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COVID-19 is associated with musculoskeletal disorders. Ultrasound is a tool to assess muscle architecture and tendon measurements, offering an idea of the proportion of the consequences of the disease, since significant changes directly reflect the reduction in the ability to produce force and, consequently, in the functionality of the patient; however, its application in post-COVID-19 infection needs to be determined. We aimed to assess the intra- and inter-rater reliability of ultrasound measures of the architecture of the vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM), gastrocnemius lateralis (GL), gastrocnemius medialis (GM), soleus (SO), and tibialis anterior (TA) muscles, as well as the patellar tendon (PT) cross-sectional area (CSA) in post-COVID-19 patients. An observational, prospective study with repeated measures was designed to evaluate 20 post-COVID-19 patients, who were measured for the pennation angle (θp), fascicular length (Lf), thickness, echogenicity of muscles, CSA and echogenicity of the PT. The intra-class correlation coefficient (ICC) and 95% limits of agreement were used. The intra-rater reliability presented high or very high correlations (ICC = 0.71–1.0) for most measures, except the θp of the TA, which was classified as moderate (ICC = 0.69). Observing the inter-rater reliability, all the evaluations of the PT, thickness and echogenicity of the muscles presented high or very high correlations. For the Lf, only the RF showed as low (ICC = 0.43), for the θp, RF (ICC = 0.68), GL (ICC = 0.70) and TA (ICC = 0.71) moderate and the SO (ICC = 0.40) low. The ultrasound reliability was acceptable for the muscle architecture, muscle and tendon echogenicity, and PT CSA, despite the low reliability for the Lf and θp of the RF and SO, respectively.

Studies have described the use of electrophysical agents (EPA) by physical therapists worldwide. However, the use of EPA by Brazilian physical therapists remains undetermined. This study aims to describe the availability, use, and perception about EPA by orthopedic and sports physical therapists in Brazil. Professionals of the area were invited to answer an online questionnaire. Demographic data and information regarding the availability, use and perception about EPA in their current clinical practice were asked. Out of 376 physical therapists included in this study, 89% declared to use EPA in clinical practice. Sensory electrotherapy with pulsed current (TENS), therapeutic ultrasound, excitomotor electrotherapy with pulsed current (FES/NMES), and cryotherapy are available for more than 3/4 of interviewees. Scientific articles and clinical experience, respectively, are the most influential factors for the choice of EPA. Ultrasound is the most frequently used EPA, followed by TENS, cryotherapy, photobiomodulation, hot packs, and FES/NMES. The top-five most useful EPA in clinical practice chosen by physical therapists are: (1) ultrasound; (2) photobiomodulation; (3) TENS; (4) cryotherapy; and (5) FES/NMES. In conclusion, EPA are widely used by orthopedic and sports physical therapists in Brazil. Therapeutic ultrasound, TENS, FES/NMES, photobiomodulation, cryotherapy, and hot packs are the most used EPA in clinical practice of these physiotherapists. RESUMO Estudos têm descrito a utilização de agentes eletrofísicos (AE) por fisioterapeutas ao redor do mundo. No entanto, o uso de AE por fisioterapeutas brasileiros permanece inexplorado. O objetivo deste estudo é descrever o acesso, a utilização e a percepção sobre os AE de fisioterapeutas ortopédicos e esportivos no Brasil. Os profissionais foram convidados a responder um questionário on-line. Foram solicitados dados demográficos e informações sobre o acesso, utilização e percepção dos profissionais sobre os AE na prática clínica. Dentre os 376 fisioterapeutas incluídos, 89% declararam ser usuários de AE na prática clínica. Eletroterapia sensorial com corrente pulsada (TENS), ultrassom terapêutico, eletroterapia excitomotora com corrente pulsada (FES/NMES) e crioterapia são acessíveis para mais de 3/4 dos participantes. Artigos científicos e experiência clínica são os fatores de maior influência na escolha por AE. O ultrassom é o AE mais frequentemente utilizado, seguido por Tens, crioterapia, fotobiomodulação, bolsas quentes e FES/NMES. Os cinco AE elencados pelos fisioterapeutas como mais úteis na prática clínica são: (1) ultrassom; (2) fotobiomodulação; (3) TENS; (4) crioterapia; e (5) FES/NMES. Em conclusão, os AE são largamente usados pelos fisioterapeutas ortopédicos e esportivos no Brasil. Ultrassom terapêutico, TENS, FES/NMES, fotobiomodulação, crioterapia e bolsas quentes são os AE mais usados na prática clínica desses fisioterapeutas. RESUMEN Los estudios ya han descrito el uso de agentes electrofísicos (AE) por fisioterapeutas en todo el mundo. Todavía no se ha explorado el uso de los AE por fisioterapeutas brasileños. El presente estudio tuvo como objetivo describir el acceso, el uso y la percepción sobre los AE por fisioterapeutas ortopédicos y deportivos en Brasil. Se invitó a los profesionales para responder a un cuestionario en línea. Se solicitaron los datos demográficos e informaciones sobre el acceso, el uso y la percepción de profesionales sobre los AE en la práctica clínica. Entre los 376 fisioterapeutas incluidos, el 89% declararon utilizar los AE en la práctica clínica. La electroterapia sensorial con corriente pulsada (TENS), el ultrasonido terapéutico, la electroterapia excitomotora con corriente pulsada (FES/NMES) y la crioterapia son accesibles para más de 3/4 de los participantes. Los artículos científicos y la experiencia clínica son los factores que más influyeron en la elección de los AE. El ultrasonido es el AE más utilizado, seguido de Tens, crioterapia, fotobiomodulación, bolsas calientes y FES/NMES. Los cinco AE más útiles en la práctica clínica enumerados por los fisioterapeutas fueron: (1) ultrasonido; (2) fotobiomodulación; (3) TENS; (4) crioterapia; y (5) FES/NMES. Los AE son ampliamente utilizados por los profesionales de la ortopedia y el deporte en Brasil. El ultrasonido terapéutico, TENS, FES/NMES, fotobiomodulación, crioterapia y bolsas calientes son los AE más utilizados en la práctica clínica por estos fisioterapeutas.

