Bárbara de Barros Gonze

As limb muscle function is age- and sex-related, both elbow and knee isokinetic muscle functions and their main predictors, such as physical activity level and cardiovascular risk factors, should be determined. We aimed to describe the percentiles of normality of the isokinetic muscle function of the knee and elbow joints. Secondarily, we developed equations to predict muscle function in apparently healthy adults aged 20-80 years, including cardiovascular risk factors. We conducted a cross-sectional study with 1,334 adults. We collected sociodemographic data, self-reported cardiovascular risk, anthropometry, body composition (bioelectrical impedance), moderate-to-vigorous physical activity (MVPA) (triaxial accelerometry), and isokinetic muscle function. Multiple regression analysis was used to develop equations to predict isokinetic muscle function. Percentiles of normality for muscle function were described by sex and age (20-39, 40-59, and >60 years). The models accounted for 49.6-70.9% of the total variability of muscle function, but MVPA and cardiovascular risk slightly influenced the coefficient of determination (additional ΔR²=0.003-0.006). Demographic and anthropometric variables were more relevant predictors of isokinetic muscle function (R²=0.50-0.70) than MVPA and cardiovascular risk. Even though they correlated with muscle function, cardiovascular risk and MVPA failed to explain the variability of muscle function largely determined by anthropometric and sociodemographic data. The percentile values and equations developed will help in interpreting the isokinetic muscle function and improve its clinical use.

Objective: Investigate the effects of photobiomodulation (PBMT) and an exercise program aerobic on pain, range of motion, mobility, functionality and quality of life of women with knee osteoarthritis (OA). 24 volunteers were included and randomized into 2 groups: Exercise and Placebo PBMT Group (EPPG) (n=12) and Exercise and Active PBMT Group (EAPG) (n=12). The aerobic exercise program was performed on a stationary bicycle, 2 times a week and PBMT was applied in the most affected lower limb. Visual Analogue Scale (VAS) of pain, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Medical Outcomes Study 36-item Short Form Health Survey (SF-36) were used. In addition, Knee Flexion Range of Motion (ROM), 40m Fast-Paced Walk Test (40mFPWT), 9-Stair Climb Test (9-step SCT) and, 30s Chair Stand Test (30sCST). Results: The level of pain was significantly reduced for both groups after the intervention (EAPG p= 0.01; EPPG p= 0.01). Also, a significant increase in the variables measured by KOOS evaluation for both groups were seen after the treatment. An increase in functional capacity of SF-36 was observed only in the EAPG group (p= 0.004) in the revaluation compared to evaluation. For the evaluations of active flexion ROM, 40m Fast-Paced Walk, 9-Stair Climb and 30s Chair Stand Tests no differences were seen for both groups in the reevaluation. Conclusions: After 8 weeks, the aerobic exercise program (with or without PBM) was effective pain, symptoms, activities of daily living, function in sport and recreation, quality of life and general KOOS score in women with knee osteoarthritis (KOA). Objetivo: Investigar los efectos de la fotobiomodulación (PBMT) y de un programa de ejercicios aeróbicos en el dolor, rango de movimiento, funcionalidad y calidad de vida de mujeres con osteoartritis (OA) en la rodilla. Se incluyeron y se asignaron al azar 24 voluntarias en 2 grupos: Grupo de Ejercicio y PBMT Placebo (EPPG) (n=12) y Grupo de Ejercicio y PBMT Activo (EAPG) (n=12). El programa de ejercicios aeróbicos se realizó en una bicicleta estacionaria, 2 veces por semana, y se aplicó PBMT en el miembro inferior más afectado. Se utilizaron la Escala Visual Analógica (VAS) para el dolor, el Cuestionario Knee Injury and Osteoarthritis Outcome Score (KOOS) y el SF-36. Además, se realizaron pruebas de Rango de Movimiento de Flexión de Rodilla, Test de Caminata Rápida de 40m (40mFPWT), Test de Subida de 9 Escalones (9-step SCT) y Test de Levantarse de la Silla en 30s (30sCST). Resultados: El nivel de dolor disminuyó significativamente para ambos grupos después de la intervención (EAPG p= 0,01; EPPG p= 0,01). Además, se observó un aumento significativo en las variables medidas por la evaluación del KOOS para ambos grupos después del tratamiento. Se observó un aumento en la capacidad funcional del SF-36 solo en el grupo EAPG (p= 0,004) en la reevaluación en comparación con la evaluación inicial. Para las pruebas de Rango de Movimiento activo de flexión de rodilla, Test de Caminata Rápida de 40m, Test de Subida de 9 Escalones y Test de Levantarse de la Silla en 30s, no se observaron diferencias entre ambos grupos en la reevaluación. Conclusiones: Después de 8 semanas, el programa de ejercicios aeróbicos (con o sin PBMT) fue efectivo en el dolor, síntomas, actividades de la vida diaria, función deportiva y recreativa, calidad de vida y puntaje general del KOOS en mujeres con OA. Objetivo: Investigar os efeitos da fotobiomodulação (PBMT) e de um programa de exercícios aeróbicos na dor, amplitude de movimento, funcionalidade e qualidade de vida de mulheres com osteoartrite (OA) no joelho. 24 voluntárias foram incluídas e randomizadas em 2 grupos: Grupo de Exercício e PBMT Placebo (EPPG) (n=12) e Grupo de Exercício e PBMT Ativo (EAPG) (n=12). O programa de exercícios aeróbicos foi realizado em uma bicicleta estacionária, 2 vezes por semana, e a PBMT foi aplicada no membro inferior mais afetado. Foram utilizadas a Escala Visual Analógica (VAS) de dor, Questionário Knee Injury and Osteoarthritis Outcome Score (KOOS) e o SF-36. Além disso, foram realizados testes de Amplitude de Movimento de Flexão do Joelho, Teste de Caminhada Rápida de 40m (40mFPWT), Teste de Subida de 9 Degraus (9-step SCT) e Teste de Levantar da Cadeira em 30s (30sCST). Resultados: O nível de dor foi significativamente reduzido para ambos os grupos após a intervenção (EAPG p= 0,01; EPPG p= 0,01). Além disso, um aumento significativo nas variáveis medidas pela avaliação do KOOS foi observado para ambos os grupos após o tratamento. Um aumento na capacidade funcional do SF-36 foi observado apenas no grupo EAPG (p= 0,004) na reavaliação em comparação com a avaliação inicial. Para as avaliações da Amplitude de Movimento ativa de flexão do joelho, Teste de Caminhada Rápida de 40m, Teste de Subida de 9 Degraus e Teste de Levantar da Cadeira em 30s, não foram observadas diferenças para ambos os grupos na reavaliação. Conclusões: Após 8 semanas, o programa de exercícios aeróbicos (com ou sem PBM) foi eficaz na dor, sintomas, atividades da vida diária, função no esporte e recreação, qualidade de vida e pontuação geral do KOOS em mulheres com OA de joelho.

