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INTRODUCTION: The mortality rate in patients on maintenance hemodialysis (HD) is high and is associated with low functional capacity (FC). We analyzed the association of FC and COVID-19 lethality among HD patients. METHODS: A cohort study that included evaluations of FC in patients on HD was underway, and the association between FC and lethality was included as an ad-hoc outcome. RESULTS: One hundred and twelve patients were submitted to a physical, 31 patients contracted symptomatic COVID-19, 20 recovered and 11 died (lethality rate of 35.5%). There was a difference between survivors and non-survivors on six-minutes-walking-test (6MWT) 386.1 ± 112.8 versus 296.9 ± 103.3 meters (p = 0.04), 30 s sit-to-stand test (30CST) score 11.7 ± 3.1 versus 7.7 ± 4.1 (p = 0.006), and timed up and go test (TUG) 9.4 versus 13.6 s (p = 0.009). There was also an association between percentages of predicted 6MWT, 30CST, and TUG with COVID-19 lethality. CONCLUSION: Patients on maintenance HD with poorer physical performance presented the worst prognosis from COVID-19 pandemic.
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COVID-19 , Insuficiência Renal Crônica , Humanos , Estudos de Coortes , Equilíbrio Postural , Pandemias , Estudos de Tempo e Movimento , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Diálise RenalRESUMO
Introdução: A fisioterapia na unidade de terapia intensiva (UTI) apresenta como objetivo utilizar estratégias de mobilização precoce a fim de reduzir o impacto da fraqueza muscular adquirida na UTI. Logo, este estudo apresenta como objetivo avaliar a efetividade de um plano de metas fisioterapêuticas para pacientes internados em uma Unidade de Terapia Intensiva.Métodos: Estudo de coorte retrospectivo e prospectivo comparativo realizado em uma UTI de um hospital público de Porto Alegre. Foram incluídos pacientes internados entre os meses de janeiro e junho de 2019, maiores de 18 anos e que tiveram alta da UTI. A coleta de dados foi realizada através de informações e relatório que constam no prontuário eletrônico utilizado na Instituição. Foi analisado o desfecho das metas estabelecidas na admissão para sentar fora do leito e deambular.Resultados: A maioria dos pacientes foi do sexo masculino (57,5%). A média de idade foi de 60,52 ± 17,64 anos. A maioria das metas estabelecidas, tanto para sentar fora do leito como para deambular, foram atingidas (89% e 86,9%, respectivamente). Houve correlação significativa entre o alcance de meta para deambulação e ganho de força muscular pelo escore MRC (p = 0,041) e ganho de força muscular quando comparada admissão e alta da UTI (p = 0,004).Conclusão: Este estudo observou que estabelecer metas para sentar fora do leito e deambular para pacientes internados em UTI é efetivo.
Introduction: Physiotherapy in the intensive care unit (ICU) aims to use early mobilization strategies in order to reduce the impact of muscle acquired weakness in the ICU. Therefore, this study aims to evaluate the effectiveness of a physiotherapeutic goal plan for patients admitted to an Intensive Care Unit. Methods: Retrospective and comparative prospective cohort study carried out in an ICU of a public hospital in Porto Alegre. Patients hospitalized between January and June 2019, over 18 years old and discharged from the ICU were included. Data collection was carried out through information and report contained in the electronic medical record used in the Institution. The outcome of goals established at admission for sitting out of bed and walking was analyzed. Results: Most patients were male (57.5%). The mean age was 63.2 ± 16.2 years. Most established goals, both for sitting out of bed and walking, were achieved (89% and 86.9%, respectively). There was a significant correlation between reaching the ambulation goal and muscle strength gain by the MRC score (p= 0.041) and muscle strength gain when comparing admission and discharge from the ICU (p = 0.004). Conclusion: This study observed that establishing goals for sitting out of bed and walking for ICU patients is effective.
