Abstract Introduction The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a personalized, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis (RA). Patients are provided with two guidance documents, the ‘Patient Exercise Booklet’ and the ‘Personal Exercise Guide’, to continue the exercises independently at home. Objective This study aimed to translate and culturally adapt the SARAH protocol into Brazilian Portuguese and validate its content. Methods The guidance documents ‘Patient Exercise Booklet’ and ‘Personal Exercise Guide’ of the SARAH program were translated and culturally adapted to Brazilian Portuguese. The content validity was obtained by calculating the content validity index (CVI). Results The Brazilian version of the SARAH protocol reached semantic, idiomatic, conceptual, and cultural equivalences. The CVI was greater than 0.8, corresponding to a satisfactory index. The verbal comprehension was 4.9, showing good verbal comprehension ofthe target population. Conclusion The Brazilian Portuguese version of the SARAH protocol is available to Brazilian people with compromised hands due to RA with satisfactory content validity.

RESUMEN La artralgia crónica poschikunguña (ACPC) puede tener como efecto repercusiones musculoesqueléticas y pérdida funcional. En este sentido, el objetivo de este estudio fue evaluar la discapacidad física y los síntomas de miembros superiores de mujeres con ACPC durante las actividades diarias, laborales y de ocio en comparación con controles sanos (CS). Por ello, se realizó un estudio transversal con 52 mujeres. Las participantes se dividieron en los grupos ACPC (37) y CS (15). La fuerza de agarre, el rango de movimiento (ROM), el nivel de dolor (escala numérica de dolor), la discapacidad física y los síntomas se evaluaron mediante el Disabilities of the Arm, Shoulder and Hand Questionnaire (Dash). Las diferencias entre los grupos se evaluaron con la aplicación de la prueba t de Student y las correlaciones de Pearson. Se utilizó la prueba de chi-cuadrado para las variables categóricas y se estableció como nivel de significación α=0,05. Se encontró que la duración de la ACPC fue de 19,5±13,1 meses. No hubo diferencia entre los grupos para la fuerza máxima (ACPC: 23,6±7,4kgf; CS: 24,5±6,2kgf; p=0,676). Los resultados mostraron una diferencia significativa entre los grupos respecto al ROM (ACPC: 63,5±17,3o; CS: 77,2±9,6o), el nivel de dolor en la mano (ACPC: 5,8±2,2; CS: 0,4±1,5) y los niveles funcionales de miembros superiores (ACPC: 44,5±17,4; CS: 16,2±20,5). Las participantes informaron una extrema dificultad o incapacidad para realizar tareas como abrir un frasco (78,4%), poner objetos en un lugar más alto (48,7%), realizar actividades domésticas pesadas (56,8%) y actividades de jardinería (51,4%). Se concluyó que la función física de los miembros superiores durante las actividades diarias, laborales y de ocio constituye el mayor compromiso a largo plazo. (ACPC funcional sentido diarias CS. . (CS) ello 5 37 (37 15. 15 (15) agarre ROM, , (ROM) escala dolor, dolor) Arm Dash. Dash (Dash) Pearson chicuadrado chi cuadrado α005 α 0 05 α=0,05 195131 19 13 1 19,5±13, meses 23,6±7,4kgf 23674kgf kgf 23 6 7 4kgf 24,5±6,2kgf 24562kgf 24 2kgf p=0,676. p0676 p p=0,676 676 p=0,676) 63,5±17,3o 635173o 63 17 3o 77,2±9,6o, 77296o 77,2±9,6o 77 2 9 6o 77,2±9,6o) 5,8±2,2 5822 8 0,4±1,5 0415 4 44,5±17,4 445174 44 16,2±20,5. 