RESUMO
Abstract Objective: To assess the prevalence of fatigue in a Brazilian population with early rheumatoid arthritis using multiple instruments, and the predictors of these instruments by differents independent variables. Methods: Cross-sectional study with direct interview and medical records review. Fatigue, dependent variable, was assessed using eight instruments: Profile of Mood States (POMS), Multidimensional Assessment of Fatigue scale (MAF), Fatigue Severity Scale (FSS), Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), Numerical Rating Scales (BRAF-NRS), Short-form Survey 36 (SF-36), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) and Visual Analogic Scale for Fatigue (VASf). Independent variables: sociodemographic, clinical and serological, were measured using medical records and direct interview. Disability and disease activity were assessed using the Health Assessment Questionnaire (HAQ) and disease activity assessed using the Disease Activity Score 28 joints (DAS28). The scores of scales demonstrated the level of fatigue and multiple linear regression method used in statistical analysis to demonstrate prediction models. Results: A total of 80 patients was assessed, and 57 reported clinically relevant fatigue (VASf > 2), representing 71.25% prevalence point (51 women [89.5%], mean age 48.35 ± 15 years, and mean disease duration of 4.92 ± 3.8 years). Eight predictive models showed statistical significance, one for each fatigue instrument. The highest coefficient of determination (R 2) was 56% for SF-36 and the lowest (R 2 = 21%) for FSS. The HAQ was the only independent variable to predict fatigue on all instruments. Conclusion: Clinically relevant fatigue is a highly prevalent symptom and is mostly predicted by disability and age in the population assessed.
Resumo Objetivo: Avaliar a prevalência de fadiga em uma coorte brasileira de pacientes com artrite reumatoide em fase inicial com múltiplos instrumentos e os preditores desses instrumentos de acordo com diferentes variáveis independentes. Métodos: Estudo transversal com entrevista direta e revisão de prontuários. A fadiga, a variável dependente, foi avaliada por meio de oito instrumentos: Profile of Mood States (POMS), Multidimensional Assessment of Fatigue Scale (MAF), Fatigue Severity Scale (FSS), Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), Numerical Rating Scales (BRAF-NRS), Short-form Survey 36 (SF-36), Functional Assessment of Chronic Illness Therapy Fatigue Scale (Facit-F) e Escala Visual Analógica de fadiga (VASf). Variáveis independentes: mensuraram-se dados sociodemográficos, clínicos e sorológicos por meio da análise de prontuários e entrevista direta. A incapacidade e a atividade da doença foram avaliadas com o Health Assessment Questionnaire (HAQ). A atividade da doença foi avaliada com o Disease Activity Score 28 joints (DAS-28). As pontuações das escalas mostraram o nível de fadiga e usou-se o método de regressão linear múltipla na análise estatística para demonstrar os modelos de predição. Resultados: Avaliaram-se 80 pacientes; 57 relataram fadiga clinicamente relevante (VASf > 2), representaram uma prevalência de 71,25% (51 mulheres [89,5%], média de 48,35 ± 15 anos e duração média da doença de 4,92 ± 3,8 anos). Oito modelos preditivos mostraram significância estatística, um para cada instrumento de fadiga. O maior coeficiente de determinação (R2) foi de 56% para o SF-36 e o menor (R2 = 21%) foi para a FSS. O HAQ foi a única variável independente que predisse a fadiga em todos os instrumentos. Conclusão: A fadiga clinicamente relevante é um sintoma altamente prevalente e é principalmente predita pela incapacidade e idade na população avaliada.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Artrite Reumatoide/complicações , Índice de Gravidade de Doença , Fadiga/diagnóstico , Fadiga/etiologia , Brasil , Prevalência , Estudos Transversais , Estudos Prospectivos , Fatores de Risco , Técnicas de Apoio para a Decisão , Fatores Etários , Avaliação da Deficiência , Fadiga/epidemiologia , Pessoa de Meia-IdadeRESUMO