Exercise intolerance, a hallmark of patients with heart failure (HF), is associated with muscle weakness. However, its causative microcirculatory and muscle characteristics among those with preserved or reduced ejection fraction (HFpEF or HFrEF) phenotype is unclear. The musculoskeletal abnormalities that could result in impaired peripheral microcirculation are sarcopenia and muscle strength reduction in HF, implying lowered oxidative capacity and perfusion affect transport and oxygen utilization during exercise, an essential task from the microvascular muscle function. Besides that, skeletal muscle microcirculatory abnormalities have also been associated with exercise intolerance in HF patients who also present skeletal muscle myopathy. This cross-sectional study aimed to compare the muscle microcirculation dynamics via near-infrared spectroscopy (NIRS) response during an isokinetic muscle strength test and ultrasound-derived parameters (echo intensity was rectus femoris muscle, while the muscle thickness parameter was measured on rectus femoris and quadriceps femoris) in heart failure patients with HFpEF and HFrEF phenotypes and different functional severities (Weber Class A, B, and C). Twenty-eight aged-matched patients with HFpEF (n = 16) and HFrEF (n = 12) were assessed. We found phenotype differences among those with Weber C severity, with HFrEF patients reaching lower oxyhemoglobin (O2Hb, μM) (−10.9 ± 3.8 vs. −23.7 ± 5.7, p = 0.029) during exercise, while HFpEF reached lower O2Hb during the recovery period (−3.0 ± 3.4 vs. 5.9 ± 2.8, p = 0.007). HFpEF with Weber Class C also presented a higher echo intensity than HFrEF patients (29.7 ± 8.4 vs. 15.1 ± 6.8, p = 0.017) among the ultrasound-derived variables. Our preliminary study revealed more pronounced impairments in local microcirculatory dynamics in HFpEF vs. HFrEF patients during a muscle strength exercise, combined with muscle-skeletal abnormalities detected via ultrasound imaging, which may help explain the commonly observed exercise intolerance in HFpEF patients.

We aimed to investigate the effects of neuromuscular electrical stimulation on muscle strength, pain relief, and improvement in function in patients with knee osteoarthritis. Databases were searched from December 2017 to July 2020 and included PubMed, Embase, LILACS, and the Cochrane Central Register of Controlled Trials. A manual search was also performed by checking the reference lists of eligible articles. The PRISMA guidelines were followed. The studies selected compared NMES with an exercise program on isometric muscle strength as a primary outcome. The secondary outcomes were pain and function. The quality of the studies was assessed using the Risk of Bias assessment and PEDro scale, and the overall quality of the evidence was assessed using the GRADE approach. Eight studies were included in this systematic review. A total of 571 patients were analyzed. Neuromuscular electrical stimulation associated with exercise promoted an increase in isometric strength of the quadriceps muscle compared to the active control group, demonstrating heterogeneity and statistical difference (95% CI=1.16 to 5.10, I2=97%, p=0.002; very low-certainty evidence). NMES associated with exercise did not improve physical function (95% CI=−0.37 to 0.59, I2=0%, p=0.67; low-certainty evidence) and showed controversial results for pain compared to an active control group (qualitative assessment). In conclusion, NMES induces an increase in muscle strength in patients with osteoarthritis compared to an active control group. No differences were found for physical function and pain outcomes. Further research is needed due to the uncertain level of evidence. RESUMO O objetivo deste estudo foi investigar os efeitos da estimulação elétrica neuromuscular (EENM) na força muscular, alívio da dor e melhora da função em pacientes com osteoartrite de joelho. Realizou-se uma pesquisa em diferentes bases de dados, como PubMed, Embase, LILACS e o Cochrane Central Register of Controlled Trials, no período de dezembro de 2017 até julho de 2020. Procedeu-se a uma busca manual com o intuito de verificar as listas de referências dos artigos elegíveis. As diretrizes PRISMA foram seguidas. Os estudos selecionados comparavam a estimulação elétrica neuromuscular com um programa de exercícios de força muscular isométrica como desfecho primário. Os resultados secundários foram dor e função. A qualidade dos estudos foi avaliada usando avaliação de risco de viés e a escala PEDro e a qualidade geral das evidências foi avaliada usando a abordagem GRADE. Oito estudos foram incluídos nesta revisão sistemática com um total de 571 pacientes analisados. A EENM associada ao exercício promoveu o aumento da força isométrica do músculo quadríceps em relação ao grupo controle ativo, demonstrando heterogeneidade e diferença estatística (IC 95%=1,16 a 5,10, I2=97%, p=0,002; evidência de muito baixa certeza), mas não melhorou a função física (IC 95%=−0,37 a 0,59, I2=0%, p=0,67; evidência de baixa certeza) e mostrou resultados controversos para dor em comparação ao grupo de controle ativo (avaliação qualitativa). Conclui-se que a EENM induz o aumento da força muscular em pacientes com osteoartrite, porém não foram encontradas diferenças nos resultados de funcionalidade e dor em comparação com o grupo de controle ativo. Devido à incerteza das evidências, são necessárias mais pesquisas sobre o assunto. RESUMEN El objetivo de este estudio fue analizar los efectos de la electroestimulación neuromuscular (NMES) sobre la fuerza muscular, el alivio del dolor y la mejora de la función en pacientes con osteoartritis de la rodilla. Se realizó una búsqueda en las bases de datos PubMed, Embase, LILACS y Cochrane Central Register of Controlled Trials, en el periodo de diciembre de 2017 y julio de 2020. Se llevó a cabo una búsqueda manual para verificar las listas de referencias de los artículos elegibles. Se aplicó las pautas PRISMA. Los estudios seleccionados compararon la electroestimulación neuromuscular con un programa de ejercicio de fuerza muscular isométrica como resultado primario. Los resultados secundarios fueron el dolor y la función. La calidad de los estudios se evaluó mediante la evaluación del riesgo de sesgo y la escala PEDro, y la calidad general de la evidencia se estimó con el uso del sistema GRADE. Ocho estudios con un total de 571 pacientes compusieron esta revisión sistemática. La EENM asociada con el ejercicio aumentó la fuerza isométrica del músculo cuádriceps en comparación con el grupo control activo, demostrando una heterogeneidad y diferencia estadística (IC 95%=1,16 a 5,10, I2=97%, p=0,002; evidencia con muy baja seguridad), pero no mejoró la función física (IC 95%=−0,37 a 0,59, I2=0%, p=0,67; evidencia con baja seguridad) y mostró resultados controvertidos para el dolor en comparación con el grupo control activo (evaluación cualitativa). Se concluyó que la EENM indujo un aumento de la fuerza muscular en pacientes con osteoartritis, pero no se encontraron diferencias en los resultados de función y dolor en comparación con el grupo control activo. Debido a la incertidumbre de la evidencia, se necesitan más estudios sobre el tema.

