PPGFS - Doutorado em Fisioterapia

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Telerreabilitação e fisioterapia presencial em pessoas com Doença de Parkinson: dados quantitativos e qualitativos de um ensaio clínico aleatorizado
(Universidade Federal do Rio Grande do Norte, 2025-10-31) Taveira, Raissa Souza; Ribeiro, Tatiana Souza; Melo, Luciana Protásio de; Franco, Carlúcia Ithamar Fernandes; Tavares, Larissa Bastos; Lucena, Larissa Coutinho de; Souza, Rogério José de; Pacheco, Thaiana Barbosa Ferreira
Introduction: Physiotherapy plays a central role in the management of Parkinson’s disease (PD), contributing to the reduction of both motor and non-motor symptoms and to the promotion of quality of life. In recent years, telerehabilitation (TR) has emerged as an alternative or complementary approach to in-person physiotherapy (PF), facilitating access, continuity of care, and the reduction of geographical and logistical barriers. Objective: To analyze the effects of TR compared with PF in individuals with PD, considering both quantitative and qualitative clinical outcomes. Methods: This randomized clinical trial involved people with PD who participated in a 16-week group physiotherapy program conducted either in-person or remotely. Assessments were performed at four time points (baseline, 8, 16, and 24 weeks) using validated instruments to measure motor symptoms (MDS-UPDRS III), quality of life (PDQ-39), cognition (MoCA), balance, and functional mobility (TUG, FGA). Session adherence and adverse events were systematically monitored. In addition, a qualitative study was carried out two months after the intervention, through semi-structured interviews analyzed using Bardin’s Content Analysis method. Inferential statistical analysis (mixed ANOVA) was applied to quantitative outcomes, while qualitative data were examined descriptively and thematically to identify perceived benefits, barriers, and facilitators. Results: Quantitative findings indicated that both TR and PF promoted clinical improvement in motor and non-motor symptoms. PF showed greater gains in the mobility and activities of daily living domains of the PDQ-39, as well as in balance and gait, whereas TR demonstrated better cognitive stability (MoCA). Adherence was high in both groups, and no serious adverse events were observed. The qualitative analysis revealed predominantly positive experiences in both groups, including feelings of motivation, support, and well-being, as well as appreciation for professional guidance. Contextual factors included social interaction and accessibility in the PF group, and convenience and autonomy in the TR group, although the latter also reported technical challenges and the need for family assistance. Conclusion: TR and PF proved to be safe and effective strategies for individuals with PD, presenting complementary benefit profiles. The choice between modalities should consider individual characteristics, personal and contextual preferences, and the need for technological support. The findings reinforce TR as a feasible and effective tool that expands access and diversifies rehabilitation options for people with PD.
Avaliação e intervenção em atletas com tendinopatia patelar com ênfase na cadeia cinética
(Universidade Federal do Rio Grande do Norte, 2025-11-11) Araújo, Eduardo Henrique Dias; Silva, Rodrigo Scattone da; https://orcid.org/0000-0002-7973-188X; http://lattes.cnpq.br/9953273388451412; http://lattes.cnpq.br/3319148986317258; Lins, Caio Alano de Almeida; https://orcid.org/0000-0001-6424-3114; http://lattes.cnpq.br/1378037748813246; Lobato, Daniel Ferreira Moreira; https://orcid.org/0000-0002-2353-8650; http://lattes.cnpq.br/3736858758375395; Dantas, Glauko André de Figueirêdo; https://orcid.org/0000-0002-4620-2877; http://lattes.cnpq.br/4433966587170692; Oliveira, Rodrigo Ribeiro de
Introduction: Patellar tendinopathy is one of the most common causes of knee pain in athletes and causes significant functional limitation, which can culminate in abandonment of sports practice. Traditional protocols, such as Heavy Slow Resistance Training (HSR), have been consolidated as effective in the rehabilitation of athletes with patellar tendinopathy, but do not contemplate relevant kinetic chain factors that can be important sources of knee overload. Objectives: Study 1 – to compare strength, flexibility and landing mechanics between athletes with patellar tendinopathy and healthy controls; Studies 2 and 3 – to evaluate the effects of an intervention based on kinetic chain factors compared to HSR on short- and long-term clinical and functional outcomes in athletes with patellar tendinopathy. Methods: Study 1 – crosssectional study with 32 athletes (16 with tendinopathy and 16 controls), evaluated for isometric hip, knee and ankle strength, quadriceps and hamstring flexibility, ankle dorsiflexion range of motion (ROM) and landing mechanics [Landing Error Scoring System (LESS)]; Studies 2 and 3 – double-blind randomized controlled trial with 28 athletes, allocated to the Kinetic Chain Group (GCC, n=14) and HSR Group (GHSR, n=14), submitted to 12 weeks of supervised intervention (3x/week). Symptom severity [Victorian Institute of Sport Assessment-Patella (VISA-P)], pain (visual analogue scale), global perception of change, isometric torque (manual dynamometer), ankle dorsiflexion ROM (forward test) and jump landing mechanics (LESS) were evaluated. Assessments were conducted by a blinded researcher at baseline, after 12 weeks and after 6 months. The data were analyzed with generalized estimation equations, with intention-to-treat analysis. Resultados: Estudo 1 – atletas com tendinopatia apresentaram força significativamente menor em todos os grupos musculares (diferenças médias (DM) entre 0,59 e 3,16 N·m/kg; p<0,01), menor ADM de dorsiflexão do tornozelo (DM=8,35°; IC95% = 5,95– 10,73; p<0,001) e menor flexibilidade de isquiotibiais (DM=10,50°; IC95% = 1,75–19,25; p=0,005), além de maior escore LESS (DM = –5,18; IC95% = –5,74 a –4,63; p<0,001) em comparação aos controles saudáveis. Estudos 2 e 3 – o GCC apresentou melhora superior na severidade dos sintomas (VISA-P), quando comparado ao GHSR, após 12 semanas (DM = 14,14 pontos; IC95% = 0,92 a 27,35; p = 0,02) e após 6 meses (DM = 14,28 pontos; IC95% = 3,56 a 25,00; p<0,001). O GCC também apresentou melhora superior na ADM de dorsiflexão do tornozelo (DM = 3,70°; IC95% = 1,42 a 5,97; p<0,001) e na mecânica de aterrissagem de salto (DM = 4,14 pontos; IC95% = 3,37 a 4,91; p<0,001) em comparação ao GHSR. O torque isométrico aumentou em todos os grupos musculares, sem diferenças entre os grupos (p>0,05). Conclusion: Athletes with patellar tendinopathy exhibit deficits in strength and flexibility in the lower limb, as well as changes in the movement pattern on the jump landing, compared to healthy athletes. An intervention targeting kinetic chain factors produced a significantly greater improvement in symptom severity compared to the classical HSR protocol immediately after 12 weeks of intervention and 6 months after the end of the interventions in athletes with patellar tendinopathy. These results highlight the importance of a comprehensive intervention in the rehabilitation of patellar tendinopathy, including not only progressive exercises for the patellar tendon, but also potential causative factors of overload in athletes.