162205 16,2±20,5 16 20 16,2±20,5) 78,4%, 784 78,4% 78 (78,4%) 48,7%, 487 48,7% 48 (48,7%) 56,8% 568 56 (56,8% 51,4%. 514 51,4% 51 (51,4%) plazo (CS 3 (3 (15 (ROM (Dash α00 α=0,0 19513 19,5±13 p067 p=0,67 67 5,8±2, 582 0,4±1, 041 44,5±17, 44517 16220 16,2±20, 78,4 (78,4% 48,7 (48,7% 56,8 (56,8 51,4 (51,4% ( (1 α0 α=0, 1951 19,5±1 p06 p=0,6 5,8±2 58 0,4±1 04 44,5±17 4451 1622 16,2±20 78, (78,4 48, (48,7 56, (56, 51, (51,4 α=0 195 19,5± p0 p=0, 5,8± 0,4± 44,5±1 445 162 16,2±2 (78, (48, (56 (51, α= 19,5 p=0 5,8 0,4 44,5± 16,2± (78 (48 (5 (51 19, p= 5, 0, 44,5 16,2 (7 (4 44, 16,

RESUMO A artralgia crônica pós-Chikungunya (ACPC) pode gerar repercussões musculoesqueléticas e perda funcional. Nesse sentido, o objetivo deste estudo foi avaliar a incapacidade física e os sintomas de membros superiores de mulheres com ACPC durante atividades diárias, laborais e de lazer comparadas aos controles saudáveis (CS). Para tanto, realizou-se um estudo transversal conduzido com 52 mulheres. As participantes foram divididas entre os grupos com ACPC (37) e CS (15). Foram avaliados força de preensão, amplitude de movimento (ADM), nível de dor (escala numérica de dor) e incapacidade física e sintomas por meio do Disabilities of the Arm, Shoulder and Hand Questionnaire (Dash). Diferenças entre os grupos foram avaliadas pelo teste t de Student e correlações de Pearson. O teste qui-quadrado foi utilizado para variáveis categóricas e α=0,05 foi estabelecido como nível de significância. Verificou-se que a duração da ACPC foi de 19,5±13,1 meses. Não houve diferença entre os grupos para a força pico (ACPC: 23,6±7,4kgf; CS: 24,5±6,2kgf; p=0,676). Os resultados demonstraram diferença significativa entre os grupos em termos de ADM (ACPC: 63,5±17,3o; CS: 77,2±9,6o), nível de dor nas mãos (ACPC: 5,8±2,2; CS: 0,4±1,5) e níveis funcionais dos membros superiores (ACPC: 44,5±17,4; CS: 16,2±20,5). As participantes relataram extrema dificuldade ou incapacidade para realizar tarefas como abrir um pote (78,4%), colocar objetos em um local acima da cabeça (48,7%), realizar atividades domésticas pesadas (56,8%) e atividades de jardinagem (51,4%). Conclui-se que a função física dos membros superiores durante as atividades diárias, laborais e de lazer constitui o maior comprometimento apresentado a longo prazo. pósChikungunya pós Chikungunya (ACPC funcional sentido diárias CS. . (CS) tanto realizouse realizou se 5 37 (37 15. 15 (15) preensão ADM, , (ADM) escala Arm Dash. Dash (Dash) Pearson quiquadrado qui quadrado α005 α 0 05 α=0,0 significância Verificouse Verificou 195131 19 13 1 19,5±13, meses 23,6±7,4kgf 23674kgf kgf 23 6 7 4kgf 24,5±6,2kgf 24562kgf 24 2kgf p=0,676. p0676 p p=0,676 676 p=0,676) 63,5±17,3o 635173o 63 17 3o 77,2±9,6o, 77296o 77,2±9,6o 77 2 9 6o 77,2±9,6o) 5,8±2,2 5822 8 0,4±1,5 0415 4 44,5±17,4 445174 44 16,2±20,5. 162205 16,2±20,5 16 20 16,2±20,5) 78,4%, 784 78,4% 78 (78,4%) 48,7%, 487 48,7% 48 (48,7%) 56,8% 568 56 (56,8% 51,4%. 514 51,4% 51 (51,4%) Concluise Conclui prazo (CS 3 (3 (15 (ADM (Dash α00 α=0, 19513 19,5±13 p067 p=0,67 67 5,8±2, 582 0,4±1, 041 44,5±17, 44517 16220 16,2±20, 78,4 (78,4% 48,7 (48,7% 56,8 (56,8 51,4 (51,4% ( (1 α0 α=0 1951 19,5±1 p06 p=0,6 5,8±2 58 0,4±1 04 44,5±17 4451 1622 16,2±20 78, (78,4 48, (48,7 56, (56, 51, (51,4 α= 195 19,5± p0 p=0, 5,8± 0,4± 44,5±1 445 162 16,2±2 (78, (48, (56 (51, 19,5 p=0 5,8 0,4 44,5± 16,2± (78 (48 (5 (51 19, p= 5, 0, 44,5 16,2 (7 (4 44, 16,

