Abstract Context: Many studies show the importance of evaluating the adaptation time of subjects in a virtual driving environment, looking forwards to a response as closest as a possible real vehicle. Objectives: This study aimed to identify and analyze the adaptation to the driving simulator in older adults and middle-aged adults with and without a distraction, and a secondary aim was to identify predictors of safe performance for older adults’ drives. Design: Male and female middle-aged adults (n = 62, age = 30.3 ± 7.1 years) and older adults (n = 102, age = 70.4 ± 5.8 years) were evaluated for braking time performance in a driving simulator; cognition performance assessment included the Mini-Mental State Examination; motor evaluation included ankle flexor muscle strength with the isokinetic dynamometer and handgrip strength; the postural balance was evaluated with Timed Up and Go test, with and without a cognitive distraction task. Results: Older adults (men and women) and middle-aged adult women require more time to adapt to the driving simulator. The distractor increases the adaptation time for all groups. The main predictors of braking time for older women are age, muscle strength, and postural balance associated with distraction, and for older men, muscle strength. Conclusions: Age, sex, and distractor interfere in the adaptation of the virtual task of driving in a simulator. The evaluation model developed with multi-domains demonstrated the ability to predict which skills are related to braking time with and without the presence of the distractor.

ABSTRACT Introduction: Ankle sprains are frequent in sports activities and can lead to joint instability with clinical and performance consequences. Sudden ankle inversion platforms have been used to study the mechanism of ankle sprain. Objectives: To test a static platform that simulates the movement of ankle sprain (sudden inversion) in soccer players. Methods: A platform was developed to perform the sudden movement of an ankle sprain dissociated in three axes: inversion, plantar flexion, and medial rotation. A computer program was also created to read the angular velocity and the time to reach the maximum amplitude of the three axes of movement, synchronized with the platform movements. Thirty soccer players without ankle sprains were evaluated on the sudden inversion platform. Each athlete performed 10 randomly initiated tests, with five per leg. Results: There was no statistical difference in angular velocity or time to reach maximum range of motion of plantar flexion and medial rotation between the tests. During the tests, the angular velocity of the inversion increased. Conclusion: The sudden static platform evaluated the movements performed by the ankle during the sprain reliably in the 10 tests with no difference in the mechanical behavior. Level of evidence I; Therapeutic studies - Investigation of treatment outcomes.

RESUMEN Introducción: El esguince de tobillo es frecuente en las actividades deportivas y puede provocar inestabilidad articular con consecuencias clínicas y de desempeño. Se han utilizado plataformas de inversión súbita del tobillo para estudiar el mecanismo del esguince de tobillo. Objetivos: Probar una plataforma estática que simule el movimiento de esguince de tobillo (inversión súbita) en jugadores de fútbol. Métodos: La plataforma fue desarrollada para realizar el movimiento brusco del esguince de tobillo disociado en tres ejes: inversión, flexión plantar y rotación medial. También se creó un programa informático para leer la velocidad angular y el tiempo para alcanzar la máxima amplitud de los tres ejes de movimiento, sincronizados con los movimientos de la plataforma. Treinta futbolistas sin esguince de tobillo fueron evaluados en la plataforma súbita. Cada atleta realizó 10 pruebas, iniciadas al azar, cinco en cada pierna. Resultados: Entre las pruebas, no hubo diferencias estadísticas en las velocidades angulares y el tiempo para alcanzar la amplitud máxima de los movimientos de flexión plantar y rotación medial. Durante las pruebas, la velocidad angular de la inversión aumentó. Conclusión: La plataforma estática súbita, evaluada en 10 intentos, fue confiable para evaluar los movimientos realizados por el tobillo durante el esguince, y no hubo diferencias en el comportamiento mecánico. Nivel de Evidencia I; Estudios terapéuticos - Investigación de los resultados del tratamiento.