Efeitos da ventilação não-invasiva com diferentes modalidades associada à reabilitação cardiovascular fase hospitalar em pacientes submetidos à cirurgia cardíaca: ensaio clínico randomizado
(Universidade Federal do Rio Grande do Norte, 2025-08-29) Araújo, Éder Rodrigues; Nogueira, Patrícia Angélica de Miranda Silva; Barbosa, Paulo Eduardo e Silva; https://orcid.org/0000-0003-1740-9155; http://lattes.cnpq.br/9229454955533353; https://orcid.org/0000-0002-3763-2410; http://lattes.cnpq.br/1788918737416095; http://lattes.cnpq.br/0563212798867336; Nogueira, Ivan Daniel Bezerra; https://orcid.org/0000-0001-8190-7656; http://lattes.cnpq.br/2221850295985118; Pedrosa, Rafaela; https://orcid.org/0000-0001-9858-2990; http://lattes.cnpq.br/6101532965309565; Bernardes Neto, Saint-Clair Gomes; http://lattes.cnpq.br/0279959015099616; Araújo, Zênia Trindade de Souto; https://orcid.org/0000-0003-3447-6990; http://lattes.cnpq.br/4623628714006403
Introduction: Cardiovascular diseases remain the leading cause of mortality, and while cardiac surgery has become safer, it is still associated with frequent pulmonary complications, increasing morbidity and hospital stay duration. Non-Invasive Ventilation (NIV), particularly CPAP and Bi-level modalities, has shown potential in preventing atelectasis, improving oxygenation, and reducing reintubation rates, although evidence on the superiority of these modes remains inconclusive. Objective: To evaluate the effects of Non-Invasive Ventilation (CPAP and Bi-level), combined with cardiac rehabilitation during the hospital phase, on pulmonary function and functional capacity in patients undergoing cardiac surgery. Methods: A double-blind randomized clinical trial, conducted in Campina Grande, Paraíba, from May to October 2024, assessed the effects of CPAP, Bi-level, and conventional care in 63 patients undergoing cardiac surgery. Approved by the Ethics Committee (CAAE: 65600722.1.0000.5187) and registered on ClinicalTrials.gov (NCT05966337), the study followed the SPIRIT protocol. Patients aged ≥18 years with hemodynamic stability were randomized into three groups (1:1:1). Primary outcomes included pulmonary function (spirometry) and functional capacity (TUG), while secondary outcomes encompassed hemodynamic variables, pulmonary complications, GPCS, hospital stay duration, and adherence. Interventions were applied in the ICU and ward, with pre- and postoperative assessments. Data were analyzed using linear mixed models (LMER) or generalized estimating equations (GEE) in SPSS software, with a significance level of p<0.05. Results: A total of 63 patients undergoing cardiac surgery were analyzed, 65.1% male, with a mean age of 61.4 years and a predominance of myocardial revascularization (63.5%). The sample showed baseline homogeneity. The CPAP group had a shorter hospital stay (β=-0.91 days, p<0.001) and lower prevalence of pulmonary complications (4.8%, p=0.066) compared to the control group (28.6%). Hemodynamic variables showed greater stability in the NIV groups, with significant increases in heart rate (+16.33 bpm, p<0.001) and respiratory rate (+5.71 breaths/min, p<0.001) in the control group. SpO2 significantly decreased in the control group (-2.14%, p<0.001), while NIV groups maintained greater stability. The GPCS was better in the Bi-level group (β=- 1.29, p=0.013). No significant improvements were observed in TUG, FVC, FEV1, or PEF in the NIV groups, but the Bi-level group suggested less functional deterioration (∆TUG: -2.4s, p=0.33). The control group showed greater functional and respiratory decline, with significant reductions in FVC (-0.85L, p<0.001) and FEV1 (-0.82L, p<0.001). Conclusions: The study demonstrated that CPAP significantly reduces hospital stay duration and suggests a lower prevalence of pulmonary complications in cardiac surgery patients. NIV promoted greater hemodynamic stability, with less increase in heart and respiratory rates in the intervention groups. The Bi-level group showed better global perception of change and a trend toward more effective spirometric outcomes. Despite limitations such as sample size, the trial reinforces the clinical potential of non-invasive ventilation in this population.
Comparação entre treinamento sensório motor e de fortalecimento muscular na dor, função e movimento de indivíduos com síndrome da dor subacromial: estudo randomizado e cego
(Universidade Federal do Rio Grande do Norte, 2020-09-15) Oliveira, Karinna Sonálya Aires da Costa; Brasileiro, Jamilson Simões; Sousa, Catarina de Oliveira; Souza, Marcelo Cardoso de; Oliveira, Anamaria Siriani de; Ferreira, José Jamacy de Almeida
Introduction: the subacromial pain syndrome is known as a compression of the subacromial tissues, mainly due to the narrowing of this space. Its etiology is wide, however, imbalances in muscle relationships and in the time of activation of these muscles can influence the functional prognosis of these patients. Objective: The aim of this study was to compare a sensory motor training protocol with a muscle strengthening protocol, in pain, function, of electromyographic activity and scapular kinematics in patients with subacromial pain syndrome. Methods: this is a randomized, blinded trial, composed of 30 volunteers of both genders, with a mean age of 48.9 ± 7.9 years. All volunteers are submitted to a previous evaluation (Av1) where they were measured: pain, function (SPADI), range of motion, muscle strength, relationship between electromyographic activities and kinematics of the shoulder complex. After the initial evaluation, the volunteers were randomly divided into two groups to perform the interventions: exercise group (GE - muscle strengthening exercises, n = 11) and motor sensory group (GSM - motor control training, n = 11). The intervention protocols were perfomed for 8 weeks. After four weeks of intervention, the second evaluation (AV2) was perfomed, identical to AV1. At the end of the intervention protocols, the third evaluations (AV3) was performed and, finally, a follow-up was performed 4 weeks after the end of the intervention protocols. Statistical Analysis: was performed using the Statistical Package for the Social Sciences (SPSS) version 20.0 for Windows, following the principles of analysis by intention to treat. In the descriptive analysis we used the mean as a measure of central tendency and the standard deviation as a measure of dispersion. A mixed model ANOVA was performed for intra and intergroup comparisons. Results: both groups had a reduction in painful sensation. Still in relation to pain, at follow-up, there is an intergroup difference for the sensory motor group, when compared to the muscle strengthening group. For the SAPDI variables, range of motion, joint strength, muscle strength and the relationship between electromyographic activity between the evalueted muscles, there was no difference between the groups. In the kinematic evaluation of the upper scapular rotation, the results showed intergroup differences in 30 and 60 degrees, with increased scores for the sensory motor group. Conclusion: both intervention protocols produced clinically important responses for patients with the subacromial pain syndrome, however, it was observed that gains in GSM last for a longer time, when compared to GE.
Análise do movimento funcional do membro superior na atividade de beber água de acordo com o lado da hemiparesia em pacientes pós-acidente vascular cerebral
(Universidade Federal do Rio Grande do Norte, 2025-06-13) Rêgo, Isabelle Ananda Oliveira; Cavalcanti, Fabricia Azevedo da Costa; https://orcid.org/0000-0002-1391-1060; http://lattes.cnpq.br/9579107830132166; http://lattes.cnpq.br/5149786313403440; Fernandes, Aline Braga Galvão Silveira; Medeiros, Candice Simões Pimenta de; Lucena, Larissa Coutinho de; Borges, Lorenna Raquel Dantas de Macedo
Introduction: Stroke results in a range of neurological impairments that compromise the patients’ functional capacity. Objective: To carry out an analysis of the functional movement of the upper limb in the activity of drinking water, in order to identify motor changes according to the side of the hemiparesis. Methods: The sample consisted of 12 post-stroke patients, 6 with right hemiparesis (RP) and 6 with left hemiparesis (LP), and 12 healthy individuals, of whom 6 performed the activity with the right hand (RH) and 6 with the left hand (LH). Participants were submitted to a kinematic assessment of the activity of drinking water by the Qualisys System, which included reaching for and grasping the glass, transporting it to the mouth, returning the glass to the table, and repositioning the hand to the initial location. Shoulder and elbow angles were calculated along the frames (time fractions). Data were analyzed using the Student’s t-test (p<0.05) and Pearson’s correlation coefficient. Results: A significant difference was observed between RP and LP in the shoulder angles in frames 9 to 14 (p<0.05), corresponding to the initial phase of reaching the cup, and at frame 91, at the end of the return of the cup to the cup table (p=0.039), with the LP group presenting lower angulation. There was no difference between the RP and LP groups in the elbow angles (p>0.05) and in the shoulder angles between RH and LH (p>0.05). A significant difference was observed in elbow angles between RH and LH in frames 22 to 31 (p<0.05), with the SD group presenting greater angle in the cup reaching phase. Atypical correlation patterns between shoulder and elbow angles were observed in RP and LP patients, indicating impaired motor coordination. Trajectory analysis revealed impaired motor control during specific phases of the drinking task, particularly in the LP group during the initial movement of bringing the glass to the mouth. Conclusion: The present study demonstrates that a kinematic evaluation of the drinking task allows the identification of distinct spatiotemporal alterations in shoulder and elbow movements patterns, depending on the side of the cerebral lesion in post-stroke patients. These results highlight the need for tailored planning in neurorehabilitation strategies.