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Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Deambulação Precoce/estatística & dados numéricos , Força Muscular , Terapia Precoce Guiada por Metas/organização & administração , Pessoas Acamadas , Serviço Hospitalar de Fisioterapia/organização & administração , Unidades de Terapia Intensiva/organização & administraçãoAssuntos
Diálise Renal , Insuficiência Renal , Humanos , Estudos Prospectivos , Sistema Nervoso AutônomoRESUMO
Considering that the hemodynamic safety is a major concern about intradialytic exercise with blood flow restriction, this analysis was performed to compare the blood pressure (BP) behavior during the first two hours of hemodialysis (HD) between sessions with no exercise (control group, CG), low/moderate intensity aerobic exercise with blood flow restriction (BFRE) and conventional aerobic exercise (AE). Adult patients with chronic kidney disease on HD at a university hospital were randomly assigned and submitted to a 12-week intradialytic training with BFRE or AE compared with the CG group. The main outcomes of this report were the change in systolic (SBP) and diastolic (DBP) BP during HD and the frequency of low BP (LBP) and high BP (HBP) episodes. A total of 6,074 BP measurements of 58 patients were analyzed. There was a larger decrease in BP in the exercise sessions compared with the control sessions, but with a similar magnitude in the BFRE and AE groups (effect size 0.49). There was a higher number of LBP in the BFRE group. The frequency of HBP was similar between the BFRE and the CG groups and lower in the AE group. Despite a greater number of mild LBP in BFRE patients, the BP change during the first two hours of HD was similar to that of patients in AE. Intradialytic aerobic exercise with blood flow restriction does not seem to be associated with a higher hemodynamic burden than conventional aerobic exercise.
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The study aimed to investigate the effect of intradialytic exercise training programmes on the submaximal functional capacity of patients with kidney failure. We searched for randomized clinical trials that assessed submaximal functional capacity using the 6-min walk test (6 MWT) in adult patients on maintenance haemodialysis submitted to intradialytic physical training. The search was performed on 15 October 2021, in different databases. Random-effect, multivariate meta-regression adjusted for multiplicity were performed to examine the relationship between exercise effect and covariates. Intradialytic physical exercise induced greater changes in 6MWT distance (k = 18; n = 1,458; WMD: 37.0; 95% CI 29.3; 50.6 metres) than control groups, with substantial heterogeneity (I2 = 78.3%). Aerobic, strength, and combined exercise promoted an average increase of 48.7 (95%CI 30.9; 66.4 metres), 16.9 (95%CI 7.6; 26.3 metres), and 75.8 (95%CI 55.1; 96.6 metres) metres, respectively. Strength training resulted in inferior gains in 6MWT distance compared to aerobic training (WMD: -25.0; 95%CI: -49.1; -0.9). Intervention length shorter than 11 weeks (WMD: 37.0; 95%CI: -5.4; 79.3 metres) did not induce greater changes in 6MWT compared to control groups. There was a positive response in submaximal functional capacity to intradialytic training in kidney failure patients on maintenance haemodialysis.
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Este artigo é resultado do "I Encontro da Fisioterapia da UFPel", que ocorreu junto ao tradicional Simpósio Nacional de Educação Física da Universidade Federal de Pelotas, e tem o objetivo de apresentar experiências vividas por profissionais fisioterapeutas sobre o momento pandêmico, o cenário apresentado, as dificuldades enfrentadas e os aprendizados. Foi relatada a experiência de profissionais que atuaram durante a pandemia nas áreas de terapia intensiva, unidade de tratamento intensivo neonatal e na clínica, após a alta hospitalar. Identificamos que as experiências vivenciadas na atuação do profissional fisioterapeuta foi marcada pela adaptação ao novo cenário e pelo enfrentamento de diferentes situações com protagonismo, o que possibilitou mostrar o quanto esses profissionais estão prontos para agir, junto aos demais membros da equipe de saúde, nas diversas situações em saúde que podem se apresentar.
This article is the result of the "I Meeting of Physiotherapy at UFPel", which took place together with the traditional National Symposium of Physical Education at the Federal University of Pelotas, and aims to present experiences lived by professional physiotherapists about the pandemic moment, the scenario presented, the difficulties faced and the lessons learned. The experience of professionals who worked during the pandemic in the areas of intensive care, neonatal intensive care unit and in the clinic, after hospital discharge, was reported. We identified that the experiences lived in the work of the physiotherapist professional were marked by the adaptation to the new scenario and by the confrontation of different situations with protagonism, which made it possible to show how these professionals are ready to act, together with the other members of the health team, in the various health situations that may arise.
Este artículo es el resultado del "I Encuentro de Fisioterapia de la UFPel", que se realizó en conjunto con el tradicional Simposio Nacional de Educación Física en la Universidad Federal de Pelotas, y tiene como objetivo presentar experiencias vividas por fisioterapeutas profesionales sobre el momento de la pandemia, el escenario presentado, las dificultades enfrentadas y las lecciones aprendidas. Se relató la experiencia de los profesionales que actuaron durante la pandemia en las áreas de cuidados intensivos, unidad de cuidados intensivos neonatales y en la clínica, después del alta hospitalaria. Identificamos que las experiencias vividas en el trabajo del profesional fisioterapeuta estuvieron marcadas por la adaptación al nuevo escenario y el enfrentamiento de diferentes situaciones con protagonismo, lo que permitió evidenciar cómo estos profesionales están preparados para actuar, junto a los demás integrantes del equipo de salud, en las diferentes situaciones de salud que se presenten.