Background Resistance training has a positive impact on functional capacity and muscle mass in the elderly. However, due to physical limitations or a simple aversion against regular exercise, a majority of the elderly do not reach the recommended exercise doses. This led us to evaluate the effect of whole-body electromyostimulation (WB-EMS), a novel, time-efficient, and smooth training technology on physical function, fat-free mass, strength, falls-efficacy, and social participation of the elderly. Methods The present study is a randomized, parallel group clinical trial approved by the Ethics Committee of our Institution. Sixty-six volunteers (age ≥ 60 years) will be recruited from the geriatric outpatient department in a tertiary hospital and primary care units and randomized into two groups: WB-EMS group or active control group (aCG). The WB-EMS or aCG protocol will consist of 16 sessions for 8 consecutive weeks, twice per week. The primary outcomes will be maximal isometric knee extension (IKE), functional lower extremity strength, fat-free mass, gait speed, and risk of falls measured before and after intervention. The secondary outcomes will be social participation and falls-efficacy assessed before and after the intervention and at three and six months of follow-up. Participant’s satisfaction with and awareness of electrical stimulation therapy will also be assessed immediately after the 8-week intervention. Discussion Patients receiving WB-EMS exercises are believed to have better outcomes than those receiving conventional, more time-consuming resistance exercises. Hence, innovative, time-efficient, joint-friendly, and highly individualized exercise technologies (such as WB-EMS) may be a good choice for the elderly with time constraints, physical limitations, or little enthusiasm, who are exercising less than the recommended amounts for impact on muscle mass, strength, and function.

O ambiente de terapia intensiva esta evoluindo em tecnologias para avaliacao e tratamento sendo uma das tecnicas mais atuais aplicadas neste ambiente o eletrodiagnostico. Esta e uma revisao sistematica desenvolvida com base nos resultados de pesquisa das principais bases de dados, seguindo o PRISMA. Neste foram incluidos somente artigos observacionais que utilizaram a tecnica de eletrodiagnostico em pacientes criticos, para os mais diferentes objetivos e desfechos. As bases de dados consultadas foram: MEDLINE (acessado via PubMed), Fisioterapia Evidence banco de dados (Pedro), Registro de Ensaios Controlados (CENTRAL Cochrane) e EMBASE alem de uma busca manual de referencias adicionais. Um total de 10 artigos foram encontrados, sendo que dois apresentaram-se repetidos e outros seis foram excluidos por nao contemplarem os criterios de inclusao obtendo-se ao final um total de dois artigos totalizando 33 pacientes. Um dos artigos apresentou resultados seguros, sem lesao muscular e o protocolo foi viavel para ser aplicado em terapia intensiva. O outro artigo que apos lesao cerebral traumatica os pacientes podem apresentar disturbios eletrofisiologicos, alem de atrofia muscular generalizada sendo evidenciados pela tecnica de eletrodiagnostico. Palavras-chave: Unidade de terapia intensiva; ventilacao mecânica; eletrodiagnostico cronaxia; musculo esqueletico; respiracao artificial

Sarcopenia is a complex multifactorial process, some of which involves fat infiltration. Intramyocellular lipid (IMCL) accumulation is postulated to play a role on sarcopenia during aging, which is believed to be due alterations in glucose homeostasis in the skeletal muscle. Sarcopenia, along with intramuscular lipids, is associated with physical inactivity. Resistance training (RT) has been indicated to minimize the age-induced muscle skeletal adaptations. Thus, we aimed to investigate the effects of RT on mRNA levels of regulatory components related to intramyocellular lipid, glucose metabolism and fiber size in soleus and gastrocnemius muscles of aged rats. Old male rats were submitted to RT (ladder climbing, progressive load, 3 times a week for 12 weeks). Age-induced accumulation of IMCL was attenuated by RT, which was linked to a PPARy-mediated mechanism, concomitant to enhanced regulatory components of glucose homeostasis (GLUT-4, G6PDH, Hk-2 and Gly-Syn-1). These responses were also linked to decreased catabolic (TNF-α, TWEAK/Fn14 axis; FOXO-1, Atrogin-1 and MuRF1; Myostatin) and increased anabolic intracellular pathways (IGF-1-mTOR-p70S6sk-1 axis; MyoD) in muscles of trained aged rats. Our results point out the importance of RT on modulation of gene expression of intracellular regulators related to age-induced morphological and metabolic adaptations in skeletal muscle.

The aim of this study was to investigate the effects of multiple cold-water immersions (CWIs) on muscle function, markers of muscle damage, systemic inflammation and ECM degradation following exercise-induced muscle damage (EIMD). Thirty physically active males were randomly assigned to either a control (n = 15) or cold-water immersion (CWI) group (n = 15). The CWI group performed one immersion (10 °C for 20 min) at post-exercise and every 24 h for the following 72 h, while the control group remained in a seated position during these corresponding periods. Muscle strength, vertical jump height, muscle thickness, delayed-onset muscle soreness (DOMS), systemic creatine kinase (CK), C-reactive protein (CRP), inflammatory cytokines and matrix metalloproteinase-2 (MMP-2) activity were assessed at Pre, Post, 24, 48, 72, 96 and 168 h following EIMD. No significant time × group interaction was obtained for muscle strength, vertical jump height recovery and MMP-2 activity (p > 0.05). At 24 h, muscle thickness from the CWI group returned to baseline and was lower than the control (p = 0.04). DOMS returned to baseline at 168 h for the CWI group (p = 0.109) but not for the control (p = 0.008). At 168 h, CK showed a time-group difference with a greater peak for the control group (p = 0.016). In conclusion, multiple CWIs attenuated muscle damage, but not altered systemic inflammation and muscle function recovery.

