the variables used to screen for sarcopenia (grip strength, sit-stand test, skeletal muscle mass, gait speed, and SPPB) and the prevalence of sarcopenia components was found according to categorization by age group. Results: In both groups, the percentage of women is higher (61.5% and 58.8%), most were married (56.5% and 49.7%) and attended school for less than 8 years (77.2% and 89.5%). Comparing the proportions between the forms of assessment, a greater proportion of sarcopenia was observed in the methods that used the MME without height adjustment for both the handgrip (B) and the sit-to-stand test (D), this proportion increased in the group aged over 75 years. Conclusion: The analysis of the study confirmed that the prevalence of sarcopenia varies according to the methods used, where it is possible to do the screening through the grip strength as well as the sit-up test and both are more sensitive when associated with muscle mass without height adjustments. The increase in the prevalence of sarcopenia is also evident as age increases.

Introduction: The Lower Limbs pain (LLP) is one of the main complaints in elderly individuals with Type 2 Diabetes Mellitus (T2DM), working as a marker for functional decline and loss of autonomy in the elderly, through painful stimuli that are more commonly experienced as pinpricks, tingling, and numbness. Objective: To investigate the relationship between lower limb pain complaints and sociodemographic, clinical-functional, and psychocognitive data in elderly individuals with T2DM. Method: This is a cross-sectional, descriptive, analytical study conducted at Onofre Lopes University Hospital in Natal, Brazil. Elderly individuals aged 60 years or older diagnosed with T2DM participated in the study. The elderly participants were evaluated through a multidimensional survey, including sociodemographic, clinical-functional, and psychocognitive data. Additionally, the following instruments were used: Mini-Mental State Exam (MMSE), Abbreviated Geriatric Depression Scale (GDS), Timed Up and Go Test (TUGT), WHODAS 2.0, and Mini-BESTest (MiniBEST) for cognitive deficit screening, depressive symptoms, functional mobility, functional capacity, and postural balance, respectively. Descriptive analysis, Mann-Whitney and Chi-square tests were performed, followed by multivariate logistic regression analysis (p<0.05 and 95% CI). Results: The sample consisted of 150 elderly individuals with a mean age of 69.4 (±6.95) years, with the majority being female (65.0%) and reporting lower limb pain complaints (53%). The final regression model showed that the pain complaint was significantly associated with overall health (p<0.001; [2.09-13.06]), GDS (p=0.024; [1.03-1.51]), and motor TUGT (p=0.002; [1.09-1.52]), and this model had an accuracy of 81.8%. Conclusion: This study suggests that the symptom of pain can lead the elderly to have a worse perception of overall health, and factors such as the presence of depressive symptoms and impairment in functional mobility are also related to pain complaints in elderly individuals with T2DM.

Introduction: Tinnitus is defined as the auditory perception of a sound generated in the auditory or para-auditory pathways. When tinnitus is influenced by the cervical spine and/or temporomandibular region, it is referred to as somatosensory tinnitus (SST). The diagnosis of SST is based on standardized criteria established in an international consensus of experts; however, the standardization of the physical examination and the measurement properties of these criteria have not yet been evaluated.

Objective: To propose a physical examination checklist of adapted items from the Diagnostic Criteria for Somatosensory Tinnitus for the diagnosis of SST and determine the discriminative validity of diagnostic criteria items between patients with and without SST.

Methods: A methodological study of known-groups validity was conducted, including individuals aged 18 years or older, of both sexes, with a complaint of tinnitus, recruited from a specialized Otorhinolaryngology outpatient clinic, totaling 100 patients divided into the SST Group (n=46) and the Non-SST Group (n=54). Patients were assessed by a multidisciplinary team to screen for the etiology of tinnitus, and in this context, underwent a physiotherapeutic assessment through a structured physical examination adapted from somatosensory tinnitus diagnostic criteria to detect the influence of the somatosensory system on the cause of tinnitus. The physical examination items assessed were tinnitus modulation by somatic maneuvers (SM), palpation of the temporomandibular joint (TMJ), the jaw and neck muscles; the presence of pain and myofascial trigger points (MTrPs). Patients were also asked about the intensity of tinnitus-related distress using the Numerical Rating Scale (NRS) and the impact of the symptom on their quality of life using the Tinnitus Handicap Inventory (THI). The known-groups validity of the physical examination checklist for the Diagnostic Criteria for Somatosensory Tinnitus (DC/SST) was evaluated using the chi-square test, Fisher's exact test, and the Fi coefficient. THI scores were compared between groups using Student's t-test with effect size measured by Cohen's d.

Results: The SST Group reported greater tinnitus distress (p<0.01); stress and sleep impairment were self-reported as worsening factors of tinnitus that affect the quality of life in 82.6% and 63% of these patients, respectively (p<0.01 and p=0.04) with associations ranging from strong to very strong (0.20-0.28), and patients in this group had a greater impact on the quality of life in the functional domain and total THI score 

(p=0.03 and p=0.05, respectively) when compared to the Non-SST Group. As for the physical examination items for the diagnosis of SST, associations were found for modulation by SM in all cervical and mandibular movements (p<0.05) and gaze-evoked (p<0.01), all with a very strong effect size (Fi 0.32-0.54) for the SST Group. Regarding the criteria related to TMJ palpation, the SST Group showed a higher frequency of palpation modulation in the left TMJ (p=0.05) and self-reported pain in the right TMJ (p<0.01), with strong to very strong associations (Fi 0.19 and 0.29, respectively). The presence of crepitation in the TMJ did not show a statistically significant difference. There was also an association for modulation upon palpation in all cervical and masticatory muscles assessed (p<0.01) with a very strong effect size (Fi 0.27-0.47). Regarding the presence of pain during active cervical and mandibular movements, there was statistical significance for flexion (p=0.05 and Fi=0.19), protrusion (p=0.01 and Fi=0.24), and retraction (p=0.02 and Fi=0.22) of the cervical spine and the right lateralization (p=0.01 and Fi=0.24) and clenching (p<0.01 and Fi=0.29) movements of the TMJ. The presence of pain upon muscle palpation showed significance for most muscles (p=0.01 to 0.04), with a strong to very strong association (Fi 0.19-0.31). Regarding the presence of MTrPs, there was a greater difference for the SST Group in the suboccipital muscles (p=0.01), right sternocleidomastoid muscle (p=0.04), right and left upper trapezius (p<0.01 and p=0.05, respectively), and bilateral rhomboid muscles (p=0.04) with a very strong association (Fi 0.18-0.27).

Conclusion: The checklist of items adapted from the diagnostic criteria for SST was able to discriminate differences between the groups with and without SST, showing strong to very strong associations for patients with SST. It is expected that the checklist may aiding in the standardized identification of patients with probable somatosensory tinnitus be easily implemented both in the clinical practice of professionals assisting patients with tinnitus and in scientific research field.

Abstract

Introduction: Amyotrophic Lateral Sclerosis (ALS) leads to progressive motor limitations, which appear differently in each patient, such as impairments related to the upper limb (UL). These impact the performance of activities of daily living and functional independence. Surface electromyography (sEMG) and accelerometer (ACC) are being integrated as additional tools for motor function analysis with technological evolution, thereby enhancing existing assessment tools. These can still be improved with the association of Machine Learning (ML) algorithms that can contribute to the development of more accurate and precise tools for rehabilitation.

Objective: To implement an ML model on sEMG and ACC data to assess the SM motor function of people with ALS.

Methods: This is a cross-sectional study approved by the Ethics Committee of the UFRN Central Campus (CAAE: 25687819.3.0000.5537). 10 healthy people and 7 with ALS were evaluated, using a standardized evaluation form, validated assessment instruments to analyze the health condition of the person with ALS and/or other neurological and/or musculoskeletal disorders, and analysis of the UL movement, from sEMG and ACC. Data processing was performed using Matlab R2022b software and statistical analysis using the Statistical Package for Social Science (SPSS) version 20.0 software.

Results:

Article 1 - Elaborate a scope review in order to describe the characteristics of UL orthoses controlled by ML algorithms, based on information extracted from published articles and patents.

Article 2 - Analyze and compare the degree of stationarity and linearity of ACC data acquired during the UL movement of people with ALS and healthy people.

Article 3 - Analyze and compare the degree of stationarity and linearity of sEMG data acquired during the UL movement of people with ALS and healthy people.

Article 4 - Analyze and compare levels of fatigue and muscle strength in healthy people and people with ALS, based on sEMG and ACC signals.

- To compare the level of muscle activation and the level of movement variation in healthy people and people with ALS, based on EMGs and ACC signals, respectively.

- Classify data from sEMG and ACC of healthy people and those with ALS, based on AM algorithms.

Conclusion: UL orthoses controlled by ML algorithms can offer additional benefits for the motor rehabilitation of people who have movement disorders caused by a disease, such as ALS. These patients depend on illnesses that differ from a healthy person. Our findings showed the difference in statistical properties of the sEMG and ACC signal, level of fatigue, muscle strength, muscle activation, and movement displacement.

ABSTRACT

Background: The COVID-19 pandemic highlighted the issue of individual and population adherence to internationally recommended measures for the prevention and control of infectious respiratory diseases. However, low compliance with recommended preventive behaviors and the scarcity of tools to assess this construct in the same population has challenged managers and researchers. Given all the possible clinical, economic, and psychosocial implications, preventive measures at the population level, integrated into public health policies, can mean effective efforts and assertive decision-making. Objectives: To develop and test the preliminary validity of an instrument for the Brazilian population, capable of measuring, through barriers and facilitators, the level of adherence to recommended measures for the prevention and control of infectious respiratory diseases. Methods:  To contemplate our objectives, we carried out two studies. Study 1 included a systematic review (SR) that followed the Cochrane recommendations for the global qualitative synthesis of themes and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The themes emerging in the SR elicited the content for the initial generation of instrument items. In turn, the Health Beliefs Model (HBM) and the Capacity, Opportunity, and Motivation Model (COM-B) frameworks contributed to classifying the items in preliminary dimensions. Study 2 comprised the development of the questionnaire and initial validations of ADHERE. For the initial construction of the items, in addition to the SR results, in-depth interviews were conducted with representatives of the target population, following the recommendations of the PRO Good Research Practices Task Force Report (ISPOR 1). Next, a panel of experts tested the face and content validity of the questionnaire before conducting a quantitative pre-test with the target population in the Survey format. The quantitative pre-test followed the modified e-Delphi Method, as well as the recommendations of the COSMIN methodology for content validity and the PRO Good Research Practices Task Force Report (ISPOR 2). An Exploratory Factor Analysis (EFA) considering the varimax rotation model investigated the factor structure of the ADHERE questionnaire considering a coefficient of 0.45. In turn, we used Cronbach's Alpha Coefficient to assess the internal consistency of the data. Finally, the items retained in the factorial analysis were submitted to a qualitative pre-test with new representatives of the target population in the format of cognitive interviews (Debriefing). The planning and execution of the step followed the recommendations described in the PRO Good Research Practices Task Force Report: Part 2 - Assessing Respondent Understanding (ISPOR 2) Results: The systematic review included 71 studies and identified 37 findings of barriers and 23 of facilitators, classified into ten themes and dimensions of the frameworks used (COM-B and HBM). The results of the systematic review and in-depth interviews allowed us to build our initial item bank. In the theoretical construct validation (content and face), a panel of experts evaluated 68 preliminary items, following the modified e-Delphi method, during three rounds and anonymously. The judgment of the items used the Jotform® platform and considered clarity, objectivity, relevance, feasibility, and scope as criteria. After the panel of experts, 138 representatives of the target population evaluated the remaining 61 items via Jotform® in the survey format. Respondents rated clarity, relevance, and comprehensiveness dichotomously and anonymously. With a cut-off of relevance established as ≥ 70% of the evaluations, we eliminated eight items due to lack of direct or indirect relevance and four due to redundancy, totaling 49 items after the content validation step. Cronbach's alpha coefficient indicated high internal consistency for the scale with 34 items (α=0.94). Subsequently, the results of the Kaiser-Meyer-Olkin test (KMO=0.80) and Barlett's test of sphericity (χ²= 3488.09; p<0.001) indicated an adequate adjustment of the data, enabling the EFA. After this analysis, the version I of the ADHERE questionnaire had 34 items grouped into four factors, considering a coefficient of 0.45, which explained 42% of the total variance. The four factors (Factor one, two, three, and four) gathered ten, ten, nine, and five items, respectively. The identified factors were: self-perception of personal and environmental barriers (α=0.89), self-efficacy (α=0.87), health policies (α=0.86) and personal interactions (α=0.80). After this step, we included 16 participants in the qualitative pre-test, obtaining a higher proportion of people with a basic level of education. At the end of this analysis, the 34 items remained after adjustments and changes in the operationalization of scales. The item evaluation process at this stage allowed adjustments to the wording of 18 items and modifications to the 5-item scale format. Therefore, the questionnaire incorporated three contexts for the Likert Scale: practices, attitudes, and knowledge, and markers of frequency, agreement, and knowledge, respectively. Conclusions: From the complete validation of the ADHERE questionnaire, its use can generate reliable reports and help policymakers to plan, monitor, review, modify, and implement health education interventions centered on the individual and community. Given this, it is essential to develop new approaches to the ADHERE instrument, considering that a significant portion of our population is not literate, lives in remote regions, and does not have access to or has a limited understanding of the use of electronic resources. That said, continuous validation and updating of the questionnaire is also necessary to ensure its relevance over time.

Introduction: The use of exergames has been gaining prominence in rehabilitation to increase levels of physical activity, promoting health, improving physical function in older adults, and as a training tool in the home environment. VirtualTer is a low-cost exergame, validated and tested in a laboratory setting, and adapted for the home context of older adults, with the aim of enhancing levels of physical activity and reducing the risk of falls in this population. In this regard, it is important to investigate the feasibility and effects of using the VirtualTer exergame at home for older adults. Objectives: The main objective of this thesis is to analyze the feasibility of using the VirtualTer exergame at home for postural balance rehabilitation in older adults. Methods: The study involved three integrated modalities: 1) Elaboration of a protocol and systematic review; 2) Pilot study with the application of the prototype of VirtualTer home version in a single 15-minutes session; 3) Feasibility analysis of the effects of using VirtualTer at home and qualitative assessment of barriers and facilitators during the application of the game. VirtualTer was executed three times a week for two weeks, with each session lasting 25 minutes. The game effects were analyzed using sociodemographic assessment, Short Physical Performance Battery (SPPB), International Physical Activity Questionnaire (IPAQ), World Health Organization Disability Assessment Schedule 2.0 (WHODAS), Functional Reach Test (FRT), System Usability Scale (SUS) and Intrinsic Motivation Inventory (IMI). During the intervention, an observational analysis of barriers and facilitators was carried out using a daily form, structured according to the domains of the International Classification of Functioning, Disability and Health (ICF). Results: Modality 1 resulted in two articles: Article 1 – The systematic review protocol defined the methodology that guided the execution of the review. Article 2 – In the systematic review, after screening 1107 records, 4 trials were eligible. The usability of exergames was classified as acceptable and good. The pooled effect indicated improvements in functional balance in the TUG test (MD = -5.90; 95%CI = -10.29 to -1.51)  and Tinetti test (MD = 4.80; 95%CI = 3.36 to 6.24), in favor of the exergame group. A significant difference was observed in the experimental group for the immersive modalities (MD = -9.14; 95%CI = -15.51 to -2.77). The certainty of evidence was classified as low and very low. Modality 2 resulted in one article: Article 3 – Approximately 25 older adults with low physical performance, high level of physical inactivity, and impaired functionality participated in the pilot study. There was a significant relationship between the SUS scale and gender (P=0.04), marital status (P=0.03), and education level (P=0.01). A motivation score of 87 points was observed in the IMI, with a usability score of 72.50 points on the SUS scale and a satisfaction level of 80%. Technical elements subject to adaptation were identified, and functional solutions were incorporated for stationary gait and overtaking obstacles for the final consolidation of the home version. Modality 3 resulted in two articles: Article 4 – The sample consisted of 15 older adults. Better test scores were observed after the intervention. A significant correlation was found between pre- and post-intervention for FRT values (P = 0.001), walking speed on the SPPB (P = 0.023) and IPAQ score (P = 0.020). The older adults exhibited high intrinsic motivation (92 points on the IMI) after training, classified the usability of the game as excellent (score of 85 on the SUS), and a satisfaction level of 86.7% was observed. There was a significant difference (P = 0.001) in game scores across the intervention. Article 5 – Mild functional disability was observed in the WHODAS without significant differences between pre and post intervention. The facilitators elements were the innovation, fun, usability, motivation and competitiveness of the game; the benefits of physical activity, the structure and comfort of the home environment, adaptations, and the encouragement and support of family members. The barriers were related to technological elements of the game (locking, inconsistencies in motion capture, and disproportionate counting of harmful energies in the game), fear and insecurity of climbing up and down the step, limited mobility, external noise, attitudes of household members, domestic animals, unexpected phone calls and visits. Conclusion: Exergames applied at home showed good usability and had significant effects on postural balance, especially the immersive modalities. The prototype of the home version of VirtualTer achieved good usability and highlighted the need for adjustments in the technical elements to promote greater specificity and robustness in the final version of the game. The VirtualTer exergame was considered a feasible and safe tool, presenting excellent usability and acceptance in the home environment, generated high motivation in the older adults and improved better scores in post-intervention clinical tests. The barriers and facilitators observed during the game execution influenced its application, emphasizing the need for supervised use of home-based VirtualTer and contributing to the improvement of this technological tool.

Different interventions have been developed in the hope of organizing the neurological outcomes of premature newborns (RNPT). However, offering early organized care and considering parental involvement seems to be an important alternative in this process. With this in mind, Tummy Time (TT) can provide the necessary stimuli to minimize the sequelae of motor and cognitive development. Additionally, it allows babies in developing countries the opportunity for stimuli even in the face of difficulties accessing rehabilitation centers. The objective of this study was to assess whether daily TT experience, added to routine care, would improve motor and cognitive development in premature infants from developing countries. This was a randomized, controlled, double-blind clinical trial involving 31 RNPT with an average gestational age at birth of 33.3+/-1.6 weeks and a weight of less than 2500g. They were followed after hospital discharge until 4 months of corrected age in the Follow-up outpatient clinic. Sixteen babies were included in the TT group, where parents were invited and guided, through an illustrative booklet, to practice TT for at least 30 minutes during their routine activities and playtime. Fifteen babies were in the usual care (UC) group, in which mothers were the main providers of their newborns' biological needs and followed routine care as instructed in outpatient consultations. Motor and cognitive results were evaluated using the Bayley-III motor and cognitive scales at 2 and 4 months of corrected age. Head elevation was measured using the angle between the ear tragus and the baby's support surface at baseline, 2, 3, and 4 months of corrected age, using the Kinovea® software. Result analyses were performed by an examiner blinded to group allocation. The composite motor score of the Bayley was higher in the TT group than in the UC group at 2 months (TT 117.85+/-9.67, UC 85.91+/-13.81, p=<0.001) and 4 months (TT 126.62+/-16.15, UC 87.80+/-18.54, p=0.003) of corrected age. The composite cognitive scale was also higher in the TT group than in the UC group only at 2 (TT 98.57+/-7.44, UC 83.33+/-13.37, p=<0.001) and 4 (TT 105.00+/-14.88, UC 81.00+/-24.24, p=<0.001) months of corrected age. There was an increase in the head elevation angle over time, but the means did not differ between groups (p=0.66). Although head elevation was similar in both groups, TT practice expanded babies' perspective to explore their own body and environment, favoring stimuli for motor and cognitive patterns appropriate for their age. One limitation of the study was that 31% of participants were lost to follow-up in the second assessment. This demonstrates the challenge of providing and sustaining early intervention programs for RNPT in low-income contexts. Thus, TT practice in premature babies can improve motor and cognitive functions as a home-based approach immediately after discharge. 

Background: Vestibular Activities and Participation measure (VAP) is an instrument that measures the effect of vestibular disorders on activity and participation using items from the International Classification of Functioning, Disability and Health. Two independent subscales were developed from 34-item original version. Objective: to perform cross-cultural adaptation of the VAP subscales and to evaluate their measurement properties (validity, internal consistency, reliability and measurement error). Methods: this is a methodological study, in which the cross-cultural adaptation followed the steps of translation, synthesis, back-translation, review by a committee of experts and pre-test. Structural validity was assessed using exploratory (EFA) and confirmatory (CFA) factor analysis, while hypothesis testing was analyzed by correlating the VAP subscales with Dizziness Handicap Inventory (DHI). Cronbach's alpha was used to measure internal consistency. Intraclass Correlation Coefficient (ICC) was used for assessing intra- and interrater reliability and measurement error was calculated by Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC). Results: VAP-BR subscales received some additional information in order to improve the understanding of the volunteers in pre-test. One factor was found in EFA for each subscale with 50% explained variance. In CFA, subscales 1 and 2 presented, respectively, adequate model fit indices (X2/df: 1.08 and 1; CFI: 0.99 for both; GFI: 0.97 and 0.98; RMESA: 0.03 and 0.08; SRMR: 0.04 and 0.01). Chronbach's alpha values found were 0.80 for subscale 1 and 0.82 for subscale 2. Subscales 1 and 2 presented respective ICC = 0.87 and 0.90; SEM = 1.01 and 1.16; and SDC = 2.79 and 3.22 for intra-rater assessment. When assessed by two different raters, both subscales showed ICC = 0.92, while values to SEM = 1.03 and 1.53; and SDC = 2.85 and 4.23 were found in subscales 1 and 2, respectively. Correlations between DHI and VAP subscales revealed coefficients above 0.57. Conclusion: Brazilian version of Vestibular Activities and Participation subscales have adequate measurement properties. Thus, VAP-BR subscales become relevant for Brazilian population with vestibular disorders in order to identify their activity limitations and participation restrictions.

Diabetes Mellitus is considered a chronic metabolic disease characterized by high blood glucose levels, which in the long term can lead to serious damage to the heart, blood vessels, eyes, kidneys, and nerves. OBJECTIVE: To identify the determinants of inadequate glycated hemoglobin A (HG) values in elderly people with type 2 DM. METHOD: This is an analytical observational cross-sectional study, whose sample (n=107) was selected for convenience and consisted of by elderly people aged 60 years or older, diagnosed with type 2 DM, according to the criteria of the American Diabetes Association (ADA), carried out between August 2017 and December 2018, through a structured interview and application of tests and scales multidimensional screening tools to investigate predictors of GH. The Mann-Whitney and Kruskal-Wallis tests were applied, followed by Dunn's test and the Spearman Correlation Coefficient (ρ), p<0.05. Then, stepwise regression analysis was performed. RESULTS: The sample was mostly female (67.3%), with a mean age of 67.3 ± 4.9 years. Half (49.5%) had an altered level of GH (8.1% or more). For the multivariate study of GH predictors, variables with p<0.10 were selected: gender, number of medications, visual analogue scale (VAS) for lower limb pain (LL), Geriatric Depression Scale-15, Timed Motor Up and Go Test (TUGT), dual-task TUGT, MiniBesTest, WHODAS, time to diagnosis, fasting glucose, subjective perception of vision, handgrip strength, insulin use, lower limb pain, orthostatic hypotension and occurrence of falls . Higher VAS values of pain in lower limbs (β=0.123; 95% CI 0.011; 0.021; p=0.031), presence of orthostatic hypotension (β= 1.061; 95% CI 0.092; 2.030; p=0.032) and using insulin (β= 0.959; 95% CI 0.088; 1.830; p=0.031) increase HG values. CONCLUSION:  In conclusion, we emphasize the importance of identifying the determinants that increase the levels of GH, considering the influence of the determinants on health that can be modifiable throughout the course of life, in order to encourage adherence to self-care and avoid severity of symptoms. damage to health that can considerably affect the quality of life of the elderly with DM2.