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Tissues usually super compensate during the period that follow physical exercise. Although this is widely accepted for muscle and glycogen, the compensatory effect is not usually applied to fat tissues. Notwithstanding, evidence for this has been present since the 1970s when it was first suggested that the increased lipogenic activity in response to training might be an adaptation that enables to restore an energy reserve that can be used in times of need. In this context, the present review aimed to summarize information about the effect of detraining on fat metabolism and the physiological responses associated with fat regain. A systematic search on PubMed and Scielo was performed using "training cessation," "detraining," "exercise detraining," and "exercise cessation" combined with "fat tissue," "adipose tissue," "adipose metabolism," and "fat metabolism," as descriptors. From 377 results, 25 were included in this review, 12 humans and 13 rodents, resulting in a sample of 6772 humans and 613 animals. The analysis provided evidence for fat super compensation, as well as differences in humans and rodents, among different protocols and possible mechanisms for fat gain after exercise cessation. In summary, exercise cessation appears to increase the ability of the adipose tissue to store energy. However, caution should be taken, especially regarding conclusions based on investigations on humans, considering the multiple factors that could affect fat metabolism.
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INTRODUCTION: Hemodialysis (HD) increases the lifespan of chronic kidney disease (CKD) patients. However, HD is only partially effective in replacing renal function. The aim of this study is to compare HD adequacy between sessions with intradialytic exercise with or without blood flow restriction (BFR) with sessions without exercise. METHODS: A crossover study including 22 adult CKD patients on HD. The patients were assigned to BFR (n = 11) or exercise alone group (n = 11). Each patient was submitted to four HD sessions (two with exercise and two control sessions). HD adequacy was assessed by equilibrated Kt/V-urea (eKT/V), single-pool Kt/V-urea (sp-Kt/V), urea and phosphorus rebound, urea reduction ratio (URR) and removal of urea and phosphorus in dialysate. FINDINGS: BFR exercise improved eKt/V and sp-Kt/V (1.32 ± 0.21 vs. 1.10 ± 0.16 for control, P < 0.001; 1.53 ± 0.26 vs. 1.27 ± 0.19 for control, P < 0.001, respectively) and URR (72.5 ± 5.4% vs. 66.1 ± 7.7% for control, P < 0.001). No difference in eKt/V, sp-Kt/V or URR could be detected between exercise alone and control HD sessions. Urea rebound was lower in BFR exercise vs. control sessions (-8.9 ± 9.1% vs. 30.7 ± 12.8%, P < 0.01) and exercise alone vs. control sessions (13.3 ± 29.0% vs. 42.4 ± 15.3%, P < 0.01). Phosphorus rebound was marginally lower in exercise vs. control sessions (14.4 ± 19.1% vs. 28.4 ± 22.1%, P = 0.18). Urea and phosphorus mass removal in dialysate were marginally higher in exercise vs. control sessions (42.2 ± 19.4 g vs. 35.7 ± 12.5 g, P = 0.24; 912.1 ± 360.9 mg vs. 778.6 ± 245.1 mg, P = 0.28). CONCLUSIONS: Intradialytic exercise with BFR was more effective than standard exercise in increasing HD adequacy.
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Hemodinâmica/fisiologia , Falência Renal Crônica/sangue , Diálise Renal/métodos , Estudos Cross-Over , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-IdadeRESUMO
Abstract Intense physical activity can increase oxidative stress and muscle damage in, causing fatigue and injury. Graduated compression stockings (GCS) can decrease these deleterious effects. The aim was to determine the acute effects of GCS on muscle damage and oxidative stress (OS) in garbage collectors. Thirteen garbage collectors, 25.4±5.2 years, participated using GCS or placebo stockings. Blood samples were collected at pre and post a working day and after 16 hours of rest. Markers of OS and muscle damage were evaluated. Two-way ANOVA (two conditions and two moments) was used for the analysis of the outcomes No significant differences were found for creatine kinase, catalase and glutathione peroxidase between the time and groups. There was a significant difference for the total thiol content and superoxide dismutase only in the control group (pre and post, p = 0.004). The use of GCS exerted acute protection against the increase of markers of OS, but did not contribute to attenuate muscle damage.
