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OBJECTIVE: The objective of this study is to investigate the association between muscle function, body composition, and metabolic control in adults with type 2 diabetes mellitus (DM2). METHODS: Forty-eight individuals with DM2 were divided into four groups according to the severity of obesity (body mass index [BMI]: lean [LN, n = 10], overweight [OW, n = 16], obese class I [OBI, n = 15], and obese class II [OBII, n = 7]). Absolute peak torque (TQ), relative peak torque (TQ/body weight [BW]), total work (TW), and fatigue index (FI) were assessed by means of an isokinetic dynamometer during concentric knee extensor contraction. Spearman's correlation coefficients were used to estimate the association between measurements. RESULTS: Although OBII had higher insulin levels than both LN and OW groups, no significant differences were found between groups for TQ, TQ/BW, TW, and FI, as well as between metabolic variables and muscle measurements. There was a positive correlation between BMI and TQ (rs = .45) and resistance tests, between BMI and TQ (rs = .43), and TW (rs = .37). CONCLUSION: Metabolic variables do not correlate with muscle strength and endurance in DM2. However, severity of obesity measured by the BMI is positively associated with muscle force-generating capacity and endurance.

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BACKGROUND & AIMS: There is little evidence showing that dynapenic obesity is associated with lipid and glucose metabolism disorders, high blood pressure, chronic disease and metabolic syndrome. Our aim was to analyze whether dynapenic abdominal obesity can be associated with lipid and glucose metabolism disorders, high blood pressure, metabolic syndrome and cardiovascular diseases in older adults living in São Paulo. METHODS: This cross-sectional study included 833 older adults who took part of the third wave of the Health, Well-being and Aging Study in 2010. Based on waist circumference (>88 cm women and >102 cm men) and handgrip strength (<16 kg women and <26 kg men), four groups were identified: non-dynapenic/non-abdominal obese (ND/NAO), abdominal obese alone (AOA), dynapenic alone (DA) and dynapenic/abdominal obese (D/AO). Dependent variables were blood pressure, lipid profile, fasting glucose and glycated-haemoglobin, metabolic syndrome and cardiovascular diseases. Logistic regression was used to analyze the associations between dynapenia and abdominal obesity status and lipid and glucose metabolic profiles, blood pressure, cardiovascular diseases and metabolic syndrome. RESULTS: The fully adjusted models showed that D/AO individuals had higher prevalence of low HDL plasma concentrations (OR = 2.51, 95%CI: 1.40-4.48), hypertriglyceridemia (OR = 2.53, 95%CI: 1.43-4.47), hyperglycemia (OR = 2.05, 95%CI: 1.14-3.69), high glycated-haemoglobin concentrations (OR = 1.84, 95%CI: 1.03-3.30) and metabolic syndrome (OR = 12.39, 95%CI: 7.38-20.79) than ND/NAO. Dynapenic and D/AO individuals had higher prevalence of heart disease (OR = 2.05, 95%CI: 1.17-3.59 and OR = 1.92, 95%CI: 1.06-3.48, respectively) than ND/NAO. CONCLUSION: D/AO was associated with high prevalence of lipid and glucose metabolism disorders and metabolic syndrome while dynapenia and D/AO were associated with high prevalence of heart disease.

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PURPOSE: To investigate if cardiovascular and metabolic responses to the six-minute walk test (6MWT) and incremental shuttle walking test (ISWT) are in agreement with cardiopulmonary exercise testing (CPX) and determine if both submaximal tests are interchangeable in obese and eutrophic individuals. METHOD: Observational and cross-sectional study included 51 obese women (ObG) and 21 controls (CG) (20-45 years old). Subjects underwent clinical evaluation, CPX, the 6MWT and ISWT. We applied Bland-Altman plots to assess agreement between walking tests and CPX. Correlation analysis assessed relationships between key variables. RESULTS: There was an agreement between CPX and both the 6MWT [oxygen uptake (VO2 mL kg(-1) min(-1)) = 6.9 (CI: 5.7-8.1), and heart rate (bpm) = 37.0 (CI: 33.3-40.7)] and ISWT [VO2 (mL kg(-1) min(-1)) = 6.1 (CI: 4.9-7.3), and heart rate (bpm) = 36.2 (CI: 32.1-40.3)]. We found similar cardiovascular and metabolic responses to both tests in the ObG but not in the CG. Strong correlations were demonstrated between 6MWT and ISWT variables: VO2 ( r = 0.70); dyspnoea (r = 0.80); and leg fatigue (r = 0.70). CONCLUSIONS: 6MWT and ISWT may both hold interchangeable clinical value when contrasted with CPX in obese women and may be a viable alternative in the clinical setting when resources and staffing are limited. Implications for Rehabilitation Obesity is a worldwide epidemic, with high prevalence in women, and it is associated to impaired cardiorespiratory fitness and functional capacity as well as high mortality risk. Assessing oxygen uptake by means of cardiopulmonary exercise testing is the gold standard method for evaluating and stratifying cardiorespiratory fitness, however it is not ever applied due to costs and staffing. Walking field tests may be a cost-effective approach that provides valuable information regarding the functional capacity in agreement to metabolic and cardiovascular responses of cardiopulmonary exercise testing.