RESUMO Introdução: A entorse do tornozelo é frequente nas atividades esportivas, podendo levar à instabilidade articular com consequências clínicas e de desempenho. As plataformas de inversão súbita do tornozelo têm sido usadas para estudar o mecanismo de entorse do tornozelo. Objetivos: Testar uma plataforma estática que simule o movimento de entorse do tornozelo (inversão súbita) em jogadores de futebol. Métodos: A plataforma foi desenvolvida para realizar o movimento súbito da entorse de tornozelo dissociado em três eixos: inversão, flexão plantar e rotação medial. Também foi criado um programa de computador para leitura da velocidade angular e do tempo para atingir a amplitude máxima dos três eixos de movimento, sincronizados com os movimentos da plataforma. Trinta jogadores de futebol sem entorse de tornozelo foram avaliados na plataforma súbita. Cada atleta fez 10 testes, iniciados de forma aleatória, sendo cinco em cada perna. Resultados: Entre os testes, não houve diferença estatística das velocidades angulares e tempo para atingir a amplitude máxima do movimento de flexão plantar e rotação medial. Durante os testes, a velocidade angular da inversão aumentou. Conclusão: A plataforma estática súbita, avaliada em 10 tentativas, foi confiável para avaliar os movimentos executados pelo tornozelo durante a entorse, e não houve diferença de comportamento mecânico. Nível de evidência I; Estudos terapêuticos - Investigação dos resultados do tratamento.

Abstract Context: Transtibial Amputation (TA) predisposes to a sedentary lifestyle. Objectives: To evaluate the efficiency of a short-term (8-week) Concurrent Training (CT) program in Unilateral Transtibial Amputees (UTA) and to compare it with the physical condition of a group of Paralympic athletes in preparation for the Rio de Janeiro Paralympics. Design: This was a longitudinal, prospective and controlled trial study. Methods: Thirty-four male subjects with UTA and using prostheses for six months or more were selected for this study. They were divided into two groups: Group 1 (G1) – 17 non-athlete and untrained UTA and Group 2 (G2) – 17 paralympic athletes with active UTA in the training phase. G1 was evaluated before and after eight weeks of CT and G2 made a single evaluation for control. All were submitted to anamnesis, clinical evaluation (blood pressure, electrocardiogram, and heart rate) and cardiopulmonary exercise testing on a lower limb cycle ergometer, and isokinetic knee dynamometry. The CT of G1 included resistance exercise and aerobic interval training on a stationary bicycle and G2 followed the training of the Paralympic teams. Results: Patients were retested by the same methods after CT. The two most important central dependent variables (maximal oxygen uptake and muscular strength) increased by 22% and knee extensor and flexor strength by 106% and 97%, respectively. Conclusion: After eight weeks of CT, there was an improvement in general functional condition, muscle strength, and cardiorespiratory performance improving protection against chronic diseases and quality of life.

ABSTRACT Objective: Fatigue of the ankle’s stabilizing muscles may influence the performance of functional activities and postural control. The purpose of this study was to evaluate the performance of healthy young adults using functional jump tests and static posturography control under pre- and post-fatigue conditions of the ankle invertor and evertor muscles. Methods: Thirty physically active healthy male and female (15 male and 15 female) volunteers (24.3 years) were enrolled in this prospective cross-sectional study. Participants performed tests on one day under a non-fatigued state of invertor and evertor muscles and on the second day in a fatigued state. Tests included static posturography on a force platform in a bipedal stance with eyes open and closed and in one-legged support with eyes open and functional jump tests (figure-of-8, side hop, 6-m crossover hop, and square hop). Fatigue of the ankle invertor and evertor muscles was induced using isokinetic dynamometry with 30 repetitions at 120°/s. Results: Participants had an average age of 24.3 years (SD ± 2.08), the height of 1.73 m (SD ± 0.08), and a weight of 68.63 kg (SD ± 10.29). The average Body Mass Index (BMI) was 22.88 (SD ± 2.46). A decrease in performance was observed in functional activities and postural control under all conditions after the induction of muscle fatigue, except for the speed at a bipedal stance with eyes open. Conclusions: Functional jump tests are low cost and useful for clinical practice and evaluation of the effects of muscle fatigue and could be used in clinical practice.

Abstract Context Aging causes a progressive worsening in postural balance, affecting functional independence and increasing the risk of falls. Objective The aim of the study was to evaluate the effect of aging on the static balance in women from 50-years to 89-years of age. Design This was a cross-sectional study, with 400 irregularly active women were evaluated and grouped by age: Group 6thdecade (age 50 to 59) ‒ 58 participants; Group 7thdecade (age 60 to 69) ‒ 214 participants; Group 8thdecade (age 70 to 79) ‒ 92 participants; Group 9thdecade (age 80 to 89) ‒ 36 participants. Postural balance was evaluated using a portable force platform in a standard standing position, with Eyes Open (EO) and Eyes Closed (EC). Results In the two measurement conditions, the elderly women in Group 9thdecade presented mediolateral displacement and range, and mean velocity greater than the women's values in Groups 6thand 7thdecade. In the EO e EC situation, the displacement was higher in the elderly Group 9thdecade compared to younger groups. Group 8thhas a mean velocity greater than Group 6thdecade in the EO situation. Conclusions Posturography showed a decline in postural balance with advancing age, suggesting that the 9thdecade of life is a borderline age to this detriment due to an increase in postural instability.

