The present study estimated the prevalence of metabolic syndrome (MS) according to the criteria established by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) and the International Diabetes Federation (IDF) and analyzed the contribution of social factors in an adult urban population in the Southeastern region of Brazil. The sample plan was based on multistage probability sampling according to family head income and educational level. A random sample of 1116 subjects aged 30 to 79 years was studied. Participants answered a questionnaire about socio-demographic variables and medical history. Fasting capillary glucose (FCG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides were determined and all non-diabetic subjects were submitted to the 75-g oral glucose tolerance test. Body mass index (BMI, kg/m²), waist circumference and blood pressure (BP) were determined. Age- and gender-adjusted prevalence of MS was 35.9 and 43.2% according to NCEP-ATPIII and IDF criteria, respectively. Substantial agreement was found between NCEP-ATPIII and IDF definitions. Low HDL-C levels and high BP were the most prevalent MS components according to NCEP-ATPIII criteria (76.3 and 59.2%, respectively). Considering the diagnostic criteria adopted, 13.5% of the subjects had diabetes and 9.7% had FCG ≥100 mg/dL. MS prevalence was significantly associated with age, skin color, BMI, and educational level. This cross-sectional population-based study in the Southeastern region of Brazil indicates that MS is highly prevalent and associated with an important social indicator, i.e., educational level. This result suggests that in developing countries health policy planning to reduce the risk of MS, in particular, should consider improvement in education.

CONTEXTUALIZAÇÃO: A dor crônica e difusa encontra-se presente tanto nas Lesões por Esforços Repetitivos (LER)/Distúrbios Osteomusculares Relacionados ao Trabalho (DORT) como na Fibromialgia, trazendo dificuldades diagnósticas, preventivas e terapêuticas para profissionais da saúde envolvidos no tratamento de acometidos. OBJETIVOS: Analisar os aspectos relevantes na emissão dos diagnósticos de DORT e Fibromialgia na percepção de médicos assistenciais e peritos. MÉTODOS: Neste estudo, 75 médicos (36 assistenciais e 39 peritos) responderam a questões estruturadas e abertas sobre aspectos considerados relevantes na emissão de diagnóstico destas síndromes. RESULTADOS: As respostas dos dois grupos foram correlacionadas pelo teste de Spearman (α=0,05) e submetidos ao método de Discurso do Sujeito Coletivo (DSC). Os médicos assistenciais tenderam a valorizar o fator "quadro clínico e tempo de evolução", enquanto os médicos peritos tenderam a apontar "história ocupacional" na definição do diagnóstico de LER/DORT. Já para o diagnóstico de Fibromialgia, os peritos tenderam a apontar o fator "quantidade de tender points", enquanto os médicos assistenciais indicaram mais frequentemente "característica da dor". Apesar dessas discretas discrepâncias, alta correlação (r=0,85, ρ=0,01) foi identificada entre os grupos quando apontaram aspectos comuns e distintos no estabelecimento do diagnóstico para as duas síndromes. Os relatos também enfatizaram a necessidade da investigação de riscos presentes no trabalho para a definição de um diagnóstico mais preciso. CONCLUSÕES: Nesse sentido, objetivando uniformizar condutas avaliativas, preventivas e terapêuticas para médicos, fisioterapeutas e demais profissionais envolvidos no atendimento dessas síndromes, seria recomendável maior divulgação dos critérios utilizados por entidades internacionais no diagnóstico da Fibromialgia e a inclusão de treinamento para identificação de efeitos adversos de condições inadequadas do trabalho na formação desses profissionais.

BACKGROUND: Chronic and diffuse pain is present either in Repetitive Strain Injuries (RSI)/Work-related Musculoskeletal Disorders (WMSD) and Fibromyalgia, leading to difficulties in determining preventive and therapeutic measures by health professionals who deals with patients presenting these disorders. OBJECTIVES: Analyze the relevant aspects in the emission of the diagnosis of WMSD and Fibromyalgia in the perception of physicians assistants and experts. METHODS: In this study 75 physicians (36 assistants and 39 experts) answered structured and open questions about aspects that they consider relevant to the establishment of diagnosis. RESULTS: Results were correlated by Spearman's test (α=0.05) and submitted to the Collective Subject's Speech method. Assistant physicians tended to emphasize the factor "clinical conditions and time elapsed", whilst expert tended to indicate "occupational history" for definition of the WMSD diagnosis. For the diagnosis of Fibromyalgia, experts physicians tended to emphasize the factor "amount of tender points", whilst the assistant physicians indicated "pain characteristics". Despite of these slight discrepancies, the results from both groups were highly correlated (r=0.85; p=0.01) when participants were asked to indicate common and different relevant aspects for the diagnosis of both syndromes. Furthermore, the physicians agreed about the necessity of risk investigation at work for a more accurate diagnosis. CONCLUSIONS: In order to standardize preventative and therapeutic measures adopted by physicians, physiotherapist and other professional evolved with these syndromes it would be advisable to make the international criteria for Fibromyalgia diagnosis better know, and also to provide better training on the identification of the adverse effects of inadequate work conditions on the musculoskeletal system to health professional.