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Impaired cardiorespiratory fitness (CRF) is a hallmark characteristic in obese and lean sedentary young women. Peak oxygen consumption (VO2peak) prediction from the six-minute step test (6MST) has not been established for sedentary females. It is recognized that lower-limb muscle strength and power play a key role during functional activities. The aim of this study was to investigate cardiorespiratory responses during the 6MST and CPX and to develop a predictive equation to estimate VO2peak in both lean and obese subjects. Additionally we aim to investigate how muscle function impacts functional performance. Lean (LN = 13) and obese (OB = 18) women, aged 20-45, underwent a CPX, two 6MSTs, and isokinetic and isometric knee extensor strength and power evaluations. Regression analysis assessed the ability to predict VO2peak from the 6MST, age and body mass index (BMI). CPX and 6MST main outcomes were compared between LN and OB and correlated with strength and power variables. CRF, functional capacity, and muscle strength and power were lower in the OB compared to LN (<0.05). During the 6MST, LN and OB reached ~90% of predicted maximal heart rate and ~80% of the VO2peak obtained during CPX. BMI, age and number of step cycles (NSC) explained 83% of the total variance in VO2peak. Moderate to strong correlations between VO2peak at CPX and VO2peak at 6MST (r = 0.86), VO2peak at CPX and NSC (r = 0.80), as well as between VO2peak, NSC and muscle strength and power variables were found (p<0.05). These findings indicate the 6MST, BMI and age accurately predict VO2peak in both lean and obese young sedentary women. Muscle strength and power were related to measures of aerobic and functional performance.

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PURPOSE: This study aimed to verify the effects of functional stabilization training on lower limb kinematics, functional performance, and eccentric hip and knee torques. METHODS: Twenty-eight women were divided into a training group (TG; n = 14), which carried out the functional stabilization training during 8 wk, and a control group (CG; n = 14), which carried out no physical training. The kinematic assessment of the lower limb was performed during a single-leg squat, and the functional performance was evaluated by way of the single-leg triple hop and the timed 6-m single-leg hop tests. The eccentric hip abductor, adductor, lateral rotator, medial rotator, and the knee flexor and extensor torques were measured using an isokinetic dynamometer. RESULTS: After 8 wk, the TG significantly reduced the values for knee abduction (from -6.86° to 1.49°), pelvis depression (from -10.21° to -7.86°) and femur adduction (from 7.08° to 5.19°) as well as increasing the excursion of femur lateral rotation (from -0.55° to -3.67°). Similarly, the TG significantly increased the values of single-leg triple hop (from 3.52 to 3.92 m) and significantly decreased the values of timed 6-m single-leg hop tests (from 2.43 to 2.14 s). Finally, the TG significantly increased the eccentric hip abductor (from 1.31 to 1.45 N · m · kg(-1)), hip lateral rotator (from 0.75 to 0.91 N · m · kg(-1)), hip medial rotator (from 1.45 to 1.66 N · m · kg(-1)), knee flexor (from 1.43 to 1.55 N · m · kg(-1)), and knee extensor (from 3.46 to 4.40 N · m · kg(-1)) torques. CONCLUSIONS: Strengthening of the hip abductor and lateral rotator muscles associated with functional training improves dynamic lower limb alignment and increases the strength and functional performance.