International audience; Erratum inCorrigendum to "Neuromuscular electrophysiological disorders and muscle atrophy in mechanically-ventilated traumatic brain injury patients: New insights from a prospective observational study" [J Crit Care 44 (2018) 87-94]. [J Crit Care. 2019]AbstractPURPOSE:It is unclear whether the muscular changes in mechanically-ventilated traumatic brain injury patients (TBI) are only associated with disuse or additionally to neuromuscular electrophysiological disorders (NED). The correlation between muscle atrophy and NED may affect functional outcomes and rehabilitation programs significantly.MATERIAL AND METHODS:An observational study was performed to investigate the presence of NED and muscle atrophy in TBI patients undergoing mechanical ventilation. NED was diagnosed by the stimulus electrodiagnosis test when chronaxie was ≥1000μs. The muscle structure (thickness and echogenicity) was assessed by B-mode ultrasound. Tibialis anterior (TA), rectus femoris (RF), and biceps brachialis (BB) muscles were analyzed. Patients were followed from the first day of admission in the intensive care unit (ICU) to the fourteenth day.RESULTS:Twenty-two patients were analyzed. An increase of 48% in NED from day 1 to day 14 was detected in TA (p=0.004). All muscles presented a significant decrease in thickness (~18%, p

Aging is a complex, multifactorial process characterized by the accumulation of deleterious effects, including biochemical adaptations of the extracellular matrix (ECM). The purpose of this study was to investigate the effects of 12 weeks of resistance training (RT) on metalloproteinase 2 (MMP-2) activity in skeletal muscles and, MMP-2 and MMP-9 activity in the blood circulation of young and old rats. Twenty-eight Wistar rats were randomly divided into four groups (n = 7 per group): young sedentary (YS); young trained (YT), old sedentary (OS), and old trained (OT). The stair climbing RT consisted of one training session every 2 other day, with 8–12 dynamic movements per climb. The animals were euthanized 48 h after the end of the experimental period. MMP-2 and MMP-9 activity was measured by zymography. There was higher active MMP-2 activity in the lateral gastrocnemius and flexor digitorum profundus muscles in the OT group when compared to the OS, YS, and YT groups (p ≤ 0.001). Moreover, there was higher active MMP-2 activity in the medial gastrocnemius muscle in the OT group when compared to the YS and YT groups (p ≤ 0.001). The YS group presented lower active MMP-2 activity in the soleus muscle than the YT, OS, OT groups (p ≤ 0.001). With respect to active MMP-2/9 activity in the bloodstream, the OT group displayed significantly reduced activity (p ≤ 0.001) when compared to YS and YT groups. In conclusion, RT up-regulates MMP-2 activity in aging muscles, while down-regulating MMP-2 and MMP-9 in the blood circulation, suggesting that it may be a useful tool for the maintenance of ECM remodeling.

International audience; Objective To test the hypotheses that, as compared with pulsed current with the same pulse duration, kilohertz frequency alternating current would not differ in terms of evoked-torque production and perceived discomfort, and as a result, it would show the same current efficiency.Design A repeated-measures design with 4 stimuli presented in random order was used to test 25 women: (1) 500-microsecond pulse duration, (2) 250-microsecond pulse duration, (3) 500-microsecond pulse duration and low carrier frequency (1 kHz), (4) 250-microsecond pulse duration and high carrier frequency (4 kHz). Isometric peak torque of quadriceps muscle was measured using an isokinetic dynamometer. Discomfort was measured using a visual analog scale.Results Currents with long pulse durations induced approximately 21% higher evoked torque than short pulse durations. In addition, currents with 500 microseconds delivered greater amounts of charge than stimulation patterns using 250-microsecond pulse durations (P < 0.05). All currents presented similar discomfort. There was no difference on stimulation efficiency with the same pulse duration.Conclusions Both kilohertz frequency alternating current and pulsed current, with the same pulse duration, have similar efficiency for inducing isometric knee extension torque and discomfort. However, neuromuscular electrical stimulation (NMES) with longer pulse duration induces higher NMES-evoked torque, regardless of the carrier frequency. Pulse duration is an important variable that should receive more attention for an optimal application of NMES in clinical settings.

Objectives: To investigate the effects of multiple cryotherapy applications after muscle injury on markers of oxidative stress. Methods: Following cryolesion-induced skeletal muscle injury in rats, ice was applied at the injured site for 30 minutes, three times per day, on the day of injury, and for 2 days after injury. To determine the effect of the cryotherapy treatment on markers of oxidative stress, biochemical analyses were performed 3, 7, and 14 days after injury. Results: Compared with non-treated animals, cryotherapy reduced dichlorofluorescein at 7 and 14 days post-injury and thiobarbituric acid reactive substances levels at 3 and 7 days post-injury (P 0.05), whereas non-treated groups demonstrated lower levels than the control group (P

The application of cryotherapy is widely used in sports medicine today. Cooling could minimize secondary hypoxic injury through the reduction of cellular metabolism and injury area. Conflicting results have also suggested cryotherapy could delay and impair the regeneration process. There are no definitive findings about the effects of cryotherapy on the process of muscle regeneration. The aim of the present study was to evaluate the effects of a clinical-like cryotherapy on inflammation, regeneration and extracellular matrix (ECM) remodeling on the Tibialis anterior (TA) muscle of rats 3, 7 and 14 days post-injury. It was observed that the intermittent application of cryotherapy (three 30-minute sessions, every 2 h) in the first 48 h post-injury decreased inflammatory processes (mRNA levels of TNF-α, NF-κB, TGF-β and MMP-9 and macrophage percentage). Cryotherapy did not alter regeneration markers such as injury area, desmin and Myod expression. Despite regulating Collagen I and III and their growth factors, cryotherapy did not alter collagen deposition. In summary, clinical-like cryotherapy reduces the inflammatory process through the decrease of macrophage infiltration and the accumulation of the inflammatory key markers without influencing muscle injury area and ECM remodeling.

