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BACKGROUND: Runners seek health benefits and performance improvement. However, fatigue might be considered a limiting factor. Transcranial Direct Current Stimulation (tDCS) has been investigated to improve performance and reduce fatigue in athletes. While some studies showing that tDCS may improve a variety of physical measures, other studies failed to show any benefit. OBJECTIVE: To evaluate the acute effects of tDCS on central and peripheral fatigue compared to a sham intervention in recreational runners. METHODS: This is a triple-blind, controlled, crossover study of 30 recreational runners who were randomized to receive one of the two interventions, anodal or sham tDCS, after the fatigue protocol. The interventions were applied to the quadriceps muscle hotspot for 20 min. Peak torque, motor-evoked potential, and perceived exertion rate were assessed before and after the interventions, and blood lactate level was assessed before, during, and after the interventions. A generalized estimated equation was used to analyze the peak torque, motor-evoked potential, and blood lactate data, and the Wilcoxon test was used for perceived exertion rate data. RESULTS: Our findings showed no difference between anodal tDCS and sham tDCS on peak torque, motor-evoked potential, blood lactate, and perceived exertion rate. CONCLUSION: The tDCS protocol was not effective in improving performance and reducing fatigue compared to a sham control intervention. BRAZILIAN CLINICAL TRIALS REGISTRY: RBR-8zpnxz.

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BACKGROUND: Pelvic floor muscle training (PFMT) is widely used for pelvic floor muscle (PFM) weakness in women; however, it has no prolonged effects. OBJECTIVE: To evaluate the effect of Transcranial Direct Current Stimulation (tDCS) associated with PFMT on PFM contraction, sexual function and quality of life (QoL) in healthy women. STUDY DESIGN: 32 nulliparous women, aged 22.7 ± 0.42 years, were randomized into two groups: G1 (active tDCS combined with PFMT) and G2 (sham tDCS combined with PFMT). The treatment was performed three times a week for 4 weeks, totaling 12 sessions. PFM function was assessed using the PERFECT scheme (P = power, E = endurance, R = repetitions, F = rapid contractions, ECT = each timed contraction) and the perineometer (cmH2O). Sexual function was assessed by The Female Sexual Function Index, and QoL by the SF-36 questionnaire. These assessments were performed before and after the 12nd treatment session and after 30-day follow-up. RESULTS: There was a significant increase (p = 0.037) in the power of G2 compared to G1; repetitions and fast contraction increased in the G1 group, and the resistance increased in both groups, however, without statistical difference between the groups. ECT increased in the G1 group (p = 0.0). CONCLUSION: Active tDCS combined with PFMT did not potentiate the effect of the PFMT to increase the PFM function, QoL, and sexual function in healthy women. However, adjunctive tDCS to PFMT improved the time of contractions, maintaining it during follow-up.

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BACKGROUND: Falls are frequent in older adults and can cause trauma, injury, and death. Fall prevention with virtual reality presents good results in improving postural control. Transcranial Direct Current Stimulation (tDCS) has been used with the same aim; however, the combination of the two techniques has still been little studied. PURPOSE: To assess whether tDCS can enhance the effect of video game training (VGT) on improving the postural balance of healthy older women. METHOD: A blinded, randomized, controlled clinical trial was conducted with 57 older women who were randomized to three balance training groups: Control Group (VGT), Anodal Group (VGT combined with anodic tDCS-atDCS), and Sham Group (VGT combined with sham tDCS-stDCS). Balance training was performed twice a week for four weeks, totalizing eight 20-min sessions using VGT associated with tDCS. Postural balance was assessed pre-and post-training and 30 days after the end of the eight sessions using the Mini-Balance Evaluation Systems Test. RESULTS: Compared to pre-intervention the Mini BEST test increased similarly in the three groups in post-intervention (control: pre 23.7 ± 2.8 to post 27.0 ± 2.2; anodal: pre 24.4 ± 1 to post 27.7 ± 0.8 and sham: pre 24.2 ± 1.9 to post 26.5 ± 1.6; p < 0.001) and follow-up (control: pre 23.7 ± 2.8 to follow-up 26.8 ± 2.3; anodal: pre 24.4 ± 1 to follow-up 27.3 ± 1.4 and sham: pre 24.2 ± 1.9 to follow-up 26.8 ± 1.5; p < 0.001). CONCLUSION: There was an improvement in the postural balance of the three training groups that were independent of tDCS. DISCUSSION: Some studies have shown the positive tDCS effects associated with other tasks to improve balance. However, these results convey the effects of only anodic-tDCS compared to sham-tDCS. Possibly, the effect of VGT surpassed the tDCS effects, promoting a ceiling effect from the combination of these two therapies. However, studies with other therapies combined with tDCS for older adults deserve to be investigated, as well as in frail older people.

