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- ItemAcesso aberto (Open Access)Atividade física no lazer e sua relação com a evolução da capacidade funcional de idosos que vivem em comunidade(Universidade Federal de São Paulo (UNIFESP), 2019) Ribeiro, Maria Claudia Martins [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; Sañudo, Adriana; http://lattes.cnpq.br/1676711953464613; http://lattes.cnpq.br/3798829566782422; http://lattes.cnpq.br/1152614954155366; Universidade Federal de São Paulo (UNIFESP)Introduction: Population aging is a worldwide phenomenon and the Brazilian population is aging at a higher speed than the world average. By 2025, Brazil will have the 6th largest elderly population in the world with 32 million people over the age of 60 years. During aging, the high prevalence of chronic diseases increases the loss of functional capacity, an important indicator of health. There is evidence that physical activity reduces disability among the elderly. Objective: To evaluate the influence of leisure-time physical activity on the functional capacity of elderly people living in the community during the follow-up time. Method: Longitudinal study with secondary data of the elderly cohort EPIDOSO Project. The study was developed in two stages: a cross-sectional analysis of the baseline with 907 elderly (≥60 years) and a longitudinal analysis that evaluated 287 individuals aged 60 years or older over an average of 3.5 years of follow-up. The dependent variable was the Functional Capacity (FC) measured by a scale of independence in activities of daily living (ADL). The independent variables were sociodemographic, health and behavioral characteristics such as leisure-time physical activity (LTPA), measured by the International Questionnaire of Physical Activity (IPAQ). For the transversal analysis, a Multinomial Logistic Regression was performed, and for the longitudinal one was performed a Multiple Linear Regression. Results: According to LTPA, the 907 participants in the study were classified as inactive (54.7%), insufficiently active (17.5%) and active (27.8%). LTPA was associated with FC (p <0.01). Among the active ones, 41% were independent (no limitation in ADLs) and inactive individuals presented a twofold higher chance of having severe dependence (more than seven limitations in ADL) when compared to the active ones. FC was also strongly associated with age, BMI and the presence of dysthymia. The advancing age, obesity and the presence of depressive disorder increased the chance of the elderly presenting more limitation. Longitudinal analysis showed that the relationship between LTPA and FC loses significance but remains in the right direction, indicating that when the minutes per week of leisure-time physical activity increase, the number of difficulties in ADL decreases. Functional capacity had a significant relationship with age, BMI, schooling and the number of difficulties in AVD in Wave 1. Conclusions: The results indicate that, a wide network of socio-demographic and health factors influence FC. Knowledge of these factors enables health actions to be better directed to this part of the population. It is noteworthy the relevance of leasure-time physical activity as one of the few behavioral factors that could change and one of the main contributors to an active and healthy aging.
- ItemSomente MetadadadosAvaliação da demanda cardiovascular, ventilatória e metabólica em pacientes com dpoc durante a realização do teste de atividades da vida diária de glittre(Universidade Federal de São Paulo (UNIFESP), 2013-11-27) Souza, Ferson Fonseca de [UNIFESP]; Nascimento, Oliver Augusto Nascimento [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by a progressive worsening of lung function and symptoms, leading to difficulty in performing activities of daily living (ADLs). It was recently proposed a new test designed to evaluate the functional performance for patients with COPD, called as the Glittre activities of daily living test (Glittre ADL – test). Up to date we neither know what are the COPD patients in term of cardiovascular, ventilatory and metabolic demand to perform the Glittre ADL – test, nor how these demands correspond to the maximum values obtained to the maximal incremental test. Objective: To evaluate metabolic, ventilatory and cardiovascular responses obtained during the Glittre activities of daily living test (Glittre ADL – Test) in mild, moderate and severe COPD patients, according to the GOLD classification. Methods: Cross-sectional observational study performed in sixty-two patients who present stable COPD. Assessment: spirometry, BMI, MRC, SGRQ and LCADL questionnaires, Glittre – ADL test, six-minute walking test (6MWT) and maximal incremental test on the treadmill (IT). We analyzed the mean