Uso da TENS combianda à fotobiomodulação a laser de baixa intensidade na redução da dor e o efeito agudo na independência funcional, capacidade funcional além das variáveis cardiorrespiratórias após cesariana
(Universidade Federal do Rio Grande do Norte, 2025-07-31) Sena, Alane Macatrão Pires de Holanda Araújo; Nogueira, Patricia Angélica de Miranda Silva; Nogueira, Ivan Daniel Bezerra; http://lattes.cnpq.br/6415505935680278; Souza, Clecio Gabriel de; Lima, Illia Nadinne Dantas Florentino; Augusto, Denise Dal Ava; Oliveira, Maria Clara Eugenia de
Introduction: Postoperative pain following cesarean sections can compromise functional capacity and influence cardiorespiratory physiological variables. For analgesic purposes, electrophysical agents applied individually, such as Transcutaneous Electrical Nerve Stimulation (TENS) and Low-Level Laser Therapy (LLLT) photobiomodulation, can be used. However, the combined effect of these two interventions on cesarean wound healing remains unknown. Objective: To analyze the additional effect of TENS combined with LLLT photobiomodulation for analgesia in women undergoing cesarean section. Methodology: A randomized clinical trial was conducted at Maternidade Divino Amor (Rio Grande do Norte, Brazil) with women who underwent cesarean delivery, distributed into four groups: TENS combined with LLLT photobiomodulation, isolated TENS, placebo, and control. Eighty-eight participants were evaluated at three time points: assessment 1 (8–12 hours postpartum), assessment 2 (20–24 hours postpartum), and assessment 3 (44–48 hours postpartum). Data included sociodemographic and clinical information, pain assessment, functional independence, functional capacity, and cardiorespiratory variables (systemic blood pressure, heart rate, respiratory rate, and oxygen saturation). The combined intervention group followed a two-session protocol using low-intensity TENS (30 min, 100 Hz, 75 μs) with electrodes placed above and below the cesarean incision, combined with LLLT photobiomodulation (660 nm, 2 J per point, 100 mW). The isolated TENS group followed the same low-intensity TENS protocol used in the combined intervention. Interventions (combined and isolated) were administered after assessments 1 and 2. Statistical analyses were performed using SPSS 20.0 software, with tests for normality (Shapiro–Wilk) and homogeneity (Levene). Continuous variables were expressed as mean ± SD, and categorical variables as frequencies. Group comparisons employed one-way ANOVA or Kruskal–Wallis tests, depending on statistical assumptions. Intragroup and intergroup analyses were conducted across three time points (t1, t2, and t3) using repeated-measures ANOVA or equivalent nonparametric tests. A significance level of α < 0.05 and partial eta squared (η²) were adopted for clinical interpretation. Results: The study showed that all four groups had homogeneous sociodemographic and clinical characteristics, with no initial statistically significant differences. Intragroup analyses revealed a progressive reduction in pain (assessed by the Numeric Pain Rating Scale) and improvement in functional independence (FIM) in the intervention groups (isolated TENS and combined therapy), indicating clinical improvement over time. Performance in the Two-Minute Walk Test (2MWT) also improved significantly between t2 and t3 in all groups. However, intergroup comparisons revealed no significant differences in physiological, functional, or pain variables. The time effect was significant for pain and FIM, showing positive progression regardless of the group. Conclusion: The findings indicate that the duration of exposure to the intervention was the main determinant of the observed improvements, with homogeneous clinical responses among the groups. These results highlight the consistency and effectiveness of the applied program and reinforce the importance of adherence to therapeutic strategies in promoting functional gains and pain control in similar clinical populations.
Um olhar para os nossos pequenos guerreiros: barreiras e oportunidades no cuidado convencional do prematuro em vulnerabilidade socioeconômica e proposta de intervenção de transição hospital-casa
(Universidade Federal do Rio Grande do Norte, 2025-08-26) Silva, Nathalia de Figueiredo; Pereira, Silvana Alves; Alvarez, Carolina Daniel de Lima; https://orcid.org/0000-0002-2126-2937; http://lattes.cnpq.br/4144337339534625; https://orcid.org/0000-0002-6226-2837; http://lattes.cnpq.br/3640379319601363; http://lattes.cnpq.br/8558209136050462; Lindquist, Ana Raquel Rodrigues; https://orcid.org/0000-0001-9628-7891; http://lattes.cnpq.br/6535678775361874; Montemezzo, Dayane; https://orcid.org/0000-0001-7680-8223; http://lattes.cnpq.br/0292703537711744; Monteiro, Karolinne Souza; http://lattes.cnpq.br/9064510807814492; Rocha, Nelci Adriana Cicuto Ferreira; https://orcid.org/0000-0002-3191-3086; http://lattes.cnpq.br/2035754554780009
The early years of life play a crucial role in an individual's development, particularly for those who experience childhood under conditions that pose risks to neurodevelopment. Prematurity is a health condition that predisposes individuals to neurodevelopmental alterations, as it combines the infant’s biological risk factors with the potential social risk factors present in their families. Socioeconomic characteristics significantly affect access to and the provision of healthcare services necessary for the care and stimulation of this population’s development. Although obstetric and neonatal care is a priority in the national health policy agenda, early intervention services for those born prematurely appear to fall short of leveraging the neurological window of opportunity in early life to prevent and minimize neurodevelopmental alterations. High-income countries have been developing effective physiotherapeutic interventions to stimulate the development of preterm infants, ranging from neonatal intensive care units to home environments. However, interventions focused on the hospital-to-home transition have not yet been tested in middle- and low-income countries such as Brazil. The objective of this study was to monitor the conventional care provided to preterm infants living in regions with limited access to healthcare services and in socially vulnerable conditions, in order to identify barriers and opportunities for the implementation of an early intervention service for the hospital-to-home transition. To achieve this objective, five studies were proposed: (1) Preterm births and early intervention procedures via SUS – an overview of the Brazilian Northeast; (2) Big Signals, Small Returns: An Ecological Study on Physical Therapy Follow-Up for Preterm Infants in the Third Stage of the Kangaroo Method; (3) Family perceptions of prematurity, neurodevelopment, and early intervention: a qualitative study; (4) Neuromotor and Cognitive Outcomes of Preterm Infants at Three Months of Corrected Age in a Northeastern Region of Brazil: A Pilot Study; and finally (5) Proposal of a hospital-to-home intervention protocol: adaptation of SPEEDI to the Brazilian context. Data analyses indicate that access to early stimulation services by preterm infants in their first year of life results in a ratio of less than one consultation per year. Although mothers report satisfaction with their participation during the initial stages of the Kangaroo Method, more than 90% of the monitored dyads do not return for physiotherapy sessions within the first month after hospital discharge. Furthermore, families of preterm infants demonstrate limited awareness regarding prematurity and the need for developmental interventions, with cognitive and motor outcomes found to be predominantly below average at three months of corrected age. The proposed adaptation of the SPEEDI model for Brazil, as a hospital-to-home transition intervention, may overcome the barriers identified in these studies. The UFRN Research Ethics Committee approved all studies, and all participants signed an informed consent form.
Esclerose lateral amiotrófica, músculos respiratórios e mortalidade
(Universidade Federal do Rio Grande do Norte, 2025-07-25) Maciel, Ana Cristina de Medeiros Garcia; Fregonezi, Guilherme Augusto de Freitas; https://orcid.org/0000-0003-4938-7018; http://lattes.cnpq.br/2201375154363914; https://orcid.org/0000-0002-2399-6221; http://lattes.cnpq.br/6736485315510084; Samora, Giane Amorim Ribeiro; Fregonezi, Vanessa Regiane Resqueti; Silva, Ana Aline Marcelino da; Fonseca, Jéssica Danielle Medeiros da
Introduction: Amyotrophic Lateral Sclerosis (ALS) is characterized as a heterogeneous and fatal neurodegenerative disorder involving the degeneration of both upper and lower motor neurons in the brain and spinal cord. The impact of pulmonary function impairment, respiratory muscle strength, and functionality throughout the disease's progression, as well as their correlation with patient mortality, remains insufficiently understood despite the critical role of respiratory function in the survival of individuals with ALS. Additionally, monitoring respiratory muscle strength in different body positions can provide clinically significant information to guide early decisions regarding ventilatory support. Measurements of maximal inspiratory and expiratory pressures, as well as nasal respiratory pressures (SNIP and SNEP), are particularly relevant methods for ensuring adequate monitoring of ALS patients. Objectives: 1) To investigate the relationship between respiratory function, funcionality and mortality in ALS patients, identifying which respiratory parameters correlate most strongly with the clinical outcome of death. 2) To evaluate differences in SNIP and SNEP respiratory muscle peak pressures measured in two different positions (seated and supine with a 45° elevation) in ALS patients compared to a matched healthy control group. Additionally, to analyze and compare the electromyographic activity of inspiratory and expiratory muscles during respiratory pressure maneuvers in both positions. Materials and Methods: 1) A retrospective cohorte conducted between January 2018 and December 2023, involving ALS patients under outpatient follow-up. Clinical, anthropometric, respiratory, and functional evaluations were performed during routine outpatient visits. 2) A cross-sectional observational study involving ALS patients and a matched healthy control group. Participants underwent spirometry and surface electromyography (sEMG) of the sternocleidomastoid, scalene, rectus abdominis, and external oblique muscles during maximal respiratory pressure maneuvers (MIP and MEP) in the seated position, as well as nasal respiratory pressures (SNIP and SNEP) in seated and 45° inclined positions (randomized). Results: 1) Data from 74 ALS patients (mean age 55.70 ± 13.52 years; 66.2% male; predominantly spinal-onset ALS in 51.3%) were analyzed. Respiratory variables, except for peak expiratory flow (PEF), showed a weak but significant inverse correlation with mortality. All respiratory variables correlated positively (weak to moderate strength) and significantly with functionality as assessed by ALSFRS-R. A one-unit decrease in PEF%pred, MIP, and SNIP increased mortality risk by 300% (OR= 2.99; 95% CI: 2.05 - 4.35), 2% (OR= 1.02; 95% CI: 1.01-1.03), and 1% (OR= 1.01; 95% CI: 1.00 - 1.02), respectively. 2) Twenty male participants were evaluated, including nine healthy controls (mean age 43.6 ± 11.6 years) and 11 ALS patients (mean age 46.8 ± 12.5 years). In ALS patients, SNEP values in the inclined position were lower than in the seated position (70.3 ± 26.7 vs. 57.3 ± 22.8 cmH₂O, p<0.05). Both SNIP and SNEP values were lower in ALS patients in the 45° inclined position compared to healthy controls (SNIP: 69.1 ± 27.2 vs. 95.5 ± 23.5 cmH₂O; SNEP: 57.3 ± 22.5 vs. 92.7 ± 26.4 cmH₂O; p<0.05). In ALS patients, resting basal electromyographic activity of the sternocleidomastoid was higher than in healthy individuals in both positions (p<0.05). No significant differences were found in electrical activity for other variables or measurements. Conclusions: In spinal-onset ALS, nasal pressures may be compromised due to reduced diaphragm and abdominal muscle efficacy in the supine position. The increased electrical activity of the sternocleidomastoid muscle in the 45° inclined position compared to controls may reflect compensatory weakness. Methodological rigor is crucial for optimal SNIP/SNEP testing performance. Retrospective study data suggest that respiratory muscle strength and function, particularly PEF and SNIP measurements, may serve as valuable markers to inform early interventions such as bronchial hygiene therapy and ventilatory support, improving quality of life and potentially extending survival.