OBJETIVO: Avaliar a amplitude de movimento (ADM) e o torque flexor e extensor do joelho após a realização de um programa de alongamento ativo excêntrico dos músculos flexores do joelho. MATERIAIS E MÉTODOS: Trinta e quatro voluntários (23 mulheres e 11 homens), 34,42±9,3 anos, realizaram um programa de alongamento ativo excêntrico dos músculos flexores do joelho na postura em pé, que consistiu de sete repetições de um minuto com 30 segundos de descanso entre as repetições. O programa de alongamento foi realizado duas vezes por semana, durante quatro semanas. A ADM de extensão e o torque flexor e extensor do joelho foram avaliados no dinamômetro isocinético pré e pós-programa de alongamento. O torque foi avaliado nos modos isométrico e isocinético concêntrico e excêntrico a 30°/s e 60°/s. RESULTADOS: Houve aumento na ADM de 53,7±13° para 30,1±16° (p=0,0001), no torque isométrico flexor de 89±32Nm para 93±33Nm (p=0,01) e extensor de 178±67Nm para 187±73Nm (p=0,006). O torque flexor concêntrico e excêntrico a 30°/s aumentou de 90±31Nm para 96±31Nm (p=0,001) e de 100±34Nm para 105±35Nm (p=0,01), respectivamente. O torque extensor concêntrico a 60°/s aumentou de 144±51Nm para 151±58Nm (p=0,02) e o excêntrico a 30°/s de 175±71Nm para 189±73Nm (p=0,01). CONCLUSÕES: O programa de alongamento proposto foi efetivo para aumentar a flexibilidade dos músculos alongados e torque dos grupos musculares agonistas (alongados) e seus antagonistas.

OBJECTIVE: To evaluate the changes in knee range of motion (ROM) and torque of knee flexor and extensor muscles after an active eccentric stretching program for the knee flexor muscles. METHODS: Thirty-four volunteers (23 women and 11 men), aged 34.42±9.3 years, performed an active eccentric stretching program for the knee flexor muscles in the standing posture, consisting of seven repetitions of one minute each, with 30 seconds of resting between them. The stretching program was performed twice a week, for four weeks. Knee extension ROM and the torque of the knee flexor and extensor muscles were evaluated using an isokinetic dynamometer before and after the stretching program. The torque was evaluated in the isometric, isokinetic concentric and eccentric modes at 30°/s and 60°/s. RESULTS: There was an increase in ROM from 53.7±13° to 30.1±16° (p=0.0001), in isometric torque of the flexors from 89±32Nm to 93±33Nm (p=0.01) and of the extensors from 178±67Nm to 187±73Nm (p=0.006). The concentric and eccentric torque of the flexors at 30°/s increased from 90±31Nm to 96±31Nm (p=0.001) and from 100±34Nm to 105±35Nm (p=0.01), respectively. The concentric torque of the extensors at 60°/s increased from 144±51Nm to 151±58Nm (p=0.02), and the eccentric torque at 30°/s increased from 175±71Nm to 189±73Nm (p=0.01). CONCLUSIONS: The stretching program proposed was effective for increasing the flexibility of the stretched muscles and the torque of the agonist (stretched) muscle groups and their antagonists.

OBJETIVO: Foi avaliada a influência da Universidade Aberta da Terceira Idade - Fundação Educacional de São Carlos (UATI-FESC) e do Programa de Revitalização Geriátrica (REVT) sobre a qualidade de vida de adultos de meia-idade e idosos. MÉTODO: Participaram deste estudo 70 indivíduos do primeiro ano da UATI e do REVT. Os critérios de inclusão foram ter 50 anos ou mais e ser capaz de preencher os questionários. A UATI é um programa interdisciplinar com seis disciplinas (uma vez por semana cada), três de atividades físicas: Tai Chi Chi Kung, Expressão Corporal, Fisioterapia e Promoção da Saúde; e três de promoção social e cultural: Educação Musical, Arte, Cidadania e Terceira Idade, além de atividades comemorativas e turismo cultural. O REVT teve 48 sessões de atividade física, três vezes por semana, com duração de 50-55 minutos cada. Todos os participantes foram avaliados por meio dos instrumentos de qualidade de vida World Health Organization Quality of Life (WHOQOL-bref) e Short-Form 36 - Medical Outcomes Study (SF36) no início e ao término da intervenção de 16 semanas. Para análise dos dados, foi utilizada ANOVA com medida repetida. RESULTADOS: Não houve diferença entre os grupos. Ambos os grupos apresentaram melhora significativa do nível de qualidade de vida de acordo com o resultado geral do WHOQOL-bref e também nos domínios psicológico, meio ambiente e questões iniciais: "Como você avaliaria sua qualidade de vida?" e "Quão satisfeito(a) você está com a sua saúde?" do WHOQOL-bref. Também houve melhora significativa do domínio Estado Geral de Saúde do SF36. Para os domínios Físico e Relações Sociais do WHOQOL-bref e outros domínios do SF36 não houve melhora significativa. CONCLUSÃO: Esses programas melhoraram a qualidade de vida segundo o WHOQOL-bref e EGS-SF36.