Abstract Context In the elderly, weak lower limb muscles impair functional tasks' performance. Objective To evaluate the healthy elderly's ankle dorsiflexion and plantarflexion maximum torque and its variability in two sets of 5 RM isokinetics evaluation. Method 50 women (68.0 ± 4.6 years old) and 50 men (72.7 ± 8.5 years old) did two sets of ankle plantar flexor and dorsiflexor isokinetic tests at 30°/s. Peak torque, total work, and coefficient of variation were analyzed. Results Men did the strongest plantarflexion torque (p < 0.05) and dorsiflexion torque (p < 0.05); their highest peak torque occurred at set 2 (p < 0.05), while the largest plantarflexion torque variability (p < 0.05), dorsiflexion torque variability (p < 0.05), and the largest plantarflexion torque variability occurred at set 1 (p < 0.05). Men did the highest plantarflexion and dorsiflexion total work (p < 0.05) at set 2 (p < 0.05). Conclusion Older men are stronger than older women. The torque variability, in men, was higher during the first set, suggesting an adaptation to the isokinetics evaluation. Clinicians and researchers should consider that different muscles might need different numbers of sets and trials to measure their maximal muscle strength.

Abstract Context: Anterior Cruciate Ligament (ACL) injury is disabling in several sports because it causes knee instability and functional deficit. Usually, surgical treatments produce the best functional outcomes, however, sometimes they are not always able to fully restore stability and function. Objective: The objective of this study was to evaluate postural balance, muscle strength, and functional performance of young athletes with an ACL injury before and after ACL reconstruction. Design: This was a longitudinal observational prospective study. Method: 74 athletes, 60 men, and 14 women, aged between 16 and 45, divided into two groups: the Group-Lesion of ACL with 34 athletes (24.1 years) and the Group-Control with 40 athletes without ACL lesion (27.7 years old). All volunteers performed posturography, isokinetic dynamometry, and the Hop-Test. The ACL-Group was evaluated before and 12 months after the reconstruction and the control group was evaluated once. Results: The Postoperative ACL Group presented greater limb symmetry, 0.96 (± 0.12), than the preoperative ACL Group, 0.87 (± 0.17), p < 0.01 in the Hop-Test. In the posturography, the displacement area was smaller in the postoperative ACL Group, 19.85 (± 5.74), compared to the preoperative ACL Group, 24.20 (± 8.97), p < 0.01. In isokinetic dynamometry the torque peak was greater in the postoperative ACL Group, 0.91 (± 0.14), than in the preoperative ACL Group, 0.74 (± 0.15), p < 0.01. Conclusion: The functional outcomes increased in ACL reconstruction athletes after 12 months, but not at the same level as in the Control Group. The result indicates an incomplete functional recovery, adaptive changes in postural control after injury, reconstruction, and return to sport.

RESUMO Introdução: A instabilidade postural afeta o controle postural desde os estágios iniciais da doença de Parkinson (DP). A literatura descreve benefícios do programa de fortalecimento muscular no equilíbrio, na capacidade funcional, porém poucos estudos investigaram seus efeitos no controle postural na DP. Objetivo: Investigar os efeitos de um programa de três meses de fortalecimento nas medidas da posturografia estática (PE) e nos testes clínicos na DP. Métodos: Participaram do ensaio aleatório controlado 74 pacientes, designados em um dos seguintes grupos: fortalecimento utilizando aparelhos de musculação (gmusc); fortalecimento com pesos livres e elásticos (gpeso); e grupo controle. As avaliações ocorreram antes da intervenção, 3 e 6 meses após intervenção. Foram avaliados alterações nas medidas da PE nas condições de olhos abertos, olhos fechados e dupla tarefa (desfecho primário), efeitos sobre sintomas motores, equilíbrio por meio de escalas clínicas, posturografia dinâmica e percepção da qualidade de vida (desfechos secundários). Resultados: Não houve interações significativas nas medidas da PE entre os grupos. As pontuações motoras da Escala Unificada de Avaliação da Doença de Parkinson (UPDRS-III) diminuíram em ambos os grupos de fortalecimento (p<0,05). Houve melhora da percepção da qualidade de vida para o domínio mobilidade no gmusc, assim como ganhos nas pontuações dos testes funcionais no gpeso, mantido no seguimento após seis meses (p<0,05). Conclusões: O programa de fortalecimento não altera o controle postural medida pela PE. Apesar disso, ambos os grupos de fortalecimento apresentaram melhor desempenho motor, efeitos positivos a médio prazo no equilíbrio no gpeso e melhor desempenho na qualidade de vida no gmusc.