Resumo Atividade física intensa pode aumentar o estresse oxidativo e danos musculares, causando fadiga e lesões. As meias de compressão graduada (MCG) podem diminuir esses efeitos deletérios. O objetivo foi determinar os efeitos agudos da MCG no dano muscular e estresse oxidativo (EO) em coletores de lixo. Treze coletores de lixo, 25,4 ± 5,2 anos, participaram usando MCG ou placebo. As amostras de sangue foram coletadas antes e após um dia útil e após 16 horas de descanso. Marcadores de EO e dano muscular foram avaliados. ANOVA de duas vias (duas condições e dois momentos) foi usada para á análise dos resultados. Não foram encontradas diferenças significativas para creatina quinase, catalase e glutationa peroxidase entre o tempo e os grupos. Houve uma diferença significativa para o conteúdo total tiólico e superóxido dismutase apenas no grupo controle (pré e pós, p = 0,004). O uso de MCG exerceu proteção aguda contra o aumento de marcadores de EO, mas não contribuiu para atenuar danos musculares
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Chronic kidney disease (CKD) is associated with physical weakness and increased oxidative stress and inflammation levels. Rehabilitation programs are associated with an improvement in the functional capacity, inflammatory and oxidative stress profile. Exercise associated with blood flow restriction (BFR) has been demonstrating positive effects in training programs, but there is lack information about exercise with BFR in CKD. Therefore, the aim of the present study is to describe a protocol using continuous moderate exercise with blood flow restriction (BFR) applied during hemodialysis (HD) to measures health indicators and immune system and oxidative stress parameters in CKD patients. Methods: A RTC will be conducted with 42 patients in HD. Baseline measures will be compared with final measures (anthropometric, cardiorespiratory, biochemical, muscle fitness, nutritional and behavioral questions). Participants will be randomly allocated to: 1) Continuous moderate exercise group with BFR; 2) Continuous moderate exercise group without BFR; 3) Control group without exercise. The intervention will be 12 weeks long during HD session. Patients will perform 20 min of continuous moderate exercise on a stationary bicycle three times a week. The present study is expected to generate significant information about the role of exercise with BFR in patients with CKD during HD.
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The measure of hemodialysis (HD) adequacy recommended nowadays by most guidelines, Kt/V-urea, presents significant drawbacks. Direct dialysis quantification (DDQ) through total dialysate collection (TDC), considered the gold standard measure of HD adequacy, is cumbersome, which precludes its widespread use in clinical practice. The present study aims to validate a low-volume continuous sampling of spent dialysate (CSSD). Cross-sectional study carried out at a university hospital. Throughout 4-h hemodialysis sessions, urea removal was measured by three DDQ methods: TDC, CSSD, and fractional sampling of dialysate (FSD). The primary outcome was the comparison between the total mass of urea removed measured by TDC and the dialysate sampling techniques. The comparison between urea distribution volume (UDV) estimated by anthropometric method and through DDQ was a secondary outcome. The analysis was done through linear regression and Bland-Altman concordance method. Twenty HD sessions were studied. The mean amount of urea collected in TDC and calculated from the 40-mL sample of CSSD were 33.70 ± 11.70 g and 33.90 ± 11.70 g, respectively [r 0.96, p < 0.0001; bias - 0.2 (95% CI - 1.8 to 1.4); limits of agreement - 6.8 to 6.4]. The anthropometric measure, when compared with DDQ method, underestimated UDV in patients with smaller body size. This new simple, inexpensive, and small volume CSSD technique can provide accurate information about the total amount of solutes removed by hemodialysis.
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Soluções para Diálise/análise , Ureia/análise , Adulto , Idoso , Tamanho Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise RenalAssuntos
Capnografia , Respiração , Desmame do Respirador , Estudos Transversais , Feminino , Humanos , Masculino , Testes de Função RespiratóriaRESUMO
High-intensity intermittent exercise (HIIE) elicits large improvements in health and cardiorespiratory fitness (CRF). HIIE can be applied with calisthenics exercises to improve strength and endurance. The acute effects of high-intensity circuit training (HICT) considering different CRF on myological variables are unknown. The aim was measure acute effects of HICT in young women considering different levels of CRF. Twelve women were allocated in two groups, who achieve 41mLO2â¢kg-1â¢min-1 or more= High Physical Fitness (HPF, n=5) and who achieve less than 41mLO2â¢kg-1â¢min-1= Low Physical Fitness (LPF,n=7). Protocol: 2x4 sets of 20 seconds at maximum intensity (all-out fashion) interspersed with 10 seconds of passive rest (jumping jacks, squat and thrust using 2kg dumbbells, mountain climber, and burpees). Blood samples were collected before, immediately after, 15minutes, 30minutes, one hour and 24 hours after. Heart rate, serum myoglobin, lactate, and creatine kinase (CK) concentration were analyzed. The HR achieved 94.1±3.7% of HRmax for LPF and 104.5±20.3% for HPF, p=0.03. The mean of delta lactate was similar between groups. The highest myoglobin has reached at 1h after the exercise protocol, with 50.0±30.2 ng/mL for LPF and 36.9±9.25 ng/mL for HPF. The delta of total CK before and after the exercise protocol shows that the serum CK level in LPF was significantly higher than HPF group (p=0.042). HICT composed by calisthenic protocol produced elevated and similar effects on HRmax, serum lactate and myoglobin in the woman with HPF and LPF. However, LPF group presented higher muscle damage inferred by serum CK concentrations.
