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To describe the perspectives, satisfaction, and self-efficacy towards aerobic exercise and to investigate the barriers to aerobic exercise identified by individuals with stroke in a developing country. A cross-sectional study was performed with 15 individuals (55 ± 12 years, 69 ± 77 months post-stroke), who received a 12-week vigorous intensity aerobic treadmill training (three 30-min sessions/week). To assess participants’ perspectives, satisfaction, self-efficacy, and barriers to aerobic exercise, a standardized interview and the Short Self-Efficacy for Exercise scale were employed. Participants considered aerobic exercise important (100% (IQR 20%), out of 100), recognized that it improves recovery (93%) and heart health (100%) and were satisfied with the training (80%). Self-efficacy was high (4 (IQR 1), out of 5). The main barriers were lack of information (86.7%), fear of falling (80%), lack of equipment (73.3%) or support (66.7%-73.3%), cognitive (66.7%) and physical impairments (60%) and severe weather conditions (60%). Most of them preferred to exercise in groups (93%). Individuals with stroke in a developing country considered aerobic exercise important. However, they perceived barriers related to safety, individual ability, social support, and aerobic exercise. It is necessary to improve education of these individuals, family members, and health care professionals regarding aerobic exercises.IMPLICATIONS FOR REHABILITATIONIndividuals after stroke in developing countries consider aerobic exercise important and recognized that it improves stroke recovery and health, although they perceived barriers related to safety, individual ability, social support, and aerobic exercise itself.It is important to improve education to stroke survivors, family members and healthcare professionals in developing countries about the possibilities, risks, and benefits of aerobic exercises.Rehabilitation professionals should provide aerobic exercise for individuals after stroke in groups.Rehabilitation professionals might use cycle ergometers or partial body weight support to overcome fear of falling and facilitate implementation of aerobic exercise after stroke. Individuals after stroke in developing countries consider aerobic exercise important and recognized that it improves stroke recovery and health, although they perceived barriers related to safety, individual ability, social support, and aerobic exercise itself. It is important to improve education to stroke survivors, family members and healthcare professionals in developing countries about the possibilities, risks, and benefits of aerobic exercises. Rehabilitation professionals should provide aerobic exercise for individuals after stroke in groups. Rehabilitation professionals might use cycle ergometers or partial body weight support to overcome fear of falling and facilitate implementation of aerobic exercise after stroke.

Purpose: To identify interventions employed to increase post-stroke physical activity, evaluate their efficacy, and identify the gaps in literature. Materials and methods: Randomized controlled trials published until March 2018 were searched in MEDLINE, PEDro, EMBASE, LILACS, and SCIELO databases. The quality of each study and overall quality of evidence were assessed using the PEDro and the GRADE scales. Results: Eighteen studies were included (good PEDro and very low GRADE-scores). In seven, the experimental groups showed significant increases in physical activity (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation during walking; functional-task training; robot-assisted arm therapy; accelerometer-based feedback, and physical activity encouragement). In seven, there were no significant between-group differences (physical activity plan; stretching, use of toe-spreaders, standard treatment; counseling; circuit video-game; functional-task; counseling and cognitive training). The combined experimental and control groups showed significant declines in physical activity in one study (aerobic training or stretching) and increases in three others (aerobic, resistance or sham resistance training; stroke-with advice or only stroke-counseling; aerobic training, educational sessions, standard treatment, and coaching, or mobilization and standard treatment). A meta-analysis could not be performed, due to heterogeneity. Conclusions: Some interventions improved physical activity after stroke. However, the interpretability is limited.Implications for rehabilitationIndividuals with stroke show low physical activity, which may compromise function and health.The use of interventions aimed at improving and maintaining physical activity of individuals with stroke are recommended.Some interventions, such as aerobic, resistance, and combined home-based training, electrical stimulation during walking, functional task training, and arm robot-assisted therapy, could improve the physical activity after stroke. Individuals with stroke show low physical activity, which may compromise function and health. The use of interventions aimed at improving and maintaining physical activity of individuals with stroke are recommended. Some interventions, such as aerobic, resistance, and combined home-based training, electrical stimulation during walking, functional task training, and arm robot-assisted therapy, could improve the physical activity after stroke.