Efeito da eletroestimulação transcraniana por corrente contínua autoadministrada em mulheres com dismenorreia primária
(Universidade Federal do Rio Grande do Norte, 2025-07-17) Silva, Tatiana Camila de Lima Alves da; Micussi, Maria Thereza Albuquerque Barbosa Cabral; https://orcid.org/0000-0003-4140-5568; http://lattes.cnpq.br/2360845979410206; http://lattes.cnpq.br/0660600540180796; Souza, Clécio Gabriel de; https://orcid.org/0000-0001-9005-7956; http://lattes.cnpq.br/6308219057546985; Correia, Grasiela Nascimento; http://lattes.cnpq.br/8878717048564522; Cavalcante, Antonio Felipe Lopes; http://lattes.cnpq.br/3625889431512917; Gouveia, Guilherme Pertinni de Morais; https://orcid.org/0000-0001-6470-2341; http://lattes.cnpq.br/4485485225731789
This doctoral thesis, presented in two studies, aimed to deepen the investigation into the efficacy of self-administered, home-based transcranial direct current stimulation (tDCS) as a non-invasive, safe, and accessible therapeutic alternative for women affected by primary dysmenorrhea (PD) and premenstrual syndrome (PMS). The research, in general, is based on the understanding that these gynecological conditions have high prevalence and are associated with significant negative impacts on pain, mood, functionality, and quality of life. Furthermore, it is acknowledged that the prolonged use of pharmacological therapies often leads to adverse effects, reinforcing the need for new therapeutic approaches. The first study consisted of a randomized, double-blind, placebo-controlled clinical trial in which women with PD and PMS used tDCS for five consecutive days during the menstrual phase of the cycle. The results revealed a clinically significant reduction in pain intensity in the active group, with the effect maintained in the following cycle, along with improvements in the psychological domain of quality of life and emotional symptoms. The intervention proved to be safe, with no reports of serious adverse events, and showed good adherence among participants. A critical analysis of the findings suggests that a reduced number of sessions may be insufficient to promote broader and more sustained changes. Therefore, the development of a second study with a greater number of sessions is proposed. In this context, the second study of this thesis aimed to design a 20-day clinical trial protocol to deepen the understanding of the effects of neuromodulation, with an emphasis on clinical and electrophysiological analyses of outcomes, especially those related to persistent pain, mood, and functionality. Finally, as a scientific contribution, it is believed that the two articles resulting from this thesis have a positive impact on strengthening the field of pelvic physical therapy. The results provide both theoretical and practical foundations for the use of tDCS in managing menstrual symptoms, in addition to expanding the possibilities for evidence-based physiotherapeutic interventions in women's health.
Usabilidade da estimulação transcraniana por corrente contínua domiciliar autoadministrada para mulheres com dismenorreia primária
(Universidade Federal do Rio Grande do Norte, 2025-04-29) Rodrigues, Yvinna Tamiris; Freitas, Rodrigo Pegado de Abreu; http://lattes.cnpq.br/3462462933163509; http://lattes.cnpq.br/6224004458610033; Magalhães, Adriana Gomes; https://orcid.org/0000-0002-0279-5930; http://lattes.cnpq.br/5918222264099117; Souza, Clecio Gabriel de; https://orcid.org/0000-0001-9005-7956; http://lattes.cnpq.br/6308219057546985; Okano, Alexandre Hideki; https://orcid.org/0000-0002-8995-1392; http://lattes.cnpq.br/9586370984131426; Gianlorenço, Anna Carolyna Lepesteur; https://orcid.org/0000-0002-7334-3835; http://lattes.cnpq.br/3861050459671690
Primary dysmenorrhea (PD) is a common condition that causes abdominal pain, discomfort, fatigue, and mood changes before and during menstruation. It significantly affects women's functionality, work, and quality of life, with pharmacological treatments often showing limited longterm effectiveness. Persistent PD may cause brain changes related to pain control. In recent years, neuromodulation therapies such as transcranial direct current stimulation (tDCS) have been suggested. Objective: This study evaluates the usability of a Bluetooth-controlled, self-administered, at-home tDCS device focused on women's health. Methods: This is a double-blind, single-center clinical usability study conducted at the Federal University of Rio Grande do Norte (UFRN), in Natal, Brazil. A total of forty-nine symptomatic women of reproductive age were randomly allocated (1:1) to receive either one session of active tDCS (n = 24) or sham tDCS (n = 25) targeting the primary motor area and the dorsolateral prefrontal cortex. The protocol followed standardized parameters (2 mA, 20 minutes), and data collection involved training, supervised remote use, and later reassessment using validated scales: the System Usability Scale (SUS) and the Patient Global Impression of Change (PGIC). Clinical assessment of each participant was collected solely to characterize the sample. Results: Regardless of whether they received active or sham stimulation, all users found the system easy to use without researcher support. Usability ratings were considered "excellent" in both groups, and no significant differences were observed between the active and sham groups, indicating effective device blinding (Active Group: 93.7 [83.1–97.5]; Sham Group: 90 [86.2–95], p = 0.79). Similarly, no significant difference was found in the Patient Global Impression of Change (PGIC) scores (Active Group: 2 [12.75]; Sham Group: 2 [1–2], p = 0.99), using unpaired t-tests or non-parametric statistical tests as appropriate. Conclusion: Self-administered tDCS is a safe intervention with high usability. Its clinical applicability in managing PD appears promising as a non-pharmacological alternative, contributing to the expansion of accessible pain management strategies for women of reproductive age.
Atividade hemodinâmica cortical por meio da Espectroscopia de Infravermelho (fNIRS) simultâneo ao paradigma de eye-tracking em lactentes expostos ao estresse pré-natal em ambientes com recursos limitados
(Universidade Federal do Rio Grande do Norte, 2025-03-07) Almeida, Valéria Azevedo de; Pereira, Silvana Alves; Morya, Edgard; https://orcid.org/0000-0003-0954-5317; http://lattes.cnpq.br/8813809602087639; https://orcid.org/0000-0002-6226-2837; http://lattes.cnpq.br/3640379319601363; https://orcid.org/0000-0001-5973-0890; http://lattes.cnpq.br/1390202794929643; Alvarez, Carolina Daniel de Lima; https://orcid.org/0000-0002-2126-2937; http://lattes.cnpq.br/4144337339534625; Paula, Celina Angélia dos Reis; Hull, Egmar Longo; https://orcid.org/0000-0001-6263-1818; http://lattes.cnpq.br/4886701146385883; Sousa, Klayton Galante; https://orcid.org/0000-0002-7710-7522; http://lattes.cnpq.br/3976136492048222; Freitas, Rodrigo Pegado de Abreu; http://lattes.cnpq.br/3462462933163509
Human babies interact in a social world, and disturbances in the quality and quantity of these interactions early in life can affect their social cognition skills and socioemotional development. Although they are born with innate predispositions to preferentially attend to social cues, their experiences in the intrauterine and extrauterine environment may contribute to variations in these cortical functions. However, the mechanisms underlying this association remain unknown. Examining the variability of functional responses or connectivity of the brain's social network early in life would be a fundamental starting point for mechanically understanding the relationship between living in socioeconomically disadvantaged environments and impaired social development. The objective of this study was to explore the influence of prenatal stress and socioeconomic conditions on infants' socioemotional and cognitive development by evaluating parental concerns and neural responses, and to develop an integrated eye-tracking and cerebral hemodynamic monitoring protocol for use in clinical settings with limited resources. To achieve this objective, three studies were proposed: (1) to determine the prevalence of infants at risk of socioemotional developmental delays and to assess the level of parental concern about the child's development and behavior; (2) to characterize neural responses over the frontotemporal, parietal, and occipital cortex in a social discrimination task in infants exposed to prenatal stress raised in socioeconomically disadvantaged environments; and (3) to propose a protocol that simultaneously integrates eye- tracking and cerebral hemodynamics monitoring for infants in clinical settings with limited resources. Results: Study 1: Out of the 80 children evaluated, 40 (50%) were at risk for global developmental delay. Regarding family concerns, most parents expressed a significant level of concern. However, no association was found between the risk of global developmental delay and parental concerns about development (p = 0.880) or behavior (p = 0.649). Study 2: The results showed greater neural activation in the occipital region for the non-social stimulus compared to the social stimulus (p = 0.001). The other cortical activation areas evaluated (right and left frontotemporal and parietal) responded similarly to both stimuli, with no statistical significance observed (p = 0.83, p = 0.99, p = 0.27, p = 0.25). Study 3: Technical challenges were identified, and components and procedures for incorporating fNIRS and Eye-Tracking in clinical neurodevelopmental monitoring were described. Additionally, the main data properties and their implications for a joint analysis of near-infrared spectroscopy and eye-tracking in this population were summarized. Study 4: The results indicate that premature newborns demonstrate a preference for social stimuli when tested seven days after birth, but this preference decreases in babies who experienced early visual deprivation. These findings support theories that preferences for social stimuli are mediated by visual experiences.
