Introdução: Considerando o rápido aumento da população de idosos e da sua expectativa de vida, junto com a expansão das intervenções de caminhada nórdica (NW) como método de treinamento para idosos, há uma necessidade de estudos de base experimental (ensaios clínicos randomizados controlados, ECRs) de caráter preventivo e de boa qualidade metodológica que permitam aos profissionais da educação física, da saúde e da reabilitação a tomada de decisões relativas ao tipo, volume, intensidade de exercício da NW na promoção da saúde dos idosos sedentários. Objetivos: o presente estudo teve como objetivos (estudo A) determinar, por meio de revisão sistemática de ensaios clínicos randomizados, se o treinamento sistematizado com NW, comparado à caminhada livre (CL), produz efeitos benéficos sobre componentes da aptidão funcional de idosos sedentários saudáveis, também avaliar (estudo B) os efeitos de oito semanas de treinamento de NW e CL na qualidade de vida (QV), no equilíbrio estático, na variabilidade dinâmica, na velocidade autosselecionada de caminhada (VAS) em esteira e no índice de reabilitação locomotor (IRL) de idosos sedentários, e também avaliar (estudo C) os efeitos de oito semanas de treinamento de NW e CL no trabalho mecânico (externo- Wext, trabalho mecânico interno- Wint, no trabalho mecânico total – Wtot), no mecanismo pendular (R), no Custo de transporte (C), na frequência cardíaca de exercício (FCexercício), na sensação subjetiva de esforço (RPE), e nos parâmetros eletromiográficos (amplitude média do sinal e co-contração) dos músculos: deltoides anterior (DA), tríceps braquial (TB), vasto lateral (VL), bíceps femoral (BF), tibial anterior (TA) e gastrocnêmio medial (GM) de idosos sedentários. Desenho Experimental: ECR. Local da Pesquisa: Escola de Educação Física, Fisioterapia e Dança (ESEFID) da Universidade Federal do Rio Grande do Sul Porto Alegre, Rio Grande do Sul, Brasil. Métodos: Participaram deste estudo 32 idosos sedentários randomizados em dois grupos (grupo NW), n=16, idade: 64,6±4,1 anos, massa: 81,5±10,7kg e estatura: 166,3±7,5cm; e o grupo CL, n=16, idade: 68,6±3,9 anos, massa: 74,6±14,5kg e estatura: 161,6±10,3cm), realizaram treinamento de NW e CL durante 8 semanas. Desfechos do estudo A: foram avaliadaos com um estudo de revisão sistemática parâmetros da aptidão funcional de idosos (força e resistência dos membros superiores, força e resistência dos membros inferiores, mobilidade, flexibilidade dos músculos da coluna lombar e da região posterior da coxa, amplitude geral da articulação do ombro, resistência aeróbia e velocidade autosselecionada). Desfechos do estudo B: foram avaliados utilizando questionário de qualidade de vida, testes de equilibrio em plataforma de força e coleta cinemática 3D durante caminhada em esteira rolante para determinação dos Parâmetros funcionais (qualidade de vida, equilíbrio estático e dinâmico, velocidade autosselecionada de caminhada e índice de reabilitação locomotor). Desfechos do estudo C: foram avaliados através coletas de dados espirométricos, cinemáticos 3D e eletromiográficos da caminhada em esteira rolante em diferentes velocidades os parâmetros mecânicos e do mecanismo pendular (trabalho mecânico externo, interno e total- Wext, Wint, Wtot, Recovery -R, Custo de transporte -C, Velocidade autosselecionada -VAS), parâmetros eletromiográficos (amplitude média do sinal e co-contração dos músculos DA, TB, VL, BF, TA e GM), frequência cardíaca de exercício – FCexercício, e sensação subjetiva de esforço - RPE, de idosos sedentários,. Análise Estatística: Os dados de descrição da amostra, no baseline, foram comparados aplicando-se ANOVA one-way. Os desfechos foram analisados utilizando as Equações de Estimativas Generalizadas (GEE), para a comparação entre os grupos (NW e CL) e os momentos (pré e pós treino). Utilizou-se um post-hoc de Bonferroni, para identificar as diferenças entre os efeitos e interações. Os dados foram apresentados em “model-based adjusted means”, e foram analisados com o software Statistical Package for the Social Science (SPSS) v.22.0. Adotou-se um nível de significância de α=0,05. Conclusão: os treinamentos de NW e de CL, promovem melhoras nos componentes da aptidão funcional; no equilíbrio estático e na variabilidade dinâmica de idosos. Contudo algumas diferenças entre as duas intervenções se relacionam ao princípio da especificidade do treinamento e ocorrem apenas nos componentes que receberam mais estímulos impostos pela técnica da caminhada com bastões, especialmente nos membros superiores. Ainda, o incremento da VAS na esteira aliada à utilização do IRL, nos permitem concluir que o treinamento de NW tem relevância clínica e é recomendado como meio de melhora do condicionamento físico e como método de reabilitação de idosos sedentários. Esta atividade física proporciona adaptações centrais com melhora significativa na mobilidade funcional de idosos. Deste modo, após treinamento de resistência aeróbica com e sem bastões os idosos aumentam a velocidade de locomoção nas atividades diárias e com menor custo metabólico devido às adaptações centrais e melhora do mecanismo pendular devido à maior proximidade da VAS à velocidade ótima de caminhada. Ainda há adaptações