ABSTRACT Background: Postural instability affects Parkinson’s disease (PD) patients’ postural control right from the early stages of the disease. The benefits of resistance training (RT) for balance and functional capacity have been described in the literature, but few studies have been conducted showing its effects on PD patients’ postural control. Objective: To investigate the effects of a three-month RT intervention on static posturography (SP) measurements and clinical functional balance assessment among PD patients. Methods: Seventy-four patients were randomly assigned to a three-month RT intervention consisting of using weightlifting machines at a gym (gym group) or RT consisting of using free weights and elastic bands (freew group), or to a control group. The participants were evaluated at baseline, three months and six months. We evaluated changes of SP measurements under eyes-open, eyes-closed and dual-task conditions (primary endpoint), along with motor performance and balance effects by means of clinical scales, dynamic posturography and perceptions of quality of life (secondary endpoints). Results: There were no significant interactions in SP measurements among the groups. Unified Parkinson Disease Rating Scale (UPDRS-III) motor scores decreased in both RT groups (p<0.05). Better perceived quality of life for the mobility domain was reported in the gym group while functional balance scores improved in the freew group, which were maintained at the six-month follow-up (p<0.05). Conclusions: This study was not able to detect changes in SP measurements following a three-month RT intervention. Both RT groups of PD patients showed improved motor performance, with positive balance effects in the freew group and better perceived quality of life in the gym group.

RESUMO Objetivo: Investigar a relação da antropometria e composição corporal com o equilíbrio postural dinâmico em idosas com baixa Densidade Mineral Óssea (DMO). Métodos: 45 idosas (≥ 60 anos), baixa DMO e diagnóstico nutricional entre baixo peso e sobrepeso. Para a avaliação da composição corporal utilizou-se a densitometria por emissão de raios x de dupla energia e exame antropométrico para aferir: massa corporal (kg), estatura (cm) e índice de massa corporal (IMC) (k/m2). A avaliação do equilíbrio postural dinâmico foi realizada pelo teste clínico mini Balance Master Evaluation System, pelo teste computadorizado Balance Master ® System e pelos testes Sit-to-Stand e Step Up/Over. Resultados: Houve correlação negativa do miniBESTest (r = − 0,566; p ≤ 0,001) e tempo de subir e descer um degrau (r = − 0,393; p ≤ 0,007) com a massa gorda, e correlação positiva do miniBESTest (r = 0,526; p ≤ 0,001) e tempo de subir e descer um degrau com a massa muscular (r = 0,297; p ≤ 0,04). Quanto às variáveis antropométricas, apenas a estatura apresentou correlação positiva (r = 0,296; p ≤ 0,04) com a velocidade no teste de sentar-se e levantar-se. Conclusão: A massa magra reduz as oscilações posturais. Em contrapartida, a massa gorda interfere de forma negativa no equilíbrio postural dinâmico de mulheres com baixa DMO. A estatura esteve relacionada ao equilíbrio postural dinâmico: quanto mais altas as idosas pior era seu equilíbrio. Nível de Evidência II, Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.

ABSTRACT Objective: To investigate the relationship between anthropometry and body composition with dynamic postural balance in elderly women with low bone mineral density (BMD). Methods: 45 older women (≥ 60 years), low BMD and nutritional diagnosis of low weight to overweight. For the assessment of body composition, Dual energy X-ray emission densitometry and anthropometric examination were used to measure: body mass (kg), height (cm) and BMI (k/m2). The assessment of dynamic postural balance was performed by the mini Balance Master Evaluation System clinical test and the computerized Balance Master® System test by the Sit to Stand and Step Up/Over tests. Results: There was a negative correlation between miniBESTest (r = − 0.566; p ≤ 0.001) and time to ascend and descend step (r = − 0.393; p ≤ 0.007) with fat mass, and positive correlation with miniBESTest (r = 0.526; p ≤0.001) and time to go up and down a step with muscle mass (r = 0.297; p ≤ 0.04). As for anthropometric variables, only height showed a positive correlation (r = 0.296; p ≤ 0.04) with the speed in the sit and stand test. Conclusion: Lean mass reduces postural oscillations; in contrast, fat mass negatively interfered with dynamic postural balance in women with low BMD. Height was related to dynamic postural balance, the taller the elderly, the worse their balance. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