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CONTEXT: Recently, attention in sports has been given to eccentric hip-muscle function, both in preventing musculoskeletal injuries and improving performance. OBJECTIVE: To determine the key isokinetic variables of eccentric hip torque that predict the functional performance of women in the single-leg triple long jump (TLJ) and the timed 6-m single-leg hop (TH). DESIGN: Within-subject correlational study. SETTING: Musculoskeletal laboratory. PARTICIPANTS: 32 healthy women age 18-25 y. INTERVENTION: The participants performed 2 sets of 5 eccentric hip-abductor/adductor and lateral/medial-rotator isokinetic contractions (30°/s) and 3 attempts in the TLJ and TH. MAIN OUTCOME MEASUREMENTS: The independent variables were the eccentric hip-abductor and -adductor and medial- and lateral-rotator isokinetic peak torque, normalized according to body mass (Nm/kg). The dependent variables were the longest distance achieved in the TLJ normalized according to body height and the shortest time spent during the execution of the TH. RESULTS: The forward-stepwise-regression analysis showed that the combination of the eccentric hip lateral-rotator and -abductor isokinetic peak torque provided the most efficient estimate of both functional tests, explaining 65% of the TLJ variance (P < .001) and 55% of the TH variance (P < .001). CONCLUSIONS: Higher values for eccentric hip lateral-rotator and hip-abductor torques reflected better performance. Thus, the eccentric action of these muscles should be considered in the development of physical training programs that aim to increase functional performance.

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The purposes of this study were to compare lower-limb kinematics between genders, and determine the relationships among eccentric hip abductor and lateral rotator torques and lower-limb kinematics. The movements of the pelvis, femur, and knee were calculated for 16 women and 16 men during the single-leg squat. Eccentric hip abductor and lateral rotator torques were measured using an isokinetic dynamometer. The results showed that women had greater contralateral pelvic depression, femur adduction, and knee abduction than men. The eccentric hip abductor and lateral rotator torques were correlated with coronal plane femur and knee movements in the overall sample. When the genders were analyzed separately, it was observed that women with greater eccentric hip abductor torque exhibited less femur adduction and femur medial rotation, and greater knee adduction excursion. No significant relationship was observed between the isokinetic and kinematic variables in the male group. The differences between the genders help to explain the greater rate of knee disorders observed in women. Moreover, the eccentric hip abduction action seemed to be more important in women to control the lower-limb movements.

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Diversas pesquisas têm sido realizadas para determinar os fatores biomecânicos responsáveis pela maior incidência da síndrome da dor femoropatelar e das lesões do ligamento cruzado anterior em mulheres quando comparadas aos homens. Objetivo: O objetivo deste estudo foi realizar uma revisão de literatura não sistemática das diferenças biomecânicas entre os gêneros, especialmente aquelas referentes à articulação do quadril, potencialmente responsáveis pela maior incidência de lesões no joelho em mulheres,bem como verificar as suas implicações na elaboração de intervenções preventivas. Metodologia: Artigos publicados entre 1985 e 2008 foram selecionados por dois revisores independentes nas seguintes bases de dados: LILACS, MEDLINE, Cochrane e PubMed. Foram selecionados estudos teóricos, transversais e de correlação, assim como ensaios clínicos controlados, com desenhos experimentais bem esclarecidos. Resultados e discussão: Os estudos selecionados revelaram que as mulheres realizam atividades funcionais com menores ângulos de flexão de joelho e quadril, assim como maior valgo dinâmico do joelho, adução e rotação medial do quadril. Sugere-se, ainda, que as diferenças observadas nos planos coronal e transversal do quadril são mais significativas para a instalação de lesões nas mulheres do que aquelas que ocorrem unicamente no plano sagital. Por fim, as pesquisas demonstram que o treino neuromuscular melhora o alinhamento dinâmico do membro inferior nas mulheres, diminuindo a incidência de lesões no joelho. Conclusão: Há evidências de que as mulheres apresentam diferenças biomecânicas do padrão demovimento do membro inferior, quando comparadas aos homens, que podem contribuir para as maiores incidências de lesões no joelho observadas nesse gênero.

