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- 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.
- A reliable M-mode ultrasound protocol for the assessment of diaphragm motionPublication . Parreira, Filipe; Machado, Rui; Tomás, Maria Teresa; Ribeiro, RicardoDiaphragm is the principal inspiratory muscle. Different techniques have been used to assess diaphragm motion. Among them, M-mode ultrasound has gain particular interest since it is non-invasive and accessible. However it is operator-dependent and no objective acquisition protocol has been established. Purpose: to establish a reliable method for the assessment of the diaphragmatic motion via the M-mode ultrasound.
- 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.
- Functional capacity and levels of physical activity in aging: a 3-year follow-upPublication . Tomás, Maria Teresa; Galán-Mercant, Alejandro; Alvarez Carnero, Elvis; Fernandes, BeatrizOver the last decades, the world elderly population has increased exponentially and this tendency will continue during the coming years; from 2000 to 2050, people over 60 will double and those over 80 will quadruple. Loss of independence occurs as people age due to mobility restrictions, frailty, and decreased functional fitness and cognitive abilities. Evidence has shown that appropriate programs and policies contribute to keep older adults healthy and independent over time. The purpose of this chapter is to report the results of our 3-year follow-up study designed to characterize functional physical fitness in a sample of Portuguese community-dwelling older adults to propose a set of functional parameters that decline the most. We studied a group of 43 elderly people, aged 60 and over. Variables assessed on the participants were anthropometric measurements, functional capacity with the Senior Fitness Test battery (muscle strength, aerobic endurance, flexibility, agility, and dynamic balance), handgrip strength, levels of physical activity, and balance. Three years after the first assessment, a second assessment of the same variables was conducted. We analyzed what were the variables that, for this group, were related to a healthier aging and the relation with different physical activity levels. Our study showed that the distance covered in 6-min walk test and handgrip strength seem to explain a great amount of variability on functional variables that have changed on this period (68% of balance, lower and upper functional strength, respectively) and the active participants showed fewer decrements with aging in anthropometric and functional variables than those inactive or insufficiently active (p < 0.05). Greater importance should be given to prescription of exercise targeting older adults and, specifically, walking and manual activities should be given more attention as components of a community exercise program.
- Association between grip strength, anthropometric data and functional capacityPublication . Nascimento, Angélica Soares do; Pinto, Inês Rosendo; Abreu, Mónica Martinho; Almeida, Sofia Pereira de; Fernandes, Beatriz; Tomás, Maria TeresaThe hand is one of the most important instruments of the human body, mainly due to the possibility of grip movements. Grip strength has been described as an important predictor of functional capacity. There are several factors that may influence it, such as gender, age and anthropometric characteristics. Functional capacity refers to the ability to perform daily activities which allow the individual to self-care and to live with autonomy. Composite Physical Function (CPF) scale is an evaluation tool for functional capacity that includes daily activities, self-care, sports activities, upper limb function and gait capacity. In 2011, Portugal had 15% of young population (0-14years) and 19% of elderly population (over 65 years). Considering the double-ageing phenomen, it is important to understand the effect of the grip strength in elderly individuals, considering their characteristics, as the need to maintainin dependency as long as possible.
- Body composition changes over three years in older adults: a descriptive longitudinal analysisPublication . Tomás, Maria Teresa; Galán-Mercant, Alejandro; Fernandes, BeatrizIntroduction: Many studies analyze body composition changes in older adults. However, few studies analyze body composition in elderly people with functional measures. Studies using Double X-Ray analysis (DXA) or Bioimpedance analysis proved to be reliable but expensive or only possible in a laboratory environment. The purpose of our study was to analyze changes in body composition over three years using anthropometric measures in a sample of elderly people in order to perceive functional changes. Methods: Forty-three participants (12 men; 31 women) aged 60 years and over and independent in activities of daily life were assessed using anthropometric measures in the first moment and past three years. Weight, height, waist and hip circumference were measured, and body mass index (BMI) and waist-to-hip ratio (WHR) were also calculated. Skeletal muscle mass (SMM) was also calculated using Al-Gindan et al. (2014) equations and normalized for height to found skeletal muscle index (SMI) in order to analyze cut-off points associated with physical disability according to Janssen et al (2004). Results: A significant difference was found over three years in SMM (p = 0.007), SMI (p = 0.027), BMI (p = 0.041) and WHR (p = 0.003). The majority of the participants has decreased SMM, SMI, and BMI and increased WHR, which favors a worst prognostic for comorbidities associated with these variables, and a tendency for sarcopenic obesity seems to be present although more studies are needed. Also, we found that using cut-off points for disability risk 83.3% of the men and 38.7% of the women of our sample were at moderate or high risk of disability. Three years later this percentage has increased but only for women to 54.8%. Conclusions: Although men are at risk of disability, women quickly lose their functional capacity, making necessary a rapid intervention to reduce the risk of disability in this population.
- Instrumented 6-minutes walk test, an approach to improve the traditional testPublication . Galán-Mercant, Alejandro; Tomás, Maria Teresa; Fernandes, BeatrizIntroduction: Exercise testing is frequently used to assist clinicians in assessing prognosis and evaluating response to treatment. The 6-min walk test is a standardized test of functional exercise capacity. Objectives: The aim of the present study was to identify and describe the anthropometric characteristics, gait velocity and instrumented 6-min walk test with kinematics parameters from the inertial sensor during the test in a Portuguese population of subjects over 65 years. Methods: They were measured variables related to anthropometrics, the 6-min walk test and kinematic variables in the 6-min walk test related to accelerations and angular velocity. Results: The results were; six minutes walk (359,26 ± 107.49 meters), initial heart rate (72,95 ± 7,74BPM), final initial heart rate (80,58 ± 13,86 BPM), initial systolic blood pressure (148,42 ± 21,25 mmHg), final systolic blood pressure (164,26 ± 24,49 mmHg), initial diastolic blood pressure (75,63 ± 11,04 mmHg), final diastolic blood pressure (77,00 ± 9,52 mmHg), gait velocity (1,04 ± 0,37 m/s), max rotation rate X (1,05 ± 0,36 rad/s), min rotation rate X (−0,82 ± 0,33 rad/s), max rotation rate Y (2,63 ± 0,96 rad/s), min rotation rate Y (−1,69 ± 0,81 rad/s), max rotation rate Z (1,03 ± 0,33 rad/s), min rotation rate Z (−1,12 ± 0,38 rad/s), max acceleration X (0,77 ± 0,37 m/s2), min acceleration X (−0,91 ± 0,44 m/s2), max acceleration Y (0,53 ± 0,23 m/s2), min acceleration Y (−1,25 ± 0,70 m/s2), max acceleration Z (0,49 ± 0,14 m/s2), min acceleration Z (−0,96 ± 0,34 m/s2). Conclusions: The only one outcome in 6-min walk the test (total distance in meters), could be complemented with inertial sensor information. This new complement could be interesting in order to understand other dimensions in the 6-min walk or identify changes in function and results in the test after a program to improve physical fitness.