O exercício intermitente de alta intensidade(HIIE) melhora a saúde e a aptidão cardiorrespiratória(CRF). HIIE pode ser aplicado com exercícios calistênicos para melhorar a força e resistência. Os efeitos agudos do treinamento de alta intensidade(HICT) considerando diferentes CRF em variáveis miológicas são desconhecidos. O objetivo foi medir os efeitos agudos do HICT em mulheres jovens, considerando diferentes níveis de CRF. Elas foram alocadas pelo nível de VO2máx. em dois grupos, as que atingiram 41mLO2•kg-1•min-1 ou mais= alta aptidão física(HPF,n=5) e menos de 41mLO2•kg-1•min-1= baixo aptidão física(LPF,n=7). Protocolo: 2x4 séries de 20s com intensidade máxima (all-out) intercalados com 10s de repouso passivo (jumping jacks, squat and thrust usando halteres 2kg, mountain climber e burpees). Sangue foi coletado antes, zero, 15, 30min, 1h e 24hs depois. Foram analisadas, freqüência cardíaca, mioglobina sérica, lactato e creatina quinase (CK). A FC alcançou 94,1±3,7% da FCmax para LPF e 104,5±20,3% para HPF, p=0,03. A média do delta lactato foi semelhante entre os grupos. O pico de mioglobina foi 1h após o protocolo de exercício, com 50.0±30.2ng/mL para LPF e 36.9±9.25ng/mL para HPF. O delta de CK total antes e depois do protocolo de exercício mostra que o nível sérico de CK no LPF foi significativamente maior do que o grupo HPF(p=0,042). O HICT com exercícios calistênicos produziu efeitos elevados e semelhantes sobre FCmax, lactato sérico e mioglobina nas mulheres com alta e baixa aptidão física. No entanto, o grupo LPF apresentou maior dano muscular inferido pelas concentrações séricas de CK.
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Humanos , Feminino , Adulto , Entorses e Distensões , Treinamento Intervalado de Alta Intensidade , Aptidão Cardiorrespiratória , Exercício Físico , Aptidão Física , Ácido Láctico , Creatina Quinase/sangue , Mioglobina/sangueRESUMO
Patients on hemodialysis (HD) are at increased risk for arrhythmias and sudden cardiac death. Autonomic nervous system (ANS) dysfunction seems to participate in the arrhythmogenic process. Genetic factors have an impact on ANS modulation, but the specific role of the insertion/deletion (I/D) polymorphism in the gene for angiotensin-converting enzyme (ACE) has not been investigated. Since the D allele increases gene expression, it is a candidate polymorphism to interact with the ANS. The aim of the present study was to compare the behavior of heart rate variability (HRV) during HD, as a surrogate for ANS response to stressors, between the ACE genotypes. In a sample of patients with chronic kidney disease I/D ACE genotypes were assessed with PCR and HRV was measured before, in the second hour, and after a HD session. HRV parameters in the time and frequency domains were analyzed by repeated-measures mixed models according to the time of measurement and ACE polymorphism. HRV parameters in the frequency domain presented significantly different variations during the HD session between patients with or without the D allele. Only patients with the II genotype presented an increase in low-frequency normalized units and in the low frequency-to-high frequency ratio throughout HD. Patients with the II genotype seemed to have a more physiological response to the volemic and electrolytic changes that occur during HD, with greater sympathetic activation than patients with ID and DD genotypes. NEW & NOTEWORTHY Adding to the effort to understand the complexity of cardiovascular system regulation, we have found that the autonomic nervous system response to the acute volume removal during hemodialysis may be different between angiotensin-converting enzyme insertion/deletion polymorphisms. To our knowledge, this is the first time that this specific interaction was analyzed during a volume removal intervention.