Pulmonary hypertension (PH) is considered a complex clinical syndrome due to increased pulmonary arterial pressure. Patients present with limitations of daily activities, dyspnea related to exercise, muscle dysfunction and functional decline. Currently, the tools for indirect assessment of exercise tolerance are performed by field tests and among them the sit-to-stand test (STS). The STS protocol was used in this population, so different tests with valid and effective measures were established as properties of measurements in the selection of PH. Objective: To determine properties such as properties (validity, reliability, internal reliability and measurement error), hypothesis testing for construct validity and responsiveness) and durability of the different STS protocols in measurements with HP. Methods: This is a systematic review that included studies with patients with PH who were evaluated by the STS test (1 minute (1-STS), 30 seconds (30-STS) or 5 repetitions (5rep-STS)). Searches were performed on PubMed/MEDLINE, EMBASE, SciELO, Cochrane Library, and Web of Science platforms following the PICOT strategy (Population: adults with PH; Intervention: assessment of exercise capacity with the STS; Comparator: control group or values of reference; Outcomes: psychometric properties; Type of studies: randomized or quasirandomized clinical trials and observational studies) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). We used Rayyan software for export, data analysis and study selection. The risk of bias was conducted by the ConsensusBased Standards for the Selection of Health Measurement Instruments (COSMIN) manual and the evidence quality analysis by the modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). The protocol was submitted on the PROSPERO platform (CRD42021244271). All evaluation steps were conducted by two independent researchers, in case of disagreement, a third evaluator was consulted. Results: 6,357 articles were identified, of which 1,310 articles were excluded due to duplication. Of the 5,047 remaining articles that went on to analyze titles and abstracts, only 7 went on to full-text analysis and of these only 3 (González-Saiz et al., 2017, Kahraman et al., 2020 and Nakazato et al., 2021) articles were included for analysis, assessment of risk of bias and quality of evidence. Four psychometric properties were evaluated: 2 studies assessed convergent validity, one study assessed cross-group validity, one assessed responsiveness, and one assessed reliability. Of these, 3 psychometric properties obtained moderate quality of evidence, the responsiveness of the 5-STS (7.5 ± 1.4 to 6.0 ± 1.1 (p<0.001)), the convergent validity of the 30-STS (30- STS vs 6MWD r= 0.660 p<0.001) and 1-STST (1- STST vs Accelerometer r= 0.593 p= 0.006). One study showed a low quality of evidence on the validity between groups of 30-STS (30-STS and NYHA Class II 13.68 (3.34) vs 30-STS and NYHA Class III 10.25 (3.49); p= 0.004) and another very low on the reliability of the 30-STS (ICC 0.95 (0.90–0.97). Conclusion: We conclude that there is a scarcity of studies on STS protocols in HP and, given the findings, we can infer that the 30-STS was considered responsive, and that the 30-STS and 1- STS protocols showed valid convergent validity in HP. The validity between groups and reliability showed methodological deficits that made it impossible to be considered reliable. Thus, we suggest that more studies with a larger sample size and with methodological rigor are necessary for the indication and interpretation of the use of STS in the population with PH

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease with variable and complex clinical manifestations, requiring a multidisciplinary approach. However, face-to-face treatment in this population may encounter some barriers, such as the difficulty of traveling to treatment centers and access to physical therapists or other professionals. As a way of overcoming these barriers, new strategies were implemented in the health systems, among them telerehabilitation, to facilitate the treatment and physical therapy follow-up of these individuals. Objective: To evaluate the effects of a home exercise protocol with face-toface and remote monitoring on clinical outcomes and treatment adherence in patients with ALS Methods: This is a randomized, blinded clinical trial, which included adult individuals of both sexes, aged between 18 and 80 years, with a definite, probable or possible clinical diagnosis of ALS. After the initial face-to-face assessment, the participants were randomized into two groups, which performed a protocol of home exercises (according to the stage of the disease), three times a week for six months. The execution of the exercise protocol was monitored weekly (1x/week), remotely (via phone calls) for the experimental group (EG) and in person (with visits from the team) for the control group (CG). The outcome measures assessed were: functional physical capacity (Amyotrophic Lateral Sclerosis Functional Rating Scale – Revised – ALSFRS-r), disease severity (Amyotrophic Lateral Sclerosis Severity Scale – Egela), fatigue (Fatigue Severity Scale – FSS) and pain (Visual Analog Scale and Body Diagram). Outcome reassessments will take place remotely every two months, during the intervention period, and one month after the intervention ends. Descriptive statistics were used to present the preliminary data and the mixed linear model will be used to compare the outcome measures between the groups and between the evaluation moments at the end of the intervention, with α=5% Results: Six participants were included, of both sexes, with a mean age of 57.8 (± 9.1) years, who had a predominance of the disease in its spinal form (66.6%), with a mean time of onset of symptoms between 1 and 2 years. Data related to outcome measures seem to demonstrate a decrease in the scores on the functional capacity and pain scale, an increase in the scores on the fatigue scale, and maintenance of the scores on the disease severity scale, when comparing the moments of initial assessment and reassessment after two months. As for the intervention, the participants showed good adherence to home treatment, performing the exercise protocol 2 to 3 times a week, following what was proposed. Only 5 participants reported fatigue during or after the intervention and there was no report of pain. Conclusion: According to the preliminary results, it can be concluded that the findings of the study are similar to what is found in the literature, regarding clinical and sociodemographic characteristics, as well as the behavior of the disease and its repercussions. So far, the intervention time to which the participants were submitted was not sufficient to detect statistical changes in the analyzed outcome measures. However, participants' adherence to the home exercise protocol has been high, and the exercises have been well tolerated

Introduction: The treatment of neuromuscular diseases has changed in recent years, from palliative management of symptoms to preventive methods of training focusing on functionality, participation, and activity. The importance of physical exercise in the quality of life of children and young people with muscular dystrophy (MD) is well known, but there are still gaps in knowledge about the types of exercise, intensity, frequency, duration, and effects that can guide interventions. Despite the therapeutic developments in rehabilitation, there is a lack of clinical trials and systematic reviews focusing on motor interventions in the population with muscular dystrophy, hindering the development of research and guidelines that can assist in decision-making and clinical practice. Objective: To identify studies on motor intervention and to characterize the approaches carried out in children and young people with muscular dystrophies. Methodology: The elaboration of the scoping review followed the guidelines of The Joanna Briggs Institute according to the following structure: (1) identification of the research question; (2) inclusion criteria; (3) identification of relevant studies; (4) study selection; (5) data mapping; and (6) comparison, summary, and reporting of results. To ensure inter-rater reliability, 20% of the sample was independently reviewed and compared by the two researchers. Results: 11,009 abstracts were found in the databases; 416 were duplicates; and 22 were eligible for full-text review. Twelve studies were included in the review. In total, 308 children and young people participated in all the included studies. The age of the participants ranged between 4 and 14 years. Different protocols with different intervention focuses were found among the modalities. The most discussed outcomes were muscle strength, muscle function, endurance, gait, and functional skills. 40.37% of the instruments used focused on functional tests. Conclusion: Considerable variability was observed in the analyzed outcomes and motor interventions applied to children and adolescents with MD. Clinical evidence on the types of exercise in muscular dystrophies is still limited and heterogeneous and does not allow a consensus on the effects of physical exercise in this clinical condition. However, there is a lack of studies that focus on the quality of life, participation, and independence of this population.

Introduction: Quality of life (QoL) in pregnant women has been investigated over the years. Family and financial support, recreational activities, psychological support, prenatal care are relevant issues so that the pregnant women may feel welcomed and inserted in the biopsychosocial scope, minimizing complications during pregnancy, childbirth and postpartum. Aims: To verify the relationship between quality of life and social support in pregnant women at usual risk. Methodology: This is an observational cross-sectional study. The initial sample consisted of 201 pregnant women, who were between the first and third trimester of pregnancy. After observing the exclusion criteria, there were 102 pregnant women who made up the final sample. An initial assessment form, The Medical Outcomes Study for Social Support Survey, and the Ferrans and Powers Quality of Life Questionnaire were used. For statistical analysis, the Kolmogorov-Smirnov tests were used to perform the distribution of quantitative variables. The correlation between social support and quality of life was performed using the Spearman test, with p value lower than 0.05. Results: The sample had chronological and gestational age mean of 31.06 (±3.65) years and 23.84 (±5.62) weeks, respectively. The data obtained demonstrated a relatively high perception of QOL, with a total score of 22.64 (±3.23). The domains with the highest values were family and psychological/spiritual, with a total score of 25.42± 3.47 and 23.76 ± 3.83 respectively. The score obtained for social support had an mean over the total score of 77.62, suggesting a good perception of social support by the participants. The correlation between social support and quality of life presented a value of 0.318, with p value less than 0.001. Conclusion: The observed data suggest that there is a relationship between social support and quality of life in the group of pregnant women, but more studies need to be carried out to confirm or refute the results of this study.

BACKGROUND: Heart failure (HF) is a complex clinical syndrome defined by the inability of the heart to generate cardiac output. In addition to cardiac alterations, patients with HF have alterations in ventilatory control, such as hyperventilation at rest, during exercise, or during sleep. Ventilatory oscillation (VO) is described as periodic breathing during exercise characterized by periods of hypopnea and hyperpnea, with no intervening apnea. It is a variable that can be found during cardiopulmonary exercise test (CPET), where it can appear as a clinical oscillation of the minute volume (VE), with typical duration and amplitudes, and may have different forms of presentation, such as subjective visual analysis through the evaluation of two or more examiners. Recently, an objective and quantifiable measure of OV was created, the “ventilatory dispersion index” (VDI), based on a mathematical calculation taking into account the dispersion of ventilation over the test time. OBJECTIVE: To evaluate ventilatory oscillation through the ventilatory dispersion index in heart failure during CPET. MATERIAL AND METHOD: This is a retrospective study that analyzed the medical records of patients with HF referred to the Cardiac Rehabilitation Service of the Hospital Universitário Onofre Lopes (CORE/HUOL/UFRN) submitted to CPET, from October 2014 to June 2019. The medical records were included for analysis of patients with HF diagnosed by the cardiologist, with functional class I, II and III according to the New York Heart Association (NYHA) and with reduced and preserved ejection fraction. The data extracted from the medical records were spreadsheetd in an Excel table, with information regarding: anthropometry, disease burden, drug load, functional load, spirometry, echocardiogram and CPET data. The identification of VO was carried out by two independent researchers and there was agreement between them, through graphic analysis of the VExTime with a 30-second filter, being positive when the LV amplitude during exercise is greater than 15% of the LV amplitude at rest and present at least 60% of the total test time. The IDV calculation was done through a mathematical calculation proposed by latelly. Statistical Package for Social Science Software (SPSS – version 20.0) was used statistical analysis, data normality (used Kolmogorov-Smirnov (K-S) or Shapiro-Wilk (S-W) tests; descriptive to parametric and non with mean and standard deviation and frequency and quartis.  significance level of 5%. The ROC curve was used to analyze the ability of the VDI to predict OV, through the area under the curve (AUC). Pearson's correlation test was used to analyze the relationship between VDI and lung function/CPET/risk stratification variables. Significance level of 5% was proposed to all hypotesis. RESULTS: Were anaysed data of 93 patients with HF eligible to study. The majority patients was male, without significant difference between men (n=65) and women (n=28) for the variables of ventilatory function, EFLV and ventilatory dispersion. Mean age in the group was 50.8±14.2 years, normoweight (mean BMI 26.1±4.6), all with heart failure and systolic dysfunction with EFLV of 42.4±0.16%). I and II were the most prevalent NYHA functional classes. In the burden of disease, SAH dominated in 66.3%, followed by diabetes (32.5%) and 12 patients had previous acute MI. As a drug load, patients used mainly antihypertensive drugs (85.7%) and beta-blockers (80.5%). As for the functional load, most patients were sedentary (54.1%), and were classified as having moderate risk (88.5%) after stratification. The mean perception of fatigue and dyspnea reported at the end of the test was 14.2±3.4 and 14.8±3.3. The analyzed VDI mean was 0.551±0.306. The VDI was moderately and positively associated with volumes and capacities measured in spirometry positively and moderately associated with the CPET variables (rest and peak of exercise) showing that the higher these values, the higher the VDI. The association of visually measured OV with the VDI showed a cut-off point of 0.601 by the Younden index in the VDI, showing good discriminatory power (p<0.001) to define the ventilatory dispersion, with an AUC of 0.84 (IC 0 .75-0.93), a specificity of 63% and a sensitivity of 81%. CONCLUSION: The IDV is a quantifiable method that shows strong predictive validity with the OV.

Abstract: Lung and airway damage can be caused by COVID-19, therefore, it is important to evaluate the respiratory muscles of subjects infected by the virus. The research aims to non-invasively assess the contraction and relaxation properties of inspiratory muscles, as well as their electrical activity. In this cross-sectional study, carried out at the Onofre Lopes University Hospital (HUOL/EBSERH), the assessment of respiratory muscles regarding their contraction (TC and MRPD) and relaxation (MRR, ½ RT and tau) properties, and electrical activity by surface electromyography (EMGs) of the sternocleidomastoid (SCOM), scalene, parasternal and rectus abdominis muscles was performed non-invasively using the SNIP test in 39 post-COVID-19 subjects (18 women and 21 men) compared to 39 healthy subjects (18 women). and 21 men). Statistical analysis was performed using the GraphPad Prism 8 software, where an alpha (a) of 5% is considered as statistical significance and a power of the test (power) of 80%. Of the relaxation properties obtained from the sniff curve, ½ RT obtained a significant decrease in the COVID-19 group (p<0.05) when compared to healthy individuals. Regarding the contraction properties, there were no significant differences, but a higher value was observed in the CT in the post-COVID-19 subjects. In addition, there was no significant difference between the electromyographic variables, however, there was an increase in electrical activity in the ECOM muscles (139.8 (110 - 167.8 vs 119 (79.2 - 193.6)), scalene (212 .2 (127.8 – 275) vs 135.9 (117.8 – 209)) and parasternal (40 (32.7 – 54.6) vs 29.9 (11.7 – 63)). we concluded that the contraction and relaxation properties of the inspiratory muscles, as well as the electrical activity of these muscles, were not altered after COVID-19. However, further studies need to be carried out.

Introduction: The presence of type 2 Diabetes Mellitus is directly related to functional deficit, low physical performance and even risk of falls in the elderly. One of the most important complications for this audience is body imbalance. Physical exercise is one of the most indicated treatments. Among the most used techniques, training based on strengthening, stretching, flexibility and relaxation induces an improvement in the postural balance of the diabetic elderly. Another strategy is the use of exergames, used for functional recovery of postural balance. Objective: to investigate the influence of an exergames protocol on the body balance of elderly people with type 2 Diabetes Mellitus. Methodology: This is a randomized clinical trial with RBR-67y6cz registration at REBEC. Individuals aged between 65 and 79 years, diabetics, with complaints of imbalance, risk of falling, without cognitive deficit and with mild or moderate peripheral neuropathy were included. The sessions lasted 40 minutes, twice a week, for 12 weeks. For both groups, in all sections, a protocol for strengthening the lower limbs was initially performed (10 min). Individuals in the control group (CG) performed a kinesiotherapy protocol (40min) focused on balance; those in the experimental group (EG) used games (40min) that simulate the GC protocol (free run, soccer heading, penguin slide, island cycling, tilt table, free steps and balance bubble). They were evaluated before and after treatment and at the 3-month follow-up period. Functional balance data (MiniBesTest), functional performance (Short Physical Performance Battery), functional capacity (Brazilian OARS Multidimensional Functional Assessment Questionnaire), hand grip strength by hand dynamometer and balance confidence (ABC scale) were evaluated. A 2x3 mixed ANOVA was used to compare the outcomes between the two groups and in the three evaluation moments. Results: in total, 34 individuals composed the study, randomized into 17 in the CG and 17 in the EG. For the control group, there was a statistical difference between T1 and T2 for SPPB (p=0,001), FPP (p=0,003) and BOMFAQ (p=0,035); between T1 and T3 only for SPPB (p=0,02) and FPP (p=0,01). For the experimental group, there was a statistical difference in the 3 times for the MBT (p<0,001; p=0,04; p=0,05), between T1 and T2 for the SPPB (p<0,001) and ABC scale (p=0,04); and between T2 and T3 for SPPB (p=0,02). Conclusion: the exergames protocol was effective to promote improvement in the body balance of elderly diabetics, however, the protocol in question was not effective to promote improvement in hand grip strength and independence for activities of daily living in this population.

Introduction: Frailty is a biological syndrome characterized by an increase in physical and psychological vulnerability and reduced resistance to stressors, physiological reserves and intrinsic capacity of an individual. The development of this condition seems to be, in parts, associated with the biological mechanisms involved in the aging process, making it essential to better understand these mechanisms. Frailty is widely associated with decreased body muscle mass, which has physical and social consequences for the older adults. The use of low-cost and easily applicable instruments and models for screening for frailty and low muscle mass in the older adults is feasible in primary health care, since their diagnoses are complex and require the use of high-cost technologies. Aim: To understand the biological aspects of frailty and low muscle mass, in addition to enabling the screening of both conditions through psychometric measures. Methods: This thesis presents a narrative review and two cross-sectional studies composed of 786 community-dwelling older adults residents in Parnamirim (Rio Grande do Norte), aged 60 or over. Sociodemographic, anthropometric, body composition and physical performance data were assessed. Short Physical Performance Battery (SPPB) diagnostic accuracy was evaluated for frailty and pre-frailty screening. For the screening of low muscle mass, analyzes were performed with a regression tree to identify a model. For the narrative review, information was gathered about the association between biomarkers of the aging phenotype proposed by López-Otín et al. (2013) and frailty. Results: SPPB has good diagnostic accuracy to discriminate between non-frail and frail older adults using a cut-off point of ≤9 points. For the identification of pre-frailty, SPPB presented measures of diagnostic accuracy from low to moderate, however, it was verified that this instrument can help in screening pre-frail older adults from the cut-off point of ≤11 points in total SPPB score. For the screening of low muscle mass, an algorithm with high accuracy was developed based on the factors of Body Mass Index (BMI) (values ≤ 22.7 kg/m² for men and ≤ 24.9 kg/m² for women), sex (female), calf circumference (values ≤ 31.7 cm for women with a BMI ≤ 24.9 kg/m²) and use of psychotropic drugs in individuals with a BMI > 29.4 kg/m². Regarding the narrative review, the main biomarkers of aging associated with frailty were identified: mitochondrial DNA (mtDNA) copy number, telomere length, global DNA methylation, Hsp70, Hsp72, IGF-1, SIRT1, GDF-15, CD4+ and CD8+ cell percentages, circulating osteogenic progenitor cells, IL-6, CRP and TNF-alpha. Conclusions: The identification of frailty is possible through the SPPB, since it has good diagnostic accuracy to discriminate between non-frail and frail older people using a cut-off point of 9 points in the total score, being better to identify those non-frail individuals. Although the SPPB's diagnostic accuracy in detecting pre-frailty was moderate to low, this instrument can help in the screening of these older adults, allowing the implementation of early interventions. The screening of low muscle mass can be possible using the developed algorithm in this study, which showed high accuracy, based on the factors of BMI, sex, calf circumference and use of psychotropic drugs. Finally, among the main biomarkers of aging associated with frailty, IGF-1, SIRT1, GDF-15, IL-6, CRP and TNF-alpha presented more robust evidence, highlighting the importance of inflammation and nutrient sensing on frailty.

Diabetes Mellitus (DM) is a complex disease that requires continuous medical care to reduce risk factors, in addition to glycemic control. Among the main complications of DM, micro and macrovascular disorders related to the renal, cardiovascular and nervous systems stand out. Hyperbaric oxygen therapy (THO) involves intermittent administration of 100% O2 under high pressure, which could reduce damage from hypoxemia and tissue hypoxia in nerve injuries. Objective: To analyze the effects of OTH on sciatic nerve regeneration in diabetic rats. Methods: 49 male Wistar rats, 60 days old, weighing about 220-300g, were divided into four groups: C (normoglycemic animals), C+L (normoglycemic animals submitted to compressive neural injury), DM+ L (diabetic animals submitted to compressive neural injury), DM+L+OTH (diabetic animals submitted to compressive neural injury and OTH). Initially, the animals of the diabetic groups were submitted to DM induction by Streptoozotocin (STZ) and the animals of the groups with lesion were submitted to the induction of sciatic nerve lesion. For the treatment protocol, the animals were submitted to OTH with pressure inside the chamber of 3 absolute atmospheres (ATA) at a rate of 2 ATA/min and will be maintained at this pressure for 60 min. The chamber was ventilated with 100% O2 at a flow of 20 L/min to minimize CO2 buildup. Morphological variables were evaluated using histology, electromyographic (peak amplitude, pulse duration and conduction velocity) and functional variables using the sciatic function index (SFI). Statistical analysis was performed using an analysis of variance (ANOVA), Tukey's test, Kruskal Wallis and Dunn's post hoc test. Results: the animals in the DM+L and DM+L+OTH groups showed a significant increase in glucose levels compared to the control groups (p<0.001) and at the end of the experiment a significant reduction in body weight was observed in the diabetic groups in relation to the control group (p<0.001). There was a significant increase in the number of axons in the GD+L group compared to the GC (p<0.05) and GC+L (p<0.05) groups. Regarding the electrophysiological variables, the GDL+L+OTH group showed significant improvement when compared to the GC (p<0.01) and GD+L (p<0.01) groups. In the assessment of functionality through the SFI, the GD+L+OTH group showed a significant improvement when compared to the GD+L group (p<0.001). Conclusion: OTH promoted an improvement in functional performance and in the amplitude of the electrophysiological signal in diabetic rats submitted to sciatic nerve injury. 

Introduction: International studies present data on the incidence or risk factors for low back pain in fighter pilots, however, in Brazil, this population still needs to be studied. With respect treatment, there is evidence that core stabilization, strength, and endurance training contributes to lowering lower back pain in general population. However, we are not aware of the effect of these exercises on fighter pilots with pain.

Objectives: Study I= To investigate the effects of an exercise protocol on low back pain in Brazilian Air Force fighter pilots. Study II= To analyze the prevalence of spinal alterations by means of Magnetic Ressonance Imaging (MRI) and to observe if the Cross-Sectional Area (AST) of the multifidus, the strength and resistance of the trunk muscles, are predictive factors for low back pain.

Materials and methods: Study I=Fourteen pilots with chronic low back pain were randomized into two groups: Stabilization exercise group (GEE-n=7, exercises twice a week for 12 weeks) and the Regular exercise group (GER – n=7). Assessments were performed before and after the training period. The primary outcome was low back pain intensity and the secondary outcomes were neck pain, functional disability, range of motion, maximal isometric strength and trunk muscle endurance. Study II= Twelve fighter aspirants performed clinical and MRI assessments at the beginning and end of the first year of fighter training. MRI was used to assess musculoskeletal changes of the lumbar spine and AST of the left multifidus muscles. Anthropometric data, work hours, physical exercise routine, intensity of chronic low back pain and disability were also collected.

Results: Study I= GEE had a significant reduction in low back pain compared to GER (2.28 point difference, p=0.01) at the end of the protocol. It was also observed that the strength of the trunk muscles was maintained throughout the period in this group, while the control group had a decrease in flexion strength to the right (difference: -3.71%, p=0.04). No differences were observed in disability level, range of motion or resistance to fatigue between the groups. Study II = Pilots with higher AST of the multifidus muscles at the beginning, had less pain at the end of the training year (r=-0.64, p=0.02). There was a high prevalence of changes in the spine by MRI at the beginning of the year, especially ligament swelling due to overload (83%). There was a decrease in trunk strength and resistance for extension at the end of training, however, performance was not a predictive factor for low back pain.

Conclusion: Study I= The specific exercise protocol for core stabilization proved to be effective in reducing low back pain in fighter pilots. Study II= Results suggested that multifidus AST is a predictive factor for low back pain in the first year of fighter flight and may be an important parameter for pilots ‘health monitoring.

Background: In the gestacional period, the woman goes throug a series of changes in order to reate na environment conducive to the development of the fetus. These can result in the devolpment of painful symptoms, such as lumpopelvic pain, impacting the functionality of this population.

Aims: To Analyse lumpopelvic pain and it’s impact on the functionality of pregnant woman.

Methodology: Cross-sectional study whose unit of analysis was the pregnant woman. Adopt as inclusion criteria, pregnant women between 18 and 40 years of age, with internet acess at any gestacional age. As contracted, the following intruments were provided: Individual Assessment Form, Oswestry Disability Index and World Health Organization Disability Assessment Shedule 2.0. Statistical data analysis was performed using the Statistical Package for the Social Science – SPSS  version 20.0. The variables selected for this study were: sociodemographic, obstetric, life habtis, pain (intensity and level of capacity generated by lumbopelvic pain - %) and funcionality and disabilities (specific core score).

Results: 142 pregnant Woman took part in this study. The results were elaborated from 4 articles.

Article 1 – Protol of sistemactic review of therapeutic exercise versus other modalities to prevent and treat low back pain and pelvic pain during pregnancy

Article 2 – 142 pregnanct women. The chronological mean, weight and height were, respectively, 31.37 ±4.93 years og age, 72.08 ±13.22 kg and 1.62± 5.91 meters. Not having a disability according to WHODAS 2.0 decreases the chance of having lumbopelvic pain in pregnancy by 81.7% compared to having severe disability. Whereas from 1 to 4 minimal income increases the the chance of having a loin pregnancy by 3.06 times having a single income with 5 property or higher income.

Article 3 – 132 women participated in this study. The median chronological age of women in the lumbopelvic group was 31.00 (19.00-39.00) and in the pain without  pain, 32.00 (20.00-38.00). When comparing women with and without pain, a statistically significant difference was observed for the cognition (p=0.0035) and participation (p=0.012) domains.