L'augmentation du niveau d'activité physique, définie comme tout mouvement corporel volontaire nécessitant une dépense d'énergie, pourrait améliorer la fonction et la santé des personnes après un accident vasculaire cérébral (AVC). L’objectif général était d’analyser le niveau d’évidences des interventions visant à augmenter le niveau d'activité physique après un AVC et de comparer l’effets d’interventions. La première étude a proposé un protocole pour une revue systématique (PROSPERO 2016: CRD42016037750) des effets d’interventions sur les niveaux d'activité physique après un AVC. La deuxième étude a consisté en une revue systématique d'essais contrôlés randomisés qui ont examiné les interventions utilisées pour augmenter les niveaux d'activité physique après un AVC. Dix-huit études ont été incluses (bons scores PEDro et très bas scores GRADE). Dans sept études, les groupes expérimentaux (aérobique seulement, résistance et entraînement à domicile; conseils, aérobie, résistance et entraînement à domicile; stimulation électrique; entraînement aux tâches fonctionnelles; thérapie assistée par robot; rétroaction basée sur accéléromètre; et encouragement à réaliser de l’activité physique) ont montré une amélioration de l'activité physique. Cependant, le petit nombre d'études et l'hétérogénéité des interventions, des mesures de résultats et des résultats ont limité les conclusions. La troisième étude a décrit un protocole d'un essai contrôlé randomisé (ClinicalTrials.gov: NCT02798237) visant à déterminer l'efficacité de l'entraînement aérobique sur l'amélioration du niveau d'activité physique et du temps consacré aux activités à faible dépense énergétique après un AVC. La quatrième étude a comparé les effets de deux interventions (essai contrôlé randomisé) de marche sur le niveau d'activité physique, le temps consacré aux activités à faible consommation d'énergie, la condition cardiorespiratoire, la dépression, l’endurance, la mobilité, la participation et la qualité de vie. Vingt-deux adultes vivant dans la communauté après un AVC chronique ont été randomisé en deux groupes. Les participants du groupe expérimental ont suivi un entraînement aérobique sur tapis roulant de 40 minutes à 60-80% de sa fréquence cardiaque de réserve, trois jours/semaine pendant 12 semaines. Les participants du groupe contrôle ont reçu la même intervention mais en limitant l’effort à 40% de la fréquence cardiaque de réserve. Il n'y a pas eu de changements significatifs sur le niveau d'activité physique ou le temps consacré aux activités à faible consommation d'énergie. Seuls les participants du groupe expérimental ont amélioré leur qualité de vie améliorée (13 points; IC95%: 3,5-23 points). Les deux groupes ont amélioré la dépression (2,2 points; IC95%: 0,01-4,3 points), leur endurance (31-55 m; IC95%: 3,8-107 m) et leur mobilité (0,12 m/s; IC95% : 0,02-0,2 m/s). Il n'y a pas eu d'autres changements significatifs. Les résultats de cette thèse ont permis de démontrer l’insuffisance d’évidences pour recommander des interventions visant à augmenter les niveaux d'activité physique des individus après un AVC. Aussi, ils nous ont amené à conclure que d’autres études sont requises pour clarifier les avantages de l'entraînement aérobique sur l'activité physique et le temps consacré aux activités à faible consommation d'énergie., The increase of physical activity levels, defined as any voluntary bodily movement that requires energy expenditure, might improve function and health in individuals after stroke. The general objective of this thesis was to analyze the current level of evidence about interventions to increase physical activity level after stroke and to develop an experimental study that could provide evidence that could help clinical practice. The first study had the objective to describe a protocol for the development of a systematic review (PROSPERO 2016: CRD42016037750) about the effects of interventions on physical activity levels after stroke. The objective of second study was to develop a systematic review of randomized controlled trials that examined which interventions have been employed for increasing physical activity levels after stroke. Eighteen studies were included (good PEDro and very low GRADE-scores). In seven studies, the experimental groups (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation; functional-task training; robot-assisted therapy; accelerometer-based feedback, and physical activity encouragement) showed significant increases in physical activity. However, the small number of studies and the heterogeneity in the interventions, outcome measures, and results limit the conclusions. The third study had the objective to describe the protocol of a randomized controlled trial (ClinicalTrials.gov: NCT02798237) aimed to investigate if aerobic training is effective on improving physical activity levels and time