Background: Subcutaneous adipose tissue may influence the transmission of electrical stimuli through to the skin, thus affecting both evoked torque and comfort perception associated with neuromuscular electrical stimulation (NMES). This could seriously affect the effectiveness of NMES for either rehabilitation or sports purposes. Objective: To investigate the effects of skinfold thickness (SFT) on maximal NMES current intensity, NMES-evoked torque, and NMES-induced discomfort. Method: First, we compared NMES current intensity, NMES-induced discomfort, and NMES-evoked torque between two subgroups of subjects with thicker (n=10; 20.7 mm) vs. thinner (n=10; 29.4 mm) SFT. Second, we correlated SFT to NMES current intensity, NMES-induced discomfort, and NMES-evoked knee extension torque in 20 healthy women. The NMES-evoked torque was normalized to the maximal voluntary contraction (MVC) torque. The discomfort induced by NMES was assessed with a visual analog scale (VAS). Results: NMES-evoked torque was 27.5% lower in subjects with thicker SFT (p=0.01) while maximal current intensity was 24.2% lower in subjects with thinner SFT (p=0.01). A positive correlation was found between current intensity and SFT (r=0.540, p=0.017). A negative correlation was found between NMES-evoked torque and SFT (r=-0.563, p=0.012). No significant correlation was observed between discomfort scores and SFT (r s =0.15, p=0.53). Conclusion: These results suggest that the amount of subcutaneous adipose tissue (as reflected by skinfold thickness) affected NMES current intensity and NMES-evoked torque, but had no effect on discomfort perception. Our findings may help physical therapists to better understand the impact of SFT on NMES and to design more rational stimulation strategies. • Subcutaneous adipose tissue may influence the transmission of electrical stimuli. • This could affect the effectiveness of NMES for either rehabilitation or sports purposes. • We clearly demonstrated that the amount of subcutaneous adipose tissue affected NMES-evoked torque. • Physical therapists must consider the subcutaneous adipose tissue to design more rational stimulation paradigms.

A proposta deste trabalho foi avaliar o músculo sóleo (S) de ratos submetidos à imobilização articular por sete dias, associado ou não ao tratamento com metformina (MET, 1,4mg.ml-1) por meio de análises morfométricas. Ratos adultos Wistar (n = 5) foram divididos nos grupos: controle (C), imobilizado em posição neutra do tornozelo (I), tratado com metformina (M), imobilizado tratado com metformina (I + MET). Foram avaliadas a área das fibras, a densidade de área do tecido conjuntivo intramuscular e a massa muscular do S. A análise estatística foi realizada pelo teste de normalidade, ANOVA e de Tukey (p < 0,05). A imobilização reduziu o peso muscular (mg) do S (34%). No grupo M não houve alteração significativa do peso muscular quando comparado com o grupo C. Já no grupo I + MET foi observado aumento do peso muscular em 29,6% quando comparado com o grupo I. O tratamento com metformina não alterou a área da fibra muscular quando comparado com grupo C. Já no grupo I, houve redução de 44% na área da fibra. Com relação ao grupo I + MET, houve aumento de 22% quando comparado com o grupo I. Por outro lado, ao compararmos o grupo C com o grupo I + MET, houve redução de 31%. Ao avaliar a densidade de área do tecido conjuntivo, observou-se que o grupo I apresentou elevação de 216% quando comparado com o grupo C. No grupo I + MET, houve redução de 67% comparado com o grupo I. O tratamento com metformina em músculos submetidos à imobilização minimizou a redução da área das fibras do S, bem como o aumento do tecido conjuntivo. Esses resultados sugerem que a metformina pode favorecer recuperação mais rápida na fase pós-imobilização.The aim of this study was to evaluate the effect of metformin treatment on the muscle mass, fibers area and connective tissue area density in soleus (S) muscle under articular immobilization. METHODS AND RESULTS: Male Wistar rats (250-300g) were divided in 4 groups (n=5): control, treated with metformin, immobilized and immobilized treated with metformin. Immobilization was performed by acrylic resin orthoses on the left hindlimb keeping the ankle in neutral position during 7 days. The animals were euthanatized and the S muscle was dissected and weighed. Samples of its ventral portion were treated for inclusion in paraffin and stained in Hematoxylin-Eosin (H:E). The results were obtained through analyses of the muscular fiber area (images analyzed - Image Pró-plus 4,0), as well as of intramuscular connective tissue by means of planimetry. The statistical analysis was performed by normality test followed by ANOVA and Tukey (p

BACKGROUND: Studies have shown that reciprocal exercise using a pre-Activation of antagonist muscles may increase the agonist neuromuscular performance. OBJECTIVE: To compare the efficiency of two modalities of resistance training (with and without antagonist muscle pre-Activation) during a six week program on knee extension neuromuscular performance of healthy men. METHODS: Forty-nine men were randomly assigned into two groups: 1) reciprocal training: REC - one concentric knee flexion immediately followed by one concentric knee extension, and 2) control: CON - one concentric knee extension exercise, without pre-Activation. Both training modes were characterized by three sets of 10 repetitions at 60°/s, 2 days/week. Knee extensor peak moment (PM), load range (LR), electromyographic activity (EMG) of the vastus medialis (VM), rectus femoris (RF), and biceps femoris (BF) co-Activation were assessed pre and post 6 weeks of training. A 2 × 2 mixed factor ANOVA was applied to evaluate differences between variables. RESULTS: Significant increases were found for PM between pre and post-evaluations for both groups. In relation to VM and RF activation, co-Activation (BF/VM and BF/RF) and LR, no significant differences between groups and moments were found. CONCLUSION: In view of the results further research is indicated in order to examine the utility of longer programs in positively affecting antagonist muscle co-Activation as well as in elucidating its clinical effects in individuals with musculoskeletal dysfunction.

