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ABSTRACT: One resorts to various postural strategies while attempting to maintain balance. OBJECTIVE: To assess the postural strategies adopted by young and elderly subjects in varying sensory conditions by using a system of tridimensional electromagnetic sensors positioned on the projection of the first thoracic vertebra and on the sacral region. Postural oscillation values for young and elderly subjects were also reported. METHOD: This observational cross-sectional study enrolled 25 young and 16 elderly individuals. A PolhemusTM device equipped with two sensors was used to assess postural oscillation parameters (maximum displacement, mean velocity, and trajectory). Data acquisition was carried out with subjects standing while undergoing a 90-second test in four sensory conditions: eyes opened, eyes closed, on a stable surface, and on an unstable surface. RESULTS: Sensors 1 and 2 presented significant cross-correlations in all sensory conditions for both groups (r > 0.99; p < 0.001). No statistically significant differences were seen when the cross-correlations for both groups were compared. CONCLUSION: This study presented an important tool to analyze postural oscillation and assess the postural strategies of young and elderly subjects in different sensory conditions. Young and elderly individuals presented strong correlations between sensors (ankle strategy), but no statistically significant differences were seen between groups.
Brazilian journal of otorhinolaryngology 04/2013; 79(2):219-225.
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ABSTRACT: BACKGROUND: Non-adherence to treatment has been identified as the main cause of uncontrolled blood pressure (BP), and may represent a greater risk in older individuals. OBJECTIVE: The aim of this study was to evaluate and compare the rate of adherence to hypertension treatment using different methods, to estimate the BP control rate, and to observe if there is an association between BP control and adherence. METHODS: Treatment adherence was evaluated in older patients with hypertension, followed by the public primary health care, through four methods, including the Morisky-Green test (reference), the Attitude regarding the Medication Intake questionnaire (AMI), an evaluation of adherence by the nurse in the office (Nurse Adherence Evaluation - NAE), and at home (Home Adherence Evaluation - HAE). Salt intake was estimated by 24-hour sodium urinary excretion. BP control was assessed by the awake ambulatory blood pressure monitoring. RESULTS: Concordance between the Morisky-Green test and AMI (Kappa=0.27) or NAE (Kappa=0.05) was poor. There was a moderate concordance between the Morisky-Green test and HAE. Eighty percent had controlled BP, including 42% with white-coat effect. The group with lower salt excretion informed to avoid salt intake more times (p<0.001) and had better medication adherence (p<0.001) than the higher salt excretion group. CONCLUSION: The evaluated tests did not show a good concordance to the Morisky-Green test. Adherence to hypertension treatment was low; however, there was a high rate of BP control when subjects with the white-coat effect were included in the analysis.
Arquivos brasileiros de cardiologia 06/2012; 99(1):636-641. · 1.32 Impact Factor
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ABSTRACT: Several studies have demonstrated that one exercise session (ES) on a cycloergometer or ergometric treadmill causes a reduction in blood pressure (BP). However, there are few similar studies on walking, which is the exercise modality most available to the elderly. We investigated the immediate and 24-h effects of walking on BP in independent, community-living elderly individuals. Volunteers participated in a single ES and resting control session (CS). Before and after each session, BP was measured by auscultatory and oscillometric methods. After each session, 24-h ambulatory blood pressure monitoring was conducted. An accelerometer was installed 48 h before the sessions and left in place for 5 days. The mean volunteer age was 67.7±3.5 years; 11 were hypertensive patients under treatment, and 12 were normotensive. In the total sample, there were immediate 14mm Hg and 12 mm Hg reductions in systolic BP (SBP) after the ES according to the auscultatory and oscillometric methods, respectively. Diastolic BP (DBP) was reduced by 4 mm Hg after the ES according to both methods. SBP during wakefulness and sleep and DBP during wakefulness were lower after the ES than after the CS (P<0.01), when wakefulness and sleep were determined individually (variable-time pattern) using data from the activity monitors and provided by the volunteers. The variable-time pattern was more effective in detecting reductions in BP than the fixed-time pattern.