spent in low-energy expenditure activities after stroke. The fourth study, a randomized controlled trial, aimed to investigate if aerobic training would improve physical activity levels and time spent in low-energy expenditure activities (primary outcomes), and cardiorespiratory fitness, depression, endurance, mobility, participation and quality of life (secondary outcomes) after stroke. Twenty-two community-dwelling adults with chronic stroke were randomized in two groups. The experimental group performed aerobic treadmill training at 60-80% of their heart rate reserve. The control group performed overground walking below 40% of heart rate reserve. Both groups received 40 minutes of intervention three days per week over 12-weeks. There were no significant changes on physical activity levels and time spent in low-energy expenditure activities. Compared to the controls, the experimental group showed increased quality of life (13 points; 95%CI: 3.5 to 23 points). Both groups improved depression (2.2 points; 95%CI: 0.01 to 4.3 points), endurance (31-55 m; 95%CI: 3.8 to 107 m), and mobility (0.12 m/s; 95%CI: 0.02 to 0.2 m/s). There were no other significant changes. The results of this thesis showed that the limited evidence currently available is insufficient to make a recommendation about interventions to increase physical activity levels of individuals after stroke. Further studies are needed to clarify the benefits of aerobic training on physical activity and time spent in low-energy expenditure activities., O aumento do nível de atividade física, definido como qualquer movimento corporal voluntário que requer gasto energético, pode melhorar a função e a saúde dos indivíduos após o acidente vascular encefálico (AVE). O objetivo geral dessa tese foi analisar o estado atual das evidências sobre intervenções com o objetivo de aumentar o nível de atividade física pós-AVE e desenvolver um estudo experimental que forneça evidências que possam auxiliar a prática clínica. O primeiro estudo teve como objetivo descrever um protocolo de uma revisão sistemática (PROSPERO 2016: CRD42016037750) sobre os efeitos de intervenções no nível de atividade física pós-AVE. O objetivo do segundo estudo foi realizar uma revisão sistemática de ensaios clínicos randomizados que examinaram quais intervenções foram empregadas para aumentar o nível de atividade física pós-AVE. Dezoito estudos foram incluídos (escores PEDro bons e GRADE muito baixo). Em sete estudos, os grupos experimentais (fortalecimento, exercícios aeróbios e domiciliares; aconselhamento, fortalecimento, exercícios aeróbios e domiciliares; estimulação elétrica; treino específico da tarefa; terapia robótica; feedback baseado em acelerômetro; e encorajamento à atividade física) mostraram aumento do nível de atividade física. Entretanto, o número limitado de estudos e a heterogeneidade das intervenções, dos desfechos mensurados e dos resultados limitam as conclusões. O terceiro estudo teve como objetivo descrever o protocolo de um ensaio clínico randomizado (ClinicalTrials.gov: NCT02798237) para investigar a eficácia do treinamento aeróbio na melhora do nível de atividade física e do tempo gasto em atividades de baixo consumo energético pós-AVE. O quarto estudo, um ensaio clínico randomizado, teve como objetivo investigar se o treinamento aeróbio melhora o nível de atividade física e o tempo gasto em atividades de baixo consumo energético (desfechos primários), a aptidão cardiorrespiratória, a depressão, a capacidade de caminhada, a mobilidade, a participação e a qualidade de vida (desfechos secundários) pós-AVE. Vinte e dois adultos residentes na comunidade pós-AVE crônico foram randomizados em dois grupos. O grupo experimental realizou treinamento aeróbio em esteira a 60-80% da frequência cardíaca de reserva. O grupo controle realizou caminhada no solo com intensidade inferior a 40% da frequência cardíaca de reserva. Ambos os grupos receberam 40 minutos de intervenção três dias por semana durante 12 semanas. Não houve diferença estatisticamente significativa no nível de atividade física e no tempo gasto em atividades de baixo consumo energético. Comparado ao grupo controle, o grupo experimental apresentou aumento da qualidade de vida (13 pontos; IC95%: 3,5-23 pontos). Ambos os grupos melhoraram a depressão (2,2 pontos; IC95%: 0,01-4,3 pontos), a capacidade de caminhada (31-55 m; IC95%: 3,8-107m) e a mobilidade (0,12 m/s; IC95%: 0,02-0,2 m/s). Não houve outras alterações significativas. Os resultados desta tese mostram que a evidência limitada disponível atualmente é insuficiente para fazer uma recomendação sobre intervenções para aumentar o nível de atividade física dos indivíduos pós-AVE. Ensaios clínicos futuros são necessários para determinar os benefícios do treinamento aeróbio no nível de atividade física e no tempo gasto em atividades de baixo consumo energético.