Resumo Trata-se de um relato de experiência, proporcionado por um projeto de extensão, que objetivou promover saúde, prevenir doenças e agravos e reduzir riscos decorrentes da pandemia de coronavírus e da inatividade física, secundária ao isolamento social, em indivíduos vulneráveis, especialmente os idosos. De agosto de 2020 a janeiro de 2021, nove graduandos em Fisioterapia, sob tutoria de seis docentes, participaram de seis ciclos, criando 22 produtos educativos (06 cartilhas, 05 posts, 06 vídeos e 05 podcasts) sobre os seguintes temas: prevenção de quedas, proteção articular, fragilidade, imunidade, demência e tabagismo. Em todas essas temáticas, o papel dos exercícios físicos e orientações sobre distanciamento social, uso de máscaras e higienização das mãos foram enfatizados. A divulgação dos produtos educativos foi realizada via e-mail, mídias sociais (WhatsApp, Instagram, Facebook e YouTube) e canais oficiais da Universidade. Até 05/04/2021, os produtos educativos alcançaram 739 idosos, em Instituições de Longa Permanência, e 6.591 pessoas, via redes sociais. Este projeto alcançou um grande número de pessoas, propiciando educação em saúde em tempos de isolamento social. Sua abrangência superou as expectativas de faixa etária do público-alvo, contudo, acredita-se que a acessibilidade de idosos à tecnologia tenha sido o principal desafio para a consolidação da educação remota nessa população. O projeto possibilitou, aos estudantes, atuação em saúde, durante o período de distanciamento social, e aquisição de saberes essenciais para a formação.