Hypertension Research 02/2012; 35(4):457-62. · 2.58 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the multisegmental static postural balance of active eutrophic and obese elderly women using a three-dimensional system under different sensory conditions.
A cross-sectional study was conducted on 31 elderly women (16 eutrophic and 15 obese) aged 65 to 75 years. The following anthropometric measurements were obtained: weight, height, waist and hip circumference, and handgrip strength. The physical activity level was evaluated using the International Physical Activity Questionnaire. Body composition was measured using the deuterium oxide dilution technique. The Polhemus(®) Patriot (three-dimensional) equipment was used to measure the parameters of postural balance along the anteroposterior and laterolateral axes. The data acquisition involved one trial of 60 s to test the limit of stability and four trials of 90 s each under the following conditions: (1) eyes open, stable surface; (2) eyes closed, stable surface; (3) eyes open, unstable surface; and (4) eyes closed, unstable surface.
For the limit of stability, significant differences were observed in the maximum anteroposterior and laterolateral displacement (p<0.01) and in the parameter maximum anteroposterior displacement in the eyes closed stable surface condition (p<0.01) and maximum anteroposterior and laterolateral displacement in the eyes open unstable surface (p<0.01 and p = 0.03) and eyes closed unstable surface (p<0.01 and p<0.01) conditions.
Obese elderly women exhibited a lower stability limit (lower sway area) compared with eutrophic women, leaving them more vulnerable to falls.
Clinics (São Paulo, Brazil) 01/2012; 67(5):475-81. · 1.59 Impact Factor
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ABSTRACT: Acute resistance exercise can reduce the blood pressure (BP) of hypertensive subjects. The aim of this study was to evaluate the effect of different volumes of acute low-intensity resistance exercise over the magnitude and the extent of BP changes in treated hypertensive elderly individuals. Sixteen participants (7 men, 9 women), with mean age of 68 ± 5 years, performed 3 independent randomized sessions: Control (C: 40 minutes of rest), Exercise 1 (E1: 20 minutes, 1 lap in the circuit), and Exercise 2 (E2: 40 minutes, 2 laps in the circuit) with the intensity of 40% of 1 repetition maximum. Blood pressure was measured before (during 20 minutes) and after each session (every 5 minutes during 60 minutes) using both a mercury sphygmomanometer and a semiautomatic device (Omrom-HEM-431). After that, 24-hour ambulatory blood pressure monitoring was performed (Dyna-MAPA). Blood pressure decreased during the first 60 minutes (systolic: p < 0.01, diastolic: p < 0.05) after all exercise sessions. Only the highest volume session promoted a reduction of mean systolic 24-hour BP and awake BP (p < 0.05) after exercise, with higher diastolic BP during sleep (p < 0.05). Diastolic 24-hour BP and both systolic and diastolic BP during sleep were higher after E1 (p < 0.05). Concluding, acute resistive exercise sessions in a circuit with different volumes reduced BP during the first 60 minutes after exercise in elderly individuals with treated hypertension. However, only the highest volume promoted a reduction of mean 24-hour and awake systolic BP.
The Journal of Strength and Conditioning Research 04/2011; 25(4):1016-23. · 1.83 Impact Factor
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ABSTRACT: Early detection of postural disorders is essential for timely interventions in patients with imbalance.
A pilot study describing a new tool for evaluating static postural balance.
A cross-sectional study of a contemporary series.
Twenty-five volunteers (15 women and 10 men) were evaluated. The mean age was 25.8 ± 4.2 years, the mean weight was 63.9 ± 13.1Kg, the mean height was 1.68 ± 0.08 m and the body mass index was 22.3±3.3kg/m2. Posturography was done by analysing postural sway with an electromagnetic system; a sensor was attached to the skin over the spinous process of the first thoracic vertebra. Tests were carried out with the subjects in the orthostatic position for 90 seconds, with eyes opened(EO) and closed(EC) on stable and unstable surfaces.
