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- Avaliação funcional, equilíbrio e risco de queda em idosos independentes residentes na comunidade no concelho de LouresPublication . Fernandes, Beatriz; Tomás, Maria Teresa; Quirino, DiogoIntrodução - Em virtude do seu crescente índice de envelhecimento a população portuguesa apresenta um potencial aumento do risco elevado de quedas. Este risco está relacionado com níveis mais baixos e força dos membros inferiores e equilíbrio, factores que estão relacionados com o declínio funcional. A fisioterapia tem reconhecidamente um papel fundamental não só na intervenção nesta área, mas também na identificação dos factores relacionados com o risco de queda. Objetivo do estudo - Caracterizar o risco de queda e factores relacionados em idosos residentes na comunidade.
- Handgrip strengthPublication . Tomás, Maria Teresa; Fernandes, BeatrizThe basic function of the human hand is the manipulation and grasping of various objects in all daily activities, including work activities. This is greatly influenced by strength and manual dexterity. However age, gender and other contexts such as work or leisure activities could influence strength. Handgrip strength, a measure of maximum voluntary force of the hand, has proved to be reliable and valid as an objective parameter to evaluate the functional integrity of the hand as part of the musculoskeletal system. It correlates highly with strength in other muscular groups and is therefore considered as a good indicator of overall muscular strength and functional stress and could be used as a predictor of physical disability. Handgrip strength assessment is simple and reliable and used commonly by several investigators and health professionals, in different contexts (medical, nutritional, rehabilitation, professional settings, engineering, etc.) and with different purposes (research, diagnostic, assessment, etc.). In clinical and rehabilitation settings is of vital importance in the determination of effectiveness of several interventions and for monitoring evolution of diseases. Various ways (methods, techniques and equipments) of collecting information on grip strength have been reported. This chapter will review basic concepts on handgrip function, methodologies of assessment, contexts of application and correlates, such as physical activity, health or nutritional status. Several populations and reference values as also the relationships between handgrip and clinical status, aging, risk of disability and diseases, will be discussed.
- Lower limbs strength, balance, mobility and risk of falling in community-dwelling older adultsPublication . Fernandes, Beatriz; Tomás, Maria Teresa; Quirino, DiogoIntroduction - During the last decades, there has been a rapid aging of the Portuguese population. The aging process involves several changes namely a decreasing in lower limbs strength, mobility and balance which contributes to increasing the risk of falling and the likelihood to suffer fractures or traumatic brain injuries among other injuries. Physiotherapy can develop an important intervention in identifying the factors that potentiate the risk of falling and can provide strategies to prevent or reverse this risk. The purpose of this study was to characterize the risk of falling and related factors in a sample of Portuguese community-dwelling older adults. Methods - A cross-sectional study. 74 subjects participated in the study (50 women, 24 men), aged 65-97 years, apparently healthy, independent and living in the community. The following tests were used: to assess lower limbs strength the 30s chair stand test; 8-foot up and go test to assess mobility and the Berg Balance Scale (BBS) to assess balance. The risk of falling was determined based on BBS. Results - The results of our study showed that for 30s chair stand test the mean value was 11 repetitions and for 8-foot up and go test was 8.63 seconds. For BBS the median was 53 points. 36.5% of the participants reported at least one fall during the previous year. Negative correlations have been found between 8-foot up and go test and 30s chair stand test (R=0.664; p=0.00) and between 8-foot up and go test and BBS (R=0.653; p=0.00). A weak positive correlation was also found between 30s chair stand test and BBS (R=0.475; p=0.00). Discussion - The results of the 8-foot up and go test (>8,5 seconds) indicate that this population was at risk of falling. In addition, BBS scores showed that the risk of falling was 11%. Lower limbs strength was decreased compared with reference values for Portuguese population. Assessment of these factors seems to be recommended in order to develop and implement strategies directed to increase lower limbs strength, balance, and mobility and decrease the risk of falling.
- Envelhecer em equilíbrioPublication . Fernandes, Beatriz; Tomás, Maria TeresaUm idoso saudável não apresenta riscos acrescidos de queda pelo simples facto de ser idoso. O estilo de vida sedentária contribui para acelerar o processo de envelhecimento. Os programas de exercísio físico regular e mantidos a longo prazo reduzem o risco de quedas nos idosos.