A proposta deste trabalho foi avaliar o efeito do sulfato de vanadil (SV) no perfil metabólico muscular de membro posterior imobilizado de ratos. Ratos Wistar foram divididos nos grupos (n = 6): controle (C), imobilizado em posição neutra do tornozelo (I), tratado com sulfato de vanadil (SV, 0,25mM, VO) e imobilizado tratado com SV (I + SV) durante sete dias. Após o período experimental, foram avaliadas as reservas de glicogênio (RG) dos músculos sóleo (S), gastrocnêmio branco (GB) e vermelho (GV), tibial anterior (TA) e extensor longo dos dedos (ELD), além do peso do S e ELD. A análise estatística foi realizada pela ANOVA seguida pelo teste de Tukey (p < 0,05). No grupo SV, os resultados mostraram elevação significativa nas RG (S 110%, GB 71%, GV 85%, TA 125%, EDL 108%) e no peso (S 9%, EDL 11%). A imobilização reduziu significativamente as RG (S 31,6%, GB 56,6%, GV 39,1%, ELD 41,7%, TA 45,2%) e peso (S 34,2% e ELD 27%); já no grupo I + SV, houve o aumento das RG em todos os músculos (S 211%, GB 115%, GV 148%, ELD 161,9%, TA 147%), além de impedir a perda de peso do S (75%) e ELD (46%). O tratamento com sulfato de vanadil promoveu elevação nas reservas de glicogênio do grupo controle e imobilizado, além de impedir a perda de peso, demonstrando que seu efeito insulino-mimético é representado pela ação glicogênica associado a uma possível ação anticatabólica.La propuesta de este trabajo ha sido la de evaluar el efecto del sulfato de vanadil (SV) en el perfil metabólico muscular de miembro posterior inmovilizado de ratones. Ratones Wistar fueron divididos en grupos (n = 6): control (C), inmovilizado en posición neutra de tobillo (I), tratado con sulfato de vanadil (SV, 0,25mM, VO) e inmovilizado tratado con SV (I + SV) durante 7 días. Después del periodo experimental, fueron evaluadas las reservas de glicógeno (RG) de los músculos soleo (S), gastrocnemio blanco (GB) y colorado (GV), tibial anterior (TA) y extensor largo de los dedos (ELD), además del peso de S y ELD. El análisis estadístico fue realizado por ANOVA seguido del test de Tukey (p < 0,05). En el grupo SV, los resultados mostraron elevación significativa en las RG (S 110%, GB 71%, GV 85%, TA 125%, EDL 108%) y en el peso (S 9%, EDL 11%). La inmovilización redujo significativamente las RG (S 31,6%, GB 56,6%, GV 39,1%, ELD 41,7%, TA 45,2%) y peso (S 34,2% e ELD 27%), por otro lado en el grupo I + SV, hubo aumento de las RG en todos los músculos (S 211%, GB 115%, GV 148%, ELD 161,9%, TA 147%), además de impedir la pérdida de peso de S (75%) y ELD (46%). El tratamiento con sulfato de vanadil promovió una elevación en las reservas de glicógeno del grupo control e inmovilizado, además de impedir la pérdida de peso, lo que demuestra que su efecto insulina mimético está representado por la acción glicogénica asociado a una posible acción anticatabólica.The purpose of this study was to evaluate the metabolic performance of immobilized skeletal muscle in rats treated with vanadyl sulphate. Male Wistar rats were divided in groups (n = 6): control (C), immobilized (I), treated with vanadyl sulphate (VS, 0,25 mM) and immobilized treated with vanadyl sulphate (I + VS) during seven days. The concentration of vanadyl sulphate diluted in water was 0,25 mM. After experimental stage, the glycogen content (GC) was evaluated in soleus (S), white gastrocnemius (WG), red gastrocnemius (RG), tibialis anterior (TA) and extensor digitorum longus (EDL) muscles, besides S and EDL weight. The statistical analysis was realized by the ANOVA followed by Tukey test (p < 0,05). In VS group, the results showed a significant increase in GC (S 110%, WG 71%, RG 85%, TA 125%, EDL 108%) and in the weight (S 9%, EDL 11%). The immobilization reduced significantly the GC (S 31.6%, WG 56.6%, RG 39.1%, EDL 41.7%, TA 45.2%) and weight (S 34.2% and ELD 27%), and in I + VS group, there was a increase of the GC in all muscles (S 211%, WG 115%, RG 148%, EDL 161.9%, TA 147%), besides hindering the weight loss in S (75%) and EDL (46%). The vanadyl sulphate treatment promoted an increase in the glycogen content of control and immobilized groups, besides hindering the weight loss, showing that the insulino-mimetic effect is represented by glycogenic action associate to a possible anti-catabolic action.

Fibromyalgia (FM) has been associated with cardiac autonomic abnormalities and pain. Heart rate variability (HRV) is reduced in FM with autonomic tone dominated by sympathetic activity. The purpose of this study was to evaluate the effects of one session of a posteroanterior glide technique on both autonomic modulation and pain in woman with FM. This was a controlled trial with immediate followup; twenty premenopausal women were allocated into 2 groups: (i) women diagnosed with FM(n=10)and (ii) healthy women(n=10). Both groups received one session of Maitland mobilization grade III posteroanterior central pressure glide, at 2 Hz for 60 s at each vertebral segment. Autonomic modulation was assessed by HRV and pain by a numeric pain scale before and after the intervention. For HRV analyses, heart rate and RR intervals were recorded for 10 minutes. FM subjects demonstrated reduced HRV compared to controls. Although the mobilization technique did not significantly reduce pain, it was able to improve HRV quantified by an increase in rMSSD and SD1 indices, reflecting an improved autonomic profile through increased vagal activity. In conclusion, women with FM presented with impaired cardiac autonomic modulation. One session of Maitland spine mobilization was able to acutely improve HRV.