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OBJECTIVE: The aim of the study is to identify the predictors of social participation in Down syndrome adults from the biopsychosocial model of the International Classification of Functioning, Disability, and Health. METHODS: An exploratory, analytical, cross-sectional study was conducted with Down syndrome adults. The social participation was assessed using the Life Habits Assessment. The independent variables were determined using the International Classification of Functioning, Disability, and Health biopsychosocial model: body functions were assessed by body mass index, cognition function (Mini-Mental State Examination), and lower limbs muscle strength (Sit-to-Stand Test). Activities were assessed by the 8-Foot Up and Go Test. Environmental factors were assessed by the measure of the quality of the environment, and personal factors were assessed by age, sex, and education level. RESULTS: The total Life Habits Assessment score indicates that individuals show moderate restriction in social participation, with major restriction in the education, employment, and responsibilities domains. The 8-Foot Up and Go Test was the best social participation predictor variable, followed by Mini-Mental State Examination, and the Sit-to-Stand Test. Contextual factors were not predictors of participation. CONCLUSIONS: It was concluded that individuals with Down syndrome present the most restrictions to social participation in activities that involve social roles. The predictors influencing social participation are functional mobility, cognition, and lower limb muscle strength.

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ABSTRACT Pelvic floor muscle weakness can lead to urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Although it can be minimized by pelvic floor muscle training (PFMT), its effects are not lasting. Therefore, using combination therapy seems promising. This study aims to evaluate the effect of transcranial direct current stimulation (tDCS) combined with PFMT on intravaginal pressure, pelvic floor muscle strength (PFMS), sexual function (SF), and quality of life (QoL) in healthy women. A total of 32 women, aged from 18 to 45 years, will undergo PFMT (with perineal contractions and relaxation) with the aid of pressure biofeedback associated with active tDCS or sham tDCS. Sessions will last 20 minutes, three times per week, for four weeks, totaling 12 sessions. During the protocol, participants will be instructed to also perform the home-based PFMT daily. The tDCS anodal electrode will be positioned over the supplementary motor area of the dominant cortical hemisphere, whereas the cathodal will be over the contralateral supraorbital region, with a 2mA intensity for 20 minutes. Intravaginal pressure (pressure gauge), PFM strength (measured by digital palpation and the PERFECT scheme), FSFI (Female Sexual Function Index), and QoL (SF-36 questionnaire) will be evaluated before and after the 12 sessions and after a 30-day follow-up.

RESUMEN La debilidad de la musculatura del suelo pélvico puede provocar incontinencia urinaria, prolapso de órganos pélvicos y disfunción sexual, y puede minimizarse mediante el entrenamiento de la musculatura del suelo pélvico (EMSP). Sin embargo, este efecto no es duradero. En este contexto, una terapia combinada puede ser prometedora para mejorar la situación. Este estudio tiene por objetivo evaluar el efecto de la estimulación transcraneal por corriente directa (ETCC) combinada con EMSP sobre la presión intravaginal, la fuerza muscular del suelo pélvico (FMSP), la función sexual (FS) y la calidad de vida (CV) en mujeres sanas. Participarán 32 mujeres, de entre 18 y 45 años, que se someterán a EMSP (contracciones y relajación del perineo) y a Biofeedback asociado a ETCC activa o ETCC sham durante 20 minutos, tres veces por semana, durante 4 semanas, con un total de 12 sesiones. Durante el protocolo, las participantes también se someterán diariamente a EMSP en casa. El electrodo anodal de la ETCC se colocará sobre el área motora suplementaria del hemisferio cortical dominante, y el electrodo catodal sobre la región supraorbital contralateral, a una intensidad de 2 mA, durante 20 minutos. Se evaluarán la presión intravaginal (manómetro), la FMSP (palpación digital, esquema Perfect), la FS (Índice de Función Sexual Femenina) y la CV (cuestionario SF-36) antes y después de las 12 sesiones, así como tras un seguimiento de 30 días.