Article 4 – 99 pregnant women iwth  a mean chronological age of 30.94 ±4.74 were included in this study, of which 6.1% (n=1) were in the firts gestacional trimester, 54.5% (n=54) in the second gestacional trimester and 38.4% (n=38) in the third gestacional trimester. The meand score for the IIO was 12.34 (10.39) and for the WHODAS, 102.62 (75.85). It was observed that 63.6% (n=63) of the women had minimal disability according of the IIo and When analysing the WHODAS 2.0, 63.6% (n=63) reported mild disability. When analysing the relationship between IIO and WHODAS 2.0, statistical significance was observed (p=0.002).

Considerations: Functionality ia a multidimensional concept and, therefore, influenced by several factors. The identification of factors thay may be related to lumbopelvic pain, as well as the understanding of the funcional status of the pregnant women, can help health professionals in the adequate management of the complaints presente throughout the pregnancy-puerperal cycle and the elaboration or adequacy of specif interventions and adapted to the needs of this population.

Introduction: Self-efficacy is considered an important predictor of therapeutic adherence and health promotion in achieving the control of chronic diseases, and its evaluation is essential for the management of asthma. So far, in Brazil, there are no specific instruments to assess the self-efficacy of adolescents with asthma. Objective: To provide the translation, cross-cultural adaptation, and evaluation of the psychometric properties of the Adolescent Asthma Self-Efficacy Questionnaire (AASEQ) for the Brazilian population. Methods: This is an exploratory and psychometric methodological study, which involves the translation, cross-cultural adaptation, and psychometric assessment of the AASEQ. The study followed international recommendations, including the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), and involved translation steps, synthesis of translations, reverse translation, synthesis of reverse translations, review by an external researcher, evaluation and approval of the author of the original version, analysis by a multidisciplinary committee of experts and pretest. Similar to the original study, internal consistency was tested; contentvalidity; convergent validity; discriminant validity, and construct validity, verified by the Confirmatory Factor Analysis (AFC). Results: The instrument adapted for the Portuguese spoken in Brazil proved to have a content equivalent to the original, in which adequate comprehensibility indexes were obtained for the Brazilian population. They were considered eligible to participate in the study 148 adolescents with asthma, aged 12 to 18 years. The AASEQ showed an adequate value for internal consistency (Cronbach's α = 0.91). The construct validity showed a regular adjustment to the data (x2 = 786.625, df = 308, χ2 / df = 3.92, GFI = 0.735, CFI = 0.830 and RMSEA = 0.104). The convergent and discriminant validities were confirmed through correlations with the General Self-Efficacy Scale (GSES), Asthma Knowledge Scale, and the number of hospitalizations for asthma in the last year. Conclusion: The AASEQ proved to be an appropriate questionnaire to assess asthma self-efficacy in Brazilian adolescents.

Introduction: Crossfit® is a sport that is gaining space on the world stage. It requires high physical demand, exposing the individual to greater muscle damage. Controlling muscle damage markers can improve athletes' performance. Cryo-immersion (CI) is widely used in sports recovery, however, its effects are still controversial and may depend on the magnitude of muscle damage. Objective: To analyze the effects of IC on the recovery of clinical, biochemical, functional and neuromuscular markers of exercise-induced muscle damage in Crossfit® practitioners. Methods: This is a controlled, randomized, blinded clinical trial, in which 16 Crossfit® practitioners were randomly divided, after an induced damage protocol, into 4 groups: low volume control group (gCBV), high volume control group (gCAV ), low volume cryimersion group (gCIBV) and high volume cryimersion group (gCIAV). Were evaluated: subjective perception of pain (VAS), Total Quality Recovery Scale (TQR), biochemical markers and muscle performance in the moments: pre, post-exercise and after intervention (immediately after, 24h and 48h). Using the SPSS, the Shapiro-Wilk test, mixed two-way ANOVA was performed considering a significance level of 5% and a confidence interval of 95%. Results: there was a difference between groups only for the TQR, where the CI groups presented better averages immediately after the intervention (p <0.05). Conclusion: Cryo-immersion seems to interfere only in the athletes' perception of recovery.

Introduction: Populational aging process affects the increase of disabling conditions prevalence for elderly. Chronic pain in elderly is considered a public health issue, causing a high demand for health services, and is associated with physical and functional disability. The prevalence of painful symptoms and mobility deficits varies in elderly populations from different social contexts. However, there are knowledge gaps about the factors involved in the association of pain with functionality in older adults. Objectives: to estimate the prevalence of painful symptoms in a population sample from countries with different aging profiles; and to identify factors associated with pain in relation to physical performance considering potential confounders. Methods: This is an analytical cross-sectional study derived from the multicenter study The International Mobility in Aging Study (IMIAS), carried out in the cities of Saint-Hyacinthe (Quebec, Canada), Kingston (Ontario Canada), Manizales (Colombia), Tirana (Albania) and in Natal (Brazil). 2000 subjects aged 65 to 74 years of both sexes were analyzed, with socioeconomic, health and anthropometric measures. Physical performance was assessed using the Short Physical Performance Battery (SPPB), and painful symptoms, by self-report of the presence of back or lower limbs pain. Results: men had a lower prevalence of pain when compared to women, with the lower limbs being more affected (p<0.001). In the assessment of physical performance, men had a better total SPPB score mean compared to women (p<0.001). Reports of pain and painful symptoms are associated with poor physical performance in the elderly of both sexes (p<0.001). The presence of depressive symptoms, body mass index, pain and worse socioeconomic conditions were associated with poor physical performance in women (p<0.001). Conclusion: Pain is a limiting factor for physical performance of the elderly population studied, even when adjusted by health and socioeconomic conditions. The results indicate the importance of prioritizing the evaluation of painful symptoms in elderly population, in order to create prevention and care strategies that can minimize the impact of pain on the functionality and quality of life of this population.

Background: Congenital Generalized Lipodystrophy (LGC) is a rare disease characterized by metabolic outcomes such as hypertriglyceridemia, hyperinsulinemia, hypoleptinemia, hypoadiponectinemia, and diabetes mellitus. Cardiovascular and respiratory disturbances have been previously observed. Conversely, there are no studies regarding the peripheral arterial disease (PAD) occurrence and the cardiovascular (CV) response to submaximal functional exercise. This study assessed the PAD occurrence and the CV response to submaximal exercise in LGC subjects. Methods: Twelve LGC individuals and 12 healthy subjects matched for age and gender were included. The PAD and the exercise capacity were measured using the ankle-brachial index (ABI) and the sixminute walk test (6MWT), respectively. The genetic diagnosis sociodemographic, and anthropometric data were obtained. Correlations among metabolic parameters, ABI, and 6MWT were also performed. Results: We found that most LGC subjects presented normal ABI value (1.0 ≤ ABI ≤ 1.4). Only 25% (n=3) had ABI≤0.9. At baseline, LGC subjects showed reduced predicted walked distance (6MWD) (p=0.009), and increased heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressures after the 6MWT compared to healthy subjects (p<0.05). LGC subjects did not present changes in ABI and blood pressure 12 months after metreleptin (MLP) replacement, but they walked a greater 6MWD in comparison to baseline (p=0.04). Further, the measurements of 6MWD and right ABI were positively correlated in LGC subjects (p=0.03). Right ABI negatively correlated with glucose, triglycerides, and VLDL-c (p<0.05). Conclusions: Our data suggest that LGC subjects had lower functional capacity and needed higher cardiac effort for similar performance of the 6MWT. There was also an association between ABI and 6MWD

The general objective of the PhD Dissertation was to evaluate the relationship of
Myofascial Trigger Points (MTrPs) with physical, psychological and clinical
characteristics of pain, mobility and strength of individuals with symptomatology of
unilateral subacromial impingement syndrome. Two studies were carried out: 1)
Immediate effects of ischemic compression therapy on myofascial trigger points in the
shoulder; and 2) Relationship between myofascial trigger points and physical, clinical
and psychological characteristics in individuals with shoulder pain. Study 1 is a singlearm
clinical study, which evaluated 15 individuals (9 men and 6 women, age between
34.4 ± 10.4 and BMI of 24.20 ± 2.18 kg / m²). The individuals were evaluated for the
amount of MTrPs in the upper trapezius, lower trapezius, supraspinatus, infraspinatus,
pectoralis minor and medium deltoid muscles; pressure pain threshold (PPT) in the
upper trapezius, lower trapezius, infraspinatus and middle deltoid muscles; range of
motion (ROM) of the shoulder; and isometric strength of the shoulder muscles. The
Wilcoxon test was used to compare the numbers of MTrPs between the baseline, pretreatment,
as well as pre- and post-treatment. There was a reduction in the total
amount of MTrPs (p <0.01) and an increase in LDP in the middle deltoid muscle (p
0.03) in the comparisons between pre and post-treatment, while there was no
difference in ADMs (p> 0.05) and strength measurements (p> 0.24). However, the pain
was less during the sagittal elevation ROM (p <0.01) and internal rotation (p = 0.04), 

and during the performance of arm elevation and external rotation strength (p =
0.01).In general, there was no difference in the variables assessed between the
baseline and pre-treatment (p> 0.06). The ICT immediately reduced the amount of
MTPs and pain during mobility and strength, but did not change the PPT, ROM or
strength variables. The evaluation of mobility and strength did not have a negative
effect on the evaluated variables. Study 2 is an observational, cross-sectional study
that evaluated 58 individuals (36 men and 22 women, age between 31 ± 10.91 and
BMI of 71 ± 12.55 kg / m²). The individuals were assessed bilaterally for the presence
of TrPs (upper and lower trapezius, infraspinatus and supraspinatus), ROM (sagittal
and scapular flexion, internal and external rotation), isometric strength (scapular
flexion, internal and external rotation) and pain during ADM and strength. The
Spearman correlation test (rs) was used to assess the relationships between the
amount of MTrPs with ROM, pain during ROM, strength and pain during strength,
adopting a significance value of p <0.05. There was a correlation (rs = -0.29, p =
<0.01) between MTrPs of the lower, trapezoid and supraspinatus with the domain of
PSS function, as well as MTrPs of the upper trapezius with pain during ROM of
internal rotation and rotation external. The number of MTrPs of the lower trapezius
correlated with pain during ROM of sagittal flexion and internal rotation (rs= 0.30 -
0.40; p <0.05). There was a correlation between the number of MTrPs of the upper
trapezius and pain during the internal rotation force, MTrPs in the supraspinatus and
sagittal flexion ROM (rs = -0.36; p <0.01), scapular flexion (rs = -0 , 42; p <0.01) and
external rotation (rs = -0.30; p <0.01). Lower trapezius PGMs correlated with pain
during internal rotation and external rotation strength (rs = 0.29 - 0.38; p <0.05), as
well as external rotation ROM (rs = -0.29 ; p <0.05), the flexion and external rotation
force (rs = 0.29 - 0.34; p <0.05 was found between the number of PGMs in the lower
trapezius. Therefore, there is a correlation between quantity of active PGMs and pain
during ROM and shoulder strength, performance of ROM and strength, as well as with
the self-report of function. The ICT was effective to immediately reduce the amount of
MTPs and pain during mobility and strength, however, it did not have any effect on
PPT, ROM or strength.

Introduction: The ICF Participation domain is defined as involvement in life situations and is considered a human right. It involves elements related to the frequency or diversity of children's participation, involvement, and preferences. These elements work as critical quality of life indicators for children with disabilities but are little used in the clinical practice of rehabilitation professionals. Thinking about expanding the look at aspects related to participation, there is a need to identify barriers and facilitators for implementation, then develop an intervention strategy through Knowledge Translation (KT) to train rehabilitation professionals. Justification: The implementation of the ICF Participation domain will provide the identification of barriers and facilitators for the implementation and the level of propensity to change rehabilitation professionals, stimulating changes in the therapeutic dynamics of professionals and better care for families and children with motor disabilities. Methodology: During this study with a mixed methods approach, 27 physical therapists and occupational therapists participated in six learning sessions facilitated by a knowledge broker. Before the intervention, the professionals were interviewed through focus groups and by the Organizational Functioning and Readness for Change (ORC) tool to analyze the level of propensity for change. After the intervention, the professionals were interviewed again through focus groups, to assess the possible change in practice. Two researchers independently carried out thematic analysis of the data. The study design combines elements of a pragmatic essay and mixed-methods model. Results: Through the focus groups and quantitative analysis of the ORC tool, it was possible to identify the barriers and individual and organizational facilitators for the implementation and the level of propensity to change after training with KT strategies. Before the training, the professionals demonstrated to have a good knowledge of the ICF but had low rates of use of the classification in clinical practice. Among the individual and organizational barriers that could hinder the implementation of the participation domain, the negative beliefs of the family and context, difficulty in expanding the view, and service barriers were identified. As facilitators for the implementation, the standardization of actions, teamwork and encouragement of the use of the ICF by other categories were mentioned. After the training, the professionals showed an increase in the levels of propensity to change, and satisfaction with the training, inserting the ICF participation domain in clinical practice. During the implementation, professionals faced barriers of time, routine and work overload; and facilitators related to good team training and personal enhancement. Conclusion: This strategy was effective in redirecting the gaze of physical therapists and occupational therapists to the notion of participation in leisure activities for children with disabilities and to establish readiness for change. This change can potentially facilitate new participation-based implementations.

Background: The DM can make the elderly bearers more susceptible to imbalance and falls because it affects the sensory systems that influence non-postural balance, associated with the process of senescence that decreases the functional reserve of the elderly and a presence of other diseases that affect these individuals. Objective: To evaluate the effectiveness of a Therapeutic Physical Exercise Program in improving body balance and the functionality of the elderly with type 2 diabetes mellitus. Methods: A blind, parallel, randomized, controlled feasibility trial will be conducted with a sample of elderly diagnosed Diabetes Mellitus type 2, attended at the Geriatrics and Endocrinology outpatient clinics of the University Hospital Onofre Lopes (HUOL) of the Federal University of Rio Grande do Norte. The Elderly Both Groups will undergo a Previously Scheduled Assessment, performed by trained evaluators, conducted at the Advanced Nucleus of Research and Technological Innovation in Health (NAPS), Laboratory of Technological Innovations (LAIS) to do HUOL. This recording in three moments: previous parties of randomization (T1), post-therapy after randomization - T2 and follow (three months after term term for operation - T3). The data are analyzed using statistical software Statistical Package for Social Sciences (SPSS), version 23.0. Expected Results: Hope, specific exercise program for the elderly with associated DM 2 as guidelines, is effective in improving the body balance and in the functionality of these individuals.

Introduction: Patellofemoral Pain (PFP) is a very frequent and debilitating musculoskeletal disorder that affects functionality and can compromise the performance of activities of daily living. This condition mainly affects the female population and the treatment is controversial. Objective: To compare the effects of additional neuromuscular electrical stimulation (NMES) to a therapeutic exercise program with emphasis on the knee extensor and hip abductor groups in women with PFP. Methods: This is a randomized controlled trial, in which 34 women with PFP, mean age 23.8 (SD 4.1), were randomly distributed into 2 groups: exercises associated with NMES (ESG) and exercises (ExG). The ExG performed an exercise protocol aimed at training the knee extensors and hip abductors, while the ESG performed the same exercises, but associated with the NMES. Interventions were carried out in both groups, twice a week, for eight weeks, totaling 16 treatment sessions. The primary outcome measure was pain intensity. Secondary outcome measures include functional limitations, vastus medialis oblique (VMO), vastus lateralis (VL), gluteus medius (GM) electromyographic activity, and isokinetic muscle performance of the knee extensors and hip abductors. These parameters were measured 72h before the beggining of the intervention (baseline), after 4 weeks (4 weeks evaluation), after 8 weeks (8 weeks evaluation) and after 16 weeks (16 weeks follow-up evaluation). Results: We did not observe any significant difference between the evaluated groups regarding pain intensity variables, functional limitations, electromyographic activity, isokinetic performance of the knee extensors and isokinetic performance of the hip abductors (p>0.05). We evidenced a significant difference in the intragroup comparison for pain intensity (p<0.01; F=42.9; ηp2=0.57) and functional limitations (p<0.01; F=43.0; ηp2=0, 57), in both groups. Conclusion: NMES did not demonstrate significant additional effects that justify its association with exercise in the treatment of PFP. However, the proposed therapeutic exercises were effective in reducing pain and improving functional limitations, with a residual effect that remained eight weeks after the end of treatment.

Introduction: In Brazil, monitoring growth and development is one of the strategies recommended by the Ministry of Health to ensure child development in an appropriate way for all Brazilian children, however, often this process is not carried out effectively. In some countries, strategies of technological innovations are being an alternative to favor the care of these children collaboratively between the family and health professionals. Objective: Develop a sofware web and mobile version and test its content validity to track growth and child development. Methodology: This is an exploratory study, using mixed methods with quantitative and qualitative approach to software development based on the methodological process called participatory interaction design composed of 4 stages. Identification of the user's needs; solution design design; Construction of a functional prototype and evaluation. For evaluation, the content validity test was performed by health professionals who monitor child growth and development and family members. By completing a form with quantitative and qualitative questions after analyzing the screens of the software in the mobile version and in the web version. The project was submitted and approved by the Ethics and Research Committee of the Alberto Santos Dumont Institute of Teaching and Research under CAAE 48108021000000129, according to resolution 466/12.Results: In the 1st stage, the needs identified in the literature were identified and discussed in a team composed of design, system developers and physiotherapists. Then, amar- application monitoring, evaluation and screening for development began to be developed through meetings to refine the system, until reaching the model for evaluation of users. The system was developed through a front end with a responsive design and the back end written in JavaScript being responsible for the communication of the two applications: Mobile and Web. For data storage and management, PostgreSQL was used in version 12.5. An Application Programming Interface (API) was also created using the Django Rest Framework version 3.12.4 to enable communication between all parts of the system. When evaluated by 10 health professionals and 10 families, the content validity obtained a Content Validity Index greater than 80% in all questions. Conclusion: AMAR proved to be well-reliability for its objective, which is to favor follow-up among families and health professionals in the monitoring of child growth and development. The next step is to implement it so that we can understand whether this collaborative practice will favor tracking development changes.

Abstract Introduction: Duchenne muscular dystrophy (DMD) results in progressive weakness and loss of all striated muscles, including the respiratory muscles, with consequences for walking, in addition to breathing difficulties, as the main cause of death. In the last decades, the survival of patients with DMD has increased thanks to a more comprehensive therapeutic approach, mainly with measures for the assessment and early management of pulmonary complications. However, there are still gaps in the understanding of how changes in respiratory muscles and body postures can influence thoracoabdominal synchrony and maximum nasal respiratory pressures in this population and how the introduction of new non-invasive clinical measures can assist in the management of these patients. Objective: The main objective of this thesis is to better understand the changes in respiratory muscle strength in Duchenne Muscular Dystrophy and its consequences on the clinical course of the disease. For this, three objectives were set: 1) Assess how body position influences thoracoabdominal asynchrony and paradoxical inspiratory movement during quiet breathing and cough in DMD; 2) Assess how the change in body positioning during the assessment of maximum nasal pressures can affect blood pressure values, relaxation rates, muscle contractile properties, as well as modify electromyographic muscle activation in DMD; 3) Monitor the clinical evolution of respiratory and motor function, in addition to the relaxation rates and contractile properties of inspiratory muscles in DMD over a 6-month follow-up. Methods: For study 1, assessed 14 DMD subjects and 12 controls using Optoelectronic Plethysmography (OEP) during quite breathing (QB) and spontaneous cough in 3 positions: supine, supine with headrest raised at 45° (45°), and sitting with back support at 80° (80°). The TAA was assessed using phase angle (θ) between upper (RCp) and lower rib cage (RCa) and abdomen (AB), as well as the percentage of inspiratory time the RCp (IPRCp), RCa (IPRCa) and AB (IPAB) moved in opposite directions. In study 2, the relaxation rates and contraction properties of the inspiratory and expiratory muscles were extracted from the sniff nasal inspiratory pressure (SNIP) and reverse sniff nasal expiratory pressure (RSNEP) curves, performed non-invasively in 9 patients with DMD in different positions. Study 3 is a 6-month study of relaxation rates and contraction properties of the inspiratory muscles were extracted from SNIP in 22 DMD subjects. Results: 1) During cough, DMD group showed higher RCp and RCa θ (p<.05), RCp and AB θ (p<.05) in supine and 45° positions, and higher RCp and Rca θ (p=.006) only in supine position compared with controls. Regarding the intragroup analysis, during cough, DMD group presented higher RCp and AB θ (p=.02) and RCa and AB θ (p=.002) in supine and higher RCa and AB θ (p=.002) in 45° position when compared to 80°. ROC curve analyzes were able to discriminate TAA between controls and DMD in RCa and AB θ in supine position [AUC: 0.81, sensibility: 78.6% and specificity: 91.7%, p=0.001]. 2) During SNIP and RSNEP, there is no difference in pressure, relaxation rates, and contraction properties in different positions. However, subjects with DMD exhibited higher activation in EI just during the SNIP test. 3) When compared to healthy subjects, patients with DMD present a lower (p<.005) maximum relaxation rate (MRR) and a greater tau (τ) and half‐relaxation time (½ RT) in baseline and after 6 months. The results of the ROC curves showed that MRR, τ, ½ RT and SNIP (%pred) parameters were significantly able to discriminate between DMD and controls in baseline and after 6 months. Conclusions: During cough, subjects with DMD yields TAA with insufficient deflation of chest wall compartments and rib cage distortion, by non-invasive assessment. In addition, the position no affects the SNIP, RSNEP, and either relaxation rates and contraction properties of SNIP and RSNEP curve in different positions. Still, it is possible to discriminate altered parameters of relaxation rates and SNIP after 6 months in individuals with DMD concerning healthy subjects. These new non-invasive measurement techniques, such as the assessment of thoracoabdominal asynchrony, and the weakness of inspiratory and expiratory muscles presented in this study may help us in the early clinical management of this population. Key words: Duchenne muscular dystrophy, thoracoabdominal asynchrony, respiratory muscles.

Introduction: Heart failure (HF) is considered a clinical syndrome with typical signs and symptoms such as dyspnea, low exercise tolerance, fatigue and dysautonomia. It occurs due to structural and functional cardiac changes that generally cause decreased cardiac output and/or increased intracardiac pressures, resulting in systolic and/or diastolic dysfunction. Different treatment approaches are investigated in order to improve the therapeutic management of these patients. Among the treatment modalities, the inclusion of IMT in cardiac Rehabilitation programs has been largely considered a good strategy for clinical improvement of additional findings in patients with (HF). Objectives - Study 1: Evaluate the effectiveness of Inspiratory Muscle Training associated with a cardiac rehabilitation program in functional capacity, exercise tolerance, thickness and mobility of the diaphragm muscle, respiratory muscle strength, quality of life and satisfaction of patients with Heart Failure. Study 2: Evaluate the effectiveness of Inspiratory Muscle Training associated with a cardiac rehabilitation program in the UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE CENTRO DE CIÊNCIAS DA SAÚDE PROGRAMA DE PÓS-GRADUAÇÃO EM FISIOTERAPIA Av. Campus Universitário – Lagoa Nova - Natal-RN, CEP 59078-970 Telefax: (84) 3342-2003 E-mail: ppgfis@ufrn.br modulation of myocardial sympathetic activity in patients with Heart failure. Study 3: To determine the cutoff point of Glittre ADL-Test that indicates a better functional capacity of individuals with CI and reduced ejection fraction (EF), compared to the cardiopulmonary exercise test (CPX), considered the gold standard test. Also, determine their agreement and reliability, and finally estimate the minimum detectable change. Methods - Study 1: Controlled, randomized, triple blind clinical trial, with 19 sedentary adult individuals aged from 21 to 60 years old, of both genders, diagnosed with systolic CI, with left ventricular ejection fraction less than 45% and inspiratory muscles weakness. Before and after the rehabilitation program, individuals were submitted to evaluation with cardiopulmonary exercise test, ADL-Glittre test, manovacuometry, pulmonary function test, diaphragmatic ultrasound, quality of life and functional capacity and satisfaction questionnaires. The program consisted of 36 sessions, divided into 12 weeks, with three weekly sessions of aerobic exercise, peripheral muscle fitness and inspiratory muscle training (IMT). The IMT was performed seven days a week, at the patient's home, using the POWERBreathe® device, which in the experimental group was calibrated at 30% of the maximum inspiratory pressure and in the control group at 10 cmH2O. Study 2: Series of cases with 11 patients divided into two groups: 06 patients – experimental group and 05 patients – control group (the same protocol as in study 1). Cardiac sympathetic activity was evaluated by scintigraphy with metaiodobenzylguanidine bound to 123 Iodine (123I-mIBG) through the ratio of 123I-mIBG uptake of heart and mediastinum (H/M) early and late and the washout rate. H/M <1.9 and cardiac washout rate of 123I- mIBG >19% characterize cardiac sympathetic hyperactivity and worse cardiovascular prognosis. Study 3: Cross-sectional study conducted with 77 adults aged from 21 to 65 years old, with heart failure and reduced ejection fraction, NYHA II-III. An analysis of Glittre ADL-Test was made and compared to CPX was performed. For comparison between the two tests, Total Time of Glittre ADL-Test and VO2peak of the CPX were used, and cutoff point used for VO2 was 16 ml/Kg/min-1, and according to the Weber classification, results below this value mean low functional capacity and worse prognosis. Through a ROC curve, it was possible to UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE CENTRO DE CIÊNCIAS DA SAÚDE PROGRAMA DE PÓS-GRADUAÇÃO EM FISIOTERAPIA Av. Campus Universitário – Lagoa Nova - Natal-RN, CEP 59078-970 Telefax: (84) 3342-2003 E-mail: ppgfis@ufrn.br determine the cutoff point with the best sensitivity and specificity, a test-retest reliability, an absolute reliability and a minimum detectable change. Results - Study 1: In both groups, it was possible to verify an increase in functional capacity, exercise tolerance, respiratory muscle strength, diaphragmatic mechanics and quality of life, with the experimental group showing a slightly higher performance, but without statistical significance. Study 2: After the intervention, the average of early H/M was 2.47 (1.94-2.72) versus 2.02 (1.60-2.36) and the late H/M was 2.02 (1.86-2.32) versus 1.64 (1.52-2.33), experimental and control, respectively. The average of washout rate was 27.82% (22.10- 30.65) in the experimental group and 34.49% (26.89-38.10) in the control group. Despite being not statistically significant, results after intervention show better control of cardiac sympathetic activity, with higher H/M and lower washout rate of 123I-mIBG in the experimental group. Study 3: The defined cutoff point was 255 seconds with a sensitivity of 75.76% (95% CI, 57.7-88.9) and specificity of 72.09% (95% CI, 56.3-84, 7), with an area under the curve of 0.773 (95% CI 0.663-0.861 and p<0.0001). The correlation between the tests was 0.83 with an effect size (R2) of 0.69 and p<0.001. The intraclass correlation coefficient between the two tests was 0.841 (95%CI: 0.454 – 0.936, p < 0.001) and Absolute Reliability (intra-subject variability) of 3.17%, the minimum detectable change (MDC95), is 23.07 seconds or 8.78%. Conclusion: Overall, the results found indicate that very low amount of IMT already have the potential to provide additional benefits to the rehabilitation of patients with CI, reduced LVEF and inspiratory muscle weakness. Furthermore, Glittre ADL-Test used as a test of tolerance to submaximal exertion proved to be capable of predicting the prognosis of patients with CI, besides the fact it is easily reproducible and with good stability in repeated tests. The determined cutoff point can be used in clinical practice to identify more severe patients when there is difficulty in performing CPX. Due to the learning effect, two tests are recommended in clinical practice.