These data describe the effects of combined aerobic plus resistance training (CT) with regards to risk factors of metabolic syndrome (MetS), quality of life, functional capacity, and pro- and anti-inflammatory cytokines in women with MetS. In this context, thirteen women (35.4±6.2 yr) completed 10 weeks of CT consisting of three weekly sessions of ∼60 min aerobic training (treadmill at 65–70% of reserve heart rate, 30 min) and resistance training (3 sets of 8–12 repetitions maximum for main muscle groups). Dependent variables were maximum chest press strength; isometric hand-grip strength; 30 s chair stand test; six minute walk test; body mass; body mass index; body adiposity index; waist circumference; systolic (SBP), diastolic and mean blood pressure (MBP); blood glucose; HDL-C; triglycerides; interleukins (IL) 6, 10 and 12, osteoprotegerin (OPG) and serum nitric oxide metabolite (NOx); quality of life (SF-36) and Z-Score of MetS. There was an improvement in muscle strength on chest press (p = 0.009), isometric hand-grip strength (p = 0.03) and 30 s chair stand (p = 0.007). There was a decrease in SBP (p = 0.049), MBP (p = 0.041), Z-Score of MetS (p = 0.046), OPG (0.42±0.26 to 0.38±0.19 ng/mL, p

CONTEXTUALIZACAO: Esta revisao abordara os principais mecanismos celulares envolvidos na reducao e aumento da sintese de mioproteinas comumente associadas as situacoes de atrofia e hipertrofia muscular, respectivamente. OBJETIVO: Analisaremos os efeitos da estimulacao eletrica (EE) e do exercicio de alongamento sobre as vias moleculares envolvidas na atrofia e hipertrofia muscular. Serao descritos os principais efeitos e os limites desses recursos no musculo esqueletico, particularmente sobre o musculo desnervado. DISCUSSAO: Recentemente, nossos estudos mostraram que a EE, aplicada de modo semelhante ao realizado na pratica clinica, e capaz de amenizar o aumento da expressao de genes envolvidos na atrofia muscular. Entretanto, a EE nao foi efetiva para deter a perda de massa muscular decorrente da desnervacao. Em relacao ao alongamento, seus mecanismos de acao sobre o musculo desnervado nao sao totalmente conhecidos, e os trabalhos nessa area sao escassos. Estudos do nosso laboratorio identificaram que o alongamento aumentou o remodelamento da matriz extracelular e diminuiu a expressao de genes relacionados a atrofia no musculo desnervado. Porem, tambem nao foi suficiente para impedir a atrofia muscular apos a desnervacao. CONCLUSOES: Apesar do uso da EE e do alongamento muscular na pratica clinica, com objetivo de minimizar a atrofia do musculo desnervado, ainda ha carencia de informacoes cientificas que justifiquem a eficacia desses recursos para prevenir a atrofia no musculo desnervado.

We evaluated the effects of chronic allergic airway inflammation and of treadmill training (12 weeks) of low and moderate intensity on muscle fiber cross-sectional area and mRNA levels of atrogin-1 and MuRF1 in the mouse tibialis anterior muscle. Six 4-month-old male BALB/c mice (28.5 +/- 0.8 g) per group were examined: 1) control, non-sensitized and non-trained (C); 2) ovalbumin sensitized (OA, 20 microg per mouse); 3) non-sensitized and trained at 50% maximum speed _ low intensity (PT50%); 4) non-sensitized and trained at 75% maximum speed _ moderate intensity (PT75%); 5) OA-sensitized and trained at 50% (OA+PT50%), 6) OA-sensitized and trained at 75% (OA+PT75%). There was no difference in muscle fiber cross-sectional area among groups and no difference in atrogin-1 and MuRF1 expression between C and OA groups. All exercised groups showed significantly decreased expression of atrogin-1 compared to C (1.01 +/- 0.2-fold): PT50% = 0.71 +/- 0.12-fold; OA+PT50% = 0.74 +/- 0.03-fold; PT75% = 0.71 +/- 0.09-fold; OA+PT75% = 0.74 +/- 0.09-fold. Similarly significant results were obtained regarding MuRF1 gene expression compared to C (1.01 +/- 0.23-fold): PT50% = 0.53 +/- 0.20-fold; OA+PT50% = 0.55 +/- 0.11-fold; PT75% = 0.35 +/- 0.15-fold; OA+PT75% = 0.37 +/- 0.08-fold. A short period of OA did not induce skeletal muscle atrophy in the mouse tibialis anterior muscle and aerobic training at low and moderate intensity negatively regulates the atrophy pathway in skeletal muscle of healthy mice or mice with allergic lung inflammation.

The aim of this work was to investigate the effect of the neuromuscular electrical stimulation (ES) on the metabolic and morfometric profile of the tibialis anterior muscle, antagonist to the soleus muscle which was stimulate, under the joint immobilization condition of the ankle for 7 and 15 days. The immobilization promoted the reduction in the muscle mass (I7: 17.36%, I15: 20.83%), in the glycogen content (I7: 48%, I15: 48%), in the muscle fibers areas (I7: 27%, I15: 40%) and increase in intramuscular connective tissue density (I7: 122%, I15: 206%). The EE didn't promote significant alterations in the mass of the immobilized groups, however, promoted increase in the glycogen (IEE7: 31.25%; IEE15: 56.25%), reduction in the muscle fibers areas (IEE7: 14%, IEE15: 24.69%) and reduction in the connective tissue density (IEE7: 25.63%, IEE15: 49.09%) when compared with the respective immobilized groups.O objetivo desse trabalho foi investigar o efeito da estimulação elétrica neuromuscular (EE) sobre o perfil metabólico e morfométrico do músculo tibial anterior, antagonista ao músculo sóleo, o qual foi estimulado, sob a condição de imobilização articular de tornozelo durante 7 e 15 dias. A imobilização promoveu redução na massa muscular (I7: 17,36%, I15: 20,83%), no conteúdo de glicogênio (I7: 48%, I15: 48%), na área das fibras musculares (I7: 27%, I15: 40%) e aumento na densidade do tecido conjuntivo intramuscular (I7: 122%, I15: 206%). A EE não promoveu alterações significativas na massa muscular dos grupos imobilizados, porém, promoveu aumento no glicogênio (IEE7: 31,25%; IEE15: 56,25%), redução na área das fibras musculares (IEE7: 14%, IEE15: 24,69%) e redução na densidade do tecido conjuntivo de (IEE7: 25,63%, IEE15: 49,09%) quando comparado aos respectivos grupos imobilizados.