importantes na ativação muscular decorrentes do treinamento de NW em idosos indicando uma redução dos níveis de co-contração de membros superiores na caminhada sem bastões, à qual repercute diretamente na melhora da aptidão física, na independência funcional dos idosos. Além disso, recomendamos à NW como uma atividade física segura e efetiva para esta população quando a periodização do treinamento são realizados com o volume e intensidade estritamente controlados. / Introduction: Considering the rapid increase in the elderly population and their life expectancy, together with the expansion of Nordic walking (NW) interventions as a training method for the elderly, there is a need for experimental studies (randomized controlled trials, ECRs) of preventive character and of good methodological quality that allow the professionals of physical education, health and rehabilitation to make decisions regarding the type, volume and intensity of NW exercise in the health promotion of sedentary elderly. Objectives: This study aimed (study A) to determine, through a systematic review of randomized clinical trials, whether systematic training with NW, compared to free walking (FW), has beneficial effects on components of the functional capacity of sedentary elderly, also (study B) avaluate the effects of eight weeks of NW and FW training on quality of life (QoL), static balance, dynamic variability, self-selected walking speed on treadmill (SSWS) and Locomotor rehabilitation index (LRI) of sedentary elderly, and also evaluate (study C) the effects of eight weeks of NW and FW training on mechanical work (external, internal and total mechanical work -Wext,Wint, Wtot), pendular mechanism (R), Cost of (C), exercise heart rate (HRexercise), rate of perceived exertion (RPE), and electromyographic parameters (mean signal amplitude and co-contraction) of muscles: Anterior Deltoid (AD), Triceps Brachii (TB), Vastus Lateralis (VL), Femoral Biceps (BF), Anterior Tibialis (TA) and Medial Gastrocnemius (MG) of sedentary elderly. Experimental Design: Controlled Clinical Trial (ECR). Research Location: School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. Methods: The sample comprised 33 sedentary participants randomly divided into two groups (NW group, n =16, age: 64.6 ± 4.1 years old, weight: 81.5 ± 10.7 kg and height: 166.3 ± 7.5 cm; and FW group, n =16, age: 68.6 ± 3.9 years, mass: 74.6 ± 14.5 kg and height: 161.6 ± 10.3 cm), performed NW and FW training for 8 weeks. Outcomes of Study A: Parameters of functional fitness of the elderly (upper limb strength and endurance, lower limb strength and endurance, mobility, lumbar spine and posterior hip muscle flexibility, general amplitude of the shoulder joint, aerobic endurance and self-selected speed). Outcomes of study B: Functional parameters (QoL, static and dynamic balance, SSWS and LRI).Outcomes of Study C: Mechanical parameters and pendular mechanism (Wext, Wint, Wtot, R, C, SSS), electromyographic parameters (mean signal amplitude and Co-contraction of AD, TB, VL, BF, AT and MG muscles), HRexercise RPE of sedentary elderly. Statistics Analysis: Sample description data, at baseline, were compared by applying one-way ANOVA. The outcomes were analyzed using Generalized Estimates (GEE), to compare the groups (NW and CL) and the moments (pre and post training). A Bonferroni post-hoc was used to identify the differences between effects and interactions. The data were presented in model-based adjusted means, and were analyzed with the software Statistical Package for the Social Science (SPSS) v.22.0. A significance level of α = 0.05 was adopted. Conclusion: NW and FW training, promotes improvements in functional fitness components; in the static balance and in the dynamic variability of the elderly. However, some differences between the two interventions are related to the principle of training specificity and occur only in the components that received the most stimuli imposed by the walking technique with poles, especially in the upper limbs. Furthermore, the increase in SSWS on the treadmill combined with the use of LRI allows us to conclude that NW training has clinical relevance and is recommended as a means of improving physical conditioning and as a method of rehabilitation of sedentary elderly. This physical activity provides central adaptations with significant improvement in the functional mobility of the elderly. Thus, after aerobic resistance training with and without poles, the elderly increase the speed of locomotion in daily activities and with lower metabolic cost due to the central adaptations and improvement of the pendulum mechanism due to the greater proximity of the SSWS to the optimal speed of walking. There are still important adaptations in muscle activation resulting from NW training in the elderly indicating a reduction in the levels of co-contraction of upper limbs in walking without walking poles, which directly affects the improvement of physical fitness and functional independence of the elderly. In addition, we recommend NW as a safe and effective physical activity for this population when the periodization of training is performed with the volume and intensity strictly controlled.