When the influence of the surface was analyzed (stable x unstable) in the EO condition, there were significant differences in the middle-lateral parameters (m-l) (p=0.004) and total path (p=0.01), and in the m-l (p=0.004) and total (p=0.014) speed. In the EC condition, there were significant differences in all parameters (p<0.001). The influence of the vision was observed in all parameters only on unstable surfaces (p<0.05).
The new tool was efficient for analysing postural sway.
Brazilian journal of otorhinolaryngology 12/2010; 76(6):783-8.
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ABSTRACT: Different methods of measuring blood pressure (BP) have been used in clinical and scientific evaluations. However, the methods employed have constraints and peculiarities to be considered.
To evaluate whether similar BP values are obtained in elderly hypertensive patients undergoing resistance exercises when using the oscillometric (Omron-HEM-431) and auscultatory methods (mercury sphygmomanometer).
Sixteen elderly hypertensive patients underwent three randomized experimental sessions with different volumes: control (C: 40 minutes), exercise 1 (E1: 20 minutes) and exercise 2 sessions (E2: 40 minutes). BP was measured simultaneously through two methods every 5 minutes for 20 minutes before the sessions and during 60 minutes after them.
In the pre-intervention period, there was concordance between systolic blood pressure (SBP) and diastolic blood pressure measurements (DBP) obtained through two methods, as well as a high overall concordance after the sessions (Lin's concordance coefficient = 0.82 and 0.81, respectively). Greater concordance in DBP was found after the control session than after exercise sessions. The difference between the measurements obtained between the two methods was greater for DBP than for SBP after all sessions (p < 0.001). Regardless of the method, SBP and DBP fell in the first 60 minutes after the exercises.
The auscultatory and oscillometric methods were consistent before and after the control and exercise sessions. However, greater differences were found in DBP than in SBP. The latter was very similar between methods.
Arquivos brasileiros de cardiologia 05/2010; 94(5):656-62. · 1.32 Impact Factor
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ABSTRACT: The assessment of food intake is essential for the development of dietetic interventions. Accuracy is low when intake is assessed by questionnaires, the under-reporting of food intake being frequent. Most such studies, however, were performed in developed countries and there is little data about the older population of developing nations. This study aimed to verify the total energy expenditure (TEE) of independent older Brazilians living in an urban area, through the doubly labelled water (DLW) method and to compare it with the reported energy intake obtained through the application of a food frequency questionnaire (FFQ). Initially, 100 volunteers aged from 60 to 75 years had their body composition determined by dual-energy X-ray absorptiometry (DEXA). Five volunteers of each quartile of body fat percentage had their energy expenditure determined by DLW. The mean age of the subjects included in this phase of the study was 66.4 +/- 3.5 years, and ten of the subjects were men. The mean TEE was 2565 +/- 614 and 2154 +/- 339 kcal.day(-1) for men and women, respectively. The Physical Activity Level (PAL) was 1.58 +/- 0.31 and 1.52 +/- 0.22, respectively. Under-reporting of food intake was highly prevalent, with a mean percentage of reported intake in relation to measured TEE of -17.7%. Thus, under-reporting of food intake is highly prevalent among Brazilian independent older persons. The DLW method is an important tool in nutritional studies and its use is to be recommended in developing countries.
Rapid Communications in Mass Spectrometry 03/2010; 24(5):506-10. · 2.79 Impact Factor
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ABSTRACT: The objective of this study was to verify the protein turnover rates of healthy older persons under a usual protein-rich diet and to compare values to those described in the literature. This cross-sectional study was conducted at Metabolism Unit, Univ. Hospital of the School of Medicine of Ribeirao Preto, Univ. of Sao Paulo, Brazil. In this study, 7 healthy older persons aged 65.4 +/- 2.8 y, with BMI 22.7 +/- 2.4 kg/m(2) and a mean daily protein intake of 1.34 g of protein/kg were studied. A 9-h whole-body (15)N-glycine single-dose study was performed after an overnight fast. During the study, each subject received 6 isoenergetic, isonitrogenous meals at 2-h intervals based on their average intake. Ammonium, urea, and total nitrogen were quantified and analyzed by mass spectrometry, with the determination of total protein turnover rates by the (15)N-glycine method. The results show that total nitrogen output was 3.2 +/- 0.96 g/N and intake 7.7 +/- 1 g/N, (15)N nitrogen flux was 30.6 +/- 6.3 g/9 h. Endogenous nitrogen balance was positive (4.5 g +/- 1 g/N in 9 h). In conclusion, the protein turnover of healthy older persons under a usual protein-rich diet is positive during the fed state and has synthesis and degradation rates similar to those previously described in studies involving diet adaptation periods.