It is unclear whether physical activity and cardiorespiratory fitness (CRF) are pathways that link low pulmonary function (LPF) to increased blood pressure (BP). Therefore, we investigated the extent to which CRF and moderate-to-vigorous physical activity (MVPA) mediate the relationship between LPF and high BP in adults. We conducted a cross-sectional study with 1,362 participants that underwent cardiopulmonary exercise testing (CPET), spirometry, and wore an accelerometer to determine physical activity patterns. We performed mediation analyses using structural equations considering peak oxygen uptake (V̇O₂) and MVPA as mediators, forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) as independent variables, and systolic and diastolic blood pressure (SBP, DBP) as dependent variables. The probability of alpha error was set at 5%. We found a significant total effect of FVC on SBP and DBP considering V̇O₂ as mediator (P2 (P2 at 14.8% for SBP and 7.6% for DBP (P<0.01). We did not find an indirect effect of FVC or FEV1 considering the MVPA as a mediator. CRF mediates the pathway that links LPF and elevated BP. Therefore, CRF is more sensitive to variations in FVC and FEV1 than MVPA.

BACKGROUND Physical inactivity is the fourth leading risk factor for mortality worldwide. Currently, we count on technologies’ vertiginous advances, mostly in smartphone applications (apps), which showed to be useful in the introduction or expansion of physical activity. However, little attention has been paid to understanding the viewpoint of researchers from human movement sciences. OBJECTIVE To understand the perception of researchers from human movement sciences about using a smartphone app to promote physical activity behavior change. METHODS Ten physically active researchers (8 men and 2 women, mean [SD] age 32.4 [5.21] years), users of the Pacer smartphone app participated in a focus group. The focus group lasted two hours and was mediated by the first author using guiding questions grouped into three categories: app features, barriers and facilitators to physical activity and challenges to behavior change. We performed a qualitative analysis, using the content analysis approach based on the audio records, using participants' verbal reports as a unit of analysis. RESULTS The focus group revealed that physical activity has always been present in the participants' lives. Participants identified changes in their patterns of physical activity over time, incorporating technologies during their exercise sessions. They realized that throughout life the goal in physical activity changed from improving performance to improving health. Participants' life history of physical activity was associated with their preference for the app that stimulated competitiveness. The possibility of competing and being rewarded by their achievements are essential motivational tools. In this way, participants appreciated the possibility of creating groups and ranking among them. As facilitators for physical activity, the group pointed to the adequate city infrastructure and the possibilities of exercising with someone and being challenged by colleagues. As barriers, participants listed a lack of safety and the need to take the smartphone for the app using. CONCLUSIONS Our study reporting challenges and possibilities to drive changes in physical activity behavior by using smartphone apps. The focus group provided important resources and characteristics that had a positive impact on the behavior change and should be considered, such as: the participants’ challenge of overcoming themselves, the opportunity to compete with their peers to achieve personal goals, and the possibility to measure the amount of physical activity. These finds can contribute to improving app development and user acceptability, especially regarding features based on behavior change techniques. Additionally, although this is a descriptive qualitative study with a limited sample, using a smartphone app seems to contribute to physical activity behavior change, even among participants with adequate levels of physical activity.

Although sedentary behavior (SB) is related to the development of metabolic diseases, there is still no consensus in literature about the association between accelerometer-based SB and obesity, especially adjusted for cardiovascular risk factors and level of daily physical activities. The aim was to evaluate the association between obesity and SB adjusted for potential confounders in adults. Data from 780 participants of the Epidemiology and Human Movement (EPIMOV) Study were analyzed. Body weight, body mass index (BMI), and fat body mass as percentage (%FBM) (bioelectrical impedance) were obtained and, then, used to stratify participants. SB was objectively measured using triaxial waist-worn accelerometers placed above the dominant hip during waking hours for at least four consecutive days (4-7 days). SB and its pattern were not significantly different between obesity groups. Although SB presented some significant correlations with obesity, the correlation and determination coefficient indicated weak association between SB and obesity (e.g., BMI and %FBM). Obesity presented little or no association with SB and its pattern after adjustment for potential confounders, especially when SB is measured through accelerometry.