ABSTRACT Post-Chikungunya chronic arthralgia (PCCA) may lead to musculoskeletal repercussions and functional loss. The objective was to assess the upper limb physical disability and symptoms during daily, work, and leisure activities of women presenting PCCA compared to healthy controls (HC). This was a cross-sectional study conducted with 52 women. The participants were divided into PCCA (37) and HC (15) groups. Handgrip strength, range of motion, level of pain (numerical rating scale), and participants’ physical disability and symptoms (Disabilities of the Arm, Shoulder, and Hand Questionnaire - DASH) were evaluated. Differences between groups were evaluated using the Students t-test and Pearson’s correlations. The chi-square test was applied for categorical variables. The significance was set at α=0.05. The disease duration was 19.5±13.1 months. We found no differences between groups for peak force (PCAA:23.6±7.4kgf; HC: 24.5±6.2kgf; p=0.676). The results showed a significant difference between groups regarding range of motion (PCCA: 63.5±17.3o; HC: 77.2±9.6o), level of hand pain (PCCA: 5.8±2.2; HC: 0.4±1.5), and upper limbs functional levels (PCCA: 44.5±17.4; HC: 16.2±20.5). Participants related severe difficulty or inability to perform tasks such as opening a jar (78.4%), placing objects above head height (48.7%), doing heavy household chores (56.8%), and gardening (51.4%). Impairment in the upper limb physical function in daily, work, and leisure activities shows the higher prevalence in the long-term. PostChikungunya Post Chikungunya (PCCA loss daily work HC. . (HC) crosssectional cross sectional 5 37 (37 15 (15 strength numerical scale, scale , scale) Disabilities Arm Shoulder DASH ttest t Pearsons Pearson s correlations chisquare chi square variables α005 α 0 05 α=0.05 195131 19 13 1 19.5±13. months PCAA23.6±7.4kgf PCAA23674kgf PCAAkgf PCAA 23.6±7.4kgf 23 6 7 4kgf kgf (PCAA:23.6±7.4kgf 24.5±6.2kgf 24562kgf 24 2kgf p=0.676. p0676 p p=0.676 676 p=0.676) 63.5±17.3o 635173o o 63 17 3o 77.2±9.6o, 77296o 77.2±9.6o 77 2 9 6o 77.2±9.6o) 5.8±2.2 5822 8 0.4±1.5, 0415 0.4±1.5 4 0.4±1.5) 44.5±17.4 445174 44 16.2±20.5. 162205 16.2±20.5 16 20 16.2±20.5) 78.4%, 784 78.4% 78 (78.4%) 48.7%, 487 48.7% 48 (48.7%) 56.8%, 568 56.8% 56 (56.8%) 51.4%. 514 51.4% 51 (51.4%) longterm. longterm long term. term long-term (HC 3 (3 (1 α00 α=0.0 19513 19.5±13 PCAA23 23674kgf p067 p=0.67 67 5.8±2. 582 041 0.4±1. 44.5±17. 44517 16220 16.2±20. 78.4 (78.4% 48.7 (48.7% 56.8 (56.8% 51.4 (51.4% ( α0 α=0. 1951 19.5±1 PCAA2 p06 p=0.6 5.8±2 58 04 0.4±1 44.5±17 4451 1622 16.2±20 78. (78.4 48. (48.7 56. (56.8 51. (51.4 α=0 195 19.5± p0 p=0. 5.8± 0.4± 44.5±1 445 162 16.2±2 (78. (48. (56. (51. α= 19.5 p=0 5.8 0.4 44.5± 16.2± (78 (48 (56 (51 19. p= 5. 0. 44.5 16.2 (7 (4 (5 44. 16.