RESUMO Objetivo: Comparar os efeitos de diferentes rotinas de treinamento em medidas de força e hipertrofia muscular. Métodos: Foram distribuídos em dois grupos de treinamento 67 indivíduos não treinados: Rotina Distribuída (n=35), com os grupos musculares treinados duas vezes por semana em uma divisão A/B com oito séries por sessão, ou Rotina de Corpo Inteiro (n=32), com os grupos musculares treinados quatro vezes por semana com quatro e oito séries por sessão de treinamento. Ambos os grupos realizaram de oito a 12 repetições máximas por série, com intervalo de 60 segundos entre as séries. A força e a espessura muscular máximas foram avaliadas no início e após oito semanas de treinamento. Resultados: Observaram-se diferenças significativas considerando o tempo (pré versus pós) para força máxima no supino, agachamento e espessura muscular de extensores do cotovelo, flexores do cotovelo e músculos do quadríceps femoral. Não foram observadas diferenças significativas entre os grupos para nenhum dos parâmetros avaliados. Conclusão: O treinamento de força realizado duas ou quatro vezes por semana com volume de séries equalizado promove adaptações neuromusculares similares.

ABSTRACT Objective: To compare the effects of different resistance training programs on measures of muscle strength and hypertrophy. Methods: Sixty-seven untrained subjects were randomized to one of two groups: Split Workout Routine (n=35), in which muscle groups were trained twice per week in an A/B split consisting of eight sets per session, or Full-Body Workout Routine (n=32), in which muscle groups were trained four times per week with four and eight sets per session. Both groups performed eight to 12 repetition maximum per set, with 60 seconds of rest between sets. Maximal strength and muscle thickness were assessed at baseline and after eight weeks of training. Results: A significant main effect of time (pre versus post) was observed for maximal strength in the bench press and squat exercises and thickness of the elbow extensor, elbow flexor and quadriceps femoris muscles. Selected variables did not differ significantly between groups. Conclusion: Resistance training twice or four times per week has similar effects on neuromuscular adaptation, provided weekly set volume is equal.

OBJECTIVES: To evaluate the clinical characteristics, ground reaction force (GRF), and function of the plantar muscles and dorsiflexors of the ankle in runners with and without Achilles tendinopathy (AT) and in non-runners. METHODS: Seventy-two participants (42 men, 30 women; mean age: 37.3±9.9 years) were enrolled in this cross-sectional study and divided into three groups: AT group (ATG, n=24), healthy runners’ group (HRG, n=24), and non-runners’ group (NRG, n=24). Both ankles were evaluated in each group. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for clinical and functional evaluation. GRF was evaluated using force plates and muscle strength was evaluated using an isokinetic dynamometer. RESULTS: The AOFAS scores were lower in the ATG. The strike impulse was higher in the ATG than in the HRG and NRG. However, GRF was similar among the groups. The ATG exhibited lower total work at 120°/s speed than the HRG. The peak torque in concentric dorsiflexion was lower in the NRG than in the ATG and HRG. The peak torque and total work in concentric plantar flexion were lower in the NRG than in the ATG. The peak torque and total work in eccentric plantar flexion were lower in the NRG than in the ATG and HRG. CONCLUSION: Runners with AT showed higher strike impulse, lower muscle strength of the plantar flexors, and higher clinical and functional damage.

OBJECTIVE: This study aimed to analyze the physical and pulmonary capacities of hospitalized patients with severe coronavirus disease and its correlation with the time of hospitalization and complications involved. METHODS: A total of 54 patients, aged ≥18 years of both sexes, were evaluated 2-4 months after hospital discharge in São Paulo, Brazil. The physical characteristics analyzed were muscle strength, balance, flexibility, and pulmonary function. The K-means cluster algorithm was used to identify patients with similar physical and pulmonary capacities, related to the time of hospitalization. RESULTS: Two clusters were derived using the K-means algorithm. Patients allocated in cluster 1 had fewer days of hospitalization, intensive care, and intubation than those in cluster 2, which reflected a better physical performance, strength, balance, and pulmonary condition, even 2-4 months after discharge. Days of hospitalization were inversely related to muscle strength, physical performance, and lung function: hand grip D (r=−0.28, p=0.04), Short Physical Performance Battery score (r=−0.28, p=0.03), and forced vital capacity (r=−0.29, p=0.03). CONCLUSION: Patients with a longer hospitalization time and complications progressed with greater loss of physical and pulmonary capacities.