Background: The sequential multiple assignment randomized trial (SMART) design allows for changes in the intervention during the trial period. Despite its potential and feasibility for defining the best sequence of interventions, so far, it has not been utilized in a smartphone/gamified intervention for physical activity. Objective: We aimed to investigate the feasibility of the SMART design for assessing the effects of a smartphone app intervention to improve physical activity in adults. We also aimed to describe the participants’ perception regarding the protocol and the use of the app for physical activity qualitatively. Methods: We conducted a feasibility 24-week/two-stage SMART in which 18 insufficiently active participants (<10,000 steps/day) were first randomized to group 1 (smartphone app only), group 2 (smartphone app + tailored messages), and a control group (usual routine during the protocol). Participants were motivated to increase their step count by at least 2000 steps/day each week. Based on the 12-week intermediate outcome, responders continued the intervention and nonresponders were rerandomized to subsequent treatment, including a new group 3 (smartphone app + tailored messages + gamification) in which they were instructed to form groups to use several game elements available in the chosen app (Pacer). We considered responders as those with any positive slope in the linear relationship between weeks and steps per day at the end of the first stage of the intervention. We compared the accelerometer-based steps per day before and after the intervention, as well as the slopes of the app-based steps per day between the first and second stages of the intervention. Results: Twelve participants, including five controls, finished the intervention. We identified two responders in group 1. We did not observe relevant changes in the steps per day either throughout the intervention or compared with the control group. However, the rerandomization of five nonresponders led to a change in the slope of the steps per day (median −198 steps/day [IQR −279 to −103] to 20 steps/day [IQR −204 to 145]; P=.08). Finally, in three participants from group 2, we observed an increase in the number of steps per day up to the sixth week, followed by an inflection to baseline values or even lower (ie, a quadratic relationship). The qualitative analysis showed that participants’ reports could be classified into the following: (1) difficulty in managing the app and technology or problems with the device, (2) suitable response to the app, and (3) difficulties to achieve the goals. Conclusions: The SMART design was feasible and changed the behavior of steps per day after rerandomization. Rerandomization should be implemented earlier to take advantage of tailored messages. Additionally, difficulties with technology and realistic and individualized goals should be considered in interventions for physical activity using smartphones. Trial Registration: Brazilian Registry of Clinical Trials RBR-8xtc9c; http://www.ensaiosclinicos.gov.br/rg/RBR-8xtc9c/.

Introduction: Previous studies suggested that body weight is a strong predictor for postural balance. High body mass index (BMI) presented an association with increased postural sway. However, it seems controversial since studies reported no difference between obese and control group regarding the position of the center of pressure in static postural balance (PB). Also, there is a lack of investigations about the impact of obesity on PB, free of the confound effect of cardiometabolic risk. Objective: The aim of this study was to evaluate the effects of obesity in static PB and occurrence of falls in asymptomatic adults and older adults over 40 years old. Method: The PB of 624 subjects divided into quartiles for BMI, waist-to-hip ratio, waist-to-height and fat body mass as percentage (%FBM) was assessed with and without vision using a force platform. An MANOVA was used to determine if there were differences between quartiles and a logistic regression analysis adjusted for confounders variables were applied to determine the obesity role in the occurrence of falls. Results: We found weak to moderate bivariate correlations between obesity and static PB, which became non-significant after adjustment. We found significant differences between first and fourth quartiles, especially using %FBM. Obesity was not related to the occurrence of falls since the odds ratio values became non-significant for all the indices of obesity after adjustment. Conclusion: Obesity presents little influence on maintaining static PB and seems not to determine the occurrence of falls among subjects over 40 years old.

Background: There is scientific evidence suggesting that app-based interventions targeted to increase the level of physical activity might be effective, although multicomponent interventions appear to be more effective than app-based interventions alone. Despite the motivating results, it remains unclear whether or not app-based interventions can increase the level of physical activity and cardiovascular health. Our study aims to investigate the effect of a smartphone app combined with gamification on the level of physical activity of adults and older adults. The specific aims are (1) to verify the effects of the intervention on cardiometabolic and cardiovascular health, lung function, and cardiorespiratory fitness; and (2) to verify the relationship between age group and the response rate. Methods/design: We will conduct a sequential multiple assignment randomized trial (SMART). The adaptive intervention protocol will last 6 months. After baseline assessments, participants will be randomized into one of three groups (group 1: app + tailored messages; group 2: app + tailored messages + gamification I; control group: physical activity counseling). For 12 weeks, we will record the average number of steps per day of participants from groups 1 and 2. At 6 weeks from initiation of recording, participants will be classified into responders and non-responders according to their increase in the average number of daily steps; all those considered as non-responders will be re-randomized, with the chance to participate in a third group – group 3: app + tailored messages + gamification II. Finally, at 12 weeks, participants will continue using the app but will no longer receive direct intervention from investigators. All participants will be reassessed at 3 and 6 months from baseline. Our pilot SMART will require 42 participants (14 per arm). Following the SMART pilot, we will calculate the sample size for the trial based on the variation of the average number of steps/day, including an up to 40% loss to follow-up and a less optimistic nonresponse rate of 65%. Discussion: To our knowledge, this will be the first trial with adaptive intervention to test the effectiveness of using a smartphone app to increase the level of physical activity of adults and older adults. Trial registration: Brazilian Clinical Trials Registry: RBR-8xtc9c. Registered on 3 August 2018, http://www.ensaiosclinicos.gov.br; UTN number: U1111–1218-1092.