A hipertensão é uma doença complexa e multifatorial no qual fatores de risco como obesidade estão envolvidos. Cerca de 48% da população brasileira feminina já apresenta sobrepeso, sendo que a prevalência de excesso de peso acomete 58% da população com idade maior ou igual a 65 anos de idade. Deve-se considerar que a obesidade é um fator de risco para hipertensão nessa população. Em mulheres de meia idade já se verifica também a sua influência negativa sobre a força muscular, sugerindo reprodutibilidade dos resultados nessa população. O objetivo desse estudo é determinar se existe uma relação negativa do IMC sobre a força muscular e pressão arterial de idosas hipertensas e comparar a força muscular de idosas hipertensas com e sem obesidade. Quarenta e oito idosas sedentárias e hipertensas participaram voluntariamente do estudo e foram divididas em dois grupos: grupo com IMC < 30,0 (kg/m²) e com IMC ≥ 30,0 (kg/m²). Os resultados do estudo demonstraram que o grupo de idosas obesas apresentou significativamente maior pressão arterial sistólica (p ≤ 0,05), pressão arterial diastólica (p ≤ 0,05), medidas antropométricas superiores (p ≤ 0,05) e menor força muscular (p ≤ 0,05) quando comparado com idosas com IMC < 30,0 (kg/m²). Ademais, o IMC correlacionou-se negativamente com a força muscular e positivamente com a pressão arterial na população estudada. O presente estudo apresenta indícios de que o IMC influencia negativamente a força muscular e pressão arterial de mulheres idosas obesas. Além disso, sugere o ponto de corte de IMC >30 kg/m² como critério prático para avaliar seu efeito negativo sobre a força muscular e pressão arterial de idosas hipertensas. (AU)
Hypertension is a complex and multifactorial disease and obesity is one of the most important associated risk factors. Considering that 48% of the female Brazilian population presents overweight, the prevalence is higher in elderly people (65 years). Considering that obesity is an independent risk factor for this age group, there are indications from previous study that obesity affects muscle strength in middle-aged women, but no study was found for elderly women. The aim of this study is to determine whether there is a negative relationship between BMI and muscle strength and blood pressure and to compare muscle strength between obese and non-obese elderly hypertensive women. Forty-eight elderly hypertensive women volunteered and were divided into two groups: participants with BMI < 30.0 (kg / m²) and BMI ≥ 30.0 (kg / m²). In addition, elderly obese women presented a higher systolic blood pressure (p ≤ 0.05), higher diastolic blood pressure (p ≤ 0.05), lower muscle strength (p ≤ 0.05), and higher anthropometric values (p ≤ 0.05) than participants with BMI < 30.0 (kg / m²). Moreover, BMI predicted negative changes in muscle strength and SBP. These results suggest that BMI predict negative changes on muscle strength and blood pressure in elderly obese hypertensive women. Moreover, suggests that the BMI of >30 kg/m² score might be a practical tool to evaluate the negative effect of obesity on blood pressure and muscle strength. (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Hipertensão/epidemiologia , Força Muscular/fisiologia , Obesidade , Estudos TransversaisRESUMO
OBJECTIVE: To assess the prevalence of fatigue in a Brazilian population with early rheumatoid arthritis using multiple instruments, and the predictors of these instruments by differents independent variables. METHODS: Cross-sectional study with direct interview and medical records review. Fatigue, dependent variable, was assessed using eight instruments: Profile of Mood States (POMS), Multidimensional Assessment of Fatigue scale (MAF), Fatigue Severity Scale (FSS), Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), Numerical Rating Scales (BRAF-NRS), Short-form Survey 36 (SF-36), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) and Visual Analogic Scale for Fatigue (VASf). INDEPENDENT VARIABLES: sociodemographic, clinical and serological, were measured using medical records and direct interview. Disability and disease activity were assessed using the Health Assessment Questionnaire (HAQ) and disease activity assessed using the Disease Activity Score 28 joints (DAS28). The scores of scales demonstrated the level of fatigue and multiple linear regression method used in statistical analysis to demonstrate prediction models. RESULTS: A total of 80 patients was assessed, and 57 reported clinically relevant fatigue (VASf>2), representing 71.25% prevalence point (51 women [89.5%], mean age 48.35±15 years, and mean disease duration of 4.92±3.8 years). Eight predictive models showed statistical significance, one for each fatigue instrument. The highest coefficient of determination (R2) was 56% for SF-36 and the lowest (R2=21%) for FSS. The HAQ was the only independent variable to predict fatigue on all instruments. CONCLUSION: Clinically relevant fatigue is a highly prevalent symptom and is mostly predicted by disability and age in the population assessed.