RESUMO Objetivo: Analisar a influência da neuropatia diabética periférica (NDP) no equilíbrio postural, atividades funcionais e na qualidade de vida em idosos. Métodos: Estudo transversal. Avaliamos 60 homens e mulheres idosos (60-79 anos) divididos em três grupos: controle, DM sem e com NDP. Foram avaliados: antropometria; qualidade de vida; equilíbrio postural (BESTest); atividades funcionais pelo equilíbrio funcional na placa de força (NeuroCom Balance). Resultados: Grupo NDP apresentou diferenças comparado a outros grupos, pior desempenho na qualidade de vida que o DM2 sem NDP em: funcionamento sensorial (p = 0,030); passado e futuro (p = 0,036); morte e morrer (p = 0,035). Déficit de equilíbrio postural no escore total (p = 0,025) e seção de restrições biomédicas (p = 0,043) do BESTest comparado ao DM2 sem NDP (p = 0,007). No equilíbrio funcional (Neurocom), o grupo NDP apresentou pior desempenho no tempo gasto no lado esquerdo (p = 0,030) comparado ao grupo controle. Durante a etapa de teste, o grupo controle executou a tarefa mais rapidamente que o grupo NDP (p = 0,004). Conclusão: Neuropatas apresentaram pior desempenho físico e déficits no equilíbrio postural, limitações sensoriais, afetando as tarefas diárias da doença e, consequentemente, diminuição da qualidade de vida em idosos brasileiros. Nível de Evidência II, Estudo observacional transversal.

ABSTRACT Objective: To analyze the impact of the Peripheral Diabetic Neuropathy (PDN) on the postural and functional balance and quality of life of Brazilian older adults. Methods: A cross-sectional study. Sixty older men and women (60-79 years) were divided into three groups: control, DM without and with PDN. The following parameters were evaluated: anthropometry; quality of life; postural balance (BESTest); functional balance in force plate (NeuroCom Balance). Results: PDN group presented significant differences compared with the other groups, with the worst performance in quality of life than DM2 without PDN in: sensory functioning (p = 0.030); past and future (p = 0.036); death and dying (p = 0.035). Postural balance deficit in the total score (p = 0.025) and biomedical constraints section (p = 0.043) of the BESTest, compared with DM2 without PDN (p = 0.007). In the functional balance (Neurocom), PDN group presented a worse performance in the time spent on the left side (p = 0.030) than the control group. During step up over test, the control group performed the task faster than the group with PDN (p = 0.004). Conclusion: This study showed that neuropaths presented worse physical performance and postural balance deficits, sensorial limitations, affecting the daily tasks and, as a consequence, decreasing the quality of life in Brazilian older adults. Level of Evidence II, Cross-sectional observational study.

RESUMO Introdução: A marcha humana é um movimento complexo dependente de controle neural multinível, que permite um padrão periódico uniforme, regular e complexo, que a caracterizam como um sistema não linear. O déficit sensitivo e motor com diminuição das respostas proprioceptivas pode diminuir a capacidade de adaptação do sistema, como já demonstrado nas doenças de Parkinson, Alzheimer e Huntington. Contudo, pouco se conhece sobre o efeito da neuropatia diabética periférica nessas respostas. Objetivos: Analisar a influência da neuropatia diabética periférica na entropia em diferentes ambientes de marcha. Métodos: Dez idosos, sem e com diagnóstico de neuropatia diabética periférica, caminharam em esteira rolante (velocidade inicial 3 km/h e incremento de 0,5 km/h a cada 5 minutos até a velocidade 5 km/h) para o registro da aceleração do centro de massa nos componentes vertical, médio-lateral, e anteroposterior ao longo de todo teste. A entropia amostral dos três vetores foi calculada para cada velocidade de teste. Resultados: O componente vertical não apresentou nenhuma diferença com significância estatística. O componente médio-lateral mostrou diferenças com significância estatística para os fatores grupo, velocidade e interação entre os fatores (grupo e velocidade). O componente anteroposterior apresentou diferenças com significância estatística para o fator grupo, mas não para o fator velocidade e interação entre os fatores (grupo e velocidade). Em todas as comparações, foram encontrados tamanhos de efeito classificados como grandes. Conclusões: A neuropatia diabética periférica produziu alterações na capacidade de adaptação sobre as variações do ambiente durante a marcha, provavelmente, em decorrência de alterações da complexidade do sistema de controle neural multinível, que depende da retroalimentação sensitiva e motora, sabidamente afetadas pela neuropatia diabética periférica. Nível de Evidência II; Estudos diagnósticos – Investigação de um exame para diagnóstico.