scores of the questionnaires, and the variables obtained before and after exercises tests: VO2 peak, VO2/VO2 peak ratio, VCO2, f, VE, VE/MVV ratio, HR, BP, VO2/FC, SpO2 and Borg dyspnea. Results: The data obtained for the three groups of COPD patients have not showed significant differences related to parameters such as age, BMI and gender. On the other hand we found statistically significant differences in mean FEV1, MRC, and VVM among groups. Patients with severe COPD showed worst quality of life and the highest dyspnea according to LCADL questionnaires. The VE/MVV ratio measured in Glittre ADL – test present distinct results of 0.46 ± 0.11, 0.68 ± 0.18, 0.92 ± 0.20 for groups of mild, moderate and severe patients, respectively. The mean VO2/VO2 peak ratio were 0.81 ± 0.1, 0.88 ± 0.2 and 0.96 ± 0.2 for same sequence of groups, with the severe COPD patients showing significantly higher ratios than the mild group (p = 0.03). The mean SpO2 values were significantly lower and dyspnea significantly higher in severe COPD patients than in the other groups. There were no statistically significant differences in other variables obtained in the Glittre ADL – test, walking distance and maximal aerobic capacity among groups. Conclusions: Patients in different stages of COPD performed the Glittre ADL – test with similar time, metabolic, ventilatory and cardiovascular demand. However, the group of most severe patients presented lower metabolic, ventilatory reserve and lower SpO2, which result in increased dyspnea to run the test.
- ItemAcesso aberto (Open Access)Correlation and adaptation among functional and cognitive instruments for staging and monitoring Alzheimer?s disease in advanced stages(Faculdade de Medicina da Universidade de São Paulo, 2014-04-01) Wajman, José Roberto; Schultz, Rodrigo Rizek; Marin, Sheilla de Medeiros Correia [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Although Alzheimer’s disease (AD) is the most prevalent form of dementia, little is known about cognitive and functional aspects in its advanced stages. Objective: This study aimed the adaptation and correlation among specific instruments for AD in advanced stages with regard to cognition objectively weighted, besides the comparison between static and ecological aspects of functional capacity. Method: 95 moderate, moderatly severe and severe AD patients (33 men and 62 women) underwent the scales CDR (Clinical for Dementia Rating), FAST (Functional Assessment Scale), MMSE (Mini-Mental State Exame), MMSEsev (Severe Mini-Mental State Examination), SIB-8 (Severe Impairment Battery) and TSI (Test for Severe Impairment), for the comparison with a golden-standard ecological scale the PADL (Performance Activities of Daily Living). Result: The evidence suggests an increasing and statistically significant linear correlation between the ecological functional scale and cognitive tests according to the stratification of AD stages once weighted by static functional scale. Discussion: The results indicate that for patients in advanced stages of AD, appropriate cognitive tests and performance-based functional scales are useful in more accurate assessment of disease staging and monitoring its progression.
- ItemSomente MetadadadosDependence in activities of daily living and cognitive impairment strongly predicted mortality in older urban residents in Brazil: A 2-year follow-up(Blackwell Science Inc, 2001-09-01) Ramos, Luiz Roberto [UNIFESP]; Simoes, Eduardo J.; Albert, Marilyn S.; Universidade Federal de São Paulo (UNIFESP); Harvard Univ; St Louis UnivOBJECTIVES: To identify a set of predictors of mortality among residents in the community, before any physical, biochemical, or image examination is performed, that could be collected on a routine standardized basis, to help the clinician define a patient follow-up strategy and the health planner make decisions regarding the care of older people.DESIGN: A household follow-up study, with an evaluation at baseline and 2 years later.SETTING: Residential area, with a low rate of in- and outmigration, in São Paulo a large industrialized urban center in southeastern Brazil.PARTICIPANTS: One thousand six hundred sixty-seven older urban residents in the community (65+), from different socioeconomic backgrounds, enrolled after a study area census.INTERVENTION: Structured home interview with Brazilian Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire, previously validated in Portuguese.MEASUREMENTS: A logistic regression model for the risk of dying in the period was developed, having as independent variables, sociodemographic characteristics plus six other dimensions: subjective self-evaluation of health, past medical history, use of health services, dependence in activities of daily living (ADLs), mental health, and cognitive status.