The manovacuometer is a simple, quick and non-invasive test which measures the maximal respiratory pressures (MRS). Guidelines recommend the use of a digital manovacuometer due to its high accuracy. The purpose of this study was to assess the test-retest reliability and concurrent validity of a digital manovacuometer in measuring the maximal inspiratory and expiratory pressures (MIP/MEP) and nasal inspiratory pressure while sniffing (SNIP). A total of 30 healthy subjects were assessed (20-30 years old) using the UFMG and MicroRPM(r) (Micro Medical, UK) digital manovacuometers. To assess reliability, Intraclass Correlation Coefficient (ICC) and Student's t test it was used for dependent samples. For the validity assessment, the following were used: Pearson correlation, Student's t test for dependent samples, linear regression and the Bland-Altman method. The level of significance was set at 5% (p0.05); the correlation between observed values from the two instruments was of high magnitude for all variables (0.82 to 0.85); no significant difference was found between the values obtained for both instruments (p>0.05); a strong association was observed between measures of MIP and MEP obtained by the two methods and Bland-Altman analysis showed no systematic overestimation or underestimation of maximal respiratory pressures and SNIP. In conclusion, the results suggest that the UFMG manovacuometer is a reliable and valid instrument for assessing MIP, MEP and SNIP in healthy subjects. La manovacuometría es una prueba sencilla, rápida y no invasiva que mide las presiones respiratorias máximas (PRM). Directrices recomiendan el uso del manuvacuómetro digital debido a su alta precisión. El objetivo de este estudio fue evaluar la reproducibilidad test-retest y la validez concurrente de un manuvacuómetro digital para medir las presiones inspiratoria y espiratoria máximas (PImáx y PEmáx) y de la presión inspiratoria nasal durante la aspiración (SNIP). Se evaluaron 30 sujetos sanos (20-30 años) por medio de los manovacuómetros digitales UFMG y MicroRPM(r) (Micro Medical, UK). Para evaluar la reproducibilidad, se utilizó el coeficiente de correlación intraclase (CCI) y el test t de student para muestras dependientes. Para el análisis de la validez se utilizaron: la correlación de Pearson, el test t de student para muestras dependientes, el análisis de regresión lineal y el método Bland-Altman. El nivel de significación considerado fue del 5% (p0,05). La correlación entre los valores observados en los dos instrumentos fue de alta magnitud para todas las variables (0,82 a 0,85); no hubo diferencia significativa entre los valores medios obtenidos en los dos instrumentos (p>0,05); Se observó una fuerte asociación entre las medidas de las PRM obtenidas por los dos métodos y el análisis de Bland-Altman no demostró sobreestimación o subestimación sistemática de las PRM y del SNIP. En conclusión, los resultados sugieren que el manovacuómetro UFMG es fiable y válido para la evaluación de las PRM y SNIP en sujetos sanos. A manovacuometria é um teste simples, rápido e não invasivo que mensura as pressões respiratórias máximas (PRM). Diretrizes recomendam o uso do manovacuômetro digital devido à sua alta precisão. O objetivo deste estudo foi avaliar a reprodutibilidade teste-reteste e a validade concorrente de um manovacuômetro digital na mensuração das pressões inspiratórias e expiratórias máximas (PImáx e PEmáx) e da pressão inspiratória nasal durante o fungar (SNIP). Foram avaliados 30 indivíduos saudáveis (20-30 anos) utilizando os manovacuômetros digitais UFMG e MicroRPM(r) (Micro Medical, UK). Para avaliar a reprodutibilidade, foi utilizado o Coeficiente de Correlação Intraclasse (CCI) e teste t de student para amostras dependentes. Para análise da validade foram utilizados: a correlação de Pearson, o teste t de student para amostras dependentes, a análise de regressão linear e o método Bland-Altman. O nível de significância considerado foi de 5% (p0,05). A correlação entre os valores observados nos dois instrumentos foi de alta magnitude para todas as variáveis (0,82 a 0,85); não houve diferença significativa entre os valores médios obtidos nos dois instrumentos (p>0,05); foi observada forte associação entre as medidas das PRM obtidas pelos dois métodos e a análise de Bland-Altman não demonstrou superestimação ou subestimação sistemática das PRM e do SNIP. Em conclusão, os resultados sugerem que o manovacuômetro UFMG é confiável e válido para avaliação das PRM e SNIP em indivíduos saudáveis.