RESUMO A fraqueza muscular do assoalho pélvico pode gerar incontinência urinária, prolapso de órgãos pélvicos e disfunção sexual, e pode ser minimizada pelo treinamento muscular do assoalho pélvico (TMAP). No entanto, este efeito não é duradouro. Assim, terapia combinada parece ser promissora para a melhora deste quadro. Dessa forma, objetiva-se avaliar o efeito da estimulação transcraniana por corrente contínua (ETCC), combinada ao TMAP, sobre a pressão intravaginal, força muscular do assoalho pélvico (FMAP), função sexual (FS) e qualidade de vida (QV) em mulheres saudáveis. Serão 32 mulheres, entre 18 e 45 anos, que realizaram TMAP (contrações e relaxamento do períneo) e Biofeedback associados a ETCC ativa ou ETCC sham por 20 minutos, três vezes por semana, por 4 semanas, totalizando 12 sessões. Durante o protocolo, as participantes também realizarão diariamente, em domicílio, o TMAP. O eletrodo anodal da ETCC será posicionado sobre a área motora suplementar do hemisfério cortical dominante, e o catodal sobre a região supraorbital contralateral, com intensidade de 2mA, por 20 minutos. A pressão intravaginal (manômetro de pressão), FMAP (palpação digital, esquema Perfect), FS (Índice de Função Sexual Feminina) e QV (questionário SF-36) foram avaliadas antes e depois das 12 sessões, bem como após acompanhamento de 30 dias.

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OBJECTIVE: To investigate the effect of osteopathic visceral manipulation (OVM) on disability and pain intensity in individuals with functional constipation and chronic nonspecific low back pain. METHODS: This study is a randomized controlled trial with a blinded assessor. Seventy-six volunteers with functional constipation and chronic nonspecific low back pain were randomized to two groups: OVM and sham OVM. The primary clinical outcome was pain intensity measured using a numeric rating scale (NRS) and disability measured using the Oswestry Disability Index (ODI). The secondary outcomes were electromyographic signals measured during the flexion-extension cycle, the finger-to-floor distance during complete flexion of the trunk and the Fear-Avoidance Beliefs Questionnaire (FABQ). All outcomes were determined after six weeks of treatment as well as three months after randomization. RESULTS: The OVM group reported a reduction in pain intensity after six weeks of treatment and at the three-month evaluation (p < .0002) and the sham group reported a reduction in pain intensity after three-month evaluation (p < .007). For the ODI was also found in the OVM group six weeks after the end of treatment (treatment effect = -6.59, 95% CI: -12.01 to -1.17, p = .01) and at the three-month evaluation (treatment effect = -6.02, 95% CI: -11.55 to -0.49, p = .03). Significant differences were also found for paravertebral muscle activity during the dynamic phases (flexion and extension) six-week evaluations. CONCLUSIONS: The OVM group demonstrated a reduction in pain intensity and improvement in disability after six-weeks and three-month follow-up while the sham group reduction in pain three-month follow-up.