Impairments in walking and balance are symptoms of normal pressure hydrocephalus. Measuring walking speed is therefore important for diagnosing and following the rehabilitation of patients with the diagnosis. However, performing the measurement at the hospital is costly and requires a lot of resources. Therefore, this study aims to propose a design concept enabling patients to measure their walking speed at home. When designing for the elderly and people with cognitive impairments there are various aspects that need to be considered. For instance, one needs to consider that these individuals may have reduced vision, attention, and memory. Through a literature review, guidelines on how to design both generally and specifically for the target group have been gathered. These guidelines were used to develop a prototype which has been evaluated in usability tests and interviews. In total, eleven people participated in the study. The study included a low-fidelity evaluation and a high-fidelity evaluation of the prototype. While the prototype was generally considered intuitive and user-friendly, participants suggested improvements such as reducing unnecessary instructions. Further, it was evident that some elements were hard to see. Overall, participants had a positive attitude to the application and to perform measurements outside of the hospital. The evaluations resulted in a set of final design requirements that concluded simplicity, clarity, and visibility to be vital when designing for the elderly and people with cognitive impairments. / Nedsättningar i gång och balans är symtom på normaltryckshydrocefalus. Att mäta gånghastighet är därför viktigt för att diagnostisera och följa rehabiliteringen av patienter med diagnosen. Att utföra mätningen på sjukhuset är dock kostsamt och kräver mycket resurser. Därför syftar denna studie till att föreslå ett designkoncept som gör det möjligt för patienter att mäta sin gånghastighet hemma. När man designar för äldre och personer med kognitiva funktionsnedsättningar finns det olika aspekter som måste beaktas. Till exempel måste man tänka på att dessa individer kan ha nedsatt syn, uppmärksamhet och minne. Genom en litteraturgenomgång har riktlinjer för hur man designar både generellt och specifikt för målgruppen samlats in. Dessa riktlinjer användes för att utveckla en prototyp som har utvärderats i användarberhetstester och intervjuer. Totalt deltog elva personer i studien. Studien inkluderade en utvärdering av prototypen tidigt i designprocessen och en i slutet av designprocessen. Medan prototypen i allmänhet ansågs logisk och användarvänlig, föreslog deltagarna att minska onödiga instruktioner. Vidare var det uppenbart att vissa element i prototypen var svåra att se. Sammantaget hade deltagarna en positiv inställning till applikationen och att utföra mätningar utanför sjukhuset. Utvärderingarna resulterade i en uppsättning slutliga designkrav som beskriver enkelhet, tydlighet och synlighet som avgörande vid design för äldre och personer med kognitiva funktionsnedsättningar.

Walking speeds are an important parameter in the process of designing for example arenas, malls and station environments, to be able to make them safe and comfortable for the users. Previous studies have mainly focused on pedestrian walking speeds at zebra crossings and the results of these are the basis for traffic signal timing. The studies have also investigated the relationship between walking speed and gender, age and density of pedestrians. From the results of these studies, conclusions have been drawn that these three factors have an impact on pedestrian walking speeds. To make microsimulations of pedestrians reflect reality as well as possible, pedestrian walking speeds should be investigated at regular intervals, as walking speeds change with the ongoing change of the composition of the population. In the simulation of station environments, pedestrian speeds should also be used that have been measured in these types of environments. Alternatively, the speeds should be measured at locations near stations, rather than using speeds from zebra crossings. As a step in improving the above-mentioned microsimulations, the aim of this work is to study walking speeds at a public transport hub during rush hour. The work also focuses on connecting walking speeds to each sex and level of crowding. To achieve this goal, video recordings were performed at the exchange point between Stockholms östra and Tekniska högskolan in Stockholm, Sweden, where public transport passengers change between light rail and subway. Analysis of the video films resulted in walking speeds which were higher than those previously measured at zebra crossings. The most obvious factors explaining this are the differences in the environment where the studies were conducted and that the walking speeds in this thesis were measured during rush hour. The results show that simulations of stations and locations nearby should not be based on walking speeds measured at zebra crossings. Analysis of the video films also resulted in the calculated mean walking speed of women being marginally lower than for men. Regarding the link between density of pedestrians and their walking speeds a conclusion can be drawn that at low densities pedestrians have good opportunities to freely select their own walking speed. The freely chosen walking speed which can thus be maintained at low densities can vary widely between different individuals. At higher, unlike at lower densities, it is difficult for pedestrians to maintain a freely chosen speed due to interactions with other pedestrians. The calculated average walking speed at higher densities therefor decreases as the density increases. Interactions with other pedestrians can either mean that a pedestrian is forced to lower the speed or that he or she must walk faster to keep up with the current pace. When analyzing the video films, several other factors effecting the walking speed could be noted. Of these factors, grouping of pedestrians and if the pedestrian is using a phone or carrying luggage could be seen to decrease the pedestrian speed. These factors’ impact on walking speeds was only superficially studied in this thesis, and no reliable conclusions can therefore be drawn. Keywords: Pedestrian walking speed, public transport traffic hub, density of pedestrians, Level of