OBJECTIVE: The influence of the Open University of the Third Age (São Carlos Educational Foundation) (UATI-FESC) and the Geriatric Revitalization Program (REVT) on the quality of life of middle-aged and elderly adults was evaluated. METHOD: Seventy individuals in their first year at UATI and REVT participated in this study. The inclusion criteria were that the subjects had to be at least 50 years old and be capable of filling out questionnaires. UATI had an interdisciplinary program comprising six lectures (once a week each). Three were on physical activities: Tai Chi Chi Kung, Body Expression and Physical Therapy and Health Promotion; three on social and cultural promotion: Musical Education, Art and Citizenship in the Third Age; and there were also commemorative activities and cultural tourism. REVT had 48 physical activity sessions, three times a week, lasting 50-55 minutes each. All the participants were evaluated using the World Health Organization Quality-of-Life (WHOQOL-bref) and Short-Form 36 Medical Outcomes Study (SF36) questionnaires at baseline and at the end of the 16-week intervention. The data were analyzed using ANOVA with repeated measurements. RESULTS: There were no differences between the groups. Both groups showed significant improvement in quality of life according to the overall result from WHOQOL-bref and also in the Psychological and Environmental domains and the initial questions: "How would you rate your quality of life?" and "How satisfied are you with your health?", in WHOQOL-bref. There was also a significant improvement in the General Health domain of SF36. For the Physical and Social Relations domains of WHOQOL-bref and other domains of SF36, there was no significant improvement. CONCLUSIONS: These programs improved quality of life according to WHOQOL-bref and the General Health domain of SF36.

OBJETIVOS: A tendência de aumento na expectativa de vida certamente representará incrementos na morbidade e na mortalidade em eventos relacionados a osteoporose. Devido à falta de protocolos bem definidos na intensidade e freqüência de exercícios físicos, que sejam fáceis de se realizarem, para mulheres brasileiras, este estudo propôs analisar os efeitos de um programa de treinamento na força muscular do tornozelo, no equilíbrio funcional e na velocidade da marcha de mulheres com diagnóstico densitométrico de osteoporose. MÉTODOS: Doze mulheres voluntárias (idade 68,7 ± 2,7) foram submetidas à avaliação física e, posteriormente, reavaliadas após doze semanas. O programa de atividade física foi orientado por um fisioterapeuta, que trabalhou 60 minutos, 3 vezes por semana, por doze semanas. Cada sessão de treinamento incluiu alguns exercícios de alongamento, fortalecimento muscular dos músculos flexores plantares e dorsiflexores do tornozelo, com 50% de 10-repetições máximas (10-RM) e treino de equilíbrio. RESULTADOS: As variáveis relacionadas ao índice de equilíbrio, à velocidade da marcha e à força muscular apresentaram melhora significativa (p < 0,05), analisadas por meio do teste não paramétrico de Wilcoxon. CONCLUSÃO: Após as doze semanas de treinamento, foram observados benefícios no condicionamento das voluntárias. Os resultados demonstram que o treinamento proposto, teve influência na melhora desse grupo de pacientes, sugerindo que o programa foi efetivo, fácil e seguro para mulheres brasileiras portadoras de osteoporose. Portanto, programas de atividade física são eficientes para melhorar o equilíbrio funcional, a velocidade da marcha e a força muscular do tornozelo de mulheres idosas portadoras de osteoporose.