The objective of the present study was to propose an orthosis of light material that would be functional for the animal and that would maintain only the ankle joint immobilized. Male Wistar rats (3 to 4 months old, 250-300 g) were divided into 2 groups (N = 6): control and immobilized for 7 days. Rats were anesthetized with sodium pentobarbital (40 mg/kg weight) and the left hindlimb was immobilized with the orthoses composed of acrylic resin model, abdominal belt and lateral supports. The following analyses were performed: glycogen content of the soleus, extensor digitorum longus, white gastrocnemius, red gastrocnemius, and tibialis anterior muscles by the phenol sulfuric method, and the weight, fiber area and intramuscular connective tissue of the soleus by the planimetric system. Data were analyzed statistically by the Kolmogorov-Smirnov, Student t and Wilcoxon tests. Immobilization decreased glycogen in all muscles (P < 0.05; soleus: 31.6%, white gastrocnemius: 56.6%, red gastrocnemius: 39%, extensor digitorum longus: 41.7%, tibialis anterior: 45.2%) in addition to reducing soleus weight by 34% (P < 0.05). Furthermore, immobilization promoted reduction of the fiber area (43%, P < 0.05) and increased the connective tissue (200%, P < 0.05). The orthosis model was efficient comparing with another alternative immobilization model, like plaster casts, in promoting skeletal muscle alterations, indicating that it could be used as a new model in other studies related to muscle disuse.

Introdução: Uma diminuição no controle postural e propriocepção é um resultado comum da amputação dos membros inferiores. No entanto, a adaptação do controle postural nos jogadores paralímpicos de vôlei sentado com amputação de membros inferiores ainda não é compreendida. Objetivo: O propósito desse estudo transversal controlado consistia em investigar o controle postural estático e dinâmico em jogadores de vôlei sentado com amputação transfemoral unilateral. Métodos: Dezesseis indivíduos participaram do estudo, oito deles eram amputados com amputação transfemoral unilateral (grupo amputado: idade: 33,5 ± 5,6 anos, peso: 77,7 ± 5,3 kg, altura: 179,4 ± 5,3 cm) e oito eram fisicamente ativos não-amputados (idade do grupo controle: 27,2 ± 8,4 anos, peso: 82,7 ± 6,6 kg, altura: 178,7 ± 6,1 cm). O controle postural estático e dinâmico foi avaliado usando a plataforma Neurocom® Balance Master System (Teste Clínico Modificado de Interação Sensorial no Equilíbrio, Limites de Estabilidade, Variação Rítmica de Carga, Sentado para de Pé, Marcha na Plataforma e Passo com Inversão Rápida). As análises estatísticas foram realizadas com o teste Shapiro-Wilk, o teste de Levene e o teste t de Student para amostras pareadas (p 0,05). Conclusão: Apesar do treinamento no vôlei sentado, nossos resultados demonstraram que os amputados apresentam um controle postural mais precário tanto em tarefas estáticas como dinâmicas, quando comparados com os não-amputados fisicamente ativos. Nível de Evidência II; Estudo prognóstico - investigar o efeito da característica do paciente no resultado de uma doença/Estudo Retrospectivo. Introduction: A decrease in postural control and proprioception is a common result of lower limb amputation. However, postural control adaptation in Paralympic sitting volleyball players with lower limb amputation is not yet understood. Objective: The purpose of this cross-sectional controlled study was to investigate static and dynamic postural control in sitting volleyball players with unilateral transfemoral amputation. Methods: Sixteen subjects participated in the study, eight of whom were amputees with unilateral transfemoral amputation (amputee group: age: 33.5 ± 5.6 years, weight: 77.7 ± 5.3 kg, height: 179.4 ± 5.3 cm) and eight physically active non-amputees (control group age: 27.2 ± 8.4 years, weight: 82.7 ± 6.6 kg, height: 178.7 ± 6.1 cm). Static and dynamic postural control was evaluated using the Neurocom® Balance Master System platform (Modified Clinical Test of Sensory Interaction on Balance, Limits of Stability, Rhythmic Weight Shift, Sit-to-Stand, Walk Across, and Step and Quick Turn). Statistical analyses were performed with the Shapiro-Wilk test, Levene's test, and Student's t-test for paired samples (p .05). Conclusion: Despite training in sitting volleyball, our results demonstrated that amputees have poorer postural control in both static and dynamic tasks when compared to physically active non-amputees. Level of Evidence II; Prognostic Studies—Investigating the Effect of a Patient Characteristic on Disease Outcome / Retrospectivef Study. Introducción: Una disminución en el control postural y propiocepción es un resultado común de la amputación de los miembros inferiores. Sin embargo, la adaptación del control postural en los jugadores paralímpicos de vóley sentado con amputación de miembros inferiores aún no es comprendida. Objetivo: El propósito de ese estudio transversal controlado consistía en investigar el control postural estático y dinámico en jugadores de vóley sentado con amputación transfemoral unilateral. Métodos: Dieciséis individuos participaron en el estudio, ocho de ellos eran amputados con amputación transfemoral unilateral (grupo amputado: edad: 33,5 ± 5,6 años, peso: 77,7 ± 5,3 kg, altura: 179,4 ± 5,3 cm) y ocho eran físicamente activos no amputados (edad del grupo control: 27,2 ± 8,4 años, peso: 82,7 ± 6,6 kg, altura: 178,7 ± 6,1 cm). El control postural estático y dinámico fue evaluado usando la plataforma Neurocom® Balance Master System (Test Clínico Modificado de Interacción Sensorial en el Equilibrio, Límites de Estabilidad, Variación Rítmica de Carga, Sentado para de pie, Marcha en la Plataforma y Paso con Inversión Rápida). Los análisis estadísticos fueron realizados con el test Shapiro-Wilk, el test de Levene y el test t de Student para muestras pareadas (p 0,05). Conclusión: A pesar del entrenamiento en el vóley sentado, nuestros resultados demostraron que los amputados presentan un control postural más precario tanto en tareas estáticas como dinámicas, cuando comparados con los no amputados físicamente activos. Nivel de Evidencia II; Estudio pronóstico - investigar el efecto de la característica del paciente en el resultado de una enfermedad/Estudio Retrospectivo.