Résumé : Au Canada, annuellement il y a près de 10 000 personnes disparues. Pour les retrouver chaque fois une alerte est donnée. La police et les groupes de recherche terrestre spécialisés travaillent pour la retrouver, mais, par où commencer? Dans quelles directions orienter les recherches? Combien du temps pour balayer les différents secteurs? C’est souvent une question d’heures ou même des minutes pour la retrouver vivante. La théorie de recherche a trois concepts essentiels; la probabilité d’aire, la probabilité de détection et la probabilité de succès. Notre travail a cherché à préciser la probabilité d’aire. L’objectif de ce travail de recherche a consisté à développer un algorithme pour élaborer des cartes d’isochrones automatiques de la vitesse de marche probable des disparus. Il tient compte des restrictions dues aux variables environnementales (relief, occupation du sol, météorologie) et anthropiques (âge, sexe, taille, poids et activité physique). Le travail est développé au tour d’un système d’information géographique. Sur ceci nous distinguons deux groupes des données. Le premier correspond aux données attributaires que servent à générer la zone tampon et les facteurs de vitesse de l’individu. Ces données sont attachées à la couche du point initial. Dans le deuxième groupe, nous trouvons les données à référence spatiale intérieures à la zone tampon. Les facteurs de vitesse de l’individu et la carte de pentes génèrent la carte de vitesses par superficie. Les données de couverture de sol, quant à elles, produisent la carte de coût de traversée de la superficie. Finalement, la multiplication des deux dernières cartes produit la carte de coût de voyage, laquelle est le résultat essentiel pour concevoir la carte des courbes isochrones. Un algorithme a été construit et développé en langage de programmation Python. Il a été exécuté avec des données saisies dans l’environnement d’ArcGis 10.2. Nous avons observé une tendance des disparus à rester dans un rayon d’une heure de marche à partir du point initial (Pl). De plus, des variables comme les routes, sentiers et lignes de transport d’énergie influencent la marche. Finalement nous avons trouvé que l’outil aide au confinement de la probabilité d’aire. L’outil se démarque par sa simplicité d’usage. À l’intégration des facteurs de marche qui sont reliés à l’individu. Ainsi qu’à l’inclusion des facteurs météorologiques. Il peut s’exécuter partout au Canada. / Abstract : In Canada, annually there are about 10 000 missing persons. To find them whenever a warning is given. Police and specialized ground search groups work to find her, but where to start? In what directions guide research? How much time to scan the different sectors? It is often a matter of hours or even minutes to find her alive. The search theory has three basic concepts; the probability of area, the probability of detection and probability of success. Our work has sought to precise the probability of area in land search. The aim of this research was to develop an algorithm to make automatic isochrone maps that show the probability walking time of the missing person. It takes account of restrictions due to environmental variables (topography, land use, meteorology) and anthropogenic (age, sex, height, weight and physical activity). The work was developed around a geographic information system. On top of this, we distinguish two groups of data. The first is the attribute data that are used to generate the buffer zone and the individual speed factors. These data are attached to the initial planning point layer. In the second group, we find the internal spatial data in the buffer zone. The individual factors of speed and slope map produced the speed map. Ground cover data generated the cost map of crossing the area. Finally, the multiplication of the last two maps produced the travel cost map, which is the last step to design the isochrone map. An algorithm has been built and developed in the Python programming language. It was performed with the data entered into the ArcGIS 10.2 environment. We observed a trend of lost persons to stay around an hour's walk from the initial planning point (IPP). In addition, variables such as roads, paths and power transmission lines affect the walking speed. We found that the tool aid to precise the containment of probability of area. The tool is distinguished by its ease of use. With the integration of walking factors that are connected to the lost persons. We include meteorological factors. It can run across Canada.

When cities grow larger the demand for more residential buildings and public transport increases. To be able to meet the demands and still make the city compact the interest for underground facilities grows. Underground facilities come with some drawbacks, one example is the evacuation where the people are expected to evacuate upwards. This master thesis is aiming to further develop the research done on the subject by examining the impact of winter clothing. Two tests were performed in Skrapan, which is 25 floors high. The participants went up for 22 of the floors and were recorded during the ascending. Some of the participants had a pulse watch and a breathing mask, which measured the oxygen consumption. The median for the walking speed varied between 0,81 m/s and 0,56 m/s with regular clothing and 0,78 m/s to 0,57 m/s with winter clothes. In the building codes it says that 0,6 m/s should be used when calculating evacuation times when ascending stairs. The heart rate did not change significantly between the two tests. However, the oxygen consumption was higher with the jacket on. The participants would not have been able to keep going for much longer than 5 minutes with their current pace. According to the results in this master thesis 0,6 m/s is too high