ABSTRACT Introduction: Human gait is a complex movement dependent on multilevel neural control, which allows a consistent, regular and complex periodic pattern, properties that characterize it as a nonlinear system. Sensory and motor deficits, with diminished proprioceptive responses, may reduce the adaptive capacity of the system, as demonstrated in Parkinson's, Alzheimer's and Huntington's diseases. However, little is known about the effect of peripheral diabetic neuropathy on these responses. Objectives: To analyze the influence of peripheral diabetic neuropathy on entropy in different gait environments. Methods: Ten elderly patients, with and without a diagnosis of peripheral diabetic neuropathy, walked on a treadmill (initial speed of 3 km/h, with 0.5 km/h increments every 5 minutes up to the speed of 5 km/h) to record center of mass acceleration in the vertical, mediolateral and anteroposterior components throughout the test. The sample entropy of the three vectors was calculated for each test speed. Results: The vertical component did not show any statistically significant differences. The mediolateral component showed statistically significant difference for the factors group, speed, and interaction between factors (group and speed). The anteroposterior component showed statistically significant differences for the group factor, but not for speed and interaction between factors (group and speed). Effect sizes classified as large were found in all the comparisons. Conclusions: Peripheral diabetic neuropathy produced changes in the ability to adapt to changes in the environment during gait, probably due to changes in the complexity of the multilevel neural control system, which depends on motor and sensory feedback, known to be affected by peripheral diabetic neuropathy. Level of Evidence II; Diagnostic studies - Investigating a diagnostic test.

RESUMEN Introducción: La marcha humana es un movimiento complejo dependiente de control neural multinivel, que permite un patrón periódico uniforme, regular y complejo, que la caracterizan como un sistema no lineal. El déficit sensitivo y motor con disminución de las respuestas propioceptivas puede disminuir la capacidad de adaptación del sistema, como ya fuera demostrado en las enfermedades de Parkinson, Alzheimer y Huntington. No obstante, poco se conoce sobre el efecto de la neuropatía diabética periférica en esas respuestas. Objetivos: Analizar la influencia de la neuropatía diabética periférica en la entropía en diferentes ambientes de marcha. Métodos: Diez ancianos, sin y con diagnóstico de neuropatía diabética periférica, caminaron en cinta rodante (velocidad inicial 3 km/h e incremento de 0,5 km/h a cada 5 minutos hasta la velocidad de 5 km/h) para el registro de la aceleración del centro de masa en los componentes vertical, medio-lateral, e anteroposterior a lo largo de todo el test. La entropía de muestreo de los tres vectores fue calculada para cada velocidad de test. Resultados: El componente vertical no presentó ninguna diferencia con significancia estadística. El componente medio-lateral mostró diferencias con significancia estadística para los factores grupo, velocidad e interacción entre los factores (grupo y velocidad). El componente anteroposterior presentó diferencias con significancia estadística para el factor grupo, pero no para el factor velocidad e interacción entre los factores (grupo y velocidad). En todas las comparaciones, se encontraron tamaños de efecto clasificados como grandes. Conclusiones: La neuropatía diabética periférica produjo alteraciones en la capacidad de adaptación sobre las variaciones del ambiente durante la marcha, probablemente como consecuencia de alteraciones de la complejidad del sistema de control neural multinivel, que depende de la retroalimentación sensitiva y motora, sabidamente afectadas por la neuropatía diabética periférica. Nivel de Evidencia II; Estudios de diagnósticos - Investigación de un examen para diagnóstico.