INTRODUÇÃO: O Teste do esfigmomanômetro modificado (TEM) tem potencial de ampla aplicação clínica para mensuração da força muscular. OBJETIVO: Realizar uma ampla revisão da literatura para descrever como o TEM vem sendo utilizado para avaliação da força muscular, bem como suas propriedades de medida. MATERIAIS E MÉTODOS: Foram realizadas buscas nas bases de dados MEDLINE/LILACS/SciELO/PEDro com combinação de termos específicos, sem restrições quanto ao idioma e publicados até novembro/2011, seguida de busca manual ativa. Todos os estudos encontrados foram analisados por dois examinadores independentes. RESULTADOS: Dos 24 estudos incluídos, 11 investigaram alguma propriedade psicométrica (validade de critério concorrente e confiabilidade) e reportaram resultados adequados. O TEM já foi utilizado para avaliação da força muscular de crianças, adultos e idosos, saudáveis ou acometidos por alguma condição de saúde; doenças reumáticas e dor lombar foram as mais comuns. Já foi utilizado para avaliação dos músculos do tronco e membros; os membros superiores foram os mais avaliados (79,16%), principalmente os preensores palmares. Todos realizaram adaptação no esfigmomanômetro, a maioria utilizou contração muscular por 5 segundos, pré-insuflação do equipamento de 20 mmHg e não foi reportado o tempo de repouso nem o número de repetições. CONSIDERAÇÕES FINAIS: Apesar de apresentar adequadas propriedades de medida e ampla aplicabilidade clínica, o TEM ainda é pouco utilizado para avaliação da força muscular e não foi empregado em estudos com indivíduos em que este desfecho é comumente avaliado. A falta de padronização e/ou descrição dos procedimentos adotados dificulta a replicação dos métodos para utilização do TEM na prática clínica. INTRODUCTION: The Modified Sphygmomanometer Test (MST) has potential for wide clinical applications for the assessment of muscular strength. OBJECTIVE: To perform a literature review to describe how the MST has been employed for the evaluation of strength and its psychometric properties. MATERIALS AND METHODS: An extensive search was performed with the MEDLINE, SciELO, LILACS, and PEDro databases, by combining specific keywords, without language restrictions, and published until November/2011, followed by active manual search. RESULTS: Out of the 24 included studies, 11 investigated criterion-related validity and reliability with adequate results. The MST has been applied for the evaluation of strength in different populations, such as children, adults, and elderly, healthy or with some health conditions, been the rheumatic diseases and low back pain the most common. It has been applied for the assessment of trunk and limb muscles, mainly for the upper limb muscles (76.19%), principally handgrip. All of the studies performed some adaptations in the equipment and the majority used 5s of contraction, equipment pre-inflation of 20 mmHg. None reported the resting time neither the number of trials. FINAL CONSIDERATIONS: Despite the clinical applicability of the MST and the adequate psychometric properties, this test is still little used for the evaluation of strength and was not applied in subjects with important strength impairments. The lack of standardization and/or description of the adopted procedures hinder the MST replication in clinical contexts.