- ItemSomente MetadadadosDoes Obstructive Sleep Apnea Impair the Cardiopulmonary Response to Exercise?(Amer Acad Sleep Medicine, 2013-04-01) Rizzi, Camila Furtado [UNIFESP]; Cintra, Fatima [UNIFESP]; Mello-Fujita, Luciane [UNIFESP]; Rios, Lais França [UNIFESP]; Mendonça, Elisangela Trevisan de [UNIFESP]; Feres, Marcia Cristina [UNIFESP]; Tufik, Sergio [UNIFESP]; Poyares, Dalva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Study Objectives: the aim of this study was to evaluate cardiopulmonary exercise performance in lean and obese patients with obstructive sleep apnea (OSA) compared with controls.Design: Case-control study.Setting: the study was carried out in São Paulo Sleep Institute, São Paulo, Brazil.Patients and Participants: Individuals with similar ages were allocated into groups: 22 to the lean OSA group, 36 to the lean control group, 31 to the obese OSA group, and 26 to the obese control group.Interventions: the participants underwent a clinical evaluation, polysomnography, a maximum limited symptom cardiopulmonary exercise test, two-dimensional transthoracic echocardiography, and spirometry.Measurements and Results: the apnea-hypopnea index, arousal index, lowest arterial oxygen saturation (SaO(2)) and time of SaO(2) < 90% were different among the groups. There were differences in functional capacity based on the following variables: maximal oxygen uptake (VO(2)max), P < 0.01 and maximal carbon dioxide production (VCO(2)max), P < 0.01. the obese patients with OSA and obese controls presented significantly lower VO(2)max and VCO(2)max values. However, the respiratory exchange ratio (RER) and anaerobic threshold (AT) did not differ between groups. Peak diastolic blood pressure (BP) was higher among the obese patients with OSA but was not accompanied by changes in peak systolic BP and heart rate (HR). When multiple regression was performed, body mass index (P < 0.001) and male sex in conjunction with diabetes (P < 0.001) independently predicted VO(2)max (mL/kg/min).Conclusions: the results of this study suggest that obesity alone and sex, when associated with diabetes but not OSA, influenced exercise cardiorespiratory function.
- ItemAcesso aberto (Open Access)Estratégia de troca entre agentes anti-TNF-alfa não melhora a capacidade funcional em pacientes com artrite reumatoide de longa evolução(Sociedade Brasileira de Reumatologia, 2012-02-01) Soares, Maria Roberta Melo Pereira [UNIFESP]; Reis Neto, Edgard Torres dos [UNIFESP]; Luz, Karine Rodrigues [UNIFESP]; Ciconelli, Rozana Mesquita [UNIFESP]; Pinheiro, Marcelo de Medeiros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: To assess clinical response after switching between anti-tumor necrosis factor-alpha (anti-TNF-alpha) agents in patients with rheumatoid arthritis (RA). PATIENTS AND METHODS: This study included 99 patients diagnosed with RA American College of Rheumatology, 1987), on anti-TNF-alpha therapy, to assess the therapeutic response after 24 weeks. Switching was performed if, after 12 to 24 weeks, a severe adverse event was reported (toxicity: T) or if no reduction greater than 0.6 in the initial Disease Activity Score 28 (DAS28) occurred (inadequate response: IR). In case of IR, the patient was considered as primary failure (PF). Secondary failure (SF) was defined as loss of response after initial improvement. Remission (DAS28 < 2.6), low disease activity (between 2.61 and 3.2), and functional improvement [increase in the initial Health Assessment Questionnaire (HAQ) > 0.2] were assessed by use of linear regression analysis. The significance level adopted was P < 0.05. RESULTS: Switching was performed in 39 (39.4%) patients, especially due to PF (24.3%), SF (35.1%) and T (40.5%). The retention rate of the first agent was 60.1%, and the mean time for switching was 14.2 ± 10.9 months. After switching, a tendency towards a decrease in DAS28 was observed (4.7 ± 1.4; P = 0.08), but not in the HAQ (1.2 ± 0.77; P = 0.11). Around 43% of the patients achieved good/moderate EULAR response. The major determinant of switching was a higher initial DAS28, independent of age, duration of disease, and functional capacity. CONCLUSION: Switching between anti-TNF-alpha agents is a valid strategy to control disease activity, despite the low likelihood of remission and no significant improvement in functional capacity
