HC Fisiologista do Exercício

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Illustration of nociception and pain perception
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👉 Pain is defined by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual orpotential tissue damage. https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/

👉 This subjective experience relies on the integration of diverse nervous signals, or the lack thereof, emanating from the peripheral nervous system (PNS), and processed in the central nervous system (CNS) (Fig.). Pain is a hypercomplex and multiple phenomenon, which involves not only one or several physiological mechanisms but also emotional, social, cognitive and cultural components, which are intimate. https://www.sciencedirect.com/science/article/abs/pii/S0169409X22002496

Physio Meets Science in Kooperation mit dem Netzwerk OnkoAktiv (NCT Heidelberg - Nationales Centrum für Tumorerkrankungen Heidelberg)

Onkologisch medizinische Trainingstherapie (OMTT) 💪💪💪

Obwohl in über 700 klinischen Studien Sicherheit und Wirksamkeit der Trainingstherapie für onkologische Patienten bestätigt werden konnten, profitieren zu wenige Betroffene von einer individuellen bewegungstherapeutischen Intervention während und nach Ihrer medizinischen Behandlung In den nächsten Jahren werden Maßnahmen der OMTT zunehmend in die ambulante Versorgung onkologischer Patienten integriert werde

Wie sollte eine individualisierte Trainingstherapie gestaltet werden, um Tumorassoziierte-Fatigue, Depressionen, sekundäre Lymphödeme, Knochengesundheit, Harninkontinenz, polyneuropathische Beschwerden und weiter Nebenwirkungen positiv zu beeinflussen?

Wie lassen sich Therapietoleranz, Selbstwirksamkeit und Selbstbild, Rezidivrate als auch Überleben steigern? Inwiefern sollten Tumorentität, Therapie, Gesundheits- sowie Leistungszustand bei der Ableitung von individuellen Trainingszielen und -inhalten, unter Beachtung von krebsspezifischen Besonderheiten beim Training mit Betroffenen Berücksichtigung finden?

All das und noch viel mehr erfahrt ihr hier!

👉 Sichert euch daher einen der letzten 10 Kursplätze!!!!

https://www.physiomeetsscience.net/produkt/onkologisch-medizinische-trainingstherapie-mit-max-koeppel-im-pms-hauptquartier-in-heidelberg-sa-so-19-20-nov22/

“Critical Power and Work-Prime Account for Variability in Endurance Training Adaptations Not Captured by V̇O2MAX” Jessica Collins, et al.
http://ow.ly/qSqT50KLsJn

Foram conhecidos ontem os mais recentes resultados do Eurobarómetro relativamente aos índices de atividade física e desporto dos portugueses, e as conclusões não podiam ser mais preocupantes.

Segundos os dados publicados no quinto relatório dedicado ao tema, 73% dos portugueses dizem nunca se exercitar ou praticar desporto, com mais 5% a fazê-lo apenas "raramente", mais do que os que o fazem "regularmente", 4%. "Com alguma regularidade" é a resposta de 18% dos portugueses inquiridos.

Os dados são particularmente graves no país, que tem a mais alta taxa dos países europeus abrangidos pelo estudo, seguido pela Grécia (68%) e pela Polónia (65%).

Poderá consultar os resultados completos do inquérito aqui »https://www.portugalactivo.pt/sites/default/files/documentos_publicos/eurobarometro_portugal_-_desporto_e_atividade_fisica_2022.pdf

“Motor cortex is greater in endurance-trained cyclists following acute ”
Brodie J. Hand, et al.
http://ow.ly/ZNyO50KHWKa

Efecto analgésico del entrenamiento de fuerza en supervivientes de cáncer de mama Recientemente se han publicado los resultados de un estudio (Rasmussen y col, 2022; Med Sci Sports Exerc 8-sep; doi: 10.1249/MSS.0000000000003034) cuyo objetivo fue investigar el efecto del entrenamiento de fuerza (RT) sobre el dolor, la fuerza máxima y la función del hombro en sobrevivientes de c...

Just pulished in "Nature Reviews Disease Primers" 🔥

Frozen Shoulder 🥶🥶

📍 Frozen shoulder (FS; also known as adhesive capsulitis) is a painful fibroproliferative disorder affecting the shoulder joint, resulting in a gradual loss of range of motion. FS can occur spontaneously and without a known cause (primary FS) or can be associated with various co-morbidities (secondary FS).

👉 Epidemiology

FS is a common condition that affects 2–5% of people in their lifetime, most often occurring in the fifth to sixth decade of life. Risk factors for FS include metabolic disorders (such as diabetes mellitus and hyperlipidaemia), hormonalconditions (such as hypothyroidism and hyperthyroidism) and systemic diseases(such as cardiopulmonary disease, cervical degenerative disc disease and cerebrovascular disease). FS is also associated with lifestyle factors (such as smoking and physical inactivity) and with trauma (for example, humeral fracture, axillary lymph node or radical neck dissection, acute cerebrovascular aneurysm surgery and radiotherapy). FS is also a cause of shoulder pain after stroke and subarachnoid haemorrhage. Risk factors intrinsic to the shoulder area include rotator cuff tendinopathy or tears, calcific or biceps tendinopathy and acromioclavicular arthritis.