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Frequência Cardíaca , Coração/inervação , Mutação INDEL , Peptidil Dipeptidase A/genética , Diálise Renal , Insuficiência Renal Crônica/terapia , Sistema Nervoso Simpático/fisiopatologia , Adulto , Idoso , Composição Corporal , Estudos Transversais , Feminino , Frequência do Gene , Heterozigoto , Homozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/enzimologia , Insuficiência Renal Crônica/genética , Insuficiência Renal Crônica/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Equilíbrio HidroeletrolíticoRESUMO
OBJETIVO: Identificar a prevalência de incontinência urinária (IU) e fatores associados em idosas da comunidade. MÉTODOS: Estudo transversal no qual foram entrevistadas idosas com 60 anos de idade ou mais que frequentavam um centro voltado exclusivamente a idosos em Pelotas-RS, Brasil. Foram utilizados como instrumentos desta pesquisa o International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) e um questionário com informações complementares, que verificou fatores associados para a incontinência urinária. Além de estatística descritiva, foi utilizado o teste t de Student para comparação das médias das variáveis quantitativas. RESULTADOS: Foram avaliadas 132 idosas na faixa etária de 60 a 91 anos, com média de idade igual a 68,56 anos (dp±6,24). Em relação à perda de urina, a prevalência encontrada foi de 40,91% (95% IC = 32,6-49,2). Do total de mulheres analisadas, encontrou-se um índice de massa corporal (IMC) médio de 25,7Kg/m2 (dp±4,06), sendo que das idosas consideradas incontinentes foi demonstrado que 59,2% apresentavam IMC≥27Kg/m2 (p<0.01), ou seja, com sobrepeso. CONCLUSÕES: A prevalência de IU encontrada (40,91%) está dentro dos parâmetros registrados para esta faixa etária. Outro dado relevante é que o número de gestações aumentou a presença de IU, sendo que aquelas idosas que apresentaram três ou mais gestações foram proporcionalmente mais atingidas. O impacto da IU na qualidade de vida foi considerado ausente ou leve pela maioria das idosas, demonstrando que, provavelmente, a IU esteja em estágio inicial e não interfira de forma significativa no cotidiano dessas mulheres. Torna-se ainda relevante destacar que o diagnóstico precoce permite o tratamento adequado em tempo hábil, ...
OBJECTIVE: Identify the prevalence of urinary incontinence (UI) and associated factors in elderly women of the community. METHODS: Cross-sectional study in which elderly women aged 60 or more who attended a center dedicated exclusively to elderly in Pelotas, Rio Grande do Sul state, Brazil, were interviewed. The instruments used were the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and a questionnaire with additional information on associated factors for urinary incontinence. Besides descriptive statistics, Student's t test was used to compare the means of quantitative variables. RESULTS: The study evaluated 132 elderly women aged 60-91 years with mean age of 68.56 years (SD±6.24). Regarding urine loss, the prevalence found was 40.91% (95% IC = 32.6-49.2). Of all women interviewed it was found a body mass index (BMI) of 25.7 kg/m2 (SD±4,06), and among elderly women considered incontinent, 59.2% had BMI ≥ 27kg/m2, that is, overweight. CONCLUSIONS: The prevalence of UI (40.91%) found is within the registered parameters for this age group. Other relevant data is that the number of pregnancies increased UI, and elderly women with three or more pregnancies were proportionally more affected. The UI impact on the quality of life was considered absent or mild by most elderly women, probably showing that UI was in initial stage and did not interfere significantly in the everyday life of those women. It is still worth highlighting that early diagnosis allows appropriate treatment in a timely manner, avoiding major compromises and improving the quality of life. .
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Previous studies have suggested that exercise during hemodialysis (HD) could increase the efficacy of solute removal, although this hypothesis has not been conclusively evaluated. The goal of this study was to compare the removal of low-molecular weight solutes between HD sessions, with and without aerobic exercise. It was a controlled clinical trial, including HD patients in a randomly cross-over design, such that each patient received a HD session with exercise (intervention) and the next one without exercise (control), three times each. In the exercise sessions, patients pedaled on a cycle ergometer for 60 minutes. The total mass of removed urea, potassium, creatinine, and phosphate were calculated from the solutes concentration in dialysate (continuous spent sampling of dialysate). This was evaluated in a total of 132 HD sessions of patients with a mean age of 54 ± 15 years, 75% male and HD vintage of 3 (2-13) years. Phosphate removal in dialysate during intervention sessions was significantly higher (5.6 [2.5-18.9] vs. 5.1 [1.5-11.2] mg/min) than during control sessions, P = 0.04. The median mass of phosphate removed during control HD session was 1226 (367.8-2697.2) vs. 1348.6 (613.0-4536.2) mg/session during intervention sessions. The exercise did not modify the removal of urea (control 122.6 [61.3-286.0] vs. exercise 112.4 [51.1-250.3] mg/min, P = 0.44), creatinine (control 5.6 [2.5-13.8] vs. exercise 5.6 [2.5-12.8] mg/min, P = 0.49), or potassium (control 13.3 [11.2-15.8] vs. exercise 13.8 [6.6-15.8] mEq/min, P = 0.49). Aerobic exercise during HD increases the efficacy of phosphate removal, without changing urea, creatinine and potassium removal. The implications of this finding in mineral and bone disease and cardiovascular disease need to be evaluated on future clinical trials.