because in the tests that were made the participants were physically active and still couldn’t keep that speed up for the whole test. Due to the test being two days in a row, almost all of the participants walked slower the second time. However, the ones that walked with winter clothes the second day walked more slowly than the ones with regular clothes compared to the first day. Therefore, it is safe to say that the clothes do affect the walking speed of evacuating people and that more clothes i.e. warm shoes or a hat will have an even greater impact. / I takt med att städerna växer, både till yta och befolkningsmängd, ökar behovet av infrastruktur bland annat inom kollektivtrafiken och transportvägar. Genom att bygga dessa anläggningar under marken går det att exploatera marken ovan till andra ändamål. Med undermarksanläggningar kommer vissa svårigheter, så som begränsade utrymningsmöjligheter. Riktlinjerna för utrymning uppåt är inte till för längre trappor, och är därför inte representativt för de nya användningsområdena. Vikten av att dimensionera utrymningsmöjligheterna utifrån vad dagens befolkning kan prestera är relevant för att säkerställa en trygg utrymning i händelse av en olycka. Examensarbetet inriktar sig därför på att vidareutveckla tidigare forskning om utrymning uppåt genom att undersöka hur gånghastigheterna i trappor påverkas av vinterkläder. Försök genomfördes med 21 personer under två dagar i ett av Skrapans utrymningstrapphus, där varje försöksperson fick gå en gång per dag. Mätmetoderna som användes var bland annat; pulsklocka, tidtagning, videoobservationer och andningsmask som mäter syreupptagningsförmågan. Medianen för gånghastigheten beräknades på varje våningsplan där de högsta värdet med vanliga kläder blev 0,81 m/s, 3 meter upp i trappan och det lägsta 0,56 m/s, 57 meter upp i trappan. Med vinterkläder blev motsvarande värden 0,78 m/s, 5 meter upp i trappan och 0,57 m/s, 33 meter upp i trappan. Enligt Boverkets allmänna råd om analytisk dimensionering ska den dimensionerande gånghastigheten i trappor sättas till 0,6 m/s. Denna riktlinje är inte godtagbar eftersom försökets urvalsgrupp hade svårt att hålla den hastigheten trots att majoriteten av försökspersonerna i examensarbetet var unga och i god kondition. Gånghastigheterna påverkades även av att försökstillfällena genomfördes dagarna efter varandra vilket gjorde att försökspersonerna inte hade möjlighet att återhämta sig helt mellan försöken. Dock var tidsskillnaden från första dagen till den andra större för de som gick med vinterkläder andra dagen än för de som gick med vanliga kläder andra dagen. Vilket visar på att försökspersonerna blivit påverkade av vinterkläderna och därför gått långsammare. Mätningarna av syreupptagningsförmågan hos försökspersonerna gav varierande resultat, mycket beroende på kön och om de hade vinterkläder på sig eller inte. Kvinnornas utnyttjande grad ökade från 70-85 % till 73-90 % av sin maximala syreförbrukning när de var iklädda vinterkläder. Jämfört med männens utnyttjande grad som sjönk från 63-85 % till 61-77 % vid användandet av vinterkläder. Försökspersonerna var nära sin maximala syreförbrukning, VO2,max, vilket tyder på att de inte skulle klara av att hålla samma tempo i en längre trappa. Männen skulle kunna hålla samma tempo i cirka 15 minuter medan kvinnorna som ligger på 90 % av sin kapacitet enbart skulle kunna hålla samma hastighet i cirka 5 minuter. Vilket är ett ytterligare tecken på att hastigheten i BBRAD är för hög i långa trappor.

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No. of bitstreams: 2 Tese - Jacqueline Danesio de Souza - 2017.pdf: 1896817 bytes, checksum: 8b8d4091000aa37121f775268ad356c0 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-06-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The study is part of a randomized, parallel clinical trial entitled "Effect of nutritional intervention and olive oil in severely obesity (DieTBra Trial)." The original articles seek to investigate sarcopenia in severe obese adults in terms of prevalence, factors associated with its diagnosis and the effectiveness of extra virgin olive oil and the traditional Brazilian diet as a dietary intervention. A total of 111 severe obese individuals (body mass index [BMI] ≥ 35.0 kg/m²) participated in the clinical trial, with a follow-up of 12 weeks and three intervention groups: Olive oil = extra virgin olive oil (52 mL/day); DieTBra = traditional Brazilian diet; DieTBra + Olive Oil = DieTBra + extra virgin olive oil (52 mL/day). Appendicular skeletal muscle mass (MMEA), measured in the total form (kg), adjusted by squared height (appendicular skeletal muscle mass index [IMMEA]) and by BMI (MMEA/BMI), strength of manual (FPM) and BMI adjusted (FPM/BMI), and walking speed. The prevalence calculation considered the cutoff points proposed in the literature and the calculation of -2 standard deviation (SD) of the mean value of the parameters of muscle mass evaluated in the study population. The ANOVA test was applied to evaluate the difference between the means of the parameters of second to the age group. The prevalence according to cutoff points proposed in the literature varied from 2.88% for IMMEA, 6.73% for total MMEA and 62.50% according to MMEA/BMI. When adopting - 2 SD below the mean of the study population, the prevalence was 2.88% for total MMEA and 3.85% for IMMEA and MMEA/BMI. Although no statistically significant difference (p > 0.05) was found between the means of the parameters according to the age group, prevalence values higher than those previously demonstrated in the age group ≥ 40 years were observed. In the second article, the explanatory variables considered were age, lifestyle, health conditions, food consumption and biochemical tests. Those with p value < 0.20 in simple linear regression were included in multiple linear regression. Among the factors inversely associated with IMMEA are serum levels of tetraiodothyronine (T4) and smoking. MMEA/BMI was inversely associated with age, serum T4 levels and presence of diabetes. MMEA also remained