👉 Diagnosis

Diagnosis of FS remains challenging because the main symptoms, shoulder pain (especially at night) and global loss of active and passive shoulder movement, do not reliably distinguish it from other shoulder pathologies. Clinical assessment and a medical history are typically sufficient to make a working diagnosis, although in patients with severe pain, assessment of range of motion should be performed in various positions with varying levels of support to avoid patient self-limiting owing to fear or pain. Imaging is not recommended for routine diagnosis, although it is crucial for detecting undiagnosed tumours and might be useful for differential diagnosis.

👉 Management

Management of FS usually consists of physiotherapy and pharmacotherapy but can involve more invasive interventions, such as surgery, although evidence for the efficacy and reduction in disease duration with the available interventions is mixed.FS treatment is aimed predominantly at ameliorating symptoms, usually starting with non-operative approaches appropriate for the disease stage.

Physiotherapy hastens pain resolution, although it is not clear whether it reduces disease duration. Pharmacotherapy is usually to provide pain relief and to reduce inflammation (corticosteroid injections).

Surgery can aid recovery (both in terms of pain and range of motion) in persistent cases by releasing or removing the tight, thickened joint capsule using approaches such as manipulation under anaesthesia and arthroscopic capsular release.
Patient education is important to emphasize the disease course (that is, FS typically resolves without intervention), self-management approaches, and appropriate restrictions to work and recreational activities to facilitate recovery.

👉 Outlook

Despite advances in the understanding of FS pathogenesis and its risk factors, these insights need to be translated into new therapies and conveyed to clinical practitioners to provide them with a comprehensive overview of FS pathophysiology. In addition, further clinical trials are needed to assess the efficacy of the many different treatments for FS, although these are challenging owing to different outcome measures, heterogeneity in patient disease stage and the long follow-up required.
https://www.nature.com/articles/s41572-022-00386-2

Pathophysiology in Post-traumatic knee Osteoarthritis (PTOA). 🤓

👉 Sustaining a knee injury is a known risk factor for the development of osteoarthritis (OA) and major trauma [such as an anterior cruciate ligament (ACL) rupture] leads to post-traumatic osteoarthritis (PTOA) in 25–50% of patients. https://pubmed.ncbi.nlm.nih.gov/36072956/

👉 Even though surgical repair can increase activity level, the incidence of PTOA is not reduced by surgery (https://pubmed.ncbi.nlm.nih.gov/24553885/, https://pubmed.ncbi.nlm.nih.gov/21884811/, https://pubmed.ncbi.nlm.nih.gov/17761605/, https://pubmed.ncbi.nlm.nih.gov/10979876/, https://pubmed.ncbi.nlm.nih.gov/15476248/ ). PTOA accounts for approximately 12% of symptomatic OA patients. https://pubmed.ncbi.nlm.nih.gov/36072956/

👉 Historically, the pathophysiology of PTOA was believed to result from pathological mechanical stress and abnormal loading of the joint, but an increasing number of studies on both human and animal models has provided strong evidence that inflammation and synovitis play a key role. https://pubmed.ncbi.nlm.nih.gov/26521728/, https://pubmed.ncbi.nlm.nih.gov/27651925/, https://pubmed.ncbi.nlm.nih.gov/27539668/, https://pubmed.ncbi.nlm.nih.gov/30081513/, https://pubmed.ncbi.nlm.nih.gov/28148295/, https://pubmed.ncbi.nlm.nih.gov/20187160/, https://pubmed.ncbi.nlm.nih.gov/22874525/, https://pubmed.ncbi.nlm.nih.gov/22886741/

👉 The pathogenic mechanism of PTOA can be divided into three phases.

📍 The first phase is the immediate phase related to pathological mechanical loading during and after knee injury.
📍 The second phase occurs directly after the immediate phase and continues throughout the first weeks after injury. This phase is characterized by an acute inflammatory phase which extracellular matrix fragmentation, cell death and in some cases hemarthrosis occurs.
📍 This phase can either resolve spontaneously after a couple of months or persists and progresses into the third phase which is characterized by a chronic inflammatory state with synovitis ultimately contributing to PTOA progression (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013366/).