OBJECTIVES: The trend towards increased life expectancy will certainly lead to increases in morbidity and mortality relating to osteoporosis. Because of the lack of well defined protocols on the intensity and frequency of easily performed physical exercises for Brazilian women, this study proposed to analyze the effects of a training program for ankle muscle strength, balance performance and gait velocity among women with a densitometric diagnosis of osteoporosis. METHODS: Twelve female volunteers (age 68.7 ± 2.7 years) underwent physical evaluation and subsequent reevaluation after twelve weeks. The physical activity program was guided by a physical therapist, who conducted 60-minute sessions, three times a week for twelve weeks. Each training session included some stretching exercises, strengthening exercises for the ankle dorsiflexor and plantar-flexor muscles, with 50% of 10-repetition maximum (10-RM), and balance training. RESULTS: The variables analyzed regarding balance index, gait velocity and muscle strength presented significant improvement (p < 0.05), as shown by the Wilcoxon non-parametric test. CONCLUSION: After the 12-week exercise program, the participants presented benefits in terms of their fitness. The results demonstrate that the training had a role in improving the condition of this group of patients, thus suggesting that this program was effective, easy to implement and safe for Brazilian women with osteoporosis. Therefore, it can be seen that physical activity programs are efficient in improving balance performance, gait velocity and ankle muscle strength among elderly women with osteoporosis.

CONTEXTUALIZAÇÃO: O instrumento mais utilizado pelos terapeutas para mensuração da amplitude de movimento (ADM) articular é o goniômetro universal. No entanto, há carência de estudos que analisem a confiabilidade das medidas da ADM do joelho realizadas no dinamômetro isocinético. OBJETIVO: O objetivo deste estudo foi analisar a correlação entre as medidas de ADM na articulação do joelho, realizadas com o goniômetro universal e no dinamômetro isocinético. MÉTODO: Foram avaliados 38 voluntários saudáveis (27 mulheres, 11 homens), com idade de 36 ± 11 anos, com limitação mínima de 20° na ADM de extensão do joelho. No membro dominante de cada sujeito foram realizadas três mensurações da ADM do joelho com o goniômetro e três mensurações no dinamômetro. RESULTADOS: Os resultados deste estudo mostraram que há alto grau de correlação entre as medidas da ADM do joelho obtidas com o goniômetro universal e no dinamômetro isocinético (Coeficiente de Correlação de Pearson = 0,90). CONCLUSÃO: Com os procedimentos realizados, tanto o goniômetro universal como o dinamômetro isocinético podem ser utilizados para avaliação da ADM do joelho, pois ambos apresentam mensurações confiáveis.

BACKGROUND: The instrument most often used by therapists for measuring joint range of motion (ROM) is the universal goniometer. However, there is a lack of studies analyzing the reliability of knee joint ROM measured by the isokinetic dynamometer. OBJECTIVE: The purpose of this study was to analyze the correlation between the knee joint ROM measurements made using a universal goniometer and an isokinetic dynamometer. METHOD: 38 healthy volunteers (27 women, 11 men) aged 36 ± 11 years were evaluated. All of them had a minimum knee extension ROM limitation of 20°. Three knee ROM measurements were made using the universal goniometer and another three using the isokinetic dynamometer, on each subject's dominant limb. RESULTS: The results showed a high degree of correlation between the knee ROM measurements made using the two instruments (Pearson correlation coefficient = 0.90). CONCLUSION: From the procedures performed, both the universal goniometer and the isokinetic dynamometer can be used to evaluate knee ROM, since they both present reliable measurements.

The aim of the present study was to determine the effect of stretching applied every 3 days to the soleus muscle immobilized in the shortened position on muscle fiber morphology. Eighteen 16-week-old Wistar rats were used and divided into three groups of 6 animals each: a) the left soleus muscle was immobilized in the shortened position for 3 weeks; b) during immobilization, the soleus was stretched for 40 min every 3 days; c) the non-immobilized soleus was only stretched. Left and right soleus muscles were examined. One portion of the soleus was frozen for histology and muscle fiber area evaluation, while the other portion was used to identify the number and length of serial sarcomeres. Immobilized muscles (group A) showed a significant decrease in weight (44 ± 6%), length (19 ± 7%), serial sarcomere number (23 ± 15%), and fiber area (37 ± 31%) compared to the contralateral muscles (P < 0.05, paired Student t-test). The immobilized and stretched soleus (group B) showed a similar reduction but milder muscle fiber atrophy compared to the only immobilized group (22 ± 40 vs 37 ± 31%, respectively; P < 0.001, ANOVA test). Muscles submitted only to stretching (group C) significantly increased the length (5 ± 2%), serial sarcomere number (4 ± 4%), and fiber area (16 ± 44%) compared to the contralateral muscles (P < 0.05, paired Student t-test). In conclusion, stretching applied every 3 days to immobilized muscles did not prevent the muscle shortening, but reduced muscle atrophy. Stretching sessions induced hypertrophic effects in the control muscles. These results support the use of muscle stretching in sports and rehabilitation.