inversely associated with serum T4 levels and diabetes. The reduction of FPM and FPM/BMI were associated with advancing age and presence of hypercholesterolemia. Already the low speed of march was associated with the presence of diabetes and hypothyroidism. The primary endpoint considered in the third article was the IMMEA and the secondary ones were: FPM, gait speed, MMEA/IMC, total MMEA, total body fat and percentage. In the endpoints and covariates analyzed, the delta was also calculated, which is the difference between the value of the end of follow-up and the baseline. Covariance analysis (ANCOVA) was performed to analyze the effect of covariates delta weight, delta physical activity, delta time of sedentary lifestyle, sex and age, on the outcomes. A significance level of 5% was adopted. After performing the ANCOVA, the covariates of the delta weight adjusted the following outcomes in the DieTBra intervention group: reduction of delta total body fat (p = 0.016), increase in delta walking speed (p = 0.042) and delta FPM (p = 0.044 ). And also for reduction of delta body fat in the DieTBra + Olive oil group (p = 0.004). When adjusted for the delta time of sedentary lifestyle, total body fat presented a significant reduction in the DieTBra + Olive oil group (p = 0.001). The prevalence of sarcopenia differed as different assessments were used for muscle mass, evidencing the need to standardize the criteria and cutoff points used in its classification. The factors associated with the evaluation parameters, evidenced the importance of the creation of clinical measures and public health aimed at the prevention of sarcopenia. The positive effects of DieTBra and DieTBra + Olive oil on the parameters of sarcopenia and adiposity, reveal the importance of the adequate evaluation, diagnosis and treatment of sarcopenia in adults with severe obesity. / O estudo está inserido no ensaio clínico, randomizado e paralelo, intitulado “Effect of nutritional intervention and olive oil in severely obesity (DieTBra Trial)”. Os artigos originais buscam investigar a sarcopenia em adultos obesos graves em termos de prevalência, fatores associados ao seu diagnóstico e a efetividade do azeite de oliva extravirgem e da dieta tradicional brasileira como intervenção dietética. Participaram do ensaio clínico 111 obesos graves (índice de massa corporal [IMC] ≥ 35,0 Kg/m²), com seguimento de 12 semanas e três grupos de intervenção: Azeite = azeite de oliva extravirgem (52 mL/dia); DieTBra = dieta tradicional brasileira; DieTBra + Azeite = DieTBra + azeite de oliva extravirgem (52 mL/dia). Foram considerados como parâmetros de avaliação da sarcopenia: massa muscular esquelética apendicular (MMEA), avaliada na forma total (kg), ajustada pela altura ao quadrado (índice de massa muscular esquelética apendicular [IMMEA]) e pelo IMC (MMEA/IMC), força de preensão manual (FPM) máxima e ajustada pelo IMC (FPM/IMC), e velocidade de marcha. O cálculo da prevalência considerou os pontos de corte propostos na literatura e o cálculo de -2 desvio padrão (DP) do valor médio dos parâmetros de massa muscular avaliados na população do estudo. O teste ANOVA foi aplicado para avaliar a diferença entre as médias dos parâmetros de segundo a faixa etária. A prevalência segundo pontos de corte propostos pela literatura variou de 2,88% por IMMEA, 6,73% pela MMEA total e 62,50% segundo MMEA/IMC. Ao adotar - 2 DP abaixo da média da população de estudo, a prevalência foi de 2,88% pela MMEA total e de 3,85% por IMMEA e MMEA/IMC. Embora não tenha sido estabelecida diferença estatística significante (p > 0,05) entre as médias dos parâmetros segundo a faixa etária, foi observado valores de prevalência superiores aos anteriormente demonstrados na faixa etária ≥ 40 anos. No segundo artigo, as variáveis explanatórias consideradas foram idade, estilo de vida, condições de saúde, consumo alimentar e exames bioquímicos. Aquelas com valor p < 0,20 na regressão linear simples foram incluídas na regressão linear múltipla. Dentre os fatores inversamente associados ao IMMEA está níveis séricos de tetraiodotironina (T4) e ser fumante. MMEA/IMC foi inversamente associado a idade, níveis séricos de T4 e presença de diabetes. A MMEA também se manteve inversamente associada a níveis sérico de T4 e diabetes. A redução da FPM e FPM/IMC foram associadas ao avançar da idade e presença de hipercolesterolemia. Já a baixa velocidade de marcha esteve associada com a presença de diabetes e hipotireoidismo. O desfecho primário considerado no terceiro artigo foi o IMMEA e os secundários foram: FPM, velocidade de marcha, MMEA/IMC, MMEA total, gordura corporal total e percentual. Nos desfechos e nas covariáveis analisadas calculou-se também o delta, que é a diferença entre o valor do final do seguimento e a linha de base. Foi realizada análise de covariância (ANCOVA) para analisar o efeito das covariáveis delta peso, delta atividade física, delta tempo de sedentarismo, sexo e idade, sobre os desfechos. Adotou-se nível de significância de 5%. Após realização da ANCOVA, a covariável delta peso ajustou os seguintes desfechos no grupo de intervenção DieTBra: redução do delta gordura corporal total (p = 0,016), aumento do delta velocidade de marcha (p = 0,042) e do delta FPM (p = 0,044). E ainda para redução do delta gordura corporal no grupo DieTBra + Azeite (p = 0,004). Quando ajustada pelo delta tempo de sedentarismo, a gordura corporal total apresentou redução significativa no grupo DieTBra + Azeite (p = 0,001). A prevalência de sarcopenia diferiu à medida que se empregou diferentes avaliações para massa muscular, evidenciando a necessidade de padronização dos critérios e pontos de corte empregados na sua classificação. Os fatores associados aos parâmetros de avaliação, evidenciaram a importância da criação de medidas clínicas e saúde pública direcionadas a prevenção da sarcopenia. Os efeitos positivos da DieTBra e DieTBra + Azeite sobre os parâmetros da sarcopenia e adiposidade, revelam a importância da adequada avaliação, diagnóstico e tratamento da sarcopenia em adultos com obesidade grave.