- Prevenir para não cair: guia de exercíciosPublication . Fernandes, Beatriz; Cebola, Marisa; Ferreira, Miguel Marques; Tomás, Maria TeresaA atividade física e o exercício regular são importantes para a saúde física e mental de qualquer cidadão desde os mais jovens aos mais idosos e desde os mais saudáveis aos menos saudáveis. A atividade física regular e o exercício regular podem reduzir o risco de desenvolver algumas doenças ou podem mesmo ser um tratamento eficaz para muitas doenças crónicas. Muitos estudos demonstraram já que pessoas com diabetes, doenças cardíacas ou respiratórias, artrites, hipertensão arterial ou problemas de equilíbrio, entre outros, beneficiam dos efeitos positivos da atividade física e do exercício regular na gestão das suas doenças. Por isso mantenha-se ativo. Faça uma atividade que lhe dê prazer, preferivelmente todos os dias pelo menos durante 30 minutos. Caminhe idealmente 10.000 passos por dia. Passeie o seu cão, suba as escadas em vez de ir de elevador, ou faça outra atividade. Reduza o tempo que passa sentado. Adicionalmente a isto, ou em alternativa, oferecemos-lhe neste guia um conjunto de exercícios que o vão ajudar a manter-se mais ativo e a manter a sua força muscular, a sua flexibilidade e no geral a sua capacidade funcional.
- Walking for functional lifePublication . Tomás, Maria Teresa; Carnero, Elvis; Galán-Mercant, Alejandro; Fernandes, BeatrizNas próximas décadas os indivíduos com mais de 60 anos duplicarão e os indivíduos com mais de 80 anos quadruplicarão. A perda de independência ocorre devido a vários fatores (restrições à mobilidade, fragilidade, etc.). Conclusões: Quando se prescreve exercicio ou programas de promoção da saúde tendo como alvo populações idênticas às deste estudo, deve existir uma atenção especial para as atividades de marcha e atividades que utilizam as mãos (motricidade fina), uma vez que estes componentes específicos parecem ter um maior impacto na aptidão física functional. Programas adequados e políticas adequadas mostraram contribuir para manter adultos mais velhos saudáveis e independentes ao longo do tempo com um impacto social, financial e suporte de saúde pública positivo. Os resultados apontam para a importância da prescrição de exercício conciso tendo como alvo adultos mais velhos. Deve ser dada mais atenção especificamente à marcha e a atividades manuais como componentes de um programa de exercício comunitário, como objetivo de aumentar o envelhecimento ativo e saudável.Também uma maior atenção deve ser dada às estruturas ambientais (parques, jardins públicos, etc.), de modo a aumentar as atividades de marcha para todos, especialmente para os mais velhos.
- Grip strength: are dinamometers equivalent? JAMAR vs E-LinkPublication . Tomás, Maria Teresa; Fernandes, BeatrizLevels of risk for future disability can be assessed with grip strength. This assessment is of fundamental importance for establishing prevention strategies. It also allows verifying relationships with functional capacity of individuals. Most studies on grip strength use the JAMAR Hydraulic dynamometer that provides the value of isometric force obtained during the performance of grip movement and is considered the “gold standard” for measurement of grip strength. However, there are different dynamometers available commercially, such as portable computerized dynamometer E-Link (Biometrics), which provides the value of maximum force (peak force) in addition to other variables as the rate of fatigue for hand strength, among others. Of our knowledge, there are no studies that allow us to accept or not and compare values obtained with both devices and perhaps use them interchangeably. The aim of this study was to evaluate the absolute agreement between the measurements of grip strength (peak force or maximum force in kg) obtained from two different devices (portable dynamometers): a computerized (E-Link, Biometrics) and one hydraulic (JAMAR).