Assuntos
Artrite Reumatoide/complicações , Fadiga/diagnóstico , Fadiga/etiologia , Índice de Gravidade de Doença , Adulto , Fatores Etários , Idoso , Brasil , Estudos Transversais , Técnicas de Apoio para a Decisão , Avaliação da Deficiência , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de RiscoRESUMO
A artrite reumatoide (AR) é uma doença autoimune que se caracteriza por poliartrite crônica simétrica, de grandes e pequenas articulações, e rigidez matinal que pode levar a comprometimento musculoesquelético, com impotência funcional. O conceito da funcionalidade diz respeito à capacidade de o indivíduo realizar atividades e tarefas da vida diária e cotidiana, de forma eficaz e independente. O objetivo desta revisão é familiarizar o reumatologista com o conceito de avaliação da capacidade funcional e os testes que podem ser aplicados nessa população, pois são passos importantes para uma prescrição adequada de exercícios físicos, A partir de testes funcionais já utilizados em população idosa, o Laboratório de Aptidão Física e Reumatologia - LAR - Brasília, que acompanha os pacientes da Coorte Brasília de Artrite Reumatoide Inicial, descreve neste artigo um protocolo de testes para avaliação da capacidade funcional para aplicação nos pacientes com diagnóstico de AR, incluindo a descrição dos seguintes testes: 1) Sentar e Alcançar; 2) Agilidade/Equilíbrio Dinâmico; 3) Dinamometria Manual; 4) Sentar e Levantar; 5) Rosca Bíceps e 6) Teste da Caminhada de Seis Minutos.
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic symmetric polyarthritis of large and small joints and by morning stiffness that may lead to musculoskeletal impairment, with functional impotence. The concept of functionality relates to the ability of an individual to perform effectively and independently daily activities and tasks of everyday life. The aim of this review is to familiarize the rheumatologist with the concept of functional capacity evaluation and with the tests that can be applied in this population, as these are important steps for a proper exercise prescription. From functional tests already used in the elderly population, the Physical Fitness and Rheumatology Laboratory - LAR - Brasilia, which is accompanying patients from Brasilia Cohort of Early Rheumatoid Arthritis, describes in this article a protocol of tests to assess functional capacity for application in patients with RA, including the description of tests: 1) Sit and Reach; 2) Agility/Dynamic Balance; 3) Manual Dynamometry; 4) Sit Back and Lift; 5) Biceps Curl and 6) Six-minute Walk Test.
Assuntos
Humanos , Artrite Reumatoide/fisiopatologia , Avaliação da Deficiência , Terapia por Exercício , Exame Físico , Artrite Reumatoide/terapiaRESUMO
Fatigue, the enduring sensation of weakness, lack of energy, tiredness or exhaustion, is described by 40%-80% of patients with rheumatoid arthritis as their most disabling symptom with wide-ranging consequences for quality of life. Little attention has been paid to its multidimensional nature or to its reliability as a measure to evaluate progression of the disease. Low impact aerobic exercise affects the level of fatigue, and this same level of fatigue influences the exercise itself. We searched Medline, Cochrane Collaboration Register of Controlled Trials (CCRCT), Lilacs, PubMed and Scopus databases for randomized controlled trials (with appropriate description of methods, materials and results) on the assessment of fatigue and exercise. Review articles, case reports, letters to the editor and editorials were excluded. Of 121 references initially identified, 4 randomized controlled trials met the inclusion criteria. Two studies used the MAF scale (Multidimensional Assessment of Fatigue), one used the MAC (Mental Adjustment to Cancer) fatigue scale, and all trials used POMS (Profile of Mood States) to assess fatigue. All four trials conducted a 12 week program of two to three times/ week and different periods of follow-up. Two studies used low impact aerobic exercise, one used dance-based exercise, and another study followed a home cardiopulmonary conditioning program using a stationary bicycle. While fatigue appears to be a reliable outcome measure in the clinical management of RA, especially when related to exercise prescription, further research is needed to evaluate the correlation between exercise, fatigue and quality of life, using fatigue scales validated to explore the different components of fatigue and its wide-ranging consequences.
Assuntos
Artrite Reumatoide/terapia , Terapia por Exercício/métodos , Fadiga/terapia , Artrite Reumatoide/complicações , Progressão da Doença , Fadiga/etiologia , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Qualidade de Vida , Reprodutibilidade dos TestesRESUMO
INTRODUCTION: Hypertension is the most prevalent modifiable risk factor with a high prevalence among older adults. Exercise is a nonpharmacological treatment shown to benefit all patients with hypertension. OBJECTIVE: This study examined the effects of a 14-week moderate intensity resistance training program (RT) on the maintenance of blood pressure and hand grip strength during an extended detraining period in elderly hypertensive women. METHODS: Twelve hypertensive sedentary elderly women completed 14 weeks of whole body RT at a moderate perceived exertion following a detraining period of 14 weeks. RESULTS: Following the training period, participants demonstrated an increase in absolute hand grip strength (P=0.001), relative hand grip strength (P=0.032) and a decrease of systolic (P=0.001), diastolic (P=0.008), and mean blood pressure (P=0.002) when compared to pre-exercise values. In addition, these effects were sustained after 14 weeks of detraining. CONCLUSION: Resistance training may be a valuable method to improve muscular strength and blood pressure in elderly people with benefits being maintained up to 14 weeks following training cessation.