🖼 The figure below shows the pathophysiology of mechanical processes and hemarthrosis that induce inflammation and can lead to chronic synovitis that contributes to PTOA development:

1⃣ : Direct impact from trauma higher than 10–20 MPa results in necrotic cell death of chondrocytes and damage to the ECM of the cartilage. https://pubmed.ncbi.nlm.nih.gov/10529909/

2⃣ : A spatial shift due to increased joint laxity after ligament rupture causes a change in load bearing contact area. https://pubmed.ncbi.nlm.nih.gov/32253481/ This leads to fibrillation of the collagen network and when fractured, these fibrils act as “damage associated molecular patterns” (DAMPs). https://pubmed.ncbi.nlm.nih.gov/15095819/, https://pubmed.ncbi.nlm.nih.gov/36072956/

3⃣ : DAMPs (e.g.,glycoproteins proteoglycans, or GAG) are released into the articular cavity as result of acute traumatic cartilage damage.

4⃣ : DAMPs bind to pattern recognition receptors (TLRs, NLRs, and RAGE) on the surface of immune cells, chondrocytes, osteoblasts (not shown here), macrophages and fibroblasts.

5⃣ : Activated cells release inflammatory cytokines such as IL-1, IL-4, IL-6, IL-8, IL-10, IL-17, TNF-α, chemokines,cathepsins, complement cascade factors, and DAMPs [e.g., S-100 proteins, high-mobility group box protein 1 (HMGB1), or uric acid]. https://pubmed.ncbi.nlm.nih.gov/33671471/, https://pubmed.ncbi.nlm.nih.gov/25707860/, https://pubmed.ncbi.nlm.nih.gov/8900407/, https://pubmed.ncbi.nlm.nih.gov/22143922/

6⃣ : Inflammatory factors promote release of MMPs and ADAMTS by synoviocytes and chondrocytes which leads to cartilage degradation. https://pubmed.ncbi.nlm.nih.gov/33537330/

7⃣ : Major periarticular tissue damage (e.g., anterior cruciate ligament rupture) causes hemarthrosis. Degradation of erythrocytes causes the release of heme-derived iron molecules.

8⃣ : Heme-derived iron molecules react with oxygen metabolites generated by monocytes and macrophages forming hydroxyl radicals. https://pubmed.ncbi.nlm.nih.gov/9228136/,

9⃣ : Hydroxyl radicals induce chondrocyte apoptosis and therefore promote cartilage damage. https://pubmed.ncbi.nlm.nih.gov/32698601/

🔟 : Synovial inflammation is induced by DAMPs, pro-inflammatory factors and hemosiderin deposits in the synovium formed by the accumulation of iron molecules. https://pubmed.ncbi.nlm.nih.gov/33537330/

1⃣1⃣: Synovial inflammation is characterized by influx of immune cells.

1⃣2⃣ : Cells in the inflamed synovium release cytokines, DAMPs and promote release of MMPs leading to cartilage breakdown which again promotes the release of DAMPs into the joint cavity. https://pubmed.ncbi.nlm.nih.gov/17195222/,

MPa, millipascal; ECM, extracellular matrix; DAMP, damage-associated molecular pattern; GAG, glycoproteins and glycosaminoglycans; TLRs, Toll-like receptors; NLRs, NOD-like receptors; RAGE, receptor for advanced glycation end-products; IL, interleukin; MMPs, matrix metalloproteinases; ADAMTS 9, a disintegrin and metalloproteinase with thrombospondin motifs.

Figure: https://www.frontiersin.org/articles/10.3389/fmed.2022.973870/full

La inmersión en agua fría mejora la recuperación de fatiga central y periférica en futbolistas Recientemente se han publicado los resultados de un estudio (Bouchita y col, 2022; Front Physiol 15-ago; doi: 10.3389/fphys.2022.860709) cuyo objetivo fue investigar el efecto de la inmersión en agua fría (CWI) en la recuperación de la fatiga neuromuscular después de un partido de fútbol simula...

“Core temperature responses to compensable vs. uncompensable heat stress in young adults (PSU Heat Project)” Rachel M. Cottle et al.
http://ow.ly/SoTG50KyTeZ
Pennsylvania State University

Efectos de diferentes modalidades de ejercicio sobre la respuesta inflamatoria en edad avanzada Recientemente se han publicado los resultados de un metaanálisis (Zhan y col, 2022; Int J Environ Res Public Health 22-ago; doi: 10.3390/ijerph191610451) cuyo objetivo fue investigar los efectos de diferentes modos de ejercicio para mejorar la respuesta inflamatoria en los ancianos. Se incluyeron u

La inmersión habitual en agua fría puede perjudicar las adaptaciones al entrenamiento de fuerza La inmersión en agua fría (CWI) es uno de los principales métodos de recuperación utilizados en los deportes y se utiliza comúnmente como un medio para acelerar la recuperación del rendimiento durante los períodos de entrenamiento físico. En las últimas décadas, ha habido indicios de que e...

🚨Time to settle the myths of youth resistance training ‼️💪🏋️‍♀️

Find out the true facts in this excellent 📈

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➡️ https://bit.ly/3KHTLgi

“Kinetic energy of left ventricular blood flow across heart failure phenotypes and in subclinical diastolic dysfunction” Per Martin Arvidsson, et al.
http://ow.ly/bWOt50KySqu
Lund University