RESUMO A máscara é um dispositivo simples, mas oferece altos níveis de proteção. Como o vírus afeta principalmente o trato respiratório – nariz, boca e pulmões – é altamente contagioso quando as pessoas espirram, tossem ou trocam gotículas respiratórias com outras pessoas. Essa troca também é promovida quando a pessoa está realizando exercícios físicos. Embora a máscara forneça alguma proteção, ela não elimina a necessidade de distanciamento social. Cerca de 25% das pessoas infectadas com o novo coronavírus podem não apresentar sintomas, mas mesmo assim, transmitem o vírus. Um dos principais problemas do uso de máscara é que ela dificulta a respiração, pois gradualmente fica úmida e aumenta a resistência à entrada de ar. É necessário um período de adaptação para a atividade física com máscara, pois o fluxo de ar para os pulmões é reduzido, exigindo a diminuição do ritmo normal até que a adaptação ocorra. Exercícios vigorosos e intensos podem aumentam a atividade inflamatória e devem ser minimizados para proteger o sistema imunológico. A imunoglobulina secretora A (IgA) é uma proteína anticorpo usada pelo sistema imunológico para neutralizar patógenos, incluindo vírus, e diminui com exercícios intensos. O exercício é considerado intenso quando é necessário respirar pela boca para eliminar a maior concentração de CO2, mas a respiração bucal está associada a infecções do trato respiratório superior. A preferência deve ser pelos exercícios leves a moderados, realizados cerca de três vezes por semana. Usar a máscara e treinar a respiração nasal são os modos melhores e mais seguros de reduzir a entrada de partículas e precisam ser incentivados durante a pandemia de COVID-19. Nível de evidência V; Opinião do especialista.

ABSTRACT A mask is a simple device yet it provides high levels of protection. As the virus affects mainly the respiratory tract – the nose, mouth, and lungs - it is highly contagious when people sneeze or cough, or exchange respiratory droplets with other people. This exchange is also promoted when a person is performing physical exercise. Although a mask provides some protection, it does not eliminate the need for social distancing. Around 25% of people infected with the new coronavirus may show no symptoms, yet still transmit the virus. One of the main problems with wearing a mask is that it hinders breathing, with the mask gradually becoming damp, increasing its resistance to air intake. Wearing a mask while performing physical activity requires a period of adaptation, as the flow of air to the lungs is reduced, requiring a reduction in the normal rhythm until the wearer has managed to adapt to it. Vigorous and intense exercise can cause inflammatory activity to increase, and should be minimized in order to protect the immune system. Secretory immunoglobulin A (IgA) is an antibody protein used by the immune system to neutralize pathogens, including viruses, and decreases with intense exercise. Exercise is considered intense when it is necessary to breathe through the mouth to eliminate the higher concentrations of CO2, but mouth breathing is associated with infections of the upper respiratory tract. Preference should be given to light to moderate exercise, around three times a week. Wearing a mask, and training in nasal breathing are the best and safest ways to reduce the entry of particles, and should be encouraged during this COVID-19 pandemic. Level of evidence V; Opinion of the specialist.

RESUMEN La máscara es un dispositivo simple, pero ofrece altos niveles de protección. Debido a que el virus afecta principalmente el tracto respiratorio (nariz, boca y pulmones) es muy contagioso cuando las personas estornudan, tosen o intercambian gotitas respiratorias con otros. Aunque la máscara proporciona cierta protección, no elimina la necesidad del distanciamiento social. Alrededor del 25% de las personas infectadas con el nuevo coronavirus pueden no tener síntomas, pero aun así transmiten el virus. Uno de los principales problemas de la máscara es que dificulta la respiración, ya que gradualmente se humedece y aumenta la resistencia a la entrada del aire. Es necesario un período de adaptación para la actividad física con una máscara, ya que reduce el flujo de aire a los pulmones, lo que requiere una disminución del ritmo normal hasta que se produzca la adaptación. El ejercicio vigoroso e intenso puede aumentar la actividad inflamatoria y debe minimizarse para proteger el sistema inmunitario. La inmunoglobulina secretora A (IgA) es una proteína anticuerpo utilizada por el sistema inmunitario para neutralizar los patógenos, incluidos los virus, y disminuye con el ejercicio intenso. El ejercicio se considera intenso cuando es necesario respirar por la boca debido la mayor concentración de CO2, pero la respiración bucal se asocia con infecciones del tracto respiratorio superior. La preferencia debe ser para la realización de ejercicios leves a moderados aproximadamente tres veces por semana. Usar la máscara y entrenar la respiración nasal es mejor y más seguro para reducir la entrada de partículas y deben estimularse durante la pandemia de COVID-19. Nivel de evidencia V; Opinión de expertos.