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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.
- 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.
- Predicted VO2 on 6 minutes walk test for FAP liver transplanted patientsPublication . Tomás, Maria Teresa; Santa-Clara, Helena; Bruno, P. M.; Monteiro, E.; Barroso, E.; Sardinha, L.Physical function is limited post-liver transplantation and exercise training can improve exercise capacity following transplantation but previously assessment of functional capacity is necessary. The 6 minute walk test (6MWT) is routinely used for studying patient’s exercise capacity and is less expensive and time consuming than a Cardiopulmonary Exercise Test (CPXT). There have been some studies looking at the relationship between 6MWT and peak VO2 in patients but few presented an adequate equation for predicted peak VO2 from 6MWT to transplanted patients and none for Familial Amyloidotic Polyneuropathy (FAP) liver transplanted patients (FAPTx). The aim of this study was to compare the validity of 6 equations as predictors of VO2 from the 6MWT and compare it with directly measured VO2 in patients FAPTx.
- Functional respiratory capacity in the elderly after COVID-19: a pilot studyPublication . Pereira, Filipe Alexandre; Tomás, Maria TeresaBackground: The pandemic spread of SARS-CoV-2 has led to an unprecedented outbreak of viral pneumonia. Despite the current focus of worldwide research being the characterization of post-COVID-19 sequelae, the level of functional impact that this disease causes in the elderly who have presented moderate, severe, or critical manifestations is still unknown. Objective: To identify the main consequences/sequelae on functional respiratory capacity in the elderly after CoViD-19. Methodology: A cross-sectional study was carried out in the community. Functional aerobic capacity (2min step test), dyspnea perception (modified Medical Research Council Dyspnea Questionnaire), respiratory and peripheral muscle strength (maximum inspiratory and expiratory pressure, grip strength), and the Frailty Index (Clinical Fragility Scale) were assessed in 25 community-dwelling individuals aged ≥65 years, who have had a diagnosis of CoViD-19 for up to 6 months, and in an equal number of elderly people with the same characteristics without a known diagnosis of CoViD-19. Results: The elderly with a diagnosis of CoViD-19 up to 6 months presented a decrease in the values of maximum inspiratory pressure (p=0.001) and maximum expiratory pressure (p=0.015), in aerobic capacity (p<0.001) with a significant presence of desaturation on exertion (p<0.001), and increased values of dyspnea perception (p=0.001) and Frailty Index (p=0.026). Conclusion: Significant changes were found in the functional respiratory capacity of elderly patients diagnosed with CoViD-19 for up to 6 months when compared with elderly individuals without a known diagnosis of CoViD-19. It is not possible to extrapolate the results obtained to the Portuguese population, however, these results may be an important indicator in the characterization of sequelae in the elderly after infection by SARS-CoV-2.
- 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.