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Exercício Físico/fisiologia , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Fosfatos/sangue , Diálise Renal/métodos , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND PURPOSE: This study aims to compare the effects of combined resistance and aerobic exercise with a resistance programme alone on functional performance among haemodialysis patients. DESIGN: The design was a randomized controlled trial. SETTING: The setting was the dialysis unit of a Brazilian university hospital. PATIENTS: Haemodialysis patients were assigned to one kind of intervention or another. INTERVENTION: The patients were assigned to receive the resistance exercise combined with an aerobic training or to maintain an ongoing resistance programme alone for a period of 10 weeks. MAIN OUTCOME MEASURE: The functional performance of patients was assessed before and after the intervention through the 6-minute walk test (6MWT). The difference over time of the 6MWT was compared between the groups through two-way repeated-measures ANOVA. RESULTS: Thirteen patients were allocated for each group of intervention. The difference in distance walked before and after intervention in the combined training group was of +39.7 ± 61.4 m, and the difference in the resistance training group was of -19.2 ± 53.9 m, p = 0.02. CONCLUSIONS: Although the best protocol of exercise for patients on dialysis is not yet clear, in our sample of haemodialysis patients the combination of aerobic and resistance training was more effective than resistance training alone to improve functional performance.
Assuntos
Exercício Físico , Falência Renal Crônica/reabilitação , Treinamento Resistido , Idoso , Feminino , Humanos , Análise de Intenção de Tratamento , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Exercícios de Alongamento Muscular , Consumo de Oxigênio , Diálise Renal , CaminhadaRESUMO
CONTEXT AND OBJECTIVE: Preeclampsia is a multi-systemic disease and one of the most frequent severe health problems during pregnancy. Binding of insulin triggers phosphorylation and activates cytoplasmic substrates such as phosphatidylinositol 3 kinase (PI3K). Phosphorylation of membrane phosphoinositide 2 (PIP2) to phosphoinositide 3 (PIP3) by PI3K starts Akt/PKB activation. Defects in phosphorylation of the insulin receptor and its substrates have an important role in insulin resistance. Studies have shown that insulin resistance is associated with preeclampsia and its pathophysiology. The aim here was to investigate insulin stimulation of the Akt/PKB pathway in the placenta, in normal and preeclampsia parturients. DESIGN AND SETTING: Cross-sectional study in a tertiary public university hospital. METHODS: Placentas were collected from 12 normal and 12 preeclampsia patients. These were stimulated and analyzed using Western blot to quantify the Akt/PKB phosphorylation. RESULTS: The insulin stimulation was confirmed through comparing the stimulated group (1.14 ± 0.10) with the non-stimulated group (0.91 ± 0.08; P < 0.001). The phosphorylation of Akt/PKB did not differ between the placenta of the normal patients (1.26 ± 0.16) and those of the preeclampsia patients (1.01 ± 0.11; P = 0.237). CONCLUSIONS: In vitro insulin stimulation of the human placenta has been well established. There was no difference in Akt/PKB phosphorylation, after stimulation with insulin, between placentas of normal and preeclampsia patients. Nevertheless, it cannot be ruled out that the Akt/PKB signaling pathway may have a role in the pathophysiology of preeclampsia, since the substrates of Akt/PKB still need to be investigated.