Telerreabilitação como ferramenta para avaliação e tratamento de indivíduos com Doença de Parkinson
(Universidade Federal do Rio Grande do Norte, 2025-05-09) Vasconcellos, Liliane Santos de; Ribeiro, Tatiana Souza; Santiago, Lorenna Marques de Melo; https://orcid.org/0000-0003-0084-7052; http://lattes.cnpq.br/9449197913960069; https://orcid.org/0000-0002-9611-1076; http://lattes.cnpq.br/6868962363056590; http://lattes.cnpq.br/2501620196378523; Espirito Santo, Caroline Cunha do; https://orcid.org/0000-0001-8657-9532; http://lattes.cnpq.br/4920759696380516; Tavares, Larissa Bastos; http://lattes.cnpq.br/7734653778503298; Lucena, Larissa Coutinho de; https://orcid.org/0000-0002-1739-5737; http://lattes.cnpq.br/3705659727218619; Pacheco, Thaiana Barbosa Ferreira
Introduction: Parkinson's disease (PD) is one of the most prevalent progressive neurodegenerative disorders among older adults, leading to a wide range of motor and non-motor symptoms. Due to the impact on individual functionality, supervision and availability of family members and/or caregivers during in-person consultations and therapies are often necessary. In this context, telerehabilitation (TR) may represent a viable alternative for supporting individuals with PD and their caregivers. Objective: To investigate the effects of physiotherapy interventions delivered via telerehabilitation (TR) in individuals with Parkinson's disease (PD), focusing on motor and functional outcomes. Methods: The study was conducted in two studies, addressing the proposed objectives. Study 1: This phase consisted of a systematic review and protocol, including clinical trials involving adults diagnosed with PD who underwent TR interventions. The comparison (control) groups included: any in-person intervention (traditional/inperson physiotherapy), the use of exergames, non-physiotherapeutic remote interventions, minimal interventions (e.g., educational booklets/guidance), or no intervention at all. Primary outcomes were: motor function, gait capacity, gait stability, and postural balance. Secondary outcomes included: gait freezing, fall risk, quality of life, adverse events, and treatment adherence. Meta-analyses were conducted to assess the post-intervention effects. Study 2: This was a prospective longitudinal study. Data were collected remotely from individuals with PD participating in a therapeutic group, evaluating both motor and non-motor aspects of the disease at five time points over a one-year period. A mixed linear model was used to examine the influence of motor and non-motor variables on motor progression. Results and Conclusions: In Study 1, TR showed comparable results to control interventions in improving motor function, gait speed and stability, gait freezing, fall risk, and quality of life in individuals with PD. TR demonstrated benefits in improving postural balance, particularly in individuals under 70 years of age. Adherence to TR was similar to that of control interventions, and adverse events were minimal in both the experimental and control groups. Therefore, TR emerged as a beneficial alternative due to its potential for engagement and personalized care, especially for individuals with limited access to rehabilitation centers. In Study 2, TR outcomes indicated stability in gait, bradykinesia, mobility, and quality of life throughout the one-year follow-up. The study also identified both barriers and facilitators related to TR. Challenges included digital health literacy and access to technology, while key facilitators included low cost—particularly in video-based sessions—and reduced time and logistical burden associated with travel.
Métodos de normalização e análise da atividade elétrica dos músculos respiratórios em indivíduos com esclerose lateral amiotrófica e sujeitos saudáveis
(Universidade Federal do Rio Grande do Norte, 2024-12-16) Lima, Thiago Bezerra Wanderley e; Fregonezi, Guilherme Augusto de Freitas; https://orcid.org/0000-0003-4938-7018; http://lattes.cnpq.br/2201375154363914; http://lattes.cnpq.br/7633205019993454; Nóbrega, Antonio José Sarmento da; Samora, Giane Amorim Ribeiro; Fonseca, Jessica Danielle Medeiros da; Gualdi, Lucien Peroni
Introduction: Surface electromyography (sEMG) is one of the methods used to assess the electrical activity of muscles, whether at rest, during functional activity or during exercise. sEMG can be used to assess skeletal and respiratory muscles in individuals in various health and disease states, allowing comparisons between different days, individuals and specific tasks. Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterised by generalised muscle weakness. One of the leading causes of death in these people is respiratory muscle weakness, which leads to respiratory failure. sEMG is becoming an important tool for monitoring respiratory muscles in people with ALS, allowing an understanding of muscle recruitment patterns and potential dysfunction in these subjects. The electromyographic signal can be influenced by intrinsic and extrinsic factors. It is therefore important to explore methods to minimise the interference of these factors to ensure that the results are as accurate as possible. One approach to this is normalisation. However, there is still no consensus in the literature on the best way to normalise the electromyographic signal. This thesis is divided into two chapters and presents the results of the research in two scientific articles. The aims of this work were: Aim of Article 1: To compare different methods of normalising the sEMG signal of the respiratory muscles in individuals with ALS and healthy subjects; Aim of Article 2: To analyse the electrical activity and the contraction and relaxation variables of the sternocleidomastoid and scalene muscles during the sniff nasal inspiratory pressure (SNIP) manoeuvre in individuals with ALS and healthy subjects using surface electromyography. Methodology: This is a cross-sectional study, approved by the University Ethics Committee under protocol number 3.127.064, involving 67 participants, 50 from the healthy group and 17 from the ALS group. The electrical activity of the sternocleidomastoid (SCM), scalene (SCA), diaphragm (DIA), parasternal (PS), external intercostal (EI), external oblique (EO) and rectus abdominis (RA) muscles was analysed during the following manoeuvres maximal inspiratory pressure (MIP), nasal inspiratory pressure (SNIP), maximal expiratory pressure (MEP) and maximal voluntary isometric contraction of the SCM and SCA (MVICSCM/SCA) and RA (MVICRA). Comparisons of sEMG were made taking into account the division of manoeuvres and muscles into inspiratory and expiratory categories. In addition, electrical activity of the SCM and SCA muscles during the SNIP manoeuvre was analysed along with contraction time (CT), relaxation time (RT), total time (TT) and pressure-time ratio variables based on sEMG data from 24 subjects (12 ALS group and 12 healthy subjects). Results: In the healthy group, inspiratory and expiratory muscles showed greater electrical activity during the MVICSCM/SCA and MVICRA manoeuvres, respectively (p<0.05). In the ALS group, this activity was higher only during the SNIP manoeuvre compared to MIP for inspiratory muscles, whereas for expiratory muscles it was higher during MVICRA compared to MEP (p<0.05). During the SNIP manoeuvre, a difference in electrical activity (RMS) of the SCM and SCA muscles was observed between groups, with healthy subjects showing higher RMS values (p<0.05). In addition, subjects with ALS had a longer CT, shorter RT and reduced pressure-time ratio in the SCM muscle. Conclusion: The normalisation method based on MVIC was the one in which the respiratory muscles showed the highest electrical activity, both for the set of manoeuvres considered as inspiratory and expiratory in healthy subjects. In people with ALS, the SNIP manoeuvre appears to be the most appropriate for normalising the inspiratory muscles, while MVIC is more appropriate for the expiratory muscles. It was also observed that in individuals with ALS there was an increase in CT and a decrease in RT of the SCM muscle, suggesting that sEMG evaluation of this muscle may be useful in monitoring disease progression.