Introduction: In subjects with obstructive respiratory diseases, several mechanical ventilatory factors cause an imbalance between the load and capacity of the respiratory system, which worsens with the increase in ventilatory demand during exercise. As increased work of breathing can trigger greater recruitment and fatigue of respiratory muscles. Associated with these changes, lower limb muscle dysfunctions in these individuals, and competition for blood flow between respiratory and locomotor muscles, further contribute to the reported symptomatology and exercise intolerance. Surface electromyography (EMGs) measures the electrical manifestations of muscle fibers and can determine the functional state of a muscle. EMGs allow continuous and non-invasive monitoring of activation levels and muscle fatigue in real-time, through different signal processing methods. Aim: To assess muscle activity and fatigue of two respiratory and one locomotor muscle during Incremental Shuttle Walking Test (ISWT) in individuals with obstructive respiratory diseases and compare with healthy individuals. Methods: This is a case-control study. Subjects with asthma (group-Asthma) and with Chronic Obstructive Pulmonary Disease (COPD) (group-COPD) participated and were matched with subjects according to age, sex, and body mass index (Asthma control group and COPD control group). The electrical signals of the sternocleidomastoid (SCM), scalene (ESC), and rectus femoris (RF) muscles were evaluated by EMGs during the ISWT. The electrical signals were analyzed in the time and frequency domains, to extract, respectively, the signal amplitude data, at baseline and at three test times (33%, 66%, and 100% of the total time of the ISWT), and the power spectrum density (including median frequency (FM), high frequency (H) and low frequency (L) content, and H/L ratio of an electrical signal) over the ISWT. Results: Results: 17 subjects with asthma were included, (age: 34.76 ± 11.18 years; FVC: 3.37 ± 0.72 L; FEV₁: 77.20 ± 17.23%) and 15  with COPD (age : 65.6 ± 7.84 years; FVC: 1.88 ± 0.44 L; FEV₁: 48.72 ± 15.81%). The asthma group had a shorter distance walked compared to the control group (445.1 ± 126 m vs 607.8 ± 127 m (p = 0.0007), with no differences between the COPD and control group. Regarding the EMGs signal amplitude, there was an increase in the activation of the muscles evaluated, in the initial moments of the ISWT in the asthma group (SCM [33%: p = 0.0005 and 66%: p = 0.004], ESC [33%: p = 0.001 and 66%: p = 0.033], and RF [33%: p = 0.02 and 66%: p = 0.004]) compared to the control. In the COPD group there was an increase of respiratory muscles and remained until the end of the test (SCM [33%: p = 0.009, 66%: p = 0.023 and 100%: p = 0.023] and ESC [33%: p = 0.006, 66%: p = 0.008 and 100%: p = 0.016]) compared to the control. The RF muscle had a greater activation at the start of the ISWT ([33%: p = 0.032 and 66%: p = 0.039) in the COPD versus the control group. There was a decrease in FM in the ESC and RF muscle in the Asthma group (p = 0.016 and p < 0.0001, respectively), compared to the control group. In the COPD group, FM decreased, for ECOM and RF, with significant values for ECOM (p<0.0001), compared to the control. The H/L ratio of the RF muscle decreased (p = 0.002) in the COPD group compared to control. Conclusion: The reduced performance in the ISWT is accompanied by increased electromyographic activity of SCM and ESC and activation of RF in individuals with obstructive respiratory diseases during ISWT.

Introduction: Stroke is the leading cause of disability in adults, resulting in functional changes such as deficit of balance and difficulty in performing activities of daily living. The sequelae result from the plastic changes in the neural tissue of these individuals, as a result of decreased excitability and non-use of the affected limbs after the injury, culminating in the reduction of the cortical representation of these areas. In the field of rehabilitation, Virtual Reality (VR) has been a great ally in the recovery of these patients. Objective: To compare the effects of a non-immersive virtual reality protocol with a kinesiotherapy protocol on the postural balance of patientes with chronic stroke. Methodology: It is a comparative study with 7 individuals, of both sexes, with a clinical diagnosis of stroke, unilateral brain injury, at least 6 months of injury, aged between 20-75 years. The individuals were initially assessed using a sociodemographic characterization form and then clinical assessment was performed: cognition (Mini Mental State Examination - MMSE), spasticity (Modified Ashworth Scale), ability to walk (Functional Walking Category), neurological impairment (National Institute Health Stroke Scale – NIHSS), quality of life (AVE Specific Quality of Life Scale), functionality (Functional Independence Measure - FIM), motivation (Intrinsic Motivation Inventory), balance and gait: BERG Balance Scale (BBS); Functional Range Test (FRT); Timed Up and Go Test (TUG); 6m Walk Test (6mWT), and Center of pressure variables by Force Platform (FP). These patientes were divided into two groups according to the proposed intervention protocol. The Kinesiotherapy group (KG) (n=4) performed lower limb strengthening (10 minutes) and kinesiotherapy focusing on balance with sensorimotor demand similar to virtual reality exercises (30 minutes) and the Virtual Reality Group (VRG) (n=3) performed the same strengthening mentioned (10 minutes) in addition to a virtual reality protocol based on body balance (30 minutes). There were 2 sessions per week, for 8 weeks, totaling 16 sessions. After completion of all therapy, patients were reassessed to the same standards as in the initial assessment. For the studied outcomes, a paired t-test was performed for intragroup analysis and t-test for intergroup comparison of the differences between pre- and post-intervention (delta) values observed in each group. Results: Both groups improved in all analyzed outcomes. However, in the intragroup analysis, only BBS (p = 0.006), total displacement of the center of pressure in the one-legged stance test with eyes open on paretic limb (p = 0.017), mean velocity in the one-legged stance test with eyes open on paretic limb (p = 0.007) and unipedal eyes closed on the healthy limb (p = 0.047) were significant in the control group. In the experimental BBS (p = 0.026) and total displacement of the center of pressure in the one-legged support test with eyes open on healthy limb (p = 0.035) were significant. In the intergroup analysis, there was a statistically significant difference for BBS (p = 0.033), and 6MWT (p = 0.021) and unipodal support with eyes open on paretic limb (p = 0.044). Conclusion: When comparing the effects of a non-immersive virtual reality protocol with a kinesiotherapy protocol on the postural balance of individuals with chronic stroke, it was observed that both were beneficial and caused improvements in the analyzed outcomes, with significance in the balance assessed by the scale of Berg balance. However, due to limitations in terms of sample size and number of sessions, it is suggested that studies be carried out with a more robust population and a longer total duration of therapy.

Parkinson's disease is a chronic, degenerative, progressive pathology of the central nervous system that affects the basal ganglia, destroying the neurons of the substantia nigra and reducing dopamine in the brain, causing bradykinesia, tremor at rest, stiffness, postural changes , balance and gait. Among the main motor rehabilitation protocols for Parkinson's gait, treadmill training stands out. In addition to this, there is currently cerebral modulation with direct current. Binaural vibro-acoustic brain stimulation (ECVAB) is a less expensive type of brain modulation, with few studies in the area of motor rehabilitation, reasons for which this work is justified. The aim of this study was to investigate the effects of ECVAB on the gait of elderly people with Parkinson's. Eighteen people with Parkinson's grades 2 to 4, on the Hoehn Yahr scale aged between 55 and 75 years, participated in this study. They were allocated to an Experimental Group (GE), treated with ECVAB and Walking Training on the Track (TM); and Control Group (CG), treated with Placebo Cerebral Stimulation (ECP) and TM. Initially, the subjects were evaluated using the Hoehn and Yahr staging protocol; the Functional Gait Assessment and the Freezing Of Gait Questionnaire; then, they were randomized in the corresponding groups for the intervention, with the EG being treated with 20 minutes of ECVAB followed by 30 minutes of TM, and the CG with 20 minutes of ECP, followed by 30 minutes of TM. 16 sessions were carried out, during 8 weeks. 48 hours after the last session, the patients were reassessed. Statistical analysis was performed by assigning a significance level of 5%. The Kruskal-Wallis test with Post Hok was used to compare the values of the control and experimental groups before and after the intervention. As a result, in the control group, an improvement in FGA was observed only in the gait criterion with eyes closed (X2: 4.07; P: 0.043). There were no significant results regarding the FOG-Q criteria. As for the experimental group, there was an improvement for both the FGA: gait speed (X2: 3.92; P: 0.048) and the ability to overcome obstacles (X2: 4.13; P: 0.042), and for the FOG -Q: freezing during gait (X2: 3.92; P: 0.048), freezing and the ADLs (X2: 6.97; P: 0.008), glued feet (X2: 4.98; P: 0.026), and freezing time (X2: 6.12; P: 0.013). Given the above, it can be suggested that the intervention protocol with ECVAB associated with the treadmill (experimental group) was better for the treatment of gait fluency when compared to the isolated treadmill protocol (control group).

Introduction: Overhead sports overload the shoulder complex mainly due to the repetition of throwing movements at high speeds, which may cause some adaptations in the athlete’s shoulder, and might increase the risk of developing shoulder pain. Moreover, it has been considered nowadays the influence of alterations throughout the kinetic chain as risk factor to injuries in the shoulder complex. Objective: to compare alterations in osseous, muscular and joint system and the function of shoulder complex, core and hip in overhead athletes with and without shoulder pain. Methods: This is an observational study, in which 41 handball and volleyball athletes were assessed. The athletes were assigned to two groups according to their shoulder pain: no pain group (NPG) (n: 20, age: 21,2 e BMI: 23,3) and pain group (PG) (n: 21; age: 23,6 e BMI: 25,02), based on pain and function self-reported through the Penn Shoulder Score (PSS) and Disabilities of the arm, shoulder, and hand (DASH) questionnaires. The individuals underwent an assessment of range of motion (ROM) of shoulder (rotation, horizontal adduction, low flexion, and humeral retroversion), hip (rotation) and trunk (flexion, extension, and lateral flexion), strength of glenohumeral (rotators), scapular (lower trapezius and serratus anterior), hip (abductors and extensors) and trunk (rotators, extensors and lateral flexors) muscles, besides endurance of the trunk (flexors, extensors and lateral flexors) and functional performance of lower and upper limbs through the Y balance test. Data were analyzed in a descriptive and inferential manner through SPSS 20.0, with a 95% confidence interval and a p<0,05 was considered statistically different. Results: Athletes from the pain group showed smaller external rotation (ER) (p<0,01) and total rotation (p<0,01) ROM in the dominant shoulder, smaller horizontal adduction (p<0,01) in non dominant shoulder, smaller hip internal rotation (IR) in dominant and non dominant hips (p<0,01), and less trunk flexion ROM (p<0,01). PG also showed less strength of trunk extension (p=0,01), short endurance time for trunk extensors (p=0,02) and flexors (p<0,01), decreased reach distance for both lower limbs in the anterior direction (p<0,05), decreased reach distance in the posteromedial direction(p=0,04) for the dominant lower limb, as well as smaller composite score for both limbs (p<0,05).Moreover, for limbs comparison, the dominant limb of the PG showed smaller ROMs of shoulder IR(p<0,01) and total ROM (p<0,01), of horizontal adduction (p=0,04) andlow flexion(p=0,01), besides decreased reach distance in the superolateral direction in the upper quarter Y balance test. As for the NPG the dominant limb showed higher shoulder ER ROM (p=0,03), and smaller values for shoulder IR ROM (p=0,02), horizontal adduction (p=0,01) and low flexion (p<0,01). Conclusion: Overhead athletes with shoulder pain show changes in ROM throughout the kinetic chain, besides lower core endurance, and decreased functional performance in the lower limbs.

Introduction: Premature birth is one of the main causes of infant mortality in Brazil and is one of the main public health problems in the world. Studies address that, despite all the complications caused by prematurity, early interventions and stimuli provided by families provide a positive effect on motor and cognitive development. And a positive engagement strategy between family, environment and newborn is the Kangaroo Method (KM). Objective: To assess the motor development of the premature newborn (PTNB) undergoing KM, from admission to the Neonatal Intensive Care Unit (NICU) to the follow-up clinic and to identify factors related to typical and atypical development. Methodology: This is a cohort study conducted at the Maternidade Escola Januário Cicco. Pre-term newborns (PTNB), with gestational age less than 37 weeks, weight below 2500g, participated in the follow-up. Clinical information about PTNB and the mother's pregnancy and during hospitalization was collected; the time of kangaroo position, during the second stage of the KM. The generalized movements (GM) of babies were evaluated in the three stages of KM and the development of PTNBs were evaluated in the second and third stages of GM. The evaluations with the test of infant motor performance (TIMP) instrument were performed in the second stage of the method and in the follow-up clinic at 3 - 4 months of corrected gestational age. For statistical analysis, a significance level of 5% and a 95% confidence interval were assigned to all analyzes. Descriptive analysis was presented as mean and standard deviation (SD). The normality of the study variables was verified using the Shapiro Wilk test. To compare means between groups, Mann-Whitney was used and for categorical variables, Fisher's exact test was used. Results: The sample consisted of 22 babies. GM analyzes showed a gradual improvement in the motor repertoire. As for the evaluation with TIMP, 63.3% showed atypical development, when analyzing the associated clinical factors, it was observed that only the number of prenatal consultations, sex, first minute apgar, O2 days, phototherapy days and IG and weight of admission to the ward showed statistically significant differences. In the second evaluation at the outpatient clinic, the instruments showed an agreement level (kappa) of 1,000 at 3 - 4 months and only 13.6% of the sample remained with the atypical motor development when evaluating. When comparing the means between the groups of babies with the typical and atypical motor repertoire, there was no significant difference between the samples at the time of the kangaroo position. Conclusion: The importance of early investigation of neurodevelopment in a hospital environment is emphasized and this can be associated with the kangaroo method which becomes a key element in family empowerment and engagement, making the home environment enriched and with the potential to promote and change the pattern motor development.

Contextualization:In view of the repercussions caused by a stroke, has been placed the importance of aerobic training, especiallythetreadmill training, in improving functional and cardiovascular variables and the quality of life of individuals affected by the disease. However, few studies have compared the effects of different inclination protocols on the improvement of these variables.Objectives: To evaluate the effects of a treadmill training protocol withdifferent inclinations on functional, cardiovascular variables and quality of life of individuals with chronic stroke.Methods:This is a randomized, blinded clinical trial, in which participated 26 individuals of both genders, aged between 20 and 70 years old, and time post-strokefor more than 6 months. Participantswere randomized into 3 groups: control group (CG, n = 8), who performed treadmill training without inclination; experimental group 1 (EG1, n = 8), who performed training with a 5% inclined treadmill; and experimental group 2 (EG2, n = 10), who performed training on a 10% inclined treadmill. Interventionsconsisted of 3 weekly sessions over a period of 6 weeks. Participantswere evaluated in 3 moments (pre-training, post-training and follow-up) regardingoutcome measures (gait speed, functional capacity [distance covered], neuromuscular torque, cardiovascular parameters [systemic blood pressure -BP and heart rate-FC] and quality of life). In the statistical analysis, the Shapiro-Wilk test was used to verify the normality of the data; in addition, the two-way Analysis of Variance (ANOVA)withrepeated measures was used to verify the effect of the interventions considering the temporal measures (pre-training, post-training and follow-up) and the “group” variable as a factor betweensubjects.Results:The ANOVAdid not demonstrate any time * group interaction in any of the HR and BP outcomes, as well as for the functional variables and quality of life. However, some mean BP values and gait speed values were different over time (mean BP: F = 3.604; P= 0.036; Gait speed: F = 4.963; P= 0.014), indicating improvement of these variables over time. Regarding functionalcapacity, the EG2 presented in the post-training, in comparison with theCG and with the EG1, an effect size of 20.6 and 28.2 meters, respectively.Conclusion: In general, training on aninclined treadmill was not more effective than training without inclination in improving the study parameters. However, it is possible that a longer training time is necessary to express improvements related to aerobic training. In addition, the results of walking speed and functional capacity suggest that, with the reach of the estimatedsample size, improvements will befound, especially in theexperimental group 2 for distance covered, which showed clinically relevant differences when compared toothergroups.

Fibromyalgia (FM) is a rheumatic syndrome characterized by diffuse and chronic body pain, with a multifactorial aspect, associated with muscular fatigue, sleep disorders, depressive and anxiety disorders. FM requires multidisciplinary treatment, and because of this there are studies associating interventions in the attempt to have the effects potentiated. Recently, the effect of the association of aerobic exercise with direct current transcranial electrostimulation (tDCS) with positive effects of this association was investigated.  However, the association of tDCS with functional exercise has not been investigated, which has provided reduction of pain and improvement in the functionality in these patients. Objective: To verify the effect of functional exercise associated with CTEF on pain, functional performance and quality of life of patients with FM. Methods: This is a randomized, placebo-controlled, double-blind clinical trial of women with clinical diagnosis of FM divided into two groups in randomized blocks: Exercise group with active stimulation (GEA)  will undergo functional exercise and active tDCS and exercise group with placebo stimulation (GEP) who will perform functional exercise and placebo tDCS. The exercise program will be held three times a week for eight weeks. The tDCS will be performed only in the first week of exercise for 5 consecutive days (2mA, 20min, ramp On / 0ff 30s, with anode in the M1 area and cathode in the DLPFC). Evaluations will be pre-assessment (T1) will be performed during the first week (T2), immediately after the first week (T3), and after exercise program (T4) of: pain (EVA and algometry), functional performance (6MWT, sit and stand test and isokinetic evaluation) and quality of life (FIQ, depression and anxiety scale) as well as the overall perception of effect (GPE) and pleasure sensation / displeasure. Statistical analysis will be performed in the SPPS 20.0 program. It will be considered an alpha (a) of 5% as statistical significance and a power of the test (power) of 80%. Expected Results and Impacts: The association of functional exercise with active tDCS is expected to provide greater remission of pain and consequently better indices of functional performance and quality of life when compared to exercise and placebo tDCS. It is also possible that the active tDCS may potentiate the effects of exercise on the rates of depression and anxiety. This, in turn, would contribute positively to the treatment of FM in the application of new strategies in the control of symptoms.

Cardiovascular diseases (CVD) alter the physical capacity of patients, besides contributing to increased health expenses. Cardiac rehabilitation (CR) is recognized as an important instrument of this process. However, during this practice, cardiac patients may present adverse events associated with exercise. Therefore, it is essential to perform the risk stratification of these patients before starting the CR program. The aim of our study was to analyze the prognostic risk and adverse events of patients who were treated in a CR program at the Cardiac Rehabilitation Unit of the Onofre Lopes University Hospital - CORE/HUOL. This is a retrospective study regarding risk stratification of patients referred for CR in the Cardiac Rehabilitation Unit of the Onofre Lopes University Hospital - CORE HUOL. Cardiovascular risk was analyzed according to the recommendation for CPET published by the AHA (2012), which stratified the variables of  CPET through colors: green (better prognosis), yellow, orange and red (worst prognosis). For this classification, we used the variables of the pre and post CR stress tests of our patients. Statistical analysis was performed using the software (IBM SPSS version 22.0). Most of the sample was didactically classified as moderate pre CR risk (78.6%) and post CR 

(64.3%), because they presented a higher number of test variables in yellow, orange and red. The mean VE/VCO2 slope was 35.2±9.4, being stratified in orange. And this value significantly reduced to 33.6±6.8 after the CR period (p<0.05), which changed the classification to yellow. Peak VO2 had a mean higher than 20.0ml.kg-1.min-1, being classified as green. And it showed a moderate and positive correlation with the test time pre CR (0.53/p=0.00) and post CR (0.60/p=0.01). We identified an association between heart rate recovery stratification and the presence of diabetes mellitus (p<0.05). Therefore, we observed that most variables classified in yellow, orange and red indicate that our patients present a progressively higher risk in the coming years. In addition, the improvement in the stratification of variables after the CR period indicates the importance of our exercise program. And when we observed variables related to the stratification metrics used, we show that other variables should be considered during the risk assessment of the cardiopathic patient.

Post-stroke sequelae indicate the need for interventions that favor the functional recovery of these patients. Objective: This study aimed to assess cortical activity and motor performance during the learning of a virtual reality game in stroke patients. Method: 12 patients participated in the study, 6 with left brain injury (LP), mean age 54.1 years (± 9.4) and 6 with right injury (RD), mean age ± 50.6 years (± 5.8) and 12 healthy individuals who activated the left (LH) and right (RH) hemispheres. Participants underwent an electroencephalographic evaluation when performing training with 3 blocks of 5 attempts of the virtual darts game (XBOX Kinect). Game performance was recorded using absolute (AE), constant (CE) and variable (VE) error measures. Data were analyzed using ANOVA with Tukey's post hoc test. Results: LP group had lower alpha potency in AF3 (left prefrontal cortex) (p = 0.031) and RP group in T8 (right temporal cortex) (p = 0.038). As for beta wave, there was less power in FC5 (left prefrontal cortex) (p = 0.001), and more power in P7 (left sensory area) (p = 0.010) for LP group. Patients showed higher AE and CE values than healthy ones (p = 0.015). Conclusion: The behavior of cortical activation and motor performance suggest the benefits of playing with virtual reality in stimulating motor learning, especially in patients with right brain injury. Perhaps patients with left brain injury need more time of exposure to virtual reality therapy to intensify brain plasticity and motor learning.

Introduction: During population aging, there is an increase in the number of health problems associated with this event, which may be related to life-course events, such as reproductive history. Among them, there is an increase in the prevalence of cardiovascular diseases and a decrease in physical performance, which may be responsible for reducing the quality of life and increasing health costs. Objectives: To analyze the relationship between reproductive history, cardiovascular risk and physical performance in middle-aged and elderly women. Materials and Methods: This is an observational, analytical, cross-sectional study with an epidemiological nature. The population consisted of women aged between 40 and 80 years, living in the municipalities of Parnamirim and Santa Cruz, Rio Grande do Norte. The variables of reproductive history (age at menarche, age at first birth, parity and menopausal status) were collected through self-report.