INTRODUCTION: Several studies have been carried out to determine the biomechanical factors responsible by the greater incidence of patellofemoral pain syndrome and anterior cruciate ligament injury in women, when compared to men. OBJECTIVE: The aim of this study was to perform a non-systematic review of the literature of the biomechanical differences between genders, especially those concerning to the hip joint, related to the higher incidence of knee injuries in women, and verify its implications for developing preventive strategies.METHODOLOGY: Articles published between 1985 and 2008 were selected by two independent reviewers of the follow data bases: LILACS, MEDLINE, Cocharane and PubMed. It was selected theoretical, transversal, and correlational studies as well as controlled clinical trial with experimental designs well defined. RESULTS AND DISCUSSION: The studies selected showed that women perform functional activities with lower angles of knee and hip flexion, as well as greater knee valgus, hip adduction and medial rotation. Furthermore, it is believed that the differences shown in the coronal and transverse planes of the hip are more significant for the development of injuries in women than those occurred only in the sagittal plane. Finally, the studies show that neuromuscular training carried out preventively improves the dynamic alignment of the lower limb in women, reducing the incidence of knee injuries on them. CONCLUSION: There are evidences that women have biomechanics differences of the lower limb movement pattern when compared to men that may contribute for the greater incidence of knee injuries observed in women.

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INTRODUÇÃO: Neste estudo estão reunidas informações históricas e atuais sobre as técnicas de revascularização do miocárdio (RM) com e sem circulação extracorpórea (CEC), bem como a sua importância para avaliação e atuação diante de alterações das funções e complicações pulmonares, com ênfase no sucesso do desmame ventilatório precoce destes pacientes. OBJETIVO: Identificar na literatura nacional e internacional publicações relativas a complicações pulmonares relacionadas ao desmame ventilatório que estas duas técnicas podem trazer aos pacientes submetidos à RM, de forma que obtenhamos subsídios para a fundamentação teórica deste assunto. METODOLOGIA: Foram utilizadas como referências publicações em inglês e português, cujos descritores foram: Circulação Extracorpórea, Revascularização do Miocárdio, Desmame Ventilatório, Ventilação Mecânica, Complicações Pulmonares, contidas nas seguintes fontes de dados:LILACS, SciELO, MedLINE, Cochrane, CAPES, PubMed, assim como em livros e sites de buscas como Google, entre outros. Buscou-se na literatura científica artigos publicados entre os anos de 1937 a 2009. Pesquisa secundária por meio de lista de referências dos artigos identificados foi também realizada. RESULTADOS/DISCUSSÃO: Foram encontrados 9 artigos relacionando os temas RM, CEC, função e complicações pulmonares e desmame ventilatório, de modo que todos buscaram avaliar e/ou comparar as repercussões de ambas as técnicas e suas consequências relacionadas ao sucesso ou insucesso do desmame do suporte ventilatório. Todos eles relatam menores prejuízos quando da realização da RM sem CEC. CONCLUSÃO: Novos estudos devem ser realizados para confirmar a impressão de que a cirurgia de revascularização do miocárdio sem esta técnica tenha importante papel na redução do tempo do suporte ventilatório quando comparado à cirurgia com CEC. Deste modo, torna-se necessária a padronização metodológica a fim de que se possa obter informações conclusivas a respeito do assunto.

INTRODUCTION: In this study are gathered historical and current informations abouttechniques for coronary artery bypass grafting (CABG) with and withoutcardiopulmonary bypass (CPB) and its importance in evaluating and treatingmodifications of the function and pulmonary complications, with emphasis onsuccess of early weaning of these patients. OBJECTIVE: To identify national andinternational literature publications on pulmonary complications related to wean inpatients undergoing myocardical revascularization surgery on and off-pump coronaryartery bypass grafting, so that we can obtain subsidies for the theoretical groundingof this subject. METHODS: We used as reference publications in english andportuguese, which descriptors were Extracorporeal Circulation, CABG, CPB,Myocardial Revascularization, Weaning, Mechanical Ventilation, PulmonaryComplications, contained in the following databases: LILACS, SciELO, MEDLINE,Cochrane, CAPES, PubMed as well as in books and websites like Google searches,among others published between the years 1937 to 2009. A secondary search of thereference lists of identified articles was also performed. RESULTS / DISCUSSION:There were nine articles relating the themes CABG,CPB, function and pulmonarycomplications and ventilator weaning, so that everyone aimed to assess and / orcompare the impact of both techniques and their consequences related to success orfailure of weaning from ventilatory support. All of them reported fewer damages whenperforming an off-pump CABG than on-pump CABG. CONCLUSION: Further studiesshould be performed to confirm the impression that the coronary artery bypassgrafting without this technique has an important role in reducing the duration ofventilatory support compared to surgery with CPB. Thus, it is necessary tostandardize the methodology so that it can obtain conclusive informations about thissubject.

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