- ItemAcesso aberto (Open Access)Fatores associados à sintomatologia depressiva numa coorte urbana de idosos(Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro, 2009-01-01) Lima, Márcio Tomita Da Rocha [UNIFESP]; Silva, Rebeca de Souza e [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: The process of population aging in Brazil has been fast and intense, increasing the prevalence of chronic diseases and psychological and mental problems, mainly depression, which is associated with functional losses of the aged one. OBJECTIVE: To analyse the association between depressive symptomatology and other indicators of functional capacity, and with mortality after 15 years of follow-up, in an urban cohort of elderly. METHODS: 1667 aged (> 65 years-old) residents in Clementino Village in São Paulo city were studied through a multidimensional evaluation of the functional capacity, as well as the death certificate of the deaths occurred between 1991 (beginning of the study) and April of 2006. In univaried analysis we calculated odds ratio and its significance statistics was evaluated by the reliable interval (95%). The logistic regression was used in the multiple analysis. RESULTS: 21,1% of the elderly were depressed in 1991. In univaried analysis the highest ratios of depressed people were found in the feminine sex, aged older than 80 years-old, illiterates, widowers or bachelors, high level of physical dependence, cognitive deficit, users of more medicines and among those who died in the period of 15 years. In multivaried analysis, controlling by sex and age, physical dependence and the users of more medicines are associated to depression. CONCLUSIONS: The worse levels of disability answer, by an expressive way, to the occurrence of depressive symptomatology between the aged ones.
- ItemSomente MetadadadosPhysiological Requirements to Perform the Glittre Activities of Daily Living Test by Subjects With Mild-to-Severe COPD(Daedalus Enterprises Inc, 2017) Souza, Gerson F. [UNIFESP]; Moreira, Graciane L. [UNIFESP]; Tufanin, Andrea [UNIFESP]; Gazzotti, Mariana R. [UNIFESP]; Castro, Antonio A. [UNIFESP]; Jardim, Jose R. [UNIFESP]; Nascimento, Oliver A. [UNIFESP]BACKGROUND: The Glittre activities of daily living (ADL) test is supposed to evaluate the functional capacity of COPD patients. The physiological requirements of the test and the time taken to perform it by COPD patients in different disease stages are not well known. The objective of this work was to compare the metabolic, ventilatory, and cardiac requirements and the time taken to carry out the Glittre ADL test by COPD subjects with mild, moderate, and severe disease. METHODS: Spirometry, Medical Research Council questionnaire, cardiopulmonary exercise test, and 2 Glittre ADL tests were evaluated in 62 COPD subjects. Oxygen uptake ((V)over dot(O2)), carbon dioxide production, pulmonary ventilation, breathing frequency, heart rate, S-pO2, and dyspnea were analyzed before and at the end of the tests. Maximum voluntary ventilation, Glittre peak (V)over dot(O2)/cardiopulmonary exercise test (CPET) peak (V)over dot(O2), Glittre (V)over dot(E)/maximum voluntary ventilation, and Glittre peak heart rate/CPET peak heart rate ratios were calculated to analyze their reserves. RESULTS: Subjects carried out the Glittre ADL test with similar absolute metabolic, ventilatory, and cardiac requirements. Ventilatory reserve decreased progressively from mild to severe COPD subjects (P < .001 for Global Initiative for Chronic Obstructive Lung Disease [GOLD] 1 vs GOLD 2, P < .001 for GOLD 1 vs GOLD 3, and P < .001 for GOLD 2 vs GOLD 3). Severe subjects with COPD presented a significantly lower metabolic reserve than the mild and moderate subjects (P = .006 and P = .043, respectively) and significantly lower Glittre peak heart rate/CPET peak heart rate than mild subjects (P = .01). Time taken to carry out the Glittre ADL test was similar among the groups (P = .82 for GOLD 1 vs GOLD 2, P = .19 for GOLD 1 vs GOLD 3, and P = .45 for GOLD 2 vs GOLD 3). CONCLUSIONS: As the degree of air-flow obstruction progresses, the COPD subjects present significant lower ventilatory reserve to perform the Glittre ADL test. In addition, metabolic and cardiac reserves may differentiate the severe subjects. These variables may be better measures to differentiate functional performance than Glittre ADL time.