Physical performance was measured by the Short Physical Performance Battery, chair stand test and unipodal balance test with eyes open. Cardiovascular risk was analyzed using the Framingham Cardiovascular Risk Score. In addition, sociodemographic, socioeconomic data, body mass index, biochemical parameters and information on the participants' physical activity were collected. Regarding the statistical analyzes, in the first article, multiple linear regression analysis was performed between the variables that presented p <0.20 in the bivariate analysis and the Framingham Cardiovascular Risk Score. For the second article, the Multiple Linear Regression analysis was performed to estimate the relationship between the physical performance variables and the Framingham Cardiovascular Risk Score, adjusted by the covariables age, years of study and physical activity. Results: Regarding the results of the first article, with each increase in the number of children, women increased the Framingham Cardiovascular Risk Score by 0.19 points (β = 0.199, p = 0.01). In addition, those who were postmenopausal had an increase of 1.6 (β = -1.601, p = 0.002) in the Framingham Cardiovascular Risk Score. In the second article, cardiovascular risk remained significant for all performance variables, in which women classified as high cardiovascular risk had worse SPPB scores (β = -0.325, 95% CI -0.643: - 0.007), in the sit test and getting up (β = 0.697, 95% CI 0.030: 1.364) and in open eyes balance (β = -2.986, 95% CI -5.525: -0.446), in relation to those classified as low cardiovascular risk. Conclusion: The present study observed that women with high parity and who were in the post-menopause had higher scores for cardiovascular risk. And those with high cardiovascular risk had worse physical function. Thus, the investigation of these factors may serve to implement new strategies for their prevention and reversion and, with that, it may reduce physical impairment and disability in middle-aged and elderly women.

Introduction: Aging causes physiological changes that may compromise the adaptation to daily living demands, leading to restrictions on postural balance and their functional independence. A variety of therapeutic approaches have prioritized postural balance restoration or maintenance, highlighting the Virtual Reality-based therapies (VR). In this sense, serious games have been developed in order to adapt the virtual environment to the patient's therapeutic demands and needs, reflecting positively on the effectiveness and usability of this type of tool. Objectives: 1) To develop a systematic review aiming to summarize the evidence of the use of serious and commercial digital games on postural balance of the older adults; 2) Develop a serious game for balance training of older adults using a low cost motion capture system. 3) To perform a content validity of the game. 4) To test, in a pilot study, the applicability and the effect of the game on the balance and physical performance of older adults.  Methodology: This study involved three types of methodological modalities: 1) Systematic Review; 2) Development and validation of a utility model (digital game) for postural balance rehabilitation and 3) Pilot study with an experimental design with 50 older adults. The participants of the pilot study were subjected to a balance assessment by using a Force Plate and the Berg Balance Scale (BBS) and a physical performance assessment with the Short Physical Performance Battery (SPPB). Participants’ were ramdomly allocated in experimental or control group. The experimental group performed an intervention protocol using the digital game developed by the researchers of this study - called VirtualTer (Virtual Therapy), 3 times a week for two weeks and duration of 20 minutes each session. The control group received a booklet with 5 exercises based on the Otago protocol to be performed at home with the same duration and frequency as the experimental group. At the end of the intervention period, participants were reevaluated, using the same procedures as the initial assessment. Results: 1) Systematic Review - 12 studies comparing exergames with no intervention were included. A total of 1520 older adults were included in the studies, with a mean age of 76±6 in the experimental groups and 76±5 in control groups. 03 studies found significant improvements in balance considering the BBS and center of pressure oscillation. 03 studies found improvements in mobility, considering the Timed up and Go test, 30-second sit-to-stand test and the alternate step test. 2) Game development: VirtualTer was developed by a team of physiotherapists and computer scientists from Federal University of Rio Grande do Norte. The main objective of this serious game was to promote balance training for older adults in a motivating and representative environment. VirtualTer uses Kinect for motion capture in tasks involving stationary walk, lateral reaching, and go up and down steps, divided in 03 phases with different levels of difficulty. 3) Content Validity: The content of the game was validated by 11 specialists (45.5% physiotherapists and 54.5% science and technology professionals). The total CVI of the game was 0.8 and Cronbach's alpha coefficient was 0.924. 4) Pilot Study: Fifty older adults participated in the pilot study.  VirtualTer group showed statistically significant within-group differences for eyes close test on CoP velocity (p = 0,04) and CoP total trajectory (p = 0,03) and both groups showed significant increase in BBS and SPPB. No between-group difference was observed. Virtualter had 77.1% of satisfaction according to SUS. Conclusion: Although signifant improvments were observed in VirtualTer group in within-group analyses, in a 2-week intervention protocol VirtualTer does not significantly improve parameters related to postural balance and SPPB in comparison to control. Future studies should investigate whether longer period of intervention can be effective.

Introduction: Primary dysmenorrhea is a chronic condition that negatively affects women's lives in many social, emotional and physical aspects. So far, drug therapy and thermotherapy have been the most effective means of treating dysmenorrhea, but these have undesirable adverse reactions or short-term local effects. Transcranial direct current electrical stimulation (tDCS) is a non-invasive cortical stimulation technique that promotes changes in brain functioning, and seems to have good effects on pain and functionality. To date, there are no studies of this therapy on the dorsolateral prefrontal cortex in patients with primary dysmenorrhea. Objectives: The main objective is to investigate the effect of tDCS on the dorsolateral prefrontal cortex on pain, functionality, mood and anxiety in patients with primary dysmenorrhea. Secondary objectives include identifying, through a systematic review, the non-pharmacological resources used for the treatment of primary dysmenorrhea and establishing a protocol for the application of tDCS for the treatment of primary dysmenorrhea. Methods: Two studies were developed with different methods, a systematic review and a controlled, randomized, blinded clinical trial. For systematic review, searches were carried out in the databases, PubMed, LILACS, Ovid EMBASE, Scielo, CAPES, IBECS, SCOPUS, SCIENCE DIRECT, from March to October 2018. The studies published in the last 10 years were considered. Using the following combinations: “primary dysmenorrhea AND treatment” and “dysmenorrhea AND treatment”. Inclusion criteria were: clinical trials, presenting in the title and summary a non-pharmacological conservative therapeutic intervention approach for primary dysmenorrhea, having pain as the primary outcome, limiting or avoiding the use of the drug during the intervention, samples in humans, presenting quantitative analysis of ache. Studies were excluded if: the text was not written in English, Spanish or Portuguese, were duplicated in the databases and addressed secondary dysmenorrhea. The searches were carried out by two independent researchers and the articles were evaluated and identified initially by the title and later by the abstract. The selected studies underwent a methodological analysis using the PEDro scale, carried out by the two authors, individually. For the clinical trial, 26 volunteers with primary dysmenorrhea were randomized into two groups. The tDCS group received therapy for 5 consecutive days, while the Sham group performed the same protocol, but the current was turned on for a period of 30 seconds and then turned off. tDCS was performed in the dorsolateral prefrontal cortex, with an intensity of 2mA. Participants in both groups were assessed at two times: in the first 24 hours of the initial menstrual cycle (AV1), in the first 24 hours of the next menstrual cycle and after intervention (AV2). To evaluate the primary outcomes of pain and functionality, the numerical pain scale was used, respectively, and the 6-minute walk test was used for functionality. For the secondary outcomes, affectivity and anxiety, the positive and negative affect scale, the Hamilton anxiety rating scale, respectively. Results: In the systematic review, 14 eligible articles were identified, which addressed techniques of electroacupuncture, acupuncture, acupressure, auriculotherapy, transcutaneous electrical nerve stimulation, Yoga, isometric exercises, stretching, relaxation with diaphragmatic breathing, pelvic floor exercises and tissue massage for pain relief. In the clinical trial, no significant interaction between intervention and time was found in the NRS [F (2.44) = 1.358, p = 0.26] and a significant effect of time was noted [F (2.44) = 4.446, p = 0.01] was found. The active group showed a significant reduction in anxiety (p = 0.03) with a mean difference of 5.12 (95% CI 0.79 to 11.05). There were no significant differences between positive and negative affect (p = 0.95 and p = 0.15, respectively). Submaximal aerobic performance was significantly higher in the active group [F (2.21) = 5.591, p = 0.02], with a mean difference of 70.87 (95% CI 8.53 to 133.21). Conclusion: Until now, the techniques used to treat primary dysmenorrhea have positive effects on analgesia, with no apparent difference between them. They seem to be complementary to each other in the treatment of primary dysmenorrhea and have effects of little durability. tDCS in the dorsolateral prefrontal cortex region appears in this study as a resource with satisfactory effect on functionality. This is effective in reducing anxiety, improving mood and functionality. However, it has no significant direct effect on pain. The application of 2mA of direct current, for 20 minutes for 5 consecutive day sessions, presents a good result. However, it is suggested to analyze the possibility of alternating sessions to improve the clinical viability of the therapy.

Introduction: Chronic Low Back Pain (CLBP) is a recurrent problem in the world population. The association between Transcutaneous Electrical Nerve Stimulation (TENS) and Cryotherapy appears as an option in the treatment of painful symptoms caused by this dysfunction. Purpose: to evaluate the effects of Conventional and Burst TENS, associated or not with cryotherapy, on non-specific CLBP. Methods: this is a randomized clinical trial, where 120 volunteers with nonspecific CLBP were recruited. The subjects were submitted to pain intensity and pressure pain threshold evaluations on the lumbar region, in the paravertebral area, at L3 and L5 vertebrae levels. Then, they were randomly allocated to six groups (n = 20 each), with application of resources for 25 minutes: placebo TENS (PCB); Burst TENS (BT); Conventional TENS (CT); Cryotherapy (CRYO); Cryotherapy + Conventional TENS (CRYOCT); and Cryotherapy + TENS Burst (CRYOBT). The evaluations were repeated immediately and 25 minutes after the interventions. Results: the CRIOCT and CRIOBT groups showed a greater immediate reduction in the intensity of low back pain, compared to the other groups, and this effect was maintained only in the CRIOBT group, after 25 minutes (p <0.05). There was also an immediate increase in the pressure pain threshold (L3 and L5) in the BT, CRIOCT and CRIOBT groups, considering intergroup comparisons (p<0.05). After 25 minutes, similar results were found in the BT and CRIOBT groups, compared to the other groups (p<0.05). Conclusion: the association of Burst TENS with cryotherapy seemed to be more effective and lasting in reducing pain intensity and increasing the pain pressure threshold, in individuals with non-specific CLBP.

Aging is a natural biological process marked by physiological changes that can bring about physical consequences to the individual, such as osteoporosis, a metabolic disease that modifies bone physiology and can compromise physical performance. Self-reported health (SRH) is a useful tool for the evaluation of the elderly population, since it provides a subjective perception of the individual's health, being a strong tool for risk assessment of comorbidities, together with physical performance tools such as Short Physical Performance Battery (SPPB), and quality of life assessments such as the Osteoporosis Assessment Questionnaire (OPAQ). However, little is known about the interaction between physical performance measures with self-reported health and how this relationship is established in elderly women with osteoporosis when mediated by quality of life.

Objective: to analyze the relationship between health self-report and functional performance when mediated by the perception of quality of life in osteoporotic women. Methodology: This is a descriptive cross-sectional study. The sample consisted of the elderly women who met the inclusion criteria of this study. The elderly was submitted to questionnaires on self-reported health, quality of life related to osteoporosis and cognitive evaluation with the Leganes test. Physical evaluations were then performed using SPPB, anthropometric and clinical data, confirmation of the presence of osteoporosis indicated by a bone density test with T-score ≤ -2.5 SD. The elderly was interviewed and evaluated at the Hospital Onofre Lopes (HUOL-UFRN) and at the physiotherapy department of UFRN. In addition, guidelines were given explaining test performance and a self-explanatory primer containing information on fall prevention forms was given to the study participants.

Results: The sample consisted of 83 women, mean age 66.98 (7.09) years. Concerning self-reported health (SAR), it was observed that 30.1% of the sample considered the evaluation to be satisfactory. As a total result of the OPAQ, the mean value was 247.27 (28.05), while for the total SPPB the value obtained was 6.40 (1.87). Women with a satisfactory perception of self-reported health showed a higher mean SPPB score compared to women who had an unsatisfactory perception of SAR. There was a negative correlation with statistical significance (r = -0.33, p <0.05) between the SPPB and the OPAQ. Women who have a satisfactory perception about self-reported health showed a higher mean SPPB score compared to women who expressed an unsatisfactory perception about SAR. women who presented an unsatisfactory perception of their health score higher in the OPAQ compared to women who expressed a more satisfactory perception about the assessment.

Introduction: Throughout the life of the woman, several events can promote structural and functional changes in the muscles of the pelvic floor. It is known that gestation and parturition modify the anatomy and physiology of the components of the pelvic floor and may favor the appearance of pelvic floor dysfunctions. The training of the MAP during the gestation period can prevent and cure the muscular involvement. However, the functional evaluation of this region is difficult due to the presence of loach. Objective: To evaluate the acute effect of exercises on pelvic floor muscles by infrared thermography.

Abstract

Introduction: It is estimated that three months after the stroke, 70% of survivors walk at a reduced speed and 20% remain wheelchair bound. Motor Imagery (MI) is defined as a mentally rehearsed task in which movement is imagined but not executed. Separately or combined with physical activity (where the movement is executed), has demonstrated promising results for rehabilitating gait after a stroke, such as increased gait speed.

Objective: To assess the treatment effects of motor imagery for enhancing ability to walk among people following stroke.

Search methods: A search strategy for words and terms was used to identify articles on the following scientific bases: CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, AMED, LILACS Bireme, SPORTDiscus, PEDRo and REHABDATA and in clinical trial records the Cochrane Stroke Group, Clinical Trials and Stroke Trials Registry. The study was carried out from July to October 2018, and the last search was made on October 15, 2018.

Selection criteria: We included studies in which the participants had a clinical diagnosis of stroke, presenting gait deficit and studies that used MI to promote gait improvement in stroke survivors.

Data collection and analysis: Data extracted from the studies were used to analyze the risk of bias, the effect of treatment and the quality of the body of evidence.

Main results: Twenty-one studies were included, totaling 747 participants. The primary outcome analyzed was ability to walk. Studies comparing MI alone or combined with another therapy versus an active practice physical control, considering the immediate effect (n = 330), were combined in meta-analysis. Regarding independent walking speed (11 studies), the estimated effect in favor of therapy was not significant (mean difference = 0.21; 95% CI -0.02 to 0.44). It was not possible to analyze the dichotomous variable dependence on personal assistance. The twenty one included studies were categorized as being at risk of low, high or uncertain bias, with a predominance of high risk of bias, and the quality of the body of evidence was considered to be very low, low, and moderate.

Author’s conclusions: There is insufficient evidence to prove that MI is more effective than other therapies in the rehabilitation of gait after stroke. Despite the findings, the choice of MI for the gait rehabilitation process after stroke should be stimulated. New randomized clinical trials should be performed with a more rigorous methodological quality, so that the evidence to be better evaluated.

Introduction: the concussion and the damages caused by this event to the brain have been extensively studied. However, little is known about subconcussive head hits, especially in MMA (Mixed Martial Arts) fighters, which is a full-contact fighting sport, in which the majority of blows is directed to the head. Subconcussion is defined as "a cranial impact that does not result in a known or diagnosed concussion in the clinical field." A subconcussion is less severe than a concussion and usually does not result in a clinical diagnosis nor is it identified by imaging. Therefore, to measure inflammation and neurodegeneration processes, the use of blood biomarkers has important potential in the clinical detection of harmful brain processes resulting from this sport practice. Objective: this study aims to evaluate the levels of biomarkers associated with concussion, and the symptoms resulting from subconcussive blows in MMA fighters. Methods: this is an exploratory study in which 30 male subjects (10 MMA fighters, 10 healthy individuals that practice muscle training, and 10 healthy sedentary individuals) aged between 18 and 32 years (25.4 ± 3.8) were evaluated. These individuals underwent blood collection to assess the levels of UCH-L1, GFAP, MCP-4, and BDNF and were evaluated for signs and symptoms related to concussion by the Sports Concussion Assessment Tool (SCAT 5) before, immediately after and 72 hours after fighting (for the fighters) and were compared between groups. Results: at baseline, significant differences were found between active and healthy fighters in BDNF levels (p = 0.03). In MCP-4 levels, significant differences were found between fighters and sedentary controls (p = 0.0002), as well as between active controls and sedentary controls (p = 0.002). In fighters, a significant increase in MCP-4 levels was observed immediately after fighting (p = 0.002). Regarding BDNF levels, a significant reduction was also observed between the post-immediate and 72h after the fight (p = 0.03). The other markers did not present differences between the evaluation times. No differences were observed in the number or severity of symptoms reported by the fighters. Conclusion: The findings of this study, despite their exploratory nature, may help to understand the influence of repeated subconcussive head hits on MMA fighters, as well as to propose preventive interventions that can minimize the impact of hits effects, preserving the neuronal integrity and function of the fighter.

INTRODUCTION: Gestation is a period characterized by a series of physical, hormonal and psychological changes, together with the influences of cultural, social, religious and emotional experienced by the pregnant woman, can affect sexuality. The two problems most frequently reported by women during gestation are presence of physical discomforts and problems related to sleep. For many women, proper sleep as well as sexual function are considered important. OBJECTIVE: To verify the relationship between sexual function and sleep quality of pregnant women, as well as their influence on their quality of life. METHODS: This is an observational cross-sectional study of pregnant women who participated in the Course for Pregnant Women of the Physiotherapy Department of the Federal University of Rio Grande do Norte from April 2013 to March 2018. A total of 317 pregnant women were evaluated through interviews and self-administered questionnaires, the Female Sexual Function Index (IFSF), the Pittsburgh Sleep Quality Index (IQSP), the Epworth Sleepiness Scale (ESSE), and the Quality Index of Life Ferrans and Powers (IQVFP). RESULTS: The data showed that poor sleep quality and the presence of excessive daytime sleepiness negatively interfere in the quality of life of the pregnant women; and that a good and healthy sexual function support the quality of life of these women. CONCLUSION: The main findings of this research have shown that poorer sexual function as well as poorer quality of sleep lead to poorer quality of life during pregnancy.

Introduction: Age related neuromuscular performance decline negatively affects functionality and contributes to frailty and disability in the elderly. The lack of interest and adherence to strength exercises ends up increasing the deficits in this population. Exercising on vibratory platforms have become a more viable alternative to potentiate the effects of the exercise. However, its benefits are still unclear. Objective: To analyze the effects of an 8-week exercise program on the vibratory platform on neuromuscular and functional lower limb performance and postural control of sedentary older adults. Methodology: This is a randomized controlled trial, with a blind evaluator, composed of 35 sedentary and healthy elderly men and women of both sexes (68.5 ± 2.6 years). All were initially submitted to evaluation of the isokinetic performance of knee extensors and plantar flexors, electromyographic activity of the Vastus Lateralis and soleus muscles, oscillation of the pressure center through baropodometry and lower limb function through Timed Up and Go test. After the initial evaluation the volunteers were randomly assigned to two groups: placebo (exercise with the platform off) and experimental group (exercise with the platform configured at a frequency of 50 Hz and peak-to-peak amplitude of 4 mm). Both participated in an exercise program on the platform, consisting of a bipodal isometric half-squat at 40º of knee flexion, with 4 sets of 1.5 min, with a rest interval of 1 minute. After the fourth and eighth weeks of training, the volunteers were submitted to the new evaluations, using the same procedures of the baseline evaluation. For analysis of the normality of the data, the Kolmogorov-Smirnov test was used and to attest the homogeneity between the groups a "t" test for independent samples was chosen. For intra and intergroup comparisons, a 2x3 mixed model ANOVA was used. Results: A reduction in the amplitude (p <0.01) and velocity (p = 0.01) of anteroposterior oscillation were observed for the experimental group after 8 weeks of training compared to the placebo group. Regarding the isokinetic performance, there was an increase in normalized peak torque and mean power in both groups, with no differences between them. No significant difference was observed in the electromyographic activity of the Vastus Lateralis and Soleus muscles nor in the TUG time. Conclusion: The 8-week exercise program on the vibratory platform promotes a reduction of postural oscillation in healthy elderly subjects. However, the improvement in isokinetic performance occurred due to the exercise performed, regardless of whether or not the platform was used.

Inhaled bronchodilator drug administration during invasive mechanical ventilation (MV) is a very common practice in Intensive Care Unit (ICU).  However, the studies reveal variability in drug delivery efficiency. This study aims to evaluate the influence of mechanical ventilation modes on the efficacy of nebulized bronchodilator in the treatment of patients with obstructive pulmonary disease. This is a blind clinical trial. The intervention protocol consists in performing nebulization (Salbutamol Sulfate, 5mg and
Ipratropium bromide, 0.5 mg) associated with invasive MV. The ventilation mode was which the patient was found, but adjustments were done with the objective of optimizing aerosol deposition. Patients under sedation and in controlled MV performed twice the intervention protocol with a randomized order: with PEEP adjusted in 85% of autoPEEP and with the PEEP elevated to 15 cmH₂O.Before and immediately after each intervention protocol, the patients were evaluated through Electrical Impedance Tomography (EIT). The outcomes variables analyzed was: total lung ventilation by total impedance variation (ΔZ_TOT), total lung aeration by End-Expiratory Lung Volume (EELV_TOT) and the distribution of regional lung ventilation and aeration by impedance variation on dependent and non-dependent pulmonar regions. It is planned to publish two scientific articles with the data collected.

Objective: evaluate the effects of the Ai Chi method on lung function, clinical control, quality of life, anxiety symptoms and sleep disorders of children with asthma. Methods: A simple-blind randomized controlled clinical trial that evaluated children between 7 and 12 years of age with diagnosis of mild to severe asthma, randomized blocks: Experimental Group (EG) and Control Group (CG). Both received an educational intervention and the EG performed the Ai Chi method 2 times a week for 6 weeks, totaling 12 sessions. The outcomes were clinical control of asthma (Child Asthma Control Test -c-ACT and Asthma Control TestACT), spirometric variables, quality of life (Pediatric Asthma Quality of Life Questionnaire PAQLQ), anxiety symptoms (Spence Children’s Anxiety Scale- SCAS) and sleep disturbance (Sleep Disturbance Scale for Children -SDSC). Results: 23 children completed the protocol EG (n = 10) CG (n = 13). The groups did not differ in clinical control, lung function, quality of life, and anxiety symptoms. In the intragroup analysis, the EG presented a difference in total PAQLQ (p = 0.03, ES = 0.57) and, in the parent-report version, obsessive-compulsive problems –OCD (p = 0.029, ES = 0.81). The EG presented a high effect size for increase in FEV1 / FVC index (p = 0.208, ES = 3.75), and a moderate effect size for the reduction of anxiety symptoms in self-report child to social phobia (p = 0.637, ES = 0.55), obsessive-compulsive problems – OCD (p = 0.302, TE = 0.66), SCAS scorig (p = 0.201, ES = 0.57) and separation anxiety in parent-report version (p = 0.178, ES = 0.55). The CG presented a difference in the FEV1 / FVC index (p = 0.002, ES = 1.32) and the emotional domain of the PAQLQ (p = 0.018, ES = 0.30). The EG presented a significant increase of the sleep disturbances UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE CENTRO DE CIÊNCIAS DA SAÚDE PROGRAMA DE PÓS-GRADUAÇÃO EM FISIOTERAPIA Av. Campus Universitário – Lagoa Nova - Natal-RN, CEP 59078-970 Telefax: (84) 3342-2003 E-mail: ppgfis@ufrn.br evidenced by the SDSC score (p = 0.03, ES = 0.43) and sleep–wake transition disorders –SWTD (p = 0.03, ES = 0.73). The CG presented a significant increase of disorders of initiating and maintaining sleep - DIMS (p = 0.027, ES = 0.60). In the intergroup analysis, the EG presented a significant increase of the SWTD (p = 0.02, ES = 0.66). Conclusion: The Ai Chi method had positive repercussions in quality of life and reduction of anxiety symptoms. However, there was an increase in the sleep-wake transition disorder in the children participating in the study. Study Registry: Clinical Trial Number: NCT03392129. Date of registration: january, 5th, 2018

TThe reduction of the dopamine neurotransmitter in Parkinson's disease (PD) results in electrophysiological changes in the activity of neurons involved with cortico-striatal circuits and with motor and non-motor symptoms. Action Observation (AO) and Motor Imagery (MI) seem to share the same internal representation of behavior, which may enhance learning and activation of motor neural circuits in PD. Thus, the aim of this study was to verify the effects AO and MI of gait, preceded by physical practice, on gait kinematic parameters, mobility and spectral power of alpha and beta rhythms of the frontal and fronto-central bilateral cortex. We conducted a randomized controlled trial with 39 individuals with PD, who were divided into experimental group (EG = 21) and control group (CG = 18). The EG received 12 sessions of AO + MI + physical gait practice. The CG observed educational videos and performed physical practice of gait during the same period. Subjects were evaluated and reassessed 1 day after the last training session for electroencephalographic activity (data collected with a 16-sensor Emotiv Epoc wireless headset); gait kinematics (data collected with Qualisys Motion Capture Systems®) and mobility (data collected with conventional and dual-task Timed Up and Go Test). Two follow-ups were performed (7 and 30 days after the last training session) analyzing gait and mobility kinematic data. The results of this study revealed that locomotor training based on the combination of AO, MI and physical practice is more effective than physical practice in reducing maximum hip flexion during gait swing phase, increasing hip range of motion, increasing knee extension in the initial contact phase, increasing speed and mobility. It was also observed that the spectral power of the alpha rhythms for the F4 channel increased significantly for the EG during gait execution, as well as the reduction of the beta rhythm power for the FC6 channel for the same group also during gait execution. These data indicate that the EG may have shown motor improvement strongly correlated with lower levels of attentional demand during gait execution after training.