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Introduction: Comorbidities in adults with Down syndrome are common making them a risk group for COVID-19. Thus, vaccinating against COVID-19 becomes necessary, but requires care against possible side effects. Objective: To investigate possible adverse effects after vaccination against COVID-19 in adults with Down Syndrome (DS). Methodology: Descriptive study in which ninety-seven adults diagnosed with DS were interviewed using a questionnaire containing seventeen questions related to personal and historical data, and seven questions related to vaccination. Results: The most applied vaccine was AstraZeneca (94%), Pfizer (4%), and CoronaVac (2%); 74% of the subjects had adverse effects, the most frequent after the first dose being pain at the injection site (65.3%), fever (37.9%), muscle pain (37.8%), malaise (29.5%); in the second dose there was a decrease in these adverse effects; 95% of symptoms disappeared after the first 24 hours following application. Conclusion: More than half of the individuals interviewed had adverse effects after the application of the first dose of the vaccine, decreasing with the second dose; the most frequent was pain at the site of application.

Introdução: Comorbidades em adultos com síndrome de Down são comuns tornando-os um grupo de risco para COVID-19. Dessa forma, vacinar contra a COVID-19 torna-se necessária, mas requer cuidados contra possíveis efeitos colaterais. Objetivo: Pesquisar possíveis efeitos adversos após vacinação contra COVID-19 em adultos com Síndrome de Down (SD). Metodologia: Estudo descritivo no qual 97 adultos diagnosticados com SD foram entrevistados por meio de um questionário contendo dezessete questões relacionadas a dados pessoais e histórico, e sete questões relacionadas à vacinação. Resultados: A vacina mais aplicada foi a AstraZeneca (94%), Pfizer (4%) e CoronaVac (2%); 74% dos sujeitos apresentaram efeitos adversos, sendo os mais frequentes após a primeira dose: dor no local da injeção (65,3%), febre (37,9%), dores musculares (37,8%), mal-estar (29,5%); na segunda dose houve diminuição desses efeitos adversos; 95% dos sintomas desapareceram após as primeiras 24 horas após a aplicação. Conclusão: Mais da metade dos indivíduos entrevistados apresentou efeitos adversos após a aplicação da primeira dose da vacina, diminuindo com a segunda dose; a mais frequente foi a dor no local de aplicação.

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Resumo Introdução: A pandemia da COVID-19 contribuiu para a diminuição das atividades habituais dos idosos, o que pode interferir na capacidade funcional (CF) dos mesmos. Objetivo: Verificar o impacto da inatividade física durante a pandemia da COVID-19 na CF de idosos e associar o nível de atividade física com a CF dos mesmos. Métodos: Participaram do estudo 20 idosos que frequentavam um programa de atividade física antes da pandemia da COVID-19. Foi avaliada a capacidade funcional pelo teste AVD-Glittre, teste de caminhada de 6 minutos (TC6) e Time Up and Go (TUG); os resultados foram comparados com os resultados dos testes obtidos em 2019 (antes da pandemia da COVID-19). Para verificar o nível de atividade física, foi aplicado o Questionário Internacional de Nível de Atividade Física (IPAQ). Os dados foram analisados pelo teste t pareado de Wilcoxon e teste de correlação de Pearson. Resultados: Houve um aumento do tempo da execução do teste de AVD-Glittre de 171.90 ± 35.56 para 272.00 ± 344.77 segundos, no TUG teste de 6.27 ± 119 para 6.92 ± 1.53 segundos, e no TC6 houve uma diminuição de 564.97 ± 85.22 para 464.65 ± 105.95 metros, com p<0.001 em todas as análises. A correlação entre IPAQ e o teste de AVD-Glittre foi fraca (r=0.11, p<0.63), fraca com TC6 (r= -0.10, p>0.001) e moderada com TUG (r=0.59, p>0.001). Conclusão: Houve diminuição da CF dos idosos durante a pandemia da COVID-19, o nível de atividade física influenciou no TUG.