Journal of Food Science 06/2009; 74(4):H112-5. · 1.66 Impact Factor
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ABSTRACT: There is an increasing interest about the use of stable isotopes for body composition analysis in pediatrics. To ensure the success of total body water analysis by the deuterium dilution method, it is fundamental to determine the equilibrium time (plateau) of deuterium in the body fluid studied.
We report here the equilibration time of deuterium oxide in the saliva of newborns after oral intake of the isotope.
Twenty healthy term newborn infants, 10 males and 10 females, were analyzed. Saliva was collected from each newborn before the oral administration of a 100 mg/kg dose of deuterium oxide (baseline sample) and then at 1-hour intervals for 5 hours after administration. Deuterium enrichment of saliva was determined by isotope ratio mass spectrometry according to the recommendations of the International Atomic Energy Agency.
The plateau time of deuterium in saliva occurred 3 hours after oral administration of the stable isotope.
These data are essential for further studies on the body composition of newborn infants. To the best of our knowledge, this is the first study regarding the equilibration time of deuterium in the saliva of term newborns.
Journal of pediatric gastroenterology and nutrition 05/2009; 48(4):471-4. · 2.18 Impact Factor
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ABSTRACT: Underreporting of energy intake is prevalent in food surveys, but there is controversy about which dietary assessment method provides greater underreporting rates. Our objective is to compare validity of self-reported energy intake obtained by three dietary assessment methods with total energy expenditure (TEE) obtained by doubly labeled water (DLW) among Brazilian women.
We used a cross-sectional study.
Sixty-five females aged 18 to 57 years (28 normal-weight, 10 overweight, and 27 obese) were recruited from two universities to participate.
TEE determined by DLW, energy intake estimated by three 24-hour recalls, 3-day food record, and a food frequency questionnaire (FFQ).
Regression and analysis of variance with repeated measures compared TEE and energy intake values, and energy intake-to-TEE ratios and energy intake-TEE values between dietary assessment methods. Bland and Altman plots were provided for each method. chi(2) test compared proportion of underreporters between the methods.
Mean TEE was 2,622 kcal (standard deviation [SD]=490 kcal), while mean energy intake was 2,078 kcal (SD=430 kcal) for the diet recalls; 2,044 kcal (SD=479 kcal) for the food record and 1,984 kcal (SD=832 kcal) for the FFQ (all energy intake values significantly differed from TEE; P<0.0001). Bland and Altman plots indicated great dispersion, negative mean differences between measurements, and wide limits of agreement. Obese subjects underreported more than normal-weight subjects in the diet recalls and in the food records, but not in the FFQ. Years of education, income and ethnicity were associated with reporting accuracy.
The FFQ produced greater under- and overestimation of energy intake. Underreporting of energy intake is a serious and prevalent error in dietary self-reports provided by Brazilian women, as has been described in studies conducted in developed countries.