A norma brasileira que trata de Saídas de Emergência, a ABNT NBR 9077:2001, pressupõe que o perfil da população de alunos em edifícios escolares, do ensino fundamental à universidade, é homogêneo, e que, portanto, não há eventuais particularidades inerentes às diferentes faixas etárias no uso das saídas de emergência. Esta pesquisa partiu da hipótese de que o perfil da população e, em particular, o de crianças do ciclo básico do ensino fundamental, pode ser diferente do adulto e, por consequência, demandar um dimensionamento específico para as saídas de emergência. Assim, realizou-se a coleta e análise de dados relativos à velocidade de caminhamento e aspectos comportamentais de crianças no movimento de descida de escadas, além de buscar correlações entre as velocidades e os dados antropométricos. Participaram da pesquisa 783 alunos do ciclo básico do ensino fundamental, oriundos de três escolas de ensino gratuito, com idade entre 6 e 10 anos. Foram testadas duas técnicas para a coleta dos dados: filmagens obtidas por meio de sistema fechado de televisão (CFTV) e sistema de identificação por rádio frequência (RFID), sendo que essa última não atendeu às expectativas e necessidades da pesquisa. As velocidades obtidas por processamento de dados de filmagens foram comparadas com as adotadas nos softwares de simulação de abandono \"FDS+EVAC\" e \"Simulex\". Constatou-se que, para os lances das escadas, as velocidades das crianças obtidas se assemelham as de referência de adultos (0,45 m/s até 1,05 m/s). Já para a velocidades obtidas nos patamares, houve grande dispersão, em relação aos valores de referência para adultos e crianças. Verificou-se, também, que o trajeto mais utilizado nos patamares foi o interno (mais curto) e que o emprego de métodos simplificados para estimar esses trajetos pode resultar em dados de velocidade imprecisos. Não foi constatada nenhuma correlação significativa entre as medidas antropométricas (IMC e bideltóide) e as velocidades dos alunos em lances ou patamares de escadas. Devido a dispersão dos resultados obtidos, não é possível a confirmação da hipótese inicial desta pesquisa. / In the Brazilian Technical Standard concerning means of egress (ABNT NBR 9077. 2001) it is presumed that the profile of students\' population in educational buildings, from elementary school to college, is homogeneous. Therefore, it does not consider the eventual particularities intrinsic to specific age groups during the use of egress systems. Assuming that the profile of elementary school children may be different from adults\', the criteria applicable to a variety of means of egress components could be more specific according to the occupant\'s characteristics. Thus, data regarding walking speeds and behavioral aspects of children in descending movement of stairs were collected and analyzed. Anthropometric data (weight, height and bideltoid measurement) from each child were also collected in order to seek correlations between these dimensions and the walking speeds. 783 elementary students from 3 different public schools, ages varying from 6 to 10 years old, participated in this research. Two techniques were tested for collecting data: recorded images from closed-circuit television (CCTV) and signals from radio-frequency identification (RFID); however, the last one was discarded due to technical difficulties. When compared to the speeds adopted by the egress simulation softwares \"FDS+EVAC\" and \"Simulex\", it was noticed that children\'s travel speeds in stairs are actually quite similar to the ones adopted for adults (0,45 m/s to 1,05 m/s), contrasting with the common sense that infants are slower than grown-ups. As for the walking speeds on landings, a wide dispersion in relation to parameters determined for adults and children was found. It was also noticed that most infants chose the shortest path (internal) on landings and that designation of a simplified average trajectory can lead to inaccurate travel speeds. Regarding the anthropometric measurements and walking speeds, no direct correlation was found. Due to the significant dispersion of the results, the initial hypothesis of this research could not be confirmed.

Le déclin des performances motrices du sujet âgé est associé à un risque accru de morbimortalitéet représente une problématique majeure pour nos sociétés vieillissantes. Son origine est le plus souvent multifactorielle et nous nous sommes plus particulièrement intéressés au rôle des facteurs de risque vasculaire à partir des données longitudinales et transversales de la cohorte dijonnaise de l’étude des 3 Cités. Les performances motrices ont été évaluées à travers la mesure de la vitesse de marche sur 6 mètres chez des sujets âgés de 65 à 85 ans à l'inclusiondans l'étude.Nous avons ainsi observé que l’hypertension artérielle à l’inclusion dans l’étude était associée à une vitesse de marche plus lente et à un déclin de la vitesse de marche plus important au cours du suivi. Parmi les participants ayant eu une IRM cérébrale à l’inclusion, nous avons observé une relation entre la vitesse de marche et les volumes sous-corticaux de substance grise cérébrale, en particulier le volume du noyau caudé. Une vitesse de marche plus lente à l'inclusion était associée à un risque accru de mortalité toutes causes 5 ans plus tard, avec une association plus forte pour la mortalité cardiovasculaire.Ces résultats sont en faveur d’une contribution cérébrovasculaire au déclin des fonctions motrices du sujet âgé, et participent à une meilleure compréhension de ce processus. / Motor decline in the elderly is associated with an increased risk of morbidity and mortality, and represents a major issue for our ageing societies. Its etiology is usually multifactorial, and, in this work, we specifically addressed the contribution of vascular risk factors, based on crosssectional and longitudinal data from the Dijon center of the Three-City study. Motor function was assessed through measures of walking speed over 6 meters in participants aged 65 to 85 years old.We observed that baseline hypertension was associated with lower walking speed at baseline and greater motor decline over follow-up. Among participants with a baseline brain MRI, we observed a relationship between walking speed and the volume of brain subcortical gray matter structures, particularly the volume of the caudate nucleus. Slower walking speed at baseline was associated with an increased risk of all-cause death over 5 years of follow-up; this association was stronger for cardiovascular deaths.These results support the hypothesis of a contribution of vascular risk factors to motor decline in the elderly and contribute to improve our understanding of this process.