Efeitos agudos de diferentes posicionamentos sobre as medidas de pressões respiratórias e ativação eletromiográfica dos músculos respiratórios em indivíduos com Distrofia Muscular de Duchenne e em indivíduos saudáveis
(Universidade Federal do Rio Grande do Norte, 2024-12-23) Silva, Lailane Saturnino da; Fregonezi, Guilherme Augusto de Freitas; https://orcid.org/0000-0003-4938-7018; http://lattes.cnpq.br/2201375154363914; http://lattes.cnpq.br/6422067872573711; Farias, Catharinne Angélica Carvalho de; Samora, Giane Amorim Ribeiro; Fonseca, Jessica Danielle Medeiros da; Florêncio, Rencio Bento
Introduction: The influence of body position on ventilation has been studied for decades in both healthy individuals and patients with various respiratory conditions. The neuromuscular system's ability to generate force is influenced by multiple factors, and postural changes have the potential to alter the length and position of respiratory muscles, thereby affecting their function and ability to generate tension and force. In Duchenne Muscular Dystrophy (DMD), disease progression leads to structural, anatomical, and functional modifications that impact respiratory muscle strength. This thesis, comprising two articles as outcomes, aimed to. 1) Evaluate the influence of sitting, supine with the head elevated at 45°, and supine body positions and the electrical activity of respiratory muscles during measurements of Maximal Inspiratory Pressure (MIP), Maximal Expiratory Pressure (MEP), Nasal Inspiratory Pressure (SNIP), and Nasal Expiratory Pressure (SNEP) in self-declared healthy subjects. 2) Assess the influence of sitting and supine with the head elevated at 45° positions and the electrical activity of respiratory muscles during SNIP and SNEP measurements in subjects with DMD compared to matched healthy individuals. Methods: 1) In the sitting, 45° supine, and supine positions, the activation of the respiratory muscles sternocleidomastoid (SCM), scalene (SC), rectus abdominis (RA), and intercostals (IC) was evaluated using surface electromyography (sEMG) during the MIP, MEP, SNIP, and SNEP maneuvers in self-declared healthy individuals. 2) In the sitting and 45° supine positions, the activation of the respiratory muscles sternocleidomastoid (SCM), scalene (SC), rectus abdominis (RA), and external oblique (EO) was evaluated using surface electromyography (sEMG) during the SNIP and SNEP maneuvers in individuals with DMD (Duchenne group, DG), paired with healthy subjects (control group, CG). Results: 1) Ten healthy individuals were evaluated, equally divided between five men and five women. In this group, SNIP and SNEP values were significantly higher in the sitting position compared to the supine position (P < 0.05). Intercostal (IC) muscle activity was greater during the MIP, MEP, and SNEP maneuvers in the sitting position (P < 0.05). Additionally, rectus abdominis (RA) activity was higher in this position during the MIP and SNEP maneuvers (P < 0.05). 2) Fifteen individuals with Duchenne muscular dystrophy (DMD) were initially included (four excluded), resulting in 11 subjects forming the Duchenne group (DG), paired with 11 healthy subjects (control group, CG). DG subjects showed lower SNIP and SNEP values compared to CG (P < 0.05). Electromyographic activity of the sternocleidomastoid (SCM), scalene (SC), and rectus abdominis (RA) muscles during maneuvers was lower in DG versus CG in the sitting position and lower in RA in the 45° supine position when comparing the same groups (P < 0.05). In intragroup analyses, SCM, SC, and RA electromyographic activity was higher in the sitting position than in the 45° supine position in DG (P < 0.05). In CG, SCM electromyographic activity was higher in the sitting position than in the 45° supine position (P < 0.05). Conclusion: Our results demonstrate that, in both individuals with DMD and healthy subjects, the pressures generated during SNIP and SNEP maneuvers, as well as sEMG activity in all maneuvers, are optimized when the trunk is in a more upright position.
Função física no envelhecimento feminino: o papel da menopausa e da terapia de reposição hormonal em diferentes contextos socioculturais
(Universidade Federal do Rio Grande do Norte, 2024-12-03) Macêdo, Pedro Rafael de Souza; Câmara, Saionara Maria Aires da; https://orcid.org/0000-0002-3054-7213; http://lattes.cnpq.br/9021377225085393; https://orcid.org/0000-0002-4150-0453; http://lattes.cnpq.br/2301894629894269; Maciel, Álvaro Campos Cavalcanti; https://orcid.org/0000-0002-8913-7868; http://lattes.cnpq.br/9441132413428495; Fernandes, Ana Tereza do Nascimento Sales Figueiredo; Dantas, Diego de Sousa; Micussi, Maria Thereza Albuquerque Barbosa Cabral
Introduction: Physical function is an important marker of health outcomes during the aging process. In women, it appears to be influenced by hormonal changes that occur during menopause. However, studies evaluating the association between physical function and menopausal status or the use of Hormone Replacement Therapy (HRT) have shown conflicting results. Understanding these relationships is essential for planning and directing practices aimed at preventing disability in this population. Objective: Study 01: To evaluate the association between menopausal status and physical function in community-dwelling older women through a systematic review; Study 02: To examine the association between Hormone Replacement Therapy (HRT) and physical performance among women in the Canadian Longitudinal Study on Aging CLSA; Study 3: To investigate the relationship between HRT and Activities of Daily Living (ADLs) between older Brazilian women. Methods: The first study was a systematic review of the associations between menopausal status and physical function in women. Observational studies assessing menopausal status and physical function in different socioeconomic contexts were included. The review followed a protocol that was previously developed and registered on the Prospective Register of Systematic Reviews platform. Meta-analysis was conducted using RevMan software. The second study was a cross-sectional analysis using data from the Canadian Longitudinal Study on Aging (CLSA) with 12,506 postmenopausal women. Participants who had used or were currently using HRT were compared with those who had never used it concerning measures of grip strength, gait speed, the Timed Up and Go (TUG) test, sit-to-stand, and balance. Multiple linear regression analyses investigated the relationships, adjusting for covariates. The third study analyzed data from the 2019 National Health Survey (PNS) involving Brazilian women from all regions of the country who were postmenopausal. Data on reported use of HRT and difficulty in performing ADLs were used, with analysis conducted using Binary Logistic Regression. The analyses for Studies 2 and 3 accounted for sample weights derived from complex sampling. Results: Study 01: The systematic review protocol was published in the journal Plos One and the article with its results was submitted to the scientific journal Climacteric. Twenty-one studies were included. The results indicate that women in natural or surgical postmenopause exhibit worse physical function compared to women in pre- and perimenopause in most functional tests considered. The differences are attenuated when adjusting for covariates such as age and body weight. The results are consistent across different socioeconomic contexts. Study 02: HRT was associated with better physical performance in the gait speed and TUG tests in the Canadian sample, with no difference between the groups in relation to the other tests. In analysis by age subgroup, the results remained significant only among those over 65 years old. Study 03: The results indicate that women who have never used HRT have more difficulty in all activities of daily living compared to those who have used it. When adjusted analyses accounted for socioeconomic data, physical exercise, lifestyle habits, chronic diseases, and age at menopause, the use of HRT remained a protective factor for 2 out of the 5 activities analyzed: difficulty bathing and walking. Conclusion: The menopausal transition represents a critical period during which physical function tends to decline, underscoring the importance of implementing health strategies for women during this phase. HRT is associated with improved markers of physical function, such as gait speed, the TUG test, and reported performance of ADLs. However, for some outcomes, the differences were small, and clinical relevance remains to be determined. Further prospective studies are needed to confirm whether HRT use leads to better functional outcomes over time.