Journal of the American Dietetic Association 01/2009; 108(12):2031-40. · 3.59 Impact Factor
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ABSTRACT: The aim of the present study was to determine whether under-reporting rates vary between dietary pattern clusters. Subjects were sixty-five Brazilian women. During 3 weeks, anthropometric data were collected, total energy expenditure (TEE) was determined by the doubly labelled water method and diet was measured. Energy intake (EI) and the daily frequency of consumption per 1000 kJ of twenty-two food groups were obtained from a FFQ. These frequencies were entered into a cluster analysis procedure in order to obtain dietary patterns. Under-reporters were defined as those who did not lose more than 1 kg of body weight during the study and presented EI:TEE less than 0.82. Three dietary pattern clusters were identified and named according to their most recurrent food groups: sweet foods (SW), starchy foods (ST) and healthy (H). Subjects from the healthy cluster had the lowest mean EI:TEE (SW = 0.86, ST = 0.71 and H = 0.58; P = 0.003) and EI - TEE (SW = - 0.49 MJ, ST = - 3.20 MJ and H = - 5.08 MJ; P = 0.008). The proportion of under-reporters was 45.2 (95 % CI 35.5, 55.0) % in the SW cluster; 58.3 (95 % CI 48.6, 68.0) % in the ST cluster and 70.0 (95 % CI 61.0, 79) % in the H cluster (P = 0.34). Thus, in Brazilian women, under-reporting of EI is not uniformly distributed among dietary pattern clusters and tends to be more severe among subjects from the healthy cluster. This cluster is more consistent with both dietary guidelines and with what lay individuals usually consider 'healthy eating'.
The British journal of nutrition 05/2008; 100(5):1060-8. · 3.45 Impact Factor
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ABSTRACT: This study aimed to verify if older patients admitted to a tertiary care geriatric ward with no spontaneous complaints of dysphagia have impaired swallowing function as detected by a specialized clinical assessment and a scintigraphic study of swallowing. Thirty patients (mean age = 76.2 years, 17 women), consecutively admitted for the treatment of acute or chronic diseases, were studied. Two control groups were also studied, one consisting of 10 healthy older persons (mean age = 69.6 years, 5 women) and the other consisting of 20 young volunteers (mean age = 25.4 years, 11 women). A complete clinical assessment of swallowing was performed by a speech pathologist. Each subject was also submitted to scintigraphic studies of oropharyngeal transit after swallowing liquid and syrup boluses labeled with 99m technetium phytate. Transit time, clearance time, and residuals were measured. Five patients had impairments in swallowing function detected by clinical assessment, three of them in the absence of complaints even after specific questioning. Scintigraphic transit times did not differ between the groups studied; however, residuals after syrup swallows were greater in the patient group compared with the healthy older volunteers. These findings suggest an increased risk for aspiration and the usefulness of a brief assessment of swallowing function in all patients admitted to tertiary care geriatric wards.
Dysphagia 04/2008; 23(1):1-6. · 1.39 Impact Factor
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ABSTRACT: Under conditions of energy balance, energy intake (EI) equals energy expenditure (EE), and the validity of EI may be determined by comparing these two measures. The doubly labeled water (DLW) method is the gold standard for the determination of EE. Its use in developed countries has showed an intense underreporting of EI. Few studies concerning underreporting have been conducted in developing nations, and none of them has used DLW. This review will present the results of such studies, extrapolating data using DLW and providing EE and EI estimates, but which were not concerned with underreporting. A panorama of underreporting and its implications in developing nations is discussed and future directions for research are identified.
Nutrition Reviews 08/2006; 64(7 Pt 1):319-30. · 4.47 Impact Factor
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ABSTRACT: To evaluate the variation in aerobic capacity and postural balance of independents elderly for a period of three years.
The aerobic capacity of the volunteers was assessed using a six minutes walk test (6MWT), the postural balance was assessed using the Berg Balance Scale (BBS), the number of falls was self-reported and physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ - long version). Evaluations undertaken in 2008 were compared to those performed in 2005.
There were no differences in balance and number of falls between 2008 and 2005 (p>0.05). There was a decrease in aerobic capacity over time of 52.46±8.4 meters walked. The IPAQ showed an increase in physical activity on the second evaluation (83.3%).
The present study demonstrated that balance, evaluated using BBS did not change in the active independent elderly for a period of three years. However, over the there year period there was a decrease in aerobic capacity evaluated using the 6MWT.
Revista Brasileira de Fisioterapia 15(4):272-7. · 0.44 Impact Factor
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