- Physiotherapy and Duchenne muscular dystrophyPublication . Fernandes, Beatriz; Tomás, Maria TeresaDuchenne muscular dystrophy (DMD) is a severe, progressive disease first described by Meryon in 1852 and later by Guillaume Duchene. It is the most common and severe form of childhood muscular dystrophy, affecting 1 in 3500 live male births. Is caused by an X—linked recessive genetic disorder resulting in a deficiency of the dystrophin protein, responsible for linking contractile proteins to the sarcolemma. Diagnosis is not always easy and the first symptoms are often related to weakness and difficulty or delay in acquiring the ability to perform simple activities. Progressive weakness leads to the use of compensatory strategies in order to maintain the ability to walk and perform other activities. Respiratory muscles are also affected and the complications resulting from its impairments are frequently the cause of early death of these patients. The advances in DMD management has increased life expectancy of these children with the need for adequate care in adulthood. DMD manifestations include muscle weakness, contractures, respiratory and cardiac complications. Some authors also refer that one-third of patients have difficulties with learning and delayed global development because the gene that encodes dystrophyn expresses various dystrophin isoforms that are found in Schwann and Purkinje celis in the brain. Body functions and structure impairments like muscle weakness, contractures and reduced range of motion lead to limitations in activities, i.e., impairments affect the performance of tasks by the individual. In a physiotherapist’s point of view analysing these limitations is mandatory because physiotherapy’s final purpose is to restore or preserve the ability to perform ADL and to improve quality of life.
- Functionality and functional capacity in a community-dwelling older adults in PortugalPublication . Tomás, Maria Teresa; Fernandes, Beatriz; Quirino, DiogoBackground and aims: Portuguese population has a higher risk of functional decline and frailty. This trend, along with a growing aging index, poses a major economic and social challenge to health in aging people. The purpose of our study was to characterize functional physical fitness in community-dwelling older adults in order to prevent functional decline and an increase in health care costs. Methods: Our sample consisted of 128 older adults (95 women, 33 men), aged 65-97 years, independent and living in Loures municipality, Portugal. Functional physical fitness was assessed with Senior Fitness Test Battery. The predicted distance was calculated with Troosters et al (1999) equation. Grip strength was assessed with hydraulic dynamometer Jamar® and functional capacity with the Composite Physical Function (CPF) Scale. A basic descriptive analysis was conducted (statistical package SPSS IBM for Windows, v22) and the sample was stratified by age. Results: Senior Fitness Test Battery and grip strength scores suggested low levels of strength, flexibility, endurance, and balance, compared with other similar populations, suggesting a higher risk for sarcopenia. Distance walked by our sample remained at 73% of the estimated distance. When stratified by age, the percentage of estimated distance shows a greater decrease. On CPF, 80% of our sample presented moderate or low levels of functional capacity. Conclusions: Functional fitness of this population appears to have lower values than expected. Distance walked shows a decrement higher than expected with a probable faster aging than the expected. Our study provides the first assessment of grip strength in an elder Portuguese population showing also lower values for this component of functionality. Compared to other populations, functional capacity (CPF) is at moderate or low level. These results are important to justify an urgent intervention in order to increase functional capacity or at least contribute to a slower decrease.
- Assessing physical activity and functional fitness level using convolutional neural networksPublication . Galán-Mercant, Alejandro; Ortiz, Andrés; Herrera-Viedma, Enrique; Tomás, Maria Teresa; Fernandes, Beatriz; Moral-Munoz, Jose A.Older adults are related to a reduction in physical functionality, as a result of a musculoskeletal system degeneration. In that way, physical exercise has been stated as a suitable intervention to prevent such health problems. Therefore, an adequate assessment of the physical activity and functional fitness levels is needed to plan the individualized intervention. A broad test used to assess the functional fitness level is the 6-minutes walk test (6MWT). It has been previously measured using accelerometer sensors. In views of this background, the main aim of the present study is to use deep learning to extract automatically and to predict the physical activity and functional fitness levels of the older adults through the acceleration signals recorded by a smartphone during the 6MWT. A total of 17 participants were recruited. Anthropometric measurements (weight, height, and body mass index), physical activity, and functional fitness levels from each participant were recorded. Consecutively, two deep learning-based methods were applied to determine the prediction. According to the results, the proposed method can predict physical activity and functional fitness levels with high accuracy, even using only one cycle. Thus, the approach described in the present work could be implemented in future mobile health systems to identify the physical activity profile of older adults.