ABSTRACT OBJECTIVE The objective of this study is to investigate the adherence and the factors that influence adherence to physical activity in adults with dyslipidemia, hypertension, or diabetes. METHODS The analyses were based on data collected at the baseline of the 14,521 participants from the study ELSA-Brasil aged between 35 and 74 years. The level of leisure time physical activity was determined using the International Physical Activity Questionnaire. Logistic regression analyses were performed to examine the influence of the demographic data, socioeconomic conditions, perceived health status, and access to exercise facilities in the neighborhood on adherence to physical activity. RESULTS Men with hypertension and dyslipidemia were more active than women. The results show that 17.8%, 15.1%, and 13.9% of the subjects who reported dyslipidemia, hypertension, and diabetes, respectively, adhere to the physical activity recommendations. The factors positively associated with adherence were higher education and income. Older individuals who reported poor perceived health, were overweight and obese, regularly smoked, and had fewer opportunities to exercise in the neighborhood presented lower adherence. CONCLUSIONS The number of adults with dyslipidemia, hypertension, and diabetes who adhere to the physical activity recommendations is very low. Higher education and income are positively associated with adherence, while age, excess body weight, negative perceived health, regular smoking, and lack of opportunity to exercise in the neighborhood were considered barriers to physical activity.

ABSTRACT OBJECTIVE The objective of this study is to investigate the adherence and the factors that influence adherence to physical activity in adults with dyslipidemia, hypertension, or diabetes. METHODS The analyses were based on data collected at the baseline of the 14,521 participants from the study ELSA-Brasil aged between 35 and 74 years. The level of leisure time physical activity was determined using the International Physical Activity Questionnaire. Logistic regression analyses were performed to examine the influence of the demographic data, socioeconomic conditions, perceived health status, and access to exercise facilities in the neighborhood on adherence to physical activity. RESULTS Men with hypertension and dyslipidemia were more active than women. The results show that 17.8%, 15.1%, and 13.9% of the subjects who reported dyslipidemia, hypertension, and diabetes, respectively, adhere to the physical activity recommendations. The factors positively associated with adherence were higher education and income. Older individuals who reported poor perceived health, were overweight and obese, regularly smoked, and had fewer opportunities to exercise in the neighborhood presented lower adherence. CONCLUSIONS The number of adults with dyslipidemia, hypertension, and diabetes who adhere to the physical activity recommendations is very low. Higher education and income are positively associated with adherence, while age, excess body weight, negative perceived health, regular smoking, and lack of opportunity to exercise in the neighborhood were considered barriers to physical activity.

OBJECTIVE: To evaluate the effect of spironolactone on ventricular stiffness in spontaneously hypertensive adult rats subjected to high salt intake. INTRODUCTION: High salt intake leads to cardiac hypertrophy, collagen accumulation and diastolic dysfunction. These effects are partially mediated by cardiac activation of the renin-angiotensin-aldosterone system. METHODS: Male spontaneously hypertensive rats (SHRs, 32 weeks) received drinking water (SHR), a 1% NaCl solution (SHR-Salt), or a 1% NaCl solution with a daily subcutaneous injection of spironolactone (80 mg.kg-1) (SHRSalt- S). Age-matched normotensive Wistar rats were used as a control. Eight weeks later, the animals were anesthetized and catheterized to evaluate left ventricular and arterial blood pressure. After cardiac arrest, a doublelumen catheter was inserted into the left ventricle through the aorta to obtain in situ left ventricular pressurevolume curves. RESULTS: The blood pressures of all the SHR groups were similar to each other but were different from the normotensive controls (Wistar = 109±2; SHR = 118±2; SHR-Salt = 117±2; SHR-Salt-S = 116±2 mmHg; P<0.05). The cardiac hypertrophy observed in the SHR was enhanced by salt overload and abated by spironolactone (Wistar = 2.90±0.06; SHR = 3.44±0.07; SHR-Salt = 3.68±0.07; SHR-Salt-S = 3.46±0.05 mg/g; P<0.05). Myocardial relaxation, as evaluated by left ventricular dP/dt, was impaired by salt overload and improved by spironolactone (Wistar = -3698±92; SHR = -3729±125; SHR-Salt = -3342±80; SHR-Salt-S = -3647±104 mmHg/s; P<0.05). Ventricular stiffness was not altered by salt overload, but spironolactone treatment reduced the ventricular stiffness to levels observed in the normotensive controls (Wistar = 1.40±0.04; SHR = 1.60±0.05; SHR-Salt = 1.67±0.12; SHR-Salt- S = 1.45±0.03 mmHg/ml; P<0.05). CONCLUSION: Spironolactone reduces left ventricular hypertrophy secondary to high salt intake and ventricular stiffness in adult SHRs.