Assuntos
Pressão Sanguínea , Força da Mão , Hipertensão/terapia , Treinamento Resistido , Pressão Sanguínea/fisiologia , Feminino , Força da Mão/fisiologia , Humanos , Hipertensão/fisiopatologia , Pessoa de Meia-Idade , Projetos Piloto , Treinamento Resistido/métodosRESUMO
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic symmetric polyarthritis of large and small joints and by morning stiffness that may lead to musculoskeletal impairment, with functional impotence. The concept of functionality relates to the ability of an individual to perform effectively and independently daily activities and tasks of everyday life. The aim of this review is to familiarize the rheumatologist with the concept of functional capacity evaluation and with the tests that can be applied in this population, as these are important steps for a proper exercise prescription. From functional tests already used in the elderly population, the Physical Fitness and Rheumatology Laboratory - LAR - Brasilia, which is accompanying patients from Brasilia Cohort of Early Rheumatoid Arthritis, describes in this article a protocol of tests to assess functional capacity for application in patients with RA, including the description of tests: 1) Sit and Reach; 2) Agility/Dynamic Balance; 3) Manual Dynamometry; 4) Sit Back and Lift; 5) Biceps Curl and 6) Six-minute Walk Test.
Assuntos
Artrite Reumatoide/fisiopatologia , Avaliação da Deficiência , Terapia por Exercício , Artrite Reumatoide/terapia , Humanos , Exame FísicoRESUMO
A obesidade é atualmente um dos maiores problemas de saúde pública em países desenvolvidos e em desenvolvimento. Apesar de a redução da força muscular estar fortemente associada à doenças cardiovasculares, poucos estudos analisaram a força muscular relativa em mulheres com e sem sobrepeso e obesidade. O presente estudo teve como objetivo comparar a força muscular absoluta e relativa de mulheres de meia idade com e sem sobrepeso e obesidade, além de correlacionar a força muscular relativa com o índice de massa corporal (IMC), com a circunferência da cintura (CC) e com a razão cintura-estatura (RCE). A hipótese inicial era de que mulheres com sobrepeso e obesidade apresentariam menores valores de força muscular relativa. Foram avaliadas 20 mulheres obesas (36,7 ± 7,9 anos; 33,4 ± 2,4 kg/m2), 46 sobrepesadas (34,8 ± 7,8 anos; 27,7 ± 1,2 kg/m2) e 53 eutróficas (33,2 ± 9,3anos; 22,3 ± 1,7 kg/m2). A classificação de sobrepeso (IMC > 25 < 29,9 kg/m2) e obesidade (IMC > 30 kg/m2) foi definida de acordo com a Organização Mundial de Saúde. A força muscular relativa [força absoluta (kg)/massa corporal (kg)] foi mensurada por meio do teste de preensão manual. A força muscular relativa foi respectivamente menor nas mulheres com obesidade e sobrepeso quando comparado as mulheres eutróficas (0,35 ± 0,05 vs 0,42 ± 0,06 vs 0,48 ± 0,08; P=0,001). Houve uma relação negativa do IMC (r=-0,60; P=0,001), CC (r=-0,45; P=0,001) e RCE (r=-0,41; P=0,001) com a forca muscular relativa. A redução da força muscular relativa é um aspecto característico de mulheres com sobrepeso e obesidade.
Obesity is currently one of the major public health problems in developed and developing countries. Although the decrease in muscle strength is highly associated with cardiovascular diseases, few studies analyzed the relative muscle strength in women with and without overweight and obesity. The present study aimed to compare absolute and relative muscle strength of middle-aged women with and without overweight and obesity, as well as, to correlate relative muscle strength with body mass index (BMI), waits circumference (WC) and waist-to-height ratio (WHR). The initial hypothesis was that overweight and obese women would present lower values of relative muscle strength. Twenty obese (36.7 ± 7.9 years; 33.4 ± 2.4 kg/m2), 46 overweight (34.8 ± 7.8 years; 27.7 ± 1.2 kg/m2) and 53 eutrophic women (33.2 ± 9.3 years; 22.3 ± 1.7 kg/m2) were evaluated. The cut-off point for overweight (IMC > 25 < 29.9 kg/m2) and obesity (IMC > 30 kg/m2) was defined according to the World Health Organization. Relative muscle strength [absolute strength (kg)/body mass (kg)] was measured by the handgrip test. Relative muscle strength was lower for women with obesity and overweight as compared with eutrophic women (0.35 ± 0.05 vs 0.42 ± 0.06 vs 0.48 ± 0.08; P=0.001), respectively. There was a negative correlation of BMI (r=-0.60; P=0.001), WC (r=-0.45; P=0.001) and RCE (r=-0.41; P=0.001) with relative muscle strength. The reduction of relative muscle strength is a characteristic aspect of women with overweight and obesity.