Introduction: Among the most clinically significant changes that occur during female aging, hormonal ones stand out, which culminate in important changes in body composition, leading to decreased muscle mass, bone density and increased fat mass. with changes in the pattern of their distribution. These changes cause significant impacts on the musculoskeletal system, reducing muscle strength and impairing the physical performance, functional capacity and health of women from middle age. Objective: To analyze the relationship between body composition, low muscle mass and physical performance in middle-aged and elderly women living in the community. Materials and Methods: This is an observational, analytical, cross-sectional study with an epidemiological nature. The population consisted of women aged 40 to 80 years, residing in the municipalities of Parnamirim and Santa Cruz, state of Rio Grande do Norte. Samples were collected for biochemical dosage, body composition and physical performance evaluations were performed, as well as the collection of sociodemographic, socioeconomic data and information regarding gynecological history and regular practice of physical activity. For statistical analysis, measures of central tendency and dispersion, Student's t-test, ROC curve, chi-square, logistic regression, Pearson correlation and canonical correlation were used, this last one is a multivariate analysis technique that aims to analyze the influence of the independent variable set on the dependent variable set. Results: The anthropometric indexes cut-off points were able to identify the presence of low muscle, except for VAI (visceral adiposity index) (p <0.05). After regression analysis, BAI (body adiposity index), WC (waist circumference), WHR (waist-hip ratio) and RCA (waist-height ratio) were associated with a higher risk of low muscle mass (14.5, 6.2, 1.8 and 5.0 respectively). The first three canonical functions were statistically significant, accounting for 97.54% of the shared variance between the two sets of variables. The first function was the one that best estimated the shared variance, in addition to presenting the highest canonical correlation and redundancy index (% cumulative variance = 82.52, Wilks Lambda = 0.66, canonical correlation = 0.532, p value <0.001). In the first canonical function, an inverse correlation was observed between the CI (conicity index) (-0.59) and the handgrip strength (0.84) and the SPPB (Short Physical Performance Battery )(0.68). While in the second canonical charge it was possible to observe that VAI and CI correlated inversely only with SPPB (0.47). Finally, the third canonical function showed inverse correlations between BAI (0.63), BMI (0.84), WHR (0.67) and CI (0.43) with gait speed (-0.59 and with the SPPB (-0.45) and direct correlation only with the time to sit and stand (0.52). Conclusions: Changes in body composition during the female aging process are associated with low muscle mass and decreased physical performance in middle-aged and elderly women. The cutoff points of the anthropometric indices seem to be effective in identifying low muscle mass, showing that increases in these indices increase the chance of presenting low muscle mass. Moreover, it can be observed that physical performance is significantly influenced by body composition. The results presented have important clinical relevance, since a better understanding about this theme is fundamental to provide scientific support for health care planning in the area of Geriatrics, Women's Health and Physical Therapy 

Background. Cardiac resynchronization therapy (CRT) is indicated for patients with severe ventricular dysfunction, advanced stages of HF and refractory to conventional treatment. It is an artificial cardiac pacing modality that aims to correct electromechanical dysfunctions of the heart, which reduce morbidity and mortality in individuals with HF and has been widely used in recent years to improve symptoms, exercise capacity and function. ventricular Central adaptations derived from CRT are accepted as beneficial in the treatment of HF with severe ventricular dysfunction. However, it is known that the cause of exercise intolerance in heart failure (HF) is multifactorial, and central alterations, with low cardiac reserve, peripheral alteration with skeletal muscle dysfunction and low pulmonary reserve contribute to low exercise capacity. Objectives. To evaluate and compare the effects of a cardiac rehabilitation program on HF patients with CRT. Methods. The patients were referred to the cardiac rehabilitation by the cardiologist and included in the research those who had a diagnosis of HF confirmed by clinical examination and echocardiography, cardiac resynchronizer implantation for at least three months, with functional class I, II and III, according to New York Heart Association (NYHA) and with reduced and preserved EF and composed the HF + CRT group. The study included a retrospective analysis of patients with heart failure without cardiac resynchronizer or any type of pacemaker who underwent cardiac rehabilitation from October 2014 to February 2018 in the HF group. All patients underwent clinical, anthropometric and spirometric evaluation. In a second moment they performed the cardiopulmonary exercise test (CPET) using a conventional treadmill. In all tests, ventilatory measures (VE, VE/VO2, VE/VCO2-, RER) and metabolic (VO2) measurements were taken of breath-by-breath with Cortex-Biophysik-Metamax3B system, as well as effort perception variables (fatigue and dyspnea) – Borg 6-20 ), HR max and systolic and diastolic blood pressures. In addition, patients with HF + CRT answered a specific quality of life questionnaire for HF patients. Cardiac rehabilitation sessions were performed three times a week for 12 weeks as a prescription for individualized exercise. A new assessment was performed after 12 weeks of training. SPSS software version 20.0 was used for statistical analysis and a value of 5% was assigned to test the hypotheses. In addition, the effect size (ES) was calculated for each variable analyzed. Results. Eighteen patients with HF with CRT were eligible for the study and 8 were excluded because they did not participate in all stages of the study, totaling 10 individuals analyzed. For the HF group 69 patients were eligible, however 47 were excluded, totaling 22 patients analyzed. The patients had a mean age of 52 ± 13 years, with male prevalence (68.7%), with mean EF of 34 ± 5% and 46.8% of ischemic etiology. After cardiac rehabilitation the mean increase in test time was 136.9 seconds in the HF group with ES=1,14 and 142.8 seconds in the HF + CRT group, with ES=1,44. After cardiac rehabilitation, patients in the HF group had a mean increase of 4.9 mL/kg/min in peak VO2 (ES=0,75)  and patients in the HF + CRT group an increase of 2.19 mL/kg/min (ES=0,49) and average predicted percentage of VO2 peak increase from 61 to 76% with ES=0,97 and from 57 to 67% with ES=0,64, respectively. In addition, patients in the HF group showed an increase in peak VO2 in AT (15.7±5 to 18±5.5 mL/kg /min, EF=0,44) and in AT time (252±92 to 366±102 seconds, ES=1,18). Additionally, this group showed improvement in ventilatory efficiency, reflected by the values of VE/VCO2 and VE/VCO2 slope (35.4±6 to 32±5.7). Although the IC+CRT group did not show significant improvement in ventilatory efficiency, a large ES was observed in this variable after CR (ES = 0.86). In addition, patients with HF+CRT improved their quality of life with a 6.3 point reduction in score. Conclusion. HF patients with CRT benefited from the cardiac rehabilitation program with increased exercise capacity and improved quality of life.

Introduction: Chronic Non Transmissible Diseases (CNTD) are the main causes of loss of quality of life in the elderly and entail important functional limitations. Among them, type 2 Diabetes Mellitus (DM2) and Fragility Syndrome (FS) stand out due to the high prevalence and associated comorbidities. The fragility burden is an elementary measure in the measurement of this condition and can be associated with several variables. Objective: To determine the sociodemographic, clinical-functional and depressive symptoms related to the frailty burden in the elderly with type 2 Diabetes Mellitus. Methodology: This is an observational, analytical cross-sectional study conducted in Natal/RN. Elderly patients aged ≥ 60 years diagnosed with T2DM, with independent ambulation and not amputated participated. They were evaluated for socio-demographic data, clinical-functional, depressive symptoms and fragility phenotype. Descriptive statistics and the chi-square test were performed, followed by multivariate logistic regression analysis (p<0,05 and 95% CI). Results: The sample consisted of 125 elderly, mostly female (36,8%), overweight (62,4%), five or more diseases (65,6%) and depressive symptoms (53,2% ), reaching a mean of 68,76 (± 6,52) years old. The group with the lowest fragility burden prevailed (56,0%) and the low level of physical activity was the most cited phenotype item (72,0%). The final regression model showed that the fragility burden was significantly associated with age (p=0,016; [1,316-8,794]), schooling (p=0,002; [1,680-10,623]), lower limb pain (p<0.001; [1,935-11,766]) and TUGT (p=0.031; [1,145-15,659]) and this multivariate model presented 80,9% accuracy. Conclusion: the elderly with greater age, lower educational level, lower limb pain and worse functional mobility presented a 3,40, 4,22, 4,77 and 4,23 times greater risk of having a greater fragility load, respectively.

Introduction: Under the need to evaluate the clinical control of asthma in children and adolescents, the importance of the availability of validated instruments for use in the Brazilian population was observed. However, few specific instruments have culturally adapted and validated versions for Portuguese. Objectives: To perform a translation, cross-cultural adaptation and evaluation of psychometric properties of the Pediatric Asthma Control and Communication Instrument (PACCI) for use in the Brazilian population. Methods: An exploratory methodological and psychometric study, which involves the process of translation, cross-cultural adaptation and evaluation of psychometric properties. Transcultural translation and adaptation followed the recommendations internationally described and used, involving translation procedures, back translation, multiprofessional committee of experts and pre-test in a representative sample of the new population. The psychometric properties were analyzed through the application of the adapted questionnaire in a sample of children and adolescents with clinical diagnosis of asthma and their parents/caregivers. Socioeconomic assessments were performed (Brazil Economic Classification Criteria); evaluation of clinical control, with the Childhood Asthma Control Test (c-ACT), Asthma Control Test (ACT); evaluation of the caregiver’s quality of life with the Pediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ), and test of pulmonary function (spirometry). It was investigated the content validity, construct, concurrent, reliability (considering the internal consistency) and the cutoff, through receiver operator characteristic curve analysis. The instruments and pulmonary function test was correlated through Spearman correlation test, and their association was verified through ANOVA and Bonfferoni post-test. Results: The multiprofessional committee of experts indicated that the items of the questionnaire were clear and compreesible, with agreement ranging from 0.78 to 1.00. Considering the pre-test procedure, parents/caregivers did not present comprehension difficulties (agreement above 0.90). The Brazilian version of PACCI showed an internal consistency of 0.80. The internal structure of the PACCI was evaluated through exploratory factorial analysis. From the acceptable adjustment indexes (KMO=0.81 and Bartlett sphericicity test, p<0,001), the exploratory factorial analysis was performed with the extraction of 4 pre-determined factors and orthogonal rotation (varimax). Considering the items grouped into factors, it was verified that each of these factors presented adequate reliability. The following factors were identified: clinical control, risks, perception of asthma status and severity. The factor asthma control showed, through its total score and problem index, correlation with c-ACT/ACT, PACQLQ. Scores for the control domain greater than 4 points (sum of the score) and above 1 point (problem index) were indicative of uncontrolled asthma. Conclusion: The PACCI questionnaire is properly translated and cross-cultural adapted for Brazilian pediatric population. Furthermore, the Brazilian version showed to be able to provide valid and reliable measures to assess the clinical control of asthma in children and adolescents.

Introduction: The aging process causes health problems such as the emergence of various chronic and degenerative diseases and geriatric syndromes, significantly increasing the presence of pain in the elderly. Pain, in its various contexts, causes several limitations and can be related to the fear of falls, especially in the elderly residing in homes for aged. Objective: To analyze the relationship between pain and fear of falls among residents of homes for aged. Methodology: A transversal survey was conducted involving 108 residents of homes for aged in the state of Paraíba, Brazil. The instruments utilized to collect data were the Geriatric Pain Measure form (GPM), to evaluate pain, and the Falls Efficacy Scale-International (FES-I), to evaluate the concern with falls. The statistical program SPSS version 20.0 was used to analyze the data, and the t-test and Spearman’s test were used in the bivariate analysis. Also, three multiple linear regression models were applied. In all the statistical tests, the confidence interval (CI) was 95%, or p < 0.05. Results: The average age of the respondents was 78.8 (±7.19) years, with predominance of women (64.8%), and 42.1% of the respondents were single. With respect to pain, chronic pain was reported by 44.8% of the respondents, while episodes of acute pain were reported by 18.1%. In the evaluation of pain by the adjusted Geriatric Pain Measure, the average score was 28.81 (±30.67) points. The pain intensity was slight (43,6%) in the large majority of the sample. A moderately positive and significant correlation was obtained between the adjusted values of the GPM and FES-I (ρ = 0.31: p < 0.001). The multivariate analysis indicated that in the three regression models applied, the variables sex, use of psychotropic drugs and GDS score had influence on the FES-I score. It was also observed that in the dichotomous model adjusted for pain, the report of pain implied 5.47 points on the FES-I. Conclusion: The present study identified a high prevalence of pain as well as great concern about the fear of falling among residents of homes for aged. When investigating the relationship between pain measures and fear of falling, a positive and significant correlation was observed between these variables.

Background: Brazil is a country of continental dimensions marked by peculiarities in the health system and regional inequities in the financing of services. Despite strong national and international recommendations for cardiovascular rehabilitation (CVR), the availability of programs is uneven and the barriers to participation are known in an incipient way in the Brazilian scenario. Therefore, it is necessary to investigate these barriers in different regions, health services and treatment stages. Aims: describe and compare barriers to participation in RCV in public and private health services. Methods: it’s an observational-analytical cross-sectional study conducted according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) between May and December 2017. In this study, CVR participants and eligible inpatient and outpatient were matched by type of service they used. The level of barriers to CVR was evaluated by the Barrier Scale for Cardiac Rehabilitation (CRBS) and U Mann-Withney and Kruskal Wallis tests were used in the comparisons between service types and treatment stages, respectively. Results: a total of 140 patients participated in the study. The mean total barrier score was 1.98 ± 0.48 and differed only between inpatients and CVR participants (p <0.05). Some barriers in access and perceived needs domains were higher in public than in private services (p <0.05). The domain perceived needs had the highest score of the sample (2.31 ± 0.71). Not knowing about CVR (3.75 ± 1.66) and lack of medical referral (2.32 ± 1.53) were the major barriers in this domain. Conclusion: there were no differences in the overall scores between public and private services, as well as between inpatients and outpatients. However, some barriers differed significantly between these groups. Therefore, approaches for dissemination of knowledge in RCV and implementation of strategies for reference of eligible should be encouraged in both services.

Introduction: The Kangaroo Method, implemented by many developing countries, is a strategy for improving neonatal care. This method seeks an organization of the immature physiological systems of the low weight premature, through the insertion of the parents into the care to the baby and the kangaroo position. Despite the already existing benefits of its development, little is known about the motor patterns and the movements generated by the premature infants undergoing this method. Aim: To evaluate the motor patterns and the generalized movements of low birth weight preterm infants submitted to the Kangaroo Method. Methodology: This is a cross-sectional study, carried out at the Januário Cicco Maternity School. The study included newborns with gestational age of less than 37 weeks, weighing less than 2500g, who were submitted to the Kangaroo Method (KM) in the first week of life. Clinical information about the baby and the mother's gestation was collected during hospitalization; the time of kangaroo position, during the second stage of the KM. In the first consultation of the third stage of the KM, the evaluation of the generalized movements and the Test Infant Motor Performance (TIMP) were applied. For statistical analysis, the significance level of 5% and 95% confidence interval were assigned for all analyzes. The descriptive analysis was presented in mean and standard deviation (SD). The normality of the study variables was verified using Shapiro Wilk test. Mann-Whitney was used to compare the means between the groups and the chi-square test was used for the categorical variables. Results: The sample consisted of 30 babies, to evaluate the generalized movements and 27 to evaluate the motor development. Of the studied population, 50% (15) presented altered spontaneous movement and 22.22% (6) presented atypical motor pattern. When comparing the means between the groups of the babies with normal and altered generalized movements, there was no significant difference between the samples regarding clinical variables and time of kangaroo position. Among the babies with typical motor pattern and atypical, there was a significant difference between the number of previous pregnancies (p = 0.04), the maximum total bilirubin level (p = 0.03) and the presence of grade I intraventricular hemorrhage (p = 0.05). Conclusion: Despite the strategies offered by the Kangaroo Method, the rate of babies with generalized motor and atypical motor patterns is still high, demonstrating the importance of this type of evaluation in the follow-up of low-weight preterm infants. In addition, it was observed that the number of pregnancies and the level of bilirubin negatively influenced the motor pattern of the babies and that the presence of grade I intraventricular hemorrhage might not influence the atypical motor pattern. Therefore, it is necessary to study the generalized movements and the motor pattern of the premature babies submitted to the Kangaroo Method to evaluate the causes of these changes and the effect of this method on these outcomes.

Introduction: The sniff nasal inspiratory pressure (SNIP) is an easy to perform test that estimates esophageal pressure and predicts inspiratory muscle strength, being complementary to maximal inspiratory and expiratory pressure measurements (MIP and MEP, respectively). In Brazil, its reference values for children have not yet been proposed. Objective: To propose SNIP prediction equations for healthy Brazilian children and determine the reference values for this population. Methods: A multicenter (Natal, Recife e Belo Horizonte), cross-sectional observational study was carried out to evaluate healthy children 6 to 12 years of age incomplete, of both sexes. They were stratified into three subgroups (6-7, 8-9, 10-11 years) within each sex. All performed after anamnesis with sociodemographic and anthropometric evaluation (percentile), the spirometry test, followed by the measurement of respiratory muscle strengths, composed of MIP (Functional Residual Capacity (FRC) and Residual Volume (RV)), MEP and SNIP. Finally, two 6-minute walk tests (6MWT) were performed to assess functional exercise capacity. Statistical analysis: We used the Kolmogorov-Smirnov test for normality of the data, and the t test to test the intergroup relations and one-way ANOVA for intragroup analyzes. Linear regression analysis was used to obtain predictive equations for the independent variables that correlate with nasal inspiratory pressure. Results: A total of 135 children were evaluated in the Natal center, of which 118 were included in the study. Girls achieved slightly higher SNIP values in boys (91.3 ± 21.2 vs 89.4 ± 19.6), but without statistical significance. While the values of MIP_FRC, MIP_VR and MEP were significantly higher in males (p = 0.039, p = 0.009 and p = 0.025, respectively). In boys, the SNIP correlated positively with height (cm) (r = 0.254)., while in girls, with weight and percentile (r = 0.233, r = 0.276) respectively. Thus, the following equations were generated for the male and female, respectively: SNIP = 21,257 + 0,497 * height_cm; SNIP = 72.12% + 0.230 * weight_kg + 0.167 * percentile. Conclusions: According to what was found from linear regression, the variables that influenced SNIP in girls were weight and percentile, and in boys only height, results found for healthy Brazilian children in the city of Natal.

Introduction: Urinary incontinence is defined as any involuntary loss of urine; your treatment may be surgical or conservative. The surgical approach involves invasive procedures that can lead to complications. Thus, conservative treatments are of increased interest, and pelvic floor muscle rehabilitation programs are the first intervention option. Objective: To compare the efficacy of pelvic floor muscle training and game therapy in the treatment of mixed urinary incontinence. Methods: A randomized, blind clinical trial, conducted at the Hospital Universitário Onofre Lopes. A total of 32 women aged 45 to 70 years with the diagnosis of mixed urinary incontinence were randomly divided into two groups: Pelvic Floor Muscle Training Group (PFMTG - n = 16) and Game Therapy Group (GG - n = 16). Participants were assessed before the intervention and eight weeks after, in relation to the functionality of the pelvic floor muscles: muscle strength (measured by modified Oxford scale) and muscle pressure (measured by manometry); amount and degree of urinary loss (measured by the Pad test); classification of urinary loss (measured by the International Consultation on Incontinence Questionnaire - ICIQ-SF Short Form); and the evaluation of the intervention (measured by the Patient Global Impression of Improvement - PGI-I). The sample data were analyzed using the statistical software SPSS (version 20.0). The Komolgorov-Smirnov test was used to test the normality of the data, and Levene Test, to analyze the variance homogeneity. The descriptive statistics were used to present the means, standard deviation and percentages of the data. According to the data distribution, a mixed-variance analysis (ANOVA Two-Way) was performed, followed by Tukey post-hoc. The time-group interaction and inter and intragroup differences were analyzed for the studied variables. Sphericity was tested using the Mauchly test, and if violated, the Greenhouse-Geisser correction was used. Results: The mean age of the sample was 50.12 (± 8.62) in the PFMTG and 54.43 (± 9.96) in the GG, most of whom had completed elementary education. All volunteers had children, had no regular menstrual cycles, were sexually active, and were overweight. There was no intergroup-time interaction or statistically significant intergroup difference in manometry (p = 0.871), pad-test 1h (p = 0.740) and ICIQ-SF (p = 0.053) when comparing the two treatments. Intragroup differences were observed in these variables mentioned above after the end of the intervention. Conclusion: Both treatments proved to be effective for the treatment of mixed urinary incontinence in the study population.

Introduction: In daily tasks the individuals need to perform simultaneous tasks such as walking and watching for obstacles, preventing accidents. However, morphological findings in elderly demonstrated a reduction in the gray matter of the frontal lobe, an important region for the execution of tasks that requires the executive function, like dual task performance. The electroencephalogram is used in the observation of brain dynamics by the capture of electrical flux. This flux is related to the activation of specific brain areas, responsible for specific functions. Bearing in mind this relationship, it can be said that the dual task training is an important tool to obtain motor and cognitive gains in elderly. Nevertheless, studies that demonstrate the brain patterns during the dual task performance are scarce. Thus, it is relevant to deploy an investigation of how the dual task performance can influence the brain activation pattern in elderly. Methodology: descritive observational study of transversal type, where 23 individuals between 65 and 75 years old were investigated. The subjects were submitted to a dual task activity through the Functional Ambulation Test, using the Emotiv EPOC for electroencephalographical analysis to observe the cortical activation during the dual task. Statistical analysis: the data were prepared by the statistical software SPSS-20. The analysis was made by the calculation of average, standard deviation and frequency. After the application of Shapiro-Wilk test – to verify the data normality – the data was submitted into the inferential statistical analysis under the Student T-test and Mann-Whitney, for parametrical and non-parametrical approaches, respectively. In correlation analysis, it was used the Pearson and Spearman tests.

Results: the duration of TDF1 test has average of 106.11±72.88 seconds. There was found a significant positive correlation between the TDF time and the age (p=<0,001; r= 0,49) and with MEEM (p<0,05; r=- 0,47). The comparative analysis between alpha and beta wave spectra highlighted slightly higher potentials in alpha frequency band (p=<0,001). The channels of cortical areas were the most activated ones. Conclusion: The obtained data points toward the fact that the dual task performance activated more the motor areas that contributes to executive functions to the detriment of the other cortical areas.

Introduction:Objective: To evaluate the acute effect of BINV on peripheral muscle function without isokinetic exercise and non-TC6 aerobic performance in COPD. Methods: Non-probabilistic sample, totaling 14 individuals with moderate to very severe COPD, without exacerbations. Procedures carried out in two days. Initially all criteria preceded clinical evaluation, disease severity, questionnaires to explain and quality of life, spirometry and manovacuometry. Secondarily taken for collection biochemistry, 6MWT, and isokinetic evaluation of the quadriceps, all basal. Then they underwent the intervention with 30 minutes of NIV Binible / placebo, according to randomization; submitted to new TC6 and test protocol in the isokinetic dynamometer, ending with a new biochemical collection. Before and after the assessment was quantified to a relative perception of dyspnea and fatigue in After washing the nobility days, participants returned, re-developing all procedures, and altering NIV according to randomization. Results: 14 participants, 57% with severe COPD and moderate COPD, a NIV showed significant improvement in the performance of lower and lower actions, isokinetic post-exercise (p≤0.02 * and ≤0.05 *), improvement in values peak torque (p≤0.00 *), total work (p≤0.00 *), fatigue index (p≤0.00 *) and power (p≤0.01 *), the NIV group walked approximately 16 meters more than the 6MWT, and obtained better in blood lactate levels (p≤0.00 *). Conclusion: A NIV directly improves the perception of dyspnea and scores assessed in isokinetic exercise. It presents clinical results on non-TC6 sub-percolation, and improvement of the blood lactate level, in patients with COPD.