Introduction: The COVID-19 pandemic contributed to a decrease in the usual activities of older adults, which may interfere with their functional capacity (FC). Objective: To verify the impact of physical inactivity during the COVID-19 pandemic on the older adults' FC and associate the level of older adults' physical activity with the FC. Methods: The study included 20 older people who attended a physical activity program before the COVID-19 pandemic. Functional capacity was evaluated by the ADL-Glittre test, 6-minute walk test (6MWT) and Time Up and Go (TUG) test. The tests' results were compared to the tests obtained in 2019 (before the COVID-19 pandemic). The International Physical Activity Level Questionnaire (IPAQ) was applied to verify the physical activity level. Data were analyzed using Wilcoxon's paired t-test and Pearson's correlation test. Results: There was an increase in the execution time of the ADL-Glittre test from 171.90 ± 35.56 to 272.00 ± 344.77 seconds, in the TUG test from 6.27 ± 119 to 6.92 ± 1.53 seconds, and in the 6MWT there was a decrease from 564.97 ± 85.22 to 464.65 ± 105.95 meters, with p<0.001 in all analyses. The correlation between IPAQ and the ADL-Glittre test was weak (r=0.11, p<0.63), weak with 6MWT (r= -0.10, p>0.001) and moderate with TUG (r=0.59, p>0.001). Conclusion: There was a decrease in the FC of older adults during the COVID-19 pandemic; the level of physical activity influenced the TUG.

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Introdução: Pacientes infectados com COVID-19 parecem manifestar evolução mais grave quando apresentam comorbidades, como a Diabetes Mellitus (DM). No entanto, dados da população brasileira ainda são pouco disponíveis. Objetivo: Analisar a associação entre DM e evolução para intubação e óbito em indivíduos internados com COVID-19. Metodologia: Estudo transversal, observacional, quantitativo com dados dos prontuários de 74 participantes adultos internados no Hospital Professora Lydia Storópoli, com diagnóstico de COVID-19. O Comitê de Ética em Pesquisa Humana aprovou este estudo e os participantes assinaram o termo de consentimento do estudo. Resultados: Dos 74 pacientes, 18 apresentavam DM, dos quais seis evoluíram para intubação e cinco evoluíram para óbito. Não houve associação significativa (p>0,05) entre DM e intubação e óbito. Conclusão: Na presente amostra a DM não foi associada com a evolução clínica para intubação e óbito.

Introduction: Patients infected with COVID-19 seem to manifest a more severe evolution when they have comorbidities, such as Diabetes Mellitus (DM). However, data on the Brazilian population are still scarcely available. Objective: To analyze the association between DM and evolution to intubation and death in individuals hospitalized with COVID-19. Methodology: Cross-sectional, observational, quantitative study with data from the medical records of 74 adult participants admitted to Professora Lydia Storópoli Hospital, diagnosed with COVID-19. The Human Research Ethics Committee approved this study, and participants signed the study consent form. Results: 74 patients with Covid-19, 18 had DM, of which six evolved to intubation, and five evolved to death. There was no significant association (p>0.05) between DM and intubation and death. Conclusion: In the present study, DM was not associated with clinical evolution to intubation and death.

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BACKGROUND: The PM-Scale was developed specifically to assess participation in individuals after stroke based on the concepts contained in the International Classification of Functioning, Disability and Health. However, this measure is only available in English and French. OBJECTIVE: To translate and cross-culturally adapt the PM-Scale to Brazilian Portuguese, followed by the validation and testing of reliability of the translated version. METHODS: The translation process followed standard guidelines. Preliminary test-retest reliability was determined using the intraclass correlation coefficient (ICC2,1). The Rasch model was employed to analyse the validity, unidimensionality, invariance, and internal consistency of the Brazilian version of the PM-Scale. RESULTS: The final translated version of the PM-Scale presented appropriate semantic, idiomatic, cultural, and conceptual equivalence. The preliminary analysis revealed excellent intra-observer and inter-observer reliability (ICC2,1 = 0.91; 95%CI: 0.83, 0.95 and ICC2,1 = 0.81; 95%CI: 0.64, 0.89, respectively). The analysis of the Rasch model revealed only one erratic item. An excellent overall fit was found for items (mean ± SD = 0.01 ± 1.02) and adequate fit was found for persons (mean ± SD = 1.16 ± 0.88). Internal consistency was considered adequate (person separation index = 1.77, reliability = 0.76). No significant invariance was found with regards to the personal characteristics of the sample (p > 0.05). CONCLUSION: The Brazilian version of the PM-Scale is a valid, unidimensional, linear, reliable scale for measuring participation in stroke survivors and can be administered in less than five minutes.

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