Efeito da terapia de fotobiomodulação na síndrome geniturinária da menopausa
(Universidade Federal do Rio Grande do Norte, 2025-03-07) Bezerra, Lívia Oliveira; Micussi, Maria Thereza Albuquerque Barbosa Cabral; Andrade, Palloma Rodrigues de; https://orcid.org/0000-0003-4140-5568; http://lattes.cnpq.br/2360845979410206; http://lattes.cnpq.br/7282155175981140; Viana, Elizabel de Souza Ramalho; Prata, Gabriela Marini; Lisboa, Lilian Lira; Parizotto, Nivaldo Antonio
Introduction: Aging is a universal and inevitable process that is attracting interest in many areas around the world. In women, in addition to the physiological changes resulting from age, other changes occur due to ovarian failure that culminates in menopause. During menopause, there is a decrease in the levels of female sexual steroids and, as a consequence, a spectrum of genitourinary symptoms and signs known as Genitourinary Syndrome of Menopause (GMS) is observed. GMS involves numerous urogenital changes, which imply changes in sexual and urinary functions. Objective: Article 1 - To conduct a systematic review with meta-analysis of clinical trials to evaluate the impact of photobiomodulation therapy (PBMT) on functional performance, covering aspects such as fatigue, strength and functional capacity in healthy individuals. Article 2 - To evaluate the effects of PBMT, both alone and in combination with pelvic floor muscle training (PFMT), on pelvic floor muscle (PFM) function, as well as on sexual function, urinary function and quality of life (QOL) in women affected by GMS. Methodology: Article 1 - A systematic review with meta-analysis was carried out from June to October 2022 in electronic databases, including Web of Science, Lilacs, Scielo, PubMed, Cochrane, Pedro, Embase, Science Direct, Scopus, Clinical Trials, Google Scholar, Open Gray and Trials Central, in addition to an active search in references of relevant studies. The following descriptors were used in combination: "Photobiomodulation Therapies" OR "Therapies Photobiomodulation" OR "Therapy Photobiomodulation" OR "Low-Level Light Therapy" OR "Diode Laser" AND "Muscle Strength" OR "Pain" OR "functionality" AND "Functional Capacity". There were no time and language restrictions in the search. Randomized clinical trials that used TFBM, Laser or LED as the only intervention and evaluated functional performance were included, while studies that compared other therapeutic modalities or involved participants with chronic diseases or acute injuries were excluded. Study selection was conducted by three independent reviewers via Rayyan, and data extraction was performed using a standardized form. Risk of bias was assessed using Risk of Bias 2 (RoB 2), and confidence in the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analysis was conducted using RevMan software. Article 2 - Randomized, blinded clinical trial. Women aged 45 to 65 years with a diagnosis of sexual and urinary dysfunction participated in the study and were randomly divided into three groups: PFMT isolated group (GTMAP isolated, n=18), PFMT associated with active photobiomodulation (PBM) group (GTMAP + active PBM, n=18) and PFMT associated with sham PBM group (GTMAP + sham PBM, n=18). The volunteers were evaluated before the intervention and after eight weeks. The Female Sexual Function Index (FSFI) was applied to assess sexual function, the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) for urinary loss, the Patient Global Impression of Improvement (PGI-I) for the level of satisfaction after the intervention and vaginal manometry was also performed to assess pelvic floor muscle (PFM) functionality. The sample data were analyzed using the Jamovi statistical software (version 2.3.28). Results: Article 1 - Sixteen studies were included, totaling 340 participants (183 men and 157 women). Most studies had a low risk of bias and heterogeneity was observed in devices and application parameters. It was observed that BMFT improved recovery from fatigue (mean difference: 5.87; 95% CI 3.83, 7.91). There was no improvement in strength: peak torque (mean difference: 12.40; 95% CI -5.55, 30.55); one repetition maximum test (mean difference: 39.97, 95% CI -2.44, 82.38); isometric and isokinetic strength (mean difference: 2.77, 95% CI -14.90, 20.44) and there was also no improvement in short-term (mean difference: 0.67, 95% CI -0.58, 1.91) and long-term (mean difference: 18.44, 95% CI -55.65, 92.54) functional capacity. Article 2 - Significant differences were observed between groups over time for the ICIQ-SF (p=0.02), the FSFI (p=0.002) and their subscales: arousal (p=0.01), lubrication (p<0.001), orgasm (p=0.04) and satisfaction (p=0.007). The final manometry results showed significant differences between the groups: GPFMT + active PBM and GPFMT + sham PBM (mean difference 3.71; CI: 0.02, 7.40; d: 0.28) and GPFMT + sham PBM versus GIPFMT (mean difference: -1.05; CI: -2.06, -0.04; d: 0.07). Conclusion: Article 1 - TFBM is a resource that can help promote recovery from fatigue in healthy individuals; however, there is no evidence to support that the use of PBM can enhance strength and improve functional capacity in the short and long term. Article 2 - Treatment with active PBM combined with PFMT had a superior trend towards improving sexual function, urinary function and QOL in women with SGM. Although PBM has relevant therapeutic potential, its integration into conventional practice remains cautious due to the need for more research to establish standardized guidelines to establish long-term efficacy.
Densidade mineral óssea e composição corporal em indivíduos com e sem Diabetes Mellitus tipo 2
(Universidade Federal do Rio Grande do Norte, 2024-12-09) Carlos, Adriana Guedes; Gazzola, Juliana Maria; https://orcid.org/0000-0002-9333-1831; http://lattes.cnpq.br/5826842469212021; http://lattes.cnpq.br/3535930893926687; Sousa, André Gustavo Pires de; http://lattes.cnpq.br/7508340761996478; Farias, Catharinne Angélica Carvalho de; Macedo, Sabrina Gabrielle Gomes Fernandes; Dias, Vanessa da Nóbrega
Introduction: Diabetes Mellitus (DM) is considered a public health issue. It is estimated that 90–95% of DM cases are type 2, with a higher prevalence in developing countries. Type 2 Diabetes Mellitus (T2DM) has evolved as a result of rapid cultural, economic, and social changes. Many individuals with T2DM are either obese or overweight. The increase in physical inactivity and associated comorbidities leads to a substantial loss of Bone Mineral Density (BMD), whereas body fat is either preserved or increased. With the global obesity epidemic, a decrease in BMD and an increase in DM cases are expected in the coming years. Within this context, the measurement and analysis of related variables are essential for managing these disorders, along with interventions aimed at maintaining an adequate BMD, which may assist in the management of T2DM. Objectives: Manuscript 1: To assess the discriminative validity and diagnostic accuracy of gynoid fat percentage measured by Dual-energy X-ray Absorptiometry (DEXA) in body composition (BC) among women with and without T2DM. Manuscript 2: To evaluate individuals with and without T2DM regarding BMD and sociodemographic, clinical, functional, and laboratory variables. Methods: Manuscript 1: This is a methodological study evaluating the discriminative validityand diagnostic accuracyof BC using gynoid fat percentage assessed by DEXA. The study followed the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) and the Standards for Reporting Diagnostic Accuracy Studies (STARD). Statistical analyses included comparisons between groups with and without T2DM using the Chi-square or Fisher's exact test and the Student's t-test or MannWhitney test. Proportion analysis of the T2DM group was performed using the Binomial test. Effect sizes were calculated using the rank-biserial correlation coefficient (r). Diagnostic accuracy was assessed using Receiver Operating Characteristic (ROC) curves, and positive and negative predictive values were calculated. Manuscript 2: The study was characterized as an observational analytical cross-sectional design, and BMD was assessed using DEXA. Statistical analyses included comparisons between groups with and without T2 DM using the independentttest and the Mann-Whitneytest. Effect sizes for the t-test were calculated using Cohen's d, while the rank-biserial correlation coefficient was used for Mann-Whitney tests. Associations between dependent variables and categorical variables were assessed using the Chi-square or Fisher's exact test. Effect sizes were calculated using Phiand Cramér'sV coefficients. In both manuscripts, the participants were aged 40 to 85 years, with or without a T2 DM diagnosis. The following instruments were applied:a clinical characterization questionnaire, cognitive assessment (MiniMental State Examination), physical activity (International Physical Activity Questionnaire), and handgrip strength (dynamometer). Results: Manuscript 1: A total of 130 women were evaluated, of whom 60 (46.2%) had a clinical diagnosis of T2DM. A statistically significant difference was observed in gynoid fat percentage between the groups (U = 1484; p = 0.004). The effect size was 0.25. A cutoff point of ≤47.90% was identified. Gynoid fat percentage demonstrated good sensitivity (81.67%) but low specificity (47.14%), with occasional false positives and moderate accuracy. Manuscript 2: A total of 168 individuals were evaluated, comprising 83 with T2DM and 85 without T2DM. Among individuals without T2DM, a significant age difference was observed between those with normal and low BMD (t = -2.10; mean difference = -5.43; p = 0.039), withan effect size of 0.59. Among those with T2DM, a significant strong association was found between BMD and complaints of lower limb pain (p = 0.033; effect size = 0.23), with a higher frequency of individuals reporting lower limb pain and normal BMD. Conclusion: Manuscript1: Gynoid fat percentage, as assessed by DEXA, effectively discriminates between women with and without T2DM. It demonstrates good diagnostic accuracy for detecting T2DM in women, particularly with a cutoff point of ≤47.90%, being more effective in identifying true negatives (women without T2DM). Manuscript 2: There is an association between increased age and low BMD in the non-T2DM group, while complaints of lower limb pain are associated with normal BMD in the T2DM group.
Carga alostática e desempenho físico em idosos: análise transversal da coorte IMIAS - International Mobility in Aging Study (IMIAS)
(Universidade Federal do Rio Grande do Norte, 2024-10-09) Germano, Matheus Lucena; Guerra, Ricardo Oliveira; https://orcid.org/0000-0003-3824-3713; http://lattes.cnpq.br/4265185619165890; http://lattes.cnpq.br/3933264716237574; Sousa, Ana Carolina Patrício de Albuquerque; Gomes, Cristiano dos Santos; Barbosa, Juliana Fernandes de Souza; Macedo, Sabrina Gabrielle Gomes Fernandes
INTRODUCTION: Allostatic Load (AL) reflects the cumulative impact of chronic stress on the body and is an important indicator of physiological adaptation to adversities throughout life. In older adults, AL is associated with increased vulnerability to chronic conditions, cognitive deficits, and depressive symptoms. Physical performance may also be linked to elevated AL levels, which can directly influence the quality of life and functional health of this population. OBJECTIVE: To evaluate the association between Allostatic Load (AL) and physical performance scores in older adults from four locations of the International Mobility in Aging Study (IMIAS). METHODS: This thesis comprises a cross-sectional analytical study with data from 1,101 participants aged over 65 years from three countries (Canada, Brazil, and Colombia). Three multiple linear regression models were developed and adjusted for age, socioeconomic status (SES), chronic conditions, depressive symptomatology, and cognitive function to estimate the independent association between the AL index and physical performance, measured by the Short Physical Performance Battery (SPPB) scores. Subsequently, a mediation analysis was conducted to examine the total, direct, and indirect effects of AL on the SPPB scores. RESULTS: In the four IMIAS study locations, AL was inversely associated with physical performance, where higher AL levels corresponded to lower SPPB scores (β: -0.234; Std: 0.033; p-value: <0.001). Indirect effects were observed between age, SES, and chronic conditions with AL and SPPB scores, while chronic conditions showed a total effect on SPPB scores mediated by AL. No significant indirect effects of depressive symptoms and cognitive deficits on SPPB scores were identified. CONCLUSION: The study demonstrated that increased AL levels are associated with poor physical performance in older adults across different socioeconomic aging profiles. AL plays a mediating role between chronic conditions, depressive symptoms, cognitive state, and physical performance, with socioeconomic status also influencing this relationship.