Introduction: Muscle endurance is an important feature for the prevention of musculotendinous lesions and peripheral vascular system. The heel-rise test (HRT) currently aids in the clinical findings of strength and endurance of the triceps surae muscle during repetitions of the plantar flexion movement. However, the protocols of the test described in the literature have great variability, differing in several parameters such as initial position, achieved height, cadence of execution, balance support, type of foot support, knee positioning, criteria and outcome measures. We believe that the elaboration of a protocol with external cadence (HRTEC) and bilaterl support can be a sensitive and safe instrument to identify the functional limitations. Objectives. The present study had as main objective to elaborate a protocol for applying HRTEC with bilateral support in healthy adults and to evaluate its reliability and intra-rater reproducibility. Secondly, determine the reference values of the bilateral support HRTEC and propose prediction equations for this population. Methods. The study was characterized as observational and transversal, with healthy adults of both sexes, aged between 20 and 59 years, with BMI <30 kg / m2. For the collection of reference values, the application was multicentric (Natal / RN, Curitiba / PR and Belo Horizonte / MG). The analysis of the measurement properties of the test were performed with the data collected in a subgroup of the metropolitan region of Natal / RN. All subjects included in the study were submitted to the protocol with a rate of 60 elevations / minute, starting from 10º of dorsiflexion, to evaluate the number of elevations, the perception of pain before and after the test, pain with 24 hours and 48 hours after the test and the perception of initial and final effort. The test-retest was performed with an interval of one week, for the reliability and reproducibility analysis of the HRTEC protocol. Statistical analysis. The Kolmogorov-Smirnov and Shapiro-Wilk tests were used for data normality. The Mann-Whitney test and the Kruskall-Wallis test with Dunn post-hoc for comparisons between the variables. The Intraclass Correlation Coefficient for intra-rater reliability analysis. The Bland-Altman comparison method for agreement analysis and the Pearson correlation for association between the tests. Results. 140 healthy adults from the metropolitan region of Natal / RN were evaluated, but only 112 (52 men) volunteers, aged 25 (23-33) years for men and 25 (23.2-34) years for women and BMI <25.0 kg / m 2. The test proved to be easy to understand, safe and simple to perform in clinical practice. In the performance outcomes of the total sample, the men presented a better performance with a higher number of elevations (p <0.02), especially in the age group of 20 to 29 years (p = 0.03), compared with the women. The main symptoms reported were burning sensation (54.5%) and fatigue (22.3%). Participants related to the end of the test of moderate intensity 4 (3-6) and graduated with mild intensity 2 (1-3) after 24 hours. Despite this, interest rates increase to 3 (1-5), being more uncomfortable. For the entire sample, the limiting test fatigue had a moderate level of intensity 3 (2-4), with significance before and after the p <0.0001 test. For reliability and reproducibility analysis, we used a sample of 21 adults and found a ICC=0.98, with excellent reliability. Pearson's correlation was r = 0.98, with a coefficient of determination r2 = 0.96 (p <0.0001). The Bland-Altman dispersion model presented a bias of -0.76, with 85% of the sample included within the limits of agreement. Conclusions. HRTEC with bilateral support was considered an easy to perform evaluative method, with clinical practice and standardization of the most adequate and safe positioning for adults, the cadence was adequate to promote the frequency of the movement of plantar flexion and to reach maximum fatigue. In addition, the study showed a good reproducibility of the analyzed variables, confirming the reliability of the test. It was not possible to obtain the reference values and prediction equations due to the small representativeness of the sample from 40 to 59 years old.

Introduction: Aging is characterized by a gradual and long-term accumulation of molecular and cellular damage that results in progressive and widespread impairment in many body functions. Among the most clinically significant changes are the muscular strength and mass (defined as sarcopenia) and increase in body adiposity that are related to the greater risk of disabilities, leading to the loss of the i functional independence. The IMIAS study aimed to analyze the difference in mobility and associated factors in older adults from different social, economic and cultural contexts. Therefore, it offers a great opportunity to examine aspects related to the aging of the musculoskeletal system, as well as factors related to functional disability in older populations that differ widely. Objectives: a) To estimate the ability of handgrip strength cut points to identify slowness in different populations of older adults; b) To identify which physical performance measures proposed for Sarcopenia screening could predict most the muscle mass in community dwelling older adults after 4 years of follow up; c) to explore the longitudinal relationship between abdominal obesity with mobility and mobility-related ADL disability controlling for physical performance and depression in older adults free from disability.  Methods: This is an analytical, observational longitudinal study, where 2002 older adults were followed for 4 years of follow-up. Baseline data were collected in the year 2012. New evaluations occurred with the interval of 2 years between them, in the years 2014 and 2016. The measures of physical performance were handgrip strength and gait speed. The muscle mass was measured by of the bio impedance analysis. Functional disability measures were self-reported difficulties in tasks related to mobility and daily living activities related to mobility; the measure of obesity was defined by waist circumference. Results: The handgrip strength cut-off points of <26 kg for men and <16 kg for women were able to identify slowness in walking speed in older adults participants of the IMIAS. In addition, handgrip strength measured at baseline was significantly related to muscle mass measured 4 years later (β= 0.003, p-value <0.05). Finally, the presence of abdominal obesity, was a risk factor for disability in mobility (OR = 1.47, 95% CI 1.01-2.15) after 4 years of follow-up, however was not associated with the risk of the onset of ADL disability (OR: 1.40, 95% CI 0.90-2.18). Conclusions: The proposed cutoff points for handgrip strength can be designed to be a useful tool to screening the older adults at risk of functional problems. Further, handgrip strength can be used as a simple method for screening sarcopenia in the community dwelling older adults. Finally, the presence of abdominal obesity is associated longitudinally and predicts the risk of disability in mobility, even over a short period of time (4 years) in community dwelling older adults from different epidemiological contexts.

Introduction: The assessment and early detection of respiratory muscle weakness resulting from amyotrophic lateral sclerosis (ALS) have gained more interest in the field of research in the recent decades. As the disease progresses, the decrease in respiratory muscle strength leads to a reduction in lung volume and consequent ventilatory insufficiency, making essential the use of bronchial hygiene techniques and the early detection of respiratory muscle weakness in order to monitor the progression of the disease as well as to anticipate the introduction of interventions. 

Objectives: 1) To estimate the amount of gas compression (Vcomp) during the application of the air stacking technique in healthy subjects and to verify if the simultaneous measurements of chest wall volume changes (ΔVCW) and changes in lung volume (ΔVao), combined with pressure variation at the airways opening (ΔPao) during air stacking are able to provide reliable data on absolute lung volumes; 2) To assess thoracoabdominal asynchrony and the presence of paradoxical movement in patients with ALS and its relations with VCW, respiratory pattern and peak cough flow; 3) To analyze the relaxation rates and contraction properties of the inspiratory muscles of patients with ALS and compare with healthy matched-paired subjects. In addition, patients with ALS were divided into three subgroups in order to determine the best parameter linked to inspiratory muscle weakness. 

Materials and Methods: 1) Twenty healthy subjects were studied during a protocol that included slow vital capacity maneuvers and application of the air stacking technique. Vcomp was calculated by subtracting ΔVao(measured by pneumotachograph) and ΔVCW (measured by optoelectronic plethysmography) during air stacking and total lung capacity was estimated by applying Boyle-Mariote's law; 2) Phase angle (θ) between pulmonary ribcage (RCp), abdominal ribcage (RCa) and abdomen (AB), as well as the percentage of inspiratory time (IP) in which RCa and AB moved in opposite directions were quantified in 12 patients with ALS through optoelectronic plethysmography during quiet spontaneous breathing and cough using control data from 12 paired-matched healthy subjects to define the normal range of movement; 3) The relaxation rates and contraction properties of the inspiratory muscles were extracted from the sniff nasal inspiratory pressure (SNIP) curve, performed non-invasively in 39 patients with ALS and compared with 39 matched-paired healthy subjects. 

Results: 1) During air stacking, 0.140±0.050 L of gas was compressed with an average ΔPao of 21.78±6.18 cmH2O. No significant differences between the estimated total lung capacity (−0.03±3.0% difference, p=0.6020), estimated functional residual capacity (−2.0±12.4% difference, p=0.5172), measured inspiratory capacity (1.2±11.2% difference, p=0.7627) and predicted values were found. 2) During quiet spontaneous breathing, a higher RCa and AB θ (p<0.05), IPRCa (p=0.001) and IPAB (p=0.02) were found in patients with ALS as well as correlations between RCp and AB θ with forced vital capacity (r = −0.773, p<0.01) and vital capacity (r = −0.663, p<0.05), and between RCa and RCp θ and peak cough flow (r = −0.601, p<0.05). During cough, correlations between AB and RCp θ and peak cough flow (r = −0.590, p<0.05), peak expiratory flow (r = −0.727, p<0.01) and VCW (r = −0.608, p<0.05); as well as between RCa and AB θ and peak cough flow (r = −0.590, p=0.01) and peak expiratory flow (r = −0.713, p=0.01) were observed. Moreover, a lower forced vital capacity (p<0.05) and a greater shortening velocity of the inspiratory muscles (p<0.05) were observed in patients with paradoxical movement of the rib cage; 3) When compared to healthy ix 

subjects, patients with ALS had a significantly lower (p<0.0001) maximum relaxation rate (MRR) and maximum rate of pressure development (MRPD), as well as a greater (p<0.0001) contraction time, tau (τ) and half-relaxation time (½RT). The results of the ROC curves showed that ½RT (AUC 0.720, p=0.01), forced vital capacity (AUC 0.700, p=0.03), τ (AUC 0.824, p<0.0001) and MRPD (AUC 0.721, p=0.01) were the most sensitive parameters in detecting a 3-point fall in the respiratory subscale of the ALS functional capacity questionnaire. In addition, the MRPD (AUC 0.781, p<0.001), τ (AUC 0.794, p=0.0001) and the peak pressure generated during the SNIP test (AUC 0.769, p=0.002) were the parameters capable of detecting a 30% decrease in forced vital capacity of the patients studied. 

Conclusions: During AS, a significant gas compression occurs and absolute lung volumes can be estimated by simultaneous measurements of ΔVCW, ΔVao and ΔPao. In addition, the identification of altered parameters, such as thoracoabdominal asynchrony and the presence of paradoxical movement between the chest wall compartments, τ, MRPD, and ½RT, represent an early sign of inspiratory muscle weakness in subjects with ALS. 

Introduction: Maximum cardiopulmonary exercise tests (CPX) performed on a bicycle or treadmill objectively measure functional capacity and quantify exercise limitation. In these tests, the analysis of peak oxygen consumption (VO_2PICO) and ventilatory threshold (VT) are useful measures to evaluate cardiorespiratory performance in several populations. Several exercise protocols using a bicycle or treadmill are used for performance evaluation, however, for obese individuals, it is not known which ergometer promotes greater physical stress and the one that better evaluates the physical performance of these subjects and has greater acceptability for these individuals. Moreover, for this population, less is known about the behavior of oxygen kinetics and ventilation, i.e. its rate of increase (VO₂ and VE kinetics) and the understanding of energy systems during an exercise using different types of exercise (cycling x pedaling). Objectives: To compare the cardiorespiratory, metabolic performance, oxygen kinetics and ventilation of obese women during cardiopulmonary exercise tests using a conventional treadmill and ergometric bicycle through incremental ramp protocols and constant load tests at two different exercise intensities. Materials and Methods: The sample consisted of 40 obese volunteers, based on sample calculations, randomized into two groups of 20 obese individuals, each of whom performed treadmill or bicycle CPX. We assessed the clinical, anthropometric and adiposity (weight, height, BMI-body mass index, BAI-body adiposity index, WBC-waist-hip ratio, HC-hip circumference, WC- waist circumference, NC- neck circumference) and spirometry (FVC-forced vital capacity, FEV¹-forced expiratory volume in the 1st second, PEF-peak expiratory flow, MVV-maximum voluntary ventilation). In both tests, ventilatory measures (VE-ventilation per minute, VE/VO₂-ventilatory equivalent of oxygen, VE/VCO₂-ventilatory equivalent of carbon dioxide, RER-gas exchange ratio) and metabolic (VO₂-consumption of oxygen, VCO₂-carbon dioxide production) of breath-by-breaths with respiratory gases (Cortex-Biophysik-Metamax3B), in addition to the variables of effort perception (fatigue and dyspnea - Borg6-20 ), HRmax (maximum heart rate) and systolic and diastolic blood pressures. Continuing with the evaluation protocol, 30 obese performed two constant load tests with different intensities (25% <VT and 25%> VT), with a 30-minute rest between the tests, to evaluate oxygen kinetics and ventilation. In these, measurements of the kinetics were taken as the time delay (TD), rate of increase (τ) of VO₂ and VT and amplitude (A). Sigma Plot 11.0 software for kinetic analysis and Statistic 10.0 software were used for the statistical analysis of the other outcomes, with a significance level of 5% being assigned to test the hypotheses. Results:The studied sample presented a high degree of obesity (BMI = 43.5± 6.6 kg/m², but without ventilatory disorders.) Both groups presented homogeneity in relation to their anthropometric and ventilatory characteristics.

During incremental CPX, the obese women in the treadmill group (TG) had the highest cardiopulmonary and metabolic response seen by VO_2peak (18.1±3.3 ml/kg/min x 12.2±2.1 ml/kg/min) and VE_peak (62.9±13.5L x 42.1±8.3L), with p <0.05. However, it was the same group that interrupted CPX earlier (153.4s), and with a lower ventilatory reserve (42.3±19.4L x 58.7±27.1L) when compared to the bicycle group (BG). Correlations between the anthropometric measurements and the performance variables between the groups, observed that only the TG had the final performance of the test influenced by the anthropometric measures as weight r= -0.56, p=0.01) and BMI (r= -0.55, p=0.02). Analyzing oxygen kinetics and ventilation, (p<0.05) for the VO₂ stable state (VO_2SS), where the TG presented an increase in VO_2SS in relation to BG (TG= 1.144 L/min, BG= 0.905 L/min; p<0.05). In the above VT test, we observed an additional ventilatory component (SLVE) for the obese women of the TG (TG= 10.0 L.min-1, BG= 5.2L.min-1; p = 0.02). Conclusion: In our study, it was evident in our sample that obesity seems to influence the test performed on a treadmill more negatively, causing obese women to stop this test earlier, requiring a higher oxygen consumption and a ventilatory response to complete the exercise. For oxygen kinetics and ventilation, apparently the type of exercise performed did not influence the response of the VO₂ and VE curve when exercise was performed below VT. However, for the above VT test, an additional ventilatory component (SLVE) was required so that the obese could finish the activity, suggesting that this activity becomes more difficult for this population.

The growth of the elderly population is a global reality that brings direct repercussions to society. Although the aging process is not necessarily related to diseases and disabilities, many pathological processes also occur as part of it. Frailty syndrome, a state of vulnerability and deficient homeostatic responses after a stressful event that occurs as a consequence of the cumulative decline of multiple physiological systems throughout life, is one of the most problematic expressions of population aging. This syndrome is an important topic from a social perspective because it identifies groups of people in need of additional medical attention and at high risk of becoming dependent. In this context, life-course epidemiology studies the long-term health effects of biological, behavioral, and psychosocial experiences throughout life. The International Mobility In Aging Study (IMIAS) draws on the lifelong approach to contribute to knowledge about health outcomes in the elderly in four countries with different epidemiological profiles. Objectives: To estimate the prevalence of frailty in the elderly participants of the study; To analyze the relationship between adversities throughout the life course and the fragility syndrome in old age. Methods: These are cross-sectional studies associated with a larger cohort study (IMIAS) in which the elderly (65%) aged 65-74 years in the community participated in the first evaluation (n = 2002) in 5 different locations (Kingston and Saint-Hyancinthe, Canada, Tirana, Albania, Manizales, Colombia and Natal, Brazil). Information was collected on sociodemographic, economic and health variables experienced during the lifecourse. The frailty syndrome was operationalized according to the criteria proposed by Linda Fried for the physical phenotype of frailty. Dispersion and central tendency measures were used to characterize the sample, bivariate, multivariate and mediation analyzes were used when appropriate in order to achieve the proposed objectives. Results: The prevalence of frailty varied according to the study sites being lower in Canada and higher in Brazil. In Tirana and Natal women were more frail than men. After multivariate analysis adjusted by covariables, the elderly who reported having suffered childhood physical abuse had a higher prevalence of frailty in old age (OR = 1.68, 95% CI: 1.01, 2.78) and the same was observed among those exposed to psychological violence perpetrated by intimate partner (OR = 2.07, 95% CI: 1.37, 3.12). The effects of childhood physical abuse were fully mediated by the presence of chronic conditions and depressive symptomatology, while the effects of psychological intimate partner violence were partially mediated by these same variables. Among women, give birth before 20 years old was associated with higher prevalence of frailty (OR 2.15, 95% CI: 1.24-3.72), those with 1-2 children had lower pre-frailty status (OR 0.54, 95 (CI 0.36-0.82) and frailty (OR 0.43 95% CI 0.22-0.86) and having performed hysterectomy was considered a factor contributing independently to higher prevalence of frailty in all models. Conclusions: Childhood physical abuse and experiences of psychological violence in adult life leave marks on the path of life leading to adverse health outcomes in old age. Age at first birth, parity and hysterectomy are factors that should be considered as indicators of women's health and seem to contribute to the greater prevalence of frailty in women when compared to men.

Introduction: Respiratory Muscular Training (RMT) in patients with Chronic Obstructive Pulmonary Disease (COPD), does not yet have consensus about the effects that could add to Pulmonary Rehabilitation (PR). Objective: Our objective was to propose a PR protocol associated with different RMT modalities and to evaluate its additional effects on primary endpoints of exercise capacity and dyspnea in individuals with COPD. Methods: This was a blinded randomized clinical trial composed of patients diagnosed with COPD randomly assigned to three groups: Pulmonary Rehabilitation (PR), PR associated with inspiratory muscle training with conical flow resistance load (PR+RMT_CFR) and PR associated with RMT endurance modality by normocapnic hyperpnea (PR+RMT_NH). The protocol lasted 10 weeks, with a frequency of 3 supervised weekly and 2 days without supervision, composed of health education, energy conservation techniques, individual aerobic training on treadmill with a load of 70% of the maximum speed reached in the incremental test and peripheral muscle strengthening for all groups. The PR+RMT_CFR group underwent training with an initial load of 35% of maximal inspiratory pressure (MIP) obtained in the initial evaluation with 5% progressions each week, up to a limit of 80% of MIP, reassessed and adjusted weekly. The PR+RMT_NH group underwent training with a rehousing pocket equivalent to 50% of vital capacity, a respiratory rate of 35 times the value of forced expiratory volume in the first second, with increments of 2 to 3 minutes per week, until the maximum time of 20 minutes. The anthropometric characteristics, pulmonary function, respiratory muscle strength and endurance (MIP, SMIP, SNIP, MEP and MVV), exercise capacity (6MWT and ISWT), thoracic wall volumes in the endurance test, peripheral muscle strength, dyspnea and fatigue (BORG_0-10), health status (CAT), risk of exacerbation and mortality of the subjects (BODE), before and after the intervention period. Statistical analysis was performed using the Shapiro-Wilk test, Anova One-way, Chi square and Anova Two-way with Bonferroni Pos hoc, according to the data distribution. A p <0.05 was considered and GraphPad Prism, 6.0 software was used. Results: A total of 34 subjects were evaluated and 33 patients (51.5%), 66.2 (± 4.9) years and BMI 28.0 (± 4.3) kg / m2 were evaluated. In the primary outcomes, we found, after 10 weeks, increased exercise capacity in the PR+RMT_CFR and PR+RMT_NH (p˂0.0001) groups, and in the intergroup analysis, the PR+RMT_NH group was higher in the ISWT group RP (Pos hoc of p <0.005). We also found a reduction in the sensations of dyspnea and fatigue after 6MWT and ISWT, in all three groups (p <0.001), with no difference between them. In addition, there was an increase in PImax in all groups (p <0.0001), in SPImax only in the PR+RMT_CFR group (p <0.0001) and improvement in SNIP in the groups that performed PR+RMT, with p<0.0001. In the PR+RMT_NH group we observed an improvement in MEP (p<0.0001) with Pos hoc of 0.004 in relation to the PR group, and in the manual grip strength (p˂0.0001). It was also verified that in all three groups, there was a reduction in the risk of mortality (p˂0.0001), with an improvement in the health status in PR+RMT_NH (p<0.001). The PR+RMT_CFRgroup presented a reduction in the risk of exacerbation (p=0.0006) and an improvement in CAT (p=0.0001). Conclusions: The association of RMT to PR programs provided additional gains on exercise capacity, health status, respiratory and peripheral muscle strength, and the benefits found in all groups with reduced risk of exacerbation, mortality, dyspnea and fatigue. Although we can´t differentiate which RMT modality was superior, we believe that PR should be emphasized and RMT added to PR in future programs for this population.

Introduction: During the aging process, there are physiological changes that promote a less efficient brain processing and motor planning, especially when compared to young individuals. In recent years, virtual reality (VR) has become more popular and has been increasingly utilized in rehabilitation centers as an additional health care tool, including for elderly. Because it is considered a motivating resource that promotes greater adhesion to treatment, RV has quickly spread. Nevertheless, there is little knowledge about how the use of game therapy influences the brain activation of different groups subjected to such stimulation. Faced with the diverse cognitive and motor demands provided by this type of resource, alternate mechanisms, such as portable electroencephalography equipment, are essential to measure how brain activity behaves in response to such exposure. Objective: The aim of this study is to investigate the immediate outcomes of performing a balance game, in virtual environment, in brain activation of frontal lobes of young adults. Methodology: comparative study, involving 20 individuals divided into two groups: young (YG) and elderly (EG). After being submitted to an evaluation of general condition, the necessary support for gait task, and cognitive status, the participants, during 4 minutes, practiced the penguin slide game of the Nintendo Wii balance category, whose effects on the cortex activity were observed through Emotiv EPOC’s acquired data. Results: The alpha wave frequency presented a greater activation power in both groups. To compare the activation power between the groups, the Mann-Whitney test was performed which did not show statistical differences between the alpha (p = 0.58) and beta (p = 0.92) frequency bands. Descriptively, it is possible to verify a tendency of GI to activate the right hemisphere channels more, while the opposite is observed in the GJ. Conclusion: Activation of alpha and beta waves in the frontal canals for young and elderly individuals does not differ when they undergo an RV experience.

Background: Being overweight is the main risk factor for a number of chronic diseases like diabetes, cardiovascular disease and cancer. Among the pathologies affected by excess of weight, there are also pelvic floor (PF) dysfunctions such as urinary incontinence (UI). Purpose: To compare the efficacy of a physiotherapeutic treatment for women with urinary incontinence through pelvic floor kinesiotherapy and kinesiotherapy associated with nutritional education. Materials and Methods: A clinical trial, randomized and simple-blind trial, carried out at the University Hospital Onofre Lopes. Twenty - six women with BMI between 25 and 40 kg / m2 were divided into two groups: Kinesiotherapy Group and Food Reeducation (GCRA - n = 13) and Kinesiotherapy Group (GC - n = 13). The data collection took place in three stages: Evaluation, with application of the evaluation form, of the questionnaires and physical examination; Intervention, with application of the kinesiotherapy protocol or nutritional education associated with kinesiotherapy protocol; And Reevaluation, Application of evaluation form, questionnaires and physical examination at the end of treatment, with 2 months. Two visits were performed per week, totaling 16 visits in both groups, with a duration of 30 minutes per service. The data were analyzed using the statistical software SPSS 20.0, assigning the significance level of 5%. The Shapiro-Wilk test was used to test the normality of the data. According to the data distribution, the t'Student or Mann-Whitney test was used to compare the intergroup means, and the paired t-test or Wilcoxon test to verify intragroup differences. Results: The perineometry presented a statistically significant difference, when compared before and after treatment, in both groups (GCRA P = 0.045; GC P = 0.028). The impact of urinary incontinence on quality of life, analyzed by the ICIQ-SF, both groups presented statistically significant differences from their initial moment to the final (GCRA P = 0.001, GC P = 0.000). Regarding quality of life, the GCRA showed an increase at the end of the treatment, regarding health satisfaction (P = 0.026). Conclusions: It is hoped that the physiotherapist will be able to enjoy a truly reliable protocol in the treatment of patients. In addition, we note the importance of interdisciplinary work, which favors an improvement of several body systems as well as improvement of the quality of life.

Asthmatic individuals show decreased functional activities due to symptoms as dyspnea and fatigue, mainly. Symptoms lead to impairment of respiratory and peripheral muscular function due to metabolic change, oxidative capacity reduction and a possible modification of muscle activation during activities. As these muscles are activated during daily activities in this population there are still a small number of studies. Thus, the aim of this study was to analyze the performance and behavior of electrical activity of respiratory and peripheral muscles in two exercise tests: Incremental Shuttle Walking Test (ISWT) and Glitter-ADL test in asthmatic subjects comparing with non asthmatic individuals.