CONTEXTO E OBJETIVO: Pré-eclâmpsia (PE) é uma doença multissistêmica das mais frequentes e graves durante a gestação. A ligação da insulina inicia a fosforilação e ativação de substratos citoplasmáticos, tais como fosfatidil-inositol 3 quinase (PI3K). A fosforilação do fosfoinositol 2 (PIP2) da membrana em fosfoinosiltol 3 (PIP3) pela PI3K inicia a ativação da Akt/PKB. Defeitos na fosforilação do receptor de insulina e seus substratos têm papel importante na resistência à insulina. Estudos demonstraram que resistência à insulina está associada com pré-eclâmpsia e sua patofisiologia. O objetivo foi investigar a via de estimulação com insulina da Akt/PKB em placenta de parturientes normais e com pré-eclampsia. TIPO DE ESTUDO E LOCAL: Estudo do tipo transversal em um hospital universitário público de nível terciário. MÉTODOS: Vinte e quatro placentas (12 normais, 12 com PE) foram coletadas, estimuladas e analisadas por Western blot para quantificar a fosforilação da Akt/PKB. RESULTADOS: A estimulação com insulina foi confirmada comparando os grupos estimulados (1,14 ± 0,10) e não estimulados (0.91 ± 0.08; P < 0.001). A fosforilação de Akt/PKB não foi diferente na placenta de pacientes normais (1,26 ± 0,16) e com PE (1,01 ± 0,11; P = 0,237). CONCLUSÕES: A estimulação in vitro da placenta humana com insulina foi bem estabelecida. Não houve diferença na fosforilação da Akt/PKB após estimulação em placentas de pacientes normais e PE. Contudo, não é possível descartar a participação desta via de sinalização na patofisiologia da PE, uma vez que os substratos da Akt/PKB ainda precisam ser investigados.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Insulina/farmacologia , Placenta/efeitos dos fármacos , Pré-Eclâmpsia/enzimologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Western Blotting , Estudos de Casos e Controles , Estudos Transversais , Ativação Enzimática , Resistência à Insulina/fisiologia , Fosforilação , Placenta/enzimologia , Transdução de SinaisRESUMO
CONTEXT AND OBJECTIVE: Preeclampsia is a multi-systemic disease and one of the most frequent severe health problems during pregnancy. Binding of insulin triggers phosphorylation and activates cytoplasmic substrates such as phosphatidylinositol 3 kinase (PI3K). Phosphorylation of membrane phosphoinositide 2 (PIP2) to phosphoinositide 3 (PIP3) by PI3K starts Akt/PKB activation. Defects in phosphorylation of the insulin receptor and its substrates have an important role in insulin resistance. Studies have shown that insulin resistance is associated with preeclampsia and its pathophysiology. The aim here was to investigate insulin stimulation of the Akt/PKB pathway in the placenta, in normal and preeclampsia parturients. DESIGN AND SETTING: Cross-sectional study in a tertiary public university hospital. METHODS: Placentas were collected from 12 normal and 12 preeclampsia patients. These were stimulated and analyzed using Western blot to quantify the Akt/PKB phosphorylation. RESULTS: The insulin stimulation was confirmed through comparing the stimulated group (1.14 ± 0.10) with the non-stimulated group (0.91 ± 0.08; P < 0.001). The phosphorylation of Akt/PKB did not differ between the placenta of the normal patients (1.26 ± 0.16) and those of the preeclampsia patients (1.01 ± 0.11; P = 0.237). CONCLUSIONS: In vitro insulin stimulation of the human placenta has been well established. There was no difference in Akt/PKB phosphorylation, after stimulation with insulin, between placentas of normal and preeclampsia patients. Nevertheless, it cannot be ruled out that the Akt/PKB signaling pathway may have a role in the pathophysiology of preeclampsia, since the substrates of Akt/PKB still need to be investigated.
Assuntos
Insulina/farmacologia , Placenta/efeitos dos fármacos , Pré-Eclâmpsia/enzimologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Adulto , Western Blotting , Estudos de Casos e Controles , Estudos Transversais , Ativação Enzimática , Feminino , Humanos , Resistência à Insulina/fisiologia , Fosforilação , Placenta/enzimologia , Gravidez , Transdução de SinaisRESUMO
UNLABELLED: Preeclampsia (PE) is a significant cause of fetal and maternal mortality around the world and there is evidence that insulin resistance has been implicated in the pathophysiology of PE. The Akt/PKB pathway is stimulated by insulin and performs several vital functions relative to growth, survival and cellular metabolism. OBJECTIVE: To investigate the basal expression of Akt/PKB, HSP90 expression, proteins that regulate Akt/PKB activity and substrate in the placenta, skeletal muscle and adipocytes of normal and PE parturient. METHOD: Samples were collected from 17 normal patients and 17 PE patients, and analyzed by Western blot to quantify the protein expression involved in signaling cascade of Akt/PKB. RESULTS: Total Akt/PKB expression for normal placentas was 1.85 (1.07-3.12) and 1.53 (1.27-3.08) in PE (p = 1.00); in the adipose tissue of normal placentas it was 1.10 (0.53-1.73) and 1.66 (0.83-2.00) in PE (p = 0.37). CONCLUSIONS: There was no difference in the Akt/PKB pathway, in basal state, in placentas and skeletal muscle of normal and PE patients. However, defects in this signaling pathway as pathophysiology of PE cannot be excluded because it is necessary to analyze this pathway during stimulation.