Capacidade intrinseca e incapacidade funcional em idosos: influências das diferenças de gênero, biomarcadores e fatores socioeconômicos
(Universidade Federal do Rio Grande do Norte, 2024-12-19) Corrêa, Luana Caroline de Assunção Cortez; Guerra, Ricardo Oliveira; https://orcid.org/0000-0003-3824-3713; http://lattes.cnpq.br/4265185619165890; https://orcid.org/0000-0002-8188-1887; http://lattes.cnpq.br/5810642050413733; Sousa, Ana Carolina Patrício de Albuquerque; Fittipaldi, Etiene Oliveira da Silva; Pinto, Juliana Martins; Câmara, Saionara Maria Aires da
INTRODUCTION: Gender differences in Intrinsic Capacity (IC) and functional disability processes are not yet fully understood, which hinders the development of effective interventions for healthy aging. The literature suggests that biological, socioeconomic, and health factors influence IC; however, how these factors interact and differently affect men and women remains unclear. Furthermore, the relationship between inflammatory and neurodegenerative biomarkers and IC over time has not been extensively explored, limiting the identification of early markers of functional decline. The impact of socioeconomic status on functional disability, particularly regarding participation frequency in daily activities and perceived limitations, also requires further investigation, especially in multicultural contexts. OBJECTIVES: This thesis comprises three papers. #Paper 01 aimed to estimate IC levels in a community-dwelling older population and identify the factors associated with IC decline in both genders. #Paper 02 examined whether cross-sectional and longitudinal associations between blood biomarkers related to inflammation and neurodegeneration and IC differ by sex. Lastly, #Paper 03 aimed to determine whether the associations between socioeconomic status and late-life disability vary by gender in a multicultural sample. METHODS: The #Paper 01 and #Paper 03 used cross-sectional data from the third wave of the International Mobility and Aging Study (IMIAS), collected in 2016. Specifically, the #Paper 01 analyzed data from 1,484 older adults. Based on a reflexive methodology, four functions were selected from the IMIAS database to assess the domains of IC: i. Locomotion (Short Physical Performance Battery), ii. Cognition (Leganes Cognitive Test), iii. Vitality (Handgrip Strength), and iv. Psychological Well-being (Center for Epidemiologic Studies Depression). A composite IC score was calculated (ranging from 0 to 100; the higher, the better). Socioeconomic and healthrelated factors included: age, marital status (single, married, divorced/widowed), educational level (lowest, middle, and highest), income sufficiency (not/not very well, suitably, very well), occupation (manual and non-manual), number of chronic diseases (≤ 1, 2 – 3, and ≥ 4), body mass index (underweight/normal weight, overweight, obesity), and history of falls in the last year (yes and no). Multiple linear regression analyses were used to investigate factors associated with reduced IC in both genders. #Paper 03 assessed late-life disability in 1,362 older adults using the disability component (frequency and limitation) of the Late-Life Function Disability Instrument (LLFDI). Socioeconomic status was self-reported through the variables: i. educational level (less than secondary, secondary, post-secondary), ii. income sufficiency (not/not very well, suitably, very well), and iii. occupation (manual and non-manual). Multiple linear regression models were used to examine gender-specific associations between late-life disability (frequency and limitation subscales) and SES. Finally, #Paper 02 used longitudinal data from 1,117 older adults from the Multidomain Alzheimer Preventive Trial (MAPT). The domains of IC were operationalized using the following functions: i. Cognition (Mini-Mental State Examination), ii. Locomotion (Short Physical Performance Battery), iii. Vitality (Handgrip Strength), and iv. Psychological Well-being (Geriatric Depression Scale), each scaled from 0 (worst possible IC) to 100 (best possible IC). Biomarkers related to inflammation and neurodegeneration included: i. Interleukin 6 (IL-6, pg/mL), ii. Growth Differentiation Factor 15 (GDF15, pg/mL), iii. Tumor Necrosis Factor Receptor 1 (TNFR1, pg/mL), iv. Neurofilament Light Chain (NfL, pg/mL), v. Progranulin (PGRN, ng/mL), and vi. Beta-Amyloid protein (Aβ42/40). Mixed linear models were performed to examine whether sex modified the cross-sectional and longitudinal association between biomarkers and IC. RESULTS: Findings indicated that women had significantly lower IC scores than men (M = 77.43; SD = 9.06 vs. M = 72.26; SD = 9.31; p < 0.001). Age, study site, marital status, multiple chronic conditions, and history of falls were negatively associated with IC scores in both genders. Additionally, insufficient income (B = -2.130; p = 0.043) and obesity (B = -1.645; p = 0.039) were negatively associated with IC scores in women, whereas low educational level (B = -2.124; p = 0.012) was a significant predictor for men. Longitudinal analyses revealed a significant interaction between sex and IL-6 (p = 0.005), where higher IL-6 levels were associated with a faster IC decline in men (B = -0.385; p = 0.055) but not in women (B = 0.287; p = 0.041). Regarding functional disability, low educational level (B = −3.11; p < 0.001) and manual occupations (B = −1.79; p < 0.05) were associated with reduced participation frequency in men, while insufficient income (B = −3.55; p < 0.01) and manual occupations (B = −2.25; p < 0.01) played a negative role in women's participation. In both men (B = −2.39; p < 0.05) and women (B = −3.39; p < 0.01), insufficient income was the only factor linked to greater perceived limitations in daily tasks. CONCLUSION: Women showed lower IC scores compared to men. Age, study locations, multiple chronic conditions, and history of falls were factors associated with reduced IC in both genders. Educational level appears to particularly influence IC in men, while income insufficiency and obesity are more significant factors for women. These findings highlight the need for genderspecific strategies to address the distinct determinants of IC, aiming to promote healthier aging. Among all biomarkers, only IL-6 showed sex-dependent associations, being linked to a rapid decline in IC in men but not in women. Men and women experienced different patterns of disability in old age. For men, previous occupational status and educational level were associated with a decrease in frequency of participation, whereas for women, this reduction was associated with perceived income and previous occupational status.
Exercício isométrico versus isotônico no manejo da tendinopatia do manguito rotador - efeitos na dor, função, força e ativação muscular do ombro: ensaio clínico randomizado
(Universidade Federal do Rio Grande do Norte, 2024-11-18) Barros, Bianca Rodrigues da Silva; Sousa, Catarina de Oliveira; Silva, Rodrigo Scattone da; https://orcid.org/0000-0002-7973-188X; http://lattes.cnpq.br/9953273388451412; https://orcid.org/0000-0002-2818-3596; http://lattes.cnpq.br/5522647106933904; http://lattes.cnpq.br/7121988323027410; Kaminseki, Danilo Harudy; Barbosa, Germanna de Medeiros; Souza, Marcelo Cardoso de; Saccol, Michele Forgiarini
Introduction: Rotator cuff (RC) tendinopathy is a common shoulder disorder, and its conservative treatment mainly involves exercise programs, including strengthening and stretching of the periscapular and RC muscles, progressive loading exercises, and concentric and eccentric activation exercises. These interventions have been shown to improve shoulder pain and function. While isometric exercises have been extensively studied in the treatment of tendinopathies in the lower limbs, their application in RC tendinopathy requires further investigation. Objective: To compare the effects of isometric versus isotonic exercises on shoulder pain, function, shoulder muscle strength and activity in individuals with RC tendinopathy. Materials and methods: Forty-seven individuals, from both genders, with unilateral supraspinatus and/or infraspinatus tendinopathy were randomized into two groups: isometric (n=25; 42,4 ±11,6 years old; 26,3 ±3,2 kg/m2) and isotonic (n=22; 42,5 ±12,3 years old; 26,8 ±4,6 kg/m2). Assessments were conducted before and after the first treatment session, and after six weeks of intervention. Outcomes included pain, general shoulder function, isometric strength of shoulder elevation, external rotation (ER) and internal rotation (IR), and electromyographic activity of the middle deltoid, infraspinatus, serratus anterior, and lower trapezius muscles during strength tests. Both groups performed a stretching and strengthening protocol for the periscapular muscles and strengthening of the RC muscles according to the allocated group. Differences within and between groups were analyzed using Generalized Estimating Equations, adopting α < 5%. Results: After six weeks, both groups showed improvements in shoulder pain and function, IR muscle strength, and better infraspinatus muscle activation during the elevation strength test. The isometric group showed greater shoulder satisfaction, higher gains in ER muscle strength, and better infraspinatus activation in the ER strength test. Conclusion: Both isometric and isotonic exercises with progressive load are effective in reducing pain and improving function in individuals with RC tendinopathy. The isometric group showed higher shoulder satisfaction and superior strength in ER muscle strength, associated with increased infraspinatus muscle activation.

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