This is an observational, analytical study that included patients with clinical diagnosis of Asthma, of both gender, aged between 20 and 50 years, with controlled disease, body mass index (BMI) below 30 kg / m². Non smokers and non asthmatic subjects matched for age, gender and BMI were also enrolled. After anthropometric and pulmonary function assessment, all participants were submitted to two exercise tests: ISWT and Glitter-ADL test. During the tests, electrical activity was evaluated through surface electromyography (EMGs) of sternocleidomastoid (SCM), scalene (ESC), rectus abdominis (RA) and rectus femoris (RF) muscles for ISWT and ESC, RA, RF and the middle deltoid (DM) muscle for Glitter-ADL test. Electromyographic signal was recorded in both tests at the moments: baseline, during the test, immediately post test and recovery. For root mean square processing (RMS) was applied a high pass filter of 20Hz, smoothing, with RMS algorithm, fullwave rectification type and a filter to reduce cardiac signals. Frequency spectrum analysis was calculated through the median frequency. Statistical analysis was performed using the statistical program GraphPad Prism version 6.0, a p value <0.05was set. Shapiro-Wilk test was used to test data normality. Intergroup analysis of cardiovascular, respiratory and Borg variables (dyspnea and fatigue) at the end of each test used Mann-Whitney test. For intergroup analysis of muscles electrical activity it was performed the unpaired T test for the ISWT and Mann-Whitney test for the Glitter-ADL test.

Sixteen asthmatic subjects were enrolled in the Asthma Group (AG) and ten non-asthmatic subjects in Control Group (CG). AG vs CG comparison  showed: age: 35.31 ± 11.31 vs 34.70 ± 15.61, BMI  kg / m2: 24.49 ± 4.15 vs 22.34 ± 1.797, FEV1%: 78.74 ± 17.41 vs 90.84 ± 7.74 (p <0.01), FEV 1 / FVC% predicted: 84.46 ± 12.53 vs. 100.6 ± 8.43 (p <0.01), respectively . There was no significant difference in reported symptomatology of dyspnea and lower limbs fatigue, cardiorespiratory variables and inspiratory capacity when the groups were compared at the end of each test. Regarding ISWT performance, AG walked a significant shorter distance compared to CG (p <0.05). For the Glitter-ADL test, AG took  almost 1 minute more to complete the test compared to CG (p <0.05). EMG analysis during ISWT showed an increase of electrical activity of the muscles evaluated in a coordinated and similar way, in both groups, with a significant difference only for SCM of CG in 100% of the test (p <0.05). In Glitter-ADL test there was no significant difference in the activation of ESC and DM muscles when AG was compared to CG. RA and RF muscles showed greater activation in the CG, however without significant difference. There was no significant difference in the slope analysis of the median frequency between the groups in both tests.

Our results suggest that during the ISWT and Glitter-ADL exercise tests, asthmatic patients show coordinated electromyographic activity similar to healthy individuals, however with lower performance in both tests.

Introduction: The Pilates method (PM) consists of a set of systematized exercises, with evidence with effects on physical conditioning and rehabilitation. Objective: Until the moment of the elaboration of this study, no studies were found to analyze the correlation between the activation of the abdominal muscles (AM) and the pelvic floor muscles (PFM) during the execution of the electromyographic activity of PM exercises in climacteric women. For this study we selected the Shoulder Bridge and Teaser exercises with variations. Methods: The study is characterized as analytical, observational and cross-sectional. 28 climacteric women were evaluated (mean age 54.14 ± 6.14 years), with an average of 4 years of Pilates practice, most of them doing it twice a week (85.7%). The sample was for convenience. All the volunteers underwent the functional evaluation of PFM by bidigital palpation. The electromyographic activity was investigated by the Miotool® device. The capture of electromyographic signals for the PFM was performed with endovaginal catheter (Chatanooga®) and, for the abdominal muscles, with Al / AgCl (Meditrace®) surface electrodes. Statistical analysis of the data was performed using the SPSS program (version 20.0). The normality test used was the Shapiro-Wilk test, using mean and standard deviation for quantitative data evaluation. The presentation of categorical data was given by relative frequencies. For the analysis of the electromyographic data, the Spearman correlation was used. Results and Conclusion: The results showed that there was no relation between electromyographic activation, simultaneously, between PFM and AM, in the selected exercises.

Background: Failure of calf muscle pump function is considered a major cause of venous insufficiency (CVI) and prolonged venous hypertension leads to weakening of the calf muscles. The evaluation can be done from different forms, from a heel lift test (TEC). Currently, several protocols have been developed for an ECT test in different populations, without a very detailed standardization.

Objectives: Firstly to evaluate the reliability and reproducibility of intra-r inter-raters in healthy adults, from two different protocols with different stimuli: self-paced (TEC_AC) and externally cadenced (TEC_CE); Secondarily, to evaluate the performance and electrical activity of lower limb muscles during an TEC_CE in subjects with CVI compared with healthy paired subjects.

Methods: Two studies were performed and both were of the observational type, with a transversal character. For Study 1, two TEC_AC and TEC_CE protocols were performed on healthy young subjects. For Study 2, subjects with ages between 35 and 65 years old were recruited, with a clinical diagnosis of CVI to perform TEC_EC associated with Surface Electromyography (EMGs).

Results: In study 1, 33 subjects were recruited (16H), aged 23.03 years (± 2.71). We observed that the TEC_AC obtained a better result both in terms of performance (53.01 elevations) and relative inter-rater reproducibility (ICC = 0.77), and TEC_CE obtained better intra-rater reproducibility (ICC = 0, 69). It was observed that at the end of both tests there was an increase in the fatigue symptoms (p <0.01), however, with maintenance of heel elevations in the three TEC_AC (p = 0.76) and decreased performance in the TEC_CE when compared T1, T2 and T3 (p <0.01). In Study 2, 44 subjects with CVI were recruited, of whom 17 comprised the sample from Group IVC, versus 17 subjects from the Control Group. There was a significant difference in the intergroup comparison of the TEC_CE performance (p <0.01) and also in the intergroup comparison of the time spent to perform TEC_CE (p <0.05). The flexure in the right lower limb was significantly lower (p <0.05) in Group IVC. In the evaluation of the muscular electrical activity during the test, significant differences were found in the moments 50% and 75% (p <0.05) of the right anterior tibial muscle and in moments 25% and 50% (p <0.05) of the muscle anterior tibialis.

Conclusion: Our results demonstrate that both can be used to provide muscle performance results. However, the presence or absence of external stimuli induces different performance behaviors during the two modalities studied. On the other hand, the individuals with CVI present inferior performance in the TECEC compared to healthy subjects, with greater muscular electric activity in the anterior tibial bilaterally.

Introduction: Chronic obstructive pulmonary disease (COPD) produces significant systemic consequences, such as skeletal muscle dysfunction, which predisposes to early muscle damage and / or fatigue. These changes may be a major reason for disability in COPD patients, decreasing performance in activities of daily living, work, and health-related quality of life. Objective: To compare neuromuscular and biochemical responses of femoral quadriceps muscle damage and fatigue among COPD and healthy individuals. Methodology: This is an observational, cross-sectional and comparative study. The sample consisted of 18 individuals allocated in two distinct groups: COPD Group (GD) and Healthy Group (GS). They were evaluated through spirometry; Of the neuromuscular performance of the quadriceps; The biochemical markers of muscle damage and fatigue; Fatigue and muscle pain. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 with significance level of 5%. Results: There was a statistically significant difference in power (p = 0.02) and a tendency to the difference in total work (p = 0.06) between the groups. In the analysis of the biochemical marker, LDH, for muscle fatigue, a significant difference between the groups was observed immediately after the isokinetic test in the quadriceps (p = 0.03). CONCLUSIONS: The neuromuscular, biochemical responses of muscle quadriceps muscle damage and fatigue in COPD are decreased in the study population.

Aim: To evaluate the effects of hospitalization on handgrip strength of hospitalized older adults in a university hospital; as well as compare means of handgrip strength at admission and discharge; to identify factors related to the worst performance in the test and to define specific cutoff points to handgrip strength in men and women older adults. Methods: An analytical observational type of the cohort type study was carried out at University Hospital Onofre Lopes (HUOL), Natal-RN. Were evaluated cognitive status (Leganés Cognitive Test), functional status (Katz Index, Lawton Scale and Functional limitation Nagi), physical performance (handgrip strength and gait speed) and presence of depressive symptomatology (GDS-15) at admission and discharge, as well information on the state of the health and functionality prior to hospitalization were collected. Results: a total of 1070 hospitalized older adults were evaluated, however 75 deaths occurred. It was observed a significant decrease in means of handgrip strength between admission and discharge for men (26,66±9,68 admission and 19,11±13,42 discharge, p<0,0001) and for women (17,93±7,43 admission and  14,24±9,41 discharge, p<0,0001). Men presented greatest decline in handgrip strength compared to women (-8,10±13,51 men and -4,33±9,14 women, p<0,0001). Remained significant in our final multiple linear regression the variables maximum handgrip strength at admission, perform surgery for both groups and be dependent 15 days before and on admission in BADL in women only. Were defined the cutoff points for handgrip strength of 22,0 Kgf for men and 15 Kgf for women. Conclusion: Our results suggest that there is a difference in handgrip strength at both moments of assessment and men have lost more strength than women. Performing surgery in both men and women decreases muscle strength. Beside this, only in women being dependent on BADL 15 days before and at moment of admission decreased muscle strength on discharge. Finally, we defined the cutoff points for handgrip strength in specific hospitalized elderly between the sexes.

Abstract:

INTRODUCTION: Parkinson's disease (PD) is a neurodegenerative disease that affects the central nervous system, characterized by the loss of dopaminergic neurons in the brainstem, mainly in the substantia nigra region. Its main clinical signs are stiffness, bradykinesia, tremor at rest and postural instability. In addition, due to disease progression, respiratory symptoms and complications deserve special attention because they present a high mortality rate. OBJECTIVE: To evaluate the acute effects of contraction maneuvers in thixotropic modality of inspiratory muscles on thoracic wall volumes in patients with PD. In a randomized cross-sectional study. METHODS: 18 patients with PD were evaluated to participate in the study. 14 patients with PD (9H, 5M) were included in the study. All were evaluated for pulmonary function, respiratory muscle strength, chest wall volume variation before and after contractions in the thixotropic modality of inspiratory muscles, residual volume novel (RV) and total lung capacity (TLC). As a control, the same maneuver was used, replacing the contraction of the inspiratory muscles with apnea. The order of accomplishment of the maneuvers were randomized and were carried out with a washout period of 7 days. RESULTS: Our results showed that in the apnea group there was a significant increase in end expiratory volume EEV values in the CW (p = 0.0010) and RCp (p = 0.0002) compartments, as well as end inspiratory volume (EIV) values increased in the CW compartments (p = 0, 0179) and RCa (p = 0.0486) after performing the maneuvers starting from TLC. After the maneuvers starting from the RV, the apnea group presented a significant decrease in EEV only in the RCp compartment (p = 0.0431) and the contraction group did not present a significant response to this type of maneuver. CONCLUSION: Our results suggest a tendency of increased chest wall volumes after thixotropic maneuvers from TLC, especially in the pulmonary rib cage and abdominal in apnea, and pulmonary rib cage in the inspiratory contraction. On the other hand, a decrease in EEV after performing the maneuvers starting from VR, to the chest wall in the apnea maneuver.

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation due to changes in the airways and alveoli caused by significant exposures to harmful particles and gases. Airflow limitation can reduce the patient's expiratory capacity, resulting in pulmonary hyperinflation, which, when there is a high ventilatory and metabolic demand, is called dynamic hyperinflation (HD). Expiratory Positive Airway Pressure (EPAP) could have the potential to minimize or prevent HD. It is now possible to more accurately measure the effect of EPAP on HD through Optoelectronic Plethysmography (POE). Objectives: The aim of this study is to evaluate the acute effects of EPAP on HD in patients with COPD who underwent physical exercise. Methodology: 18 patients were recruited, 4 were excluded, totaling a final sample of 14 patients (7 men and 7 women). This is an observational cross-over, cross-over study with patients with clinical diagnosis of COPD and moderate to severe airflow obstruction. The patients were evaluated in three moments; moment 1: pulmonary function, respiratory muscle strength, Human Activity Profile (PAH), Medical Research Council (MRC) Scale, Incremental Shuttle Walking Test (ISWT); and at moments 2 and 3: chest wall volumes (POE) during the exercise protocol with constant load with and without the use of EPAP, with resistance graded at 7.5 cmH₂O in  a random order. Results: In intragroup analyzes, a significant increase in the volumes of all chest wall compartments was observed in the EPAP group, and only in the abdominal compartment (Rib cage abdominal - Rca) and Abdomen (Abdomen - Ab) compartments in the placebo group during exercise . There was a statistically significant decrease in inspiratory (Ti), expiratory (Te) and total time (Ttot) times during exercise in the placebo group, and a significant increase in index of  shortening velocity of inspiratory and expiratory muscles in both the EPAP and placebo groups during exercise. In the intergroup analyzes we observed a significant decrease in the times (Ti, Te and Ttot) in the placebo group, in addition to the significant decrease in diaphragm index of shortening velocity (ΔVab / Ti) in the EPAP group. Additionally, we obtained a lower total exercise time and a higher dyspnea (BORG) at the end of the exercise in the EPAP group. Conclusion: The use of EPAP during exercise did not promote reduction in the development of HD.

The throwing movement imposes an excessive stress on the glenohumeral joint (GU), since during these movements a very high angular velocity is generated, leading this joint to suffer with great traction forces. Repeated performance of such movements generates some bone, joint capsule and muscle adaptations that culminate in the development of the posterior stiffness of the shoulder and the Glenoumeral Internal Rotation Deficit, known as GIRD. As a consequence of these deficits, there is an association of a decreased range of motion (ROM), imbalance of muscle strength between medial and lateral rotators and shoulder proprioception, which increases the risk of osteomyoarticular lesions. The objective of this study was to analyze the influence of GIRD on biomechanics and neuromuscular performance of the shoulder complex of thrower athletes. It was an observational cross-sectional study of 61 athletes practicing handball and beach handball (34 males and 27 females, 27.03 ± 5.99 years, BMI 25.58 ± 3.84) and 23 non-athletes (11 men and 12 women, 26.26 ± 4.32 years, BMI 23.61 ± 2.78). There were evaluated: ROM for medial (MR) and lateral (LR) rotations and horizontal shoulder adduction (HA); sense of joint position of shoulder during ROM of LR using an Accumar® digital inclinometer; and isometric ROM of LR and MR strength using a Lafayette® manual dynamometer for both groups (athletes and non-athletes). Based on the ROM for MR evaluation, athletes with shoulder differences between limbs of less than 10º were allocated to the group without GIRD (44 individuals) and those with a difference greater than 10º in the group with GIRD (17 individuals). The statistical analysis used was one-way ANOVA for all demographic variables, comparison of differences between groups and difference between dominant shoulder (DS) and nondominant shoulder (NDS) for ADM's (MR, LR and HA). And two-way ANOVA for comparison between groups and limbs, for the MR, LR, total, and HA ROMs, sense of joint position, LR and MR strength variables and LR/MR force ratio. And, when necessary, the post hoc tests of Tukey were employed. P <0.05 was considered. As a result, group-to-limb interaction was observed for the MR variable MR (p <0.01), difference between groups in LR ROM (p = 0.03) and limb difference for ROM of HA (p = 0.005). For the sense of joint position there was no difference between members or groups. In the evaluation of strength in the three groups there was difference between the groups in the strength of LR and in the LR/MR force ratio (p≤0.01). Throwing athletes are subjected to large loads and repetitive movements, and from this, shoulder ROM and strength suffer alterations which can lead to an increased risk of injury.

Background: Heart failure (HF) is one of the most important clinical challenges in the world health area, with an epidemic profile in progression. In this sense, self-rated health (SRH), widely used in health surveys, is presented as a tool to monitor the health status of chronic non-communicable diseases and, therefore, better plan the assistance and effectiveness of health policies. SRH is categorized into good self-rated health (SRH G) and poor (SRH P), which in turn is a predictor of morbidity and mortality. Objective: To estimate the prevalence of HF and association with SRH in Brazil. Methods: A cross-sectional study using data from the National Health Survey (NHS) conducted in 2013, with data valid for 59,655 adults (≥ 18 years). The prevalence of heart failure assessed by the question "Have any doctors ever diagnosed heart failure?" Was related to sociodemographic characteristics, health status perception (SRH, perceptions of physical and mental health), diagnosis of depression and practice of physical exercise. Descriptive, bivariate and multivariate analyzes were performed. The final model of the main association was tested by Poisson regression with robust variance. Results: The diagnosis of HF was reported by 1.1% of the interviewees. It was observed that having a medical diagnosis of HF increased four times the chance of having a worse health perception (OR = 4.17, 95% CI 3.65-4.76), but this point measure reduces to less than half, when adjusted for age and physical health perception (OR = 1.78, 95% CI 1.52-2.08). Conclusion: The association between precarious HF and SRH reveals how this disease influences the quality of life of Brazilians with such disease. In addition, the information from the NHS, being representative of the Brazilian population, is useful to subsidize the formulation of public policies in the areas of promotion, surveillance and health care of the Unified Health System in individuals with HF.

Contextualization: Evaluation of oxygen uptake (VO₂) kinetics can elucidate issues related to low physical fitness in obese patients. Most day-to-day and work activities are performed on sub-maximal exercise intensity, and require various energy transitions, going from a resting condition to a moderate or vigorous activity at short and repeated time, requiring metabolism of different energy substrates. The ability to deal with a rest-activity transition involves a high coordination between the cardiovascular, respiratory and neuromuscular systems. An examination of the oxygen kinetics provides an adequate approximation of the oxygen transport and utilization processes in the muscle. Thus, it was raised the questioning if there is a slowing in oxygen kinetics in obese individuals, considering that there are no published studies addressing the temporal behavior of VO₂ in obese adults. Objective: To analyze and compare the VO₂ kinetics in eutrophic and obese women in different ergometers and test intensities. Materials and Methods: Cross-sectional observational study where obese and eutrophic women were evaluated. Volunteer were submitted to  physical clinical evaluation, pulmonary function testing, sleep disturbance assessment (Epworth Scale, Stanford Sleepiness Scale, Stanford Snoring Scale), self-perceived fatigue sensation (Fatigue Severity Scale), manual dynamometer (Jamar® Dynamometer), evaluation of exercise capacity and VO₂ kinetics through the Cardiopulmonary Exercise Test (CPX) and Square-wave Exercise Test (SWET) on a treadmill or cycle ergometer, with measurements of breath-by-breathy gas expired by the Cortex Metamax 3B. Group distribution for ergometer was performed by randomization, and four groups were formed: eutrophic evaluated on treadmill (ET), eutrophic on cycle ergometer (EC), obese on treadmill (OT) and obese on cycle ergometer (OC). Results: 142 volunteers were evaluated, 100 obese and 42 eutrophic. Of this total, 72 volunteers did not meet the inclusion criteria, resulting in a final sample of 60 women (15 ET, 15 EC, 15 OT, 15 OC). The sample was homogeneous in terms of age, height, and pulmonary function. CPX was performed by all volunteers, with obese subjects presenting lower VO₂/Kg_Peak and HR_MAX in the two ergometers studies. Analysis of oxygen kinetics showed that there is no difference between groups of obese and eutrouphic in time constant(τ) in the tests with intensity below (ET=42,7s, EC=36,4s, OT=37,6s, OC=34,1s, p>0,05) and above (ET=41,8s, OT=55,8s, p>0,05) the gas exchange threshold (GET). The slow oxygen component (VO_2SL) was higher to obese group evaluated on treadmill compared to eutrophics (ET=0,162L/min, OT=0,283L/min, p<0,05). Conclusion: Our findings suggest that there is no limitation on transport of O₂ during exercise with intensity below GET. However, the increase in VO_2SL amplitude in OT, suggests a greater metabolic inefficiency in adjusting oxidative metabolism to energy demand in exercise supra-GET, which may be related to low exercise tolerance. Thus, we suggest that exercise prescription must be done considering GET, not VO_2MAX, prioritizing endurance training in rehabilitation programs and physical training, aiming to improve the exercise capacity of the obese.

Introduction and objective:  The inspiratory muscle training (IMT) is utilized to increase the muscular respiratory strength with various positive effects for diverse population. The objective of the present study was to verify the tolerance to exercise, respiratory muscular strength, and diaphragmatic thickness and mobility before and after 9 weeks of IMT.

Subjects: 24 healthy individuals of both genders randomized in two groups.

Methodology: It is an experimental clinical trial study, controlled, randomized, and double-blind. The IMT was performed with two loads of the MIP: 10% (G10%) and 55% (G55%), twice a day, six times per week, for 9 weeks.  The 6-minutes step test (6MST), manovacuometry, spirometry, and ultrasonography of the diaphragm muscle were performed before and after the training.

Results: There was a significant difference between the number of steps moved up, and inspiratory muscular strength for both groups. A difference on cardiac frequency, and dyspnoea perception for the G10% was also perceived. There was an intergroup difference on the MIP at the post training moment.

Conclusion: Protocols with low and moderated loads promote increase on muscular strength and 6-minutes step test results. However, there was no difference intergroup. The utilized protocol was not capable of promoting morphological changes on the diaphragm.

Introduction: Women have presented higher charge of physical decline and disability during aging compared to men. Consequently, several biological explanations have been proposed to explain the reason why women have worse health outcomes. Among them, has knowledge that the reproductive history and possible urogynecological changes has been associated with limitations in physical function. However, little is known about the relationship between urinary incontinence, pelvic organ prolapse and physical performance. Objective: To verify the relationship between urinary incontinence, pelvic organ prolapse and physical performance in middle-aged women. Methodology: A cross-sectional study, accomplished with women (40-65 years), living in Parnamirim-RN, between September of 2014 and July of 2015, with a sample of 361 women. All participants were assessed using a structured questionnaire, being collected socioeconomic and demographic data, urogynecological changes and physical performance. In the statistical analysis, the normality of the data was verified using the Kolmogorov-Smirnov test. To evaluate the relationship between independent variables and physical performance variables were used test t and ANOVA. Linear regression analysis was performed to observe the relationship between urinary incontinence, pelvic organ prolapse and physical performance, adjusted for covariates. Results: A total of 361 women were assessed with mean of age 52.0 (± 5.6) years. Women who had urinary incontinence showed worse performance in the chair stand test (p = 0.04) and those with pelvic organ prolapse, worse balance with open eyes (p = 0.04). After multiple linear regression analysis, urogynecological changes related to the test remained related chair stand test (urinary incontinence: β = 0.923; CI: 0.016 : 1.830) and balance with open eyes (pelvic prolapse: β = -2.467; CI: -4.706 : -0.228). Conclusion: Women who had urinary incontinence showed worse performance in the chair stand test and those with pelvic organ prolapse, worse balance with open eyes.

Introdução: Exercícios de alongamento muscular são frequentemente empregados em rotinas de preparação para o exercício ou como forma de desaquecimento. Dentre estes, o alongamento estático e dinâmico destacam-se por promoverem diferentes desfechos sobre a flexibilidade e desempenho neuromuscular. Objetivo: Verificar os efeitos agudos e crônicos do alongamento estático e dinâmico na flexibilidade e desempenho neuromuscular e funcional em indivíduos ativos e saudáveis. Materiais e métodos: Trata-se de um ensaio clínico randomizado e cego, composto por 45 voluntários do sexo masculino, ativos e saudáveis (22,07±3,16 anos; 71,5±8,8 kg; 1,74±0,1 m; 23,1±2,1 kg/m²), aleatoriamente distribuídos em três grupos: controle (gC – sem intervenção; n=15), alongamento estático (gAE; n=15) e alongamento dinâmico (gAD; n=15). Todos foram submetidos às medidas de avaliação de amplitude de movimento (ADM), desempenho neuromuscular (eletromiografia e dinamometria isocinética) e funcional (testes funcionais) do membro inferior não dominante (MND), realizadas nos seguintes momentos: 48h antes do início dos protocolos de alongamento (Av1), imediatamente após a 1ª (Av2) e a 10ª (Av3) intervenções e 48h após esta última (Av4). Os protocolos experimentais foram compostos por 10 sessões de alongamento estático (gAE: 3x30 segundos) ou dinâmico (gAD: 3x30 repetições), dos músculos isquiotibiais em ambos os membros. Durante todas as intervenções, os voluntários foram avaliados quanto à sensação dolorosa e, ao final dos protocolos, quanto à valência afetiva. Na análise dos dados, foi atribuído um nível de significância de 5%. Resultados: O gAE apresentou redução aguda e crônica no pico de torque (PT_EXC; p=0,014) e trabalho total excêntrico (TT_EXC; p=0,036). O gAD obteve aumento da flexibilidade (p=0,011); redução do índice de fadiga extensor (IF_EXT; p=0,047) e aumento do TT flexor (TT_FLEX; p=0,029) na contração concêntrica e aumento da distância no salto horizontal triplo consecutivo (SHTC; p=0,026) - todos após as 10 sessões do protocolo de alongamento. Conclusão: O alongamento estático promoveu redução aguda e crônica no desempenho muscular excêntrico, enquanto o dinâmico aumentou a flexibilidade e o desempenho muscular e funcional após o programa de alongamento, sendo este tipo de alongamento recomendado para indivíduos ativos ou atletas que almejam melhora na flexibilidade e desempenho.