Assuntos
Humanos , Feminino , Idoso , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares , Força Muscular , Sobrepeso , Saúde Pública , Mulheres , Diabetes Mellitus , Qualidade de Vida , Circunferência da Cintura , Organização Mundial da SaúdeRESUMO
BACKGROUND: The purpose of the present study was to compare dynamic muscle strength, functional performance, fatigue, and quality of life in premenopausal systemic lupus erythematosus (SLE) patients with low disease activity versus matched-healthy controls and to determine the association of dynamic muscle strength with fatigue, functional performance, and quality of life in SLE patients. METHODS: We evaluated premenopausal (18-45 years) SLE patients with low disease activity (Systemic lupus erythematosus disease activity index [SLEDAI]: mean 1.5 ± 1.2). The control (n = 25) and patient (n = 25) groups were matched by age, physical characteristics, and the level of physical activities in daily life (International Physical Activity Questionnaire IPAQ). Both groups had not participated in regular exercise programs for at least six months prior to the study. Dynamic muscle strength was assessed by one-repetition maximum (1-RM) tests. Functional performance was assessed by the Timed Up and Go (TUG), in 30-s test a chair stand and arm curl using a 2-kg dumbbell and balance test, handgrip strength and a sit-and-reach flexibility test. Quality of life (SF-36) and fatigue were also measured. RESULTS: The SLE patients showed significantly lower dynamic muscle strength in all exercises (leg press 25.63%, leg extension 11.19%, leg curl 15.71%, chest press 18.33%, lat pulldown 13.56%, 1-RM total load 18.12%, P < 0.001-0.02) compared to the controls. The SLE patients also had lower functional performance, greater fatigue and poorer quality of life. In addition, fatigue, SF-36 and functional performance accounted for 52% of the variance in dynamic muscle strength in the SLE patients. CONCLUSIONS: Premenopausal SLE patients with low disease activity showed lower dynamic muscle strength, along with increased fatigue, reduced functional performance, and poorer quality of life when compared to matched controls.
Assuntos
Fadiga/etiologia , Nível de Saúde , Lúpus Eritematoso Sistêmico/complicações , Força Muscular , Pré-Menopausa , Qualidade de Vida , Atividades Cotidianas , Adolescente , Adulto , Estudos de Casos e Controles , Estudos Transversais , Teste de Esforço , Fadiga/diagnóstico , Fadiga/fisiopatologia , Fadiga/psicologia , Feminino , Força da Mão , Humanos , Modelos Lineares , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/psicologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
The purpose of this study was to analyze the effects of resistance training (RT) order on number of repetitions, total training volume, ratings of perceived exertion (RPE), and the lactate response in male adolescents. Twelve adolescents (age: 15.7 ± 1.4 yrs) completed two RT sessions in a counterbalanced crossover design: one with exercises for smaller muscle groups followed by larger muscle groups (SM-LM), whereas the other session was performed in the opposite sequence (LM-SM). The exercise order for SM-LM was standing triceps extension (TE), dumbbell biceps curl (BC), bench press (BP), and seated row machine (RM), while the order for LM-SM was the opposite. Subjects performed three sets of a predetermined 10 repetition maximum for each exercise. Total repetitions completed for each exercise and RPE were assessed after each set, and blood lactate (BL) was measured before RT, 1 m after the first exercise, 1 m after the third exercise, and 10 m after each RT session. Blood lactate (BL) was higher for the LM-SG compared with SM-LM 10 m after exercise (7.4 ± 1.8 versus 6.5 ± 2.1 mmol/L; p < 0.05). More repetitions were completed on the TE and BC in the SM-LM compared with LM-SG (24.9 ± 3.4 and 16.2 ± 3.2 versus 16.3 ± 4.2 and 14.6 ± 3.0, respectively; p < 0.02), while more repetitions were completed on the BP and RM following the LM-SM (14.3 ± 2.3 and 23.4 ± 4.5 versus 12.4 ± 4.2 and 13.6 ± 5.1, respectively; p < 0.02). No differences were found for RPE. It may be appropriate to perform multijoint exercises first to improve general coordination and force, while the use of smaller muscle groups first may be interesting to target specific muscle weaknesses.