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-19T16:11:19Z No. of bitstreams: 1 Natalia Pereira da Silva.pdf: 971997 bytes, checksum: 4c5816fd5b9a093d74b751b628111118 (MD5) / Made available in DSpace on 2018-06-19T16:11:19Z (GMT). No. of bitstreams: 1 Natalia Pereira da Silva.pdf: 971997 bytes, checksum: 4c5816fd5b9a093d74b751b628111118 (MD5) Previous issue date: 2016-02-03 / Background: Little is known about the functional cardiorespiratory capacity of children with Cerebral Palsy (CP). Many questions also arise regarding the modulation of the autonomic nervous system for different motor severity of them. Consolidating evaluative forms of functional capacity easily accessible and simple understanding for these children that are reliable and reproducible. Objective: Study 1: To investigate whether the six-minute walk test (6MWT) and walk test 10 meter (TC10m) are performed to assess functional capacity in children and adolescents with CP. Study 2: To investigate whether there are differences in autonomic modulation in different levels of motor severity in children with CP. Study 3: To investigate the reproducibility of the 6MWT and Shuttle Walk Test Incremental (SWTI) in children with CP in different levels System Functional Classification Engine Gross (GMFCS) I to III. Material and Methods: Study 1: This is a systematic review with meta-analysis. The survey was conducted until November 2015 in 5 databases: Pubmed, Pedro, Medline, Cochrane, CINAHL under results criteria in 6MWD and TC10m. Study 2: This is a cross-sectional study. Attended by 30 children with levels of GMFCS I to III. The Heart Rate (HR) and RR interval data were collected through a HR monitor (Polar RS800CX Polar, Finland). Children were instructed to remain lying in the supine position for 10 minutes then remained standing for 10 minutes. Study 3: This is a cross-sectional study. Each child held 2 times the same test (6MWT and SWTI) with an interval of 30 minutes between them. The reproducibility of both tests was tested for children with CP, GMFCS I to III. Results: Study 1: 39 studies met the criteria consistent with the objective of the systematic review. We conducted a meta-analysis of 5 studies, including three studies reported the 6MWT, only one is in favor of the experimental group (EG); and 2 to TC10m, both close in favor of GE. Study 2: There were no statistically significant differences (p> 0.05) on the parameters LF, HF and LF / HF ratio between different classifications of GMFCS. Study 3: The distance covered on the 1st and 2nd test, for both tests was not statistically significant (p = 0.63 for 6MWT and p = 0.39 for SWTI). Conclusion: Simple and valid tools are likely to become practice of professional conduct on behalf of individuals with CP. The autonomic modulation is not correlated with the severity of motor children with CP. Field tests: 6MWT and SWT are reproducible and reliable for this population. / Introdução: Pouco se conhece da capacidade funcional cardiorrespiratória de crianças com Paralisia Cerebral (PC). Muitas dúvidas também surgem a respeito da modulação do sistema nervoso autônomo para diferentes gravidades motoras das mesmas. Consolidar formas avaliativas da capacidade funcional de fácil acesso e simples entendimento para essas crianças, que sejam confiáveis e reprodutíveis. Objetivo: Estudo 1: Investigar se os testes de caminhada de seis minutos (TC6) e teste de caminhada de 10 metros (TC10m) são realizados para avaliação da capacidade funcional em crianças e adolescentes com PC. Estudo 2: Investigar se existem diferenças na modulação autonômica em diferentes níveis de gravidade motora em crianças com PC. Estudo 3: Investigar a reprodutibilidade do TC6 e Shuttle Walk Test Incremental (SWTI) em crianças com PC em diferentes níveis do System Classification Functional Motor Gross (GMFCS) I a III. Material e Métodos: Estudo 1: Trata-se de uma Revisão Sistemática com Metanálise. A pesquisa foi realizada até novembro de 2015 em 5 bases de dados: Pubmed, Pedro, Medline, Cochrane, CINAHL sob critérios de resultados em distância percorrida no TC6 e TC10m. Estudo 2: Trata-se de um estudo transversal. Participaram 30 crianças com níveis do GMFCS I a III. A Frequência Cardíaca (FC) e os dados de intervalos RR foram coletados por meio de um monitor de FC (Polar RS800CX Polar, Finlândia). As crianças foram instruídas a permanecerem deitadas em posição supina durante 10 minutos, em seguida, permanecerem em pé durante 10 minutos. Estudo 3: Trata-se de um estudo transversal. Cada criança realizou 2 vezes o mesmo teste (TC6 e SWTI) com intervalo de 30 minutos entre eles. A reprodutibilidade de ambos os testes foi testada para crianças com PC, GMFCS I a III. Resultados: Estudo 1: 39 estudos apresentaram critérios compatíveis com o objetivo da revisão sistemática. Realizou-se a metanálise de 5 estudos, dentre eles 3 estudos se reportaram ao TC6, apenas 1 sendo favorável ao grupo experimental (GE); e 2 ao TC10m, ambos próximos a favor do GE. Estudo 2: Não houve diferenças estatísticas significativas (p>0,05) nos parâmetros LF, HF e de relação LF/HF entre classificações diferentes do GMFCS. Estudo 3: A distância percorrida no 1º e 2º teste, para ambos os testes, não foi estatisticamente significativa (p=0,63 para TC6 e p=0,39 para SWTI). Conclusão: Ferramentas simples e válidas podem vir a tornar-se prática da conduta profissional em prol dos indivíduos com PC. A modulação autonômica não está correlacionada com a gravidade motora das crianças com PC. Os testes de campo: TC6 e SWT são reprodutíveis e confiáveis para esta população.

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