ABSTRACT: Evaluating muscle strength in the pediatric population allows comparing healthy and affected individuals, establishing recovery goals, tracking the results of interventions and the evolution over time due to health conditions, as well as monitoring load progression and level of training. The Modified Sphygmomanometer Test (MST) is a technique used to measure isometric muscle strength in this population. The objective of the study is to gather and synthesize studies that used MST to measure the muscular strength of children and adolescents, identifying the muscle groups, measurement properties investigated, and the applied protocols. Bibliographic search was conducted on the MEDLINE, Embase, PEDro, SciELO, and LILACS databases. Original, peer-reviewed studies published up to September 2021 that evaluated isometric muscle strength using MST in children and adolescents aged 0 to 19 years were selected. A total of 1,610 studies were identified, and 17 were considered eligible. Of these, 12 studies (70.6%) were conducted with a mixed population and five (29.4%) with only children and adolescents. The most evaluated muscle groups were hip adductors (47.5%) and handgrip (29.4%) with a predominance of the non-adapted sphygmomanometer (47.1%) and 20mmHg pre-insufflation (47.1%). Only six studies (35.3%) evaluated MST measurement properties . In conclusion, there are few studies aimed at the pediatric population, which hinders the standardization of MST application in clinical practice, despite being easy to access and handle.

Physical activity and exercise are different constructs. However, professionals usually employ heterogeneous definitions for these distinct constructs, resulting in nonspecific and inaccurate assessments, which compromise clinical decision making. The aim of this study was to verify if the levels of physical activity behave similarly between individuals with stroke and healthy-control individuals with the same levels of exercise. Seventy-five stroke survivors and 75 healthy-control individuals matched by levels of exercise, age, and sex were evaluated. The level of exercise was classified as inactive, insufficient, and moderate/vigorous according to the Centers for Disease Control and Prevention criteria. The level of physical activity was assessed with the Human Activity Profile (HAP) and classified as “inactive,” “moderately active,” and “active.” The physical activity level was compared between groups of subjects (stroke versus healthy-control) and subgroups of the level of exercise (“inactive,” “insufficient,” and “moderate/vigorous” level of exercise) (α = 5%). Stroke survivors had a significantly lower level of physical activity (HAP: 51 ± 22 and 71 ± 19 points, respectively). Only for individuals with stroke, a statistically significant difference was found in the levels of physical activity between subgroups of level of exercise, specifically between “inactive” and “moderate/vigorous” subgroups (HAP:47 ± 22 and 70 ± 8 points, respectively). Physical activity behaved differently between individuals with stroke and healthy-control individuals with the same levels of exercise. Individuals with stroke had worse physical activity levels than matched controls. Furthermore, different from individuals with stroke, in healthy-control individuals with different levels of exercise, the level of physical activity was similar.

RESUMO Indivíduos acometidos pelo acidente vascular encefálico (AVE) se beneficiam de diferentes estratégias terapêuticas que apresentam comprovação da eficácia por meio da condução de ensaios clínicos aleatorizados (ECA) bem delineados. Compreender as etapas do estudo pode auxiliar os pesquisadores na realização de futuros ensaios clínicos. Dessa forma, o objetivo deste estudo foi descrever o processo de recrutamento, retenção, presença e adesão na condução de um ECA realizado com indivíduos pós-AVE na fase crônica na cidade de Belo Horizonte (MG), Brasil, com o propósito de investigar a eficácia do treino específico da tarefa para membros superiores e inferiores na melhora do nível de atividade física e mobilidade. Nos resultados, foi observado que dos 674 potenciais participantes, não foi possível contatar 240; 384 não foram avaliados por não atenderem aos critérios de elegibilidade. Participaram da avaliação presencial 50 indivíduos e 14 não fizeram parte do estudo pelo mesmo motivo. Apenas 36 indivíduos iniciaram as intervenções (taxa de recrutamento de 5,3%). Uma taxa de retenção de 80,6% foi observada. Sete indivíduos abandonaram o estudo, principalmente por desinteresse pelas atividades. A taxa de presença foi de 80,9%, e o principal motivo para ausência nas sessões foi incompatibilidade de horário com as consultas médicas. A taxa de adesão foi de 82,7%, com 180 interrupções durante as sessões, sendo sair mais cedo o motivo mais comum. Esses resultados indicam algumas dificuldades no processo de condução do ECA com indivíduos na fase crônica do AVE envolvendo treino específico da tarefa. Apesar dessas dificuldades, a intervenção proposta pode ser considerada viável.

ABSTRACT Individuals who suffered stroke benefit from different therapeutic strategies whose efficacy has been proved by well-designed randomized controlled trials (RCTs). Understanding study steps may assist researchers in conducting future RCTs. Thus, the objective of this study was to describe the process of recruitment, retention, attendance, and adherence in conducting RCTs with individuals in the chronic phase of stroke in the municipality of Belo Horizonte/MG/Brazil, with the purpose of investigating the efficacy of specific task training for both lower and upper limbs in improving patients’ physical activity and mobility. Results showed that, of the 674 potential participants, it was impossible to contact 240 individuals and 384 were excluded from our sample for failing to meet eligibility criteria. In total, 50 individuals participated in clinical evaluations and 14 were excluded from the study for the same reason. Overall, 36 individuals started the interventions, a 5.3% recruitment rate. An 80.6% retention rate was observed. In total, seven individuals left the study, mainly due to lack of interest in the activities. We found an 80.9% attendance rate, and the main reason for missing medical appointments was incompatibility with treatment schedule. We also observed an 82.7% adherence rate. Of these, 180 interrupted sessions were mainly due to patients leaving early. These results indicate some difficulties found in conducting RCTs with individuals in the chronic phase of stroke, especially regarding specific task training. Despite these difficulties, the proposed intervention can be considered feasible.

Abstract Introduction: According to studies from developed countries, post-stroke individuals commonly have a low level of physical activity. Considering the benefits of maintaining a good level of physical activity in these subjects, it is important to provide specific and complete information, based on the assessment of all dimensions of physical activity, which supports interventions. Objective: To compare the physical activity levels between individuals with stroke and matched healthy individuals that use the public health system in Brazil considering the different dimensions of physical activity. Methods: Individuals with stroke (n = 11) and matched healthy individuals (n = 11) were assessed. Physical activity levels, considering all dimensions -duration (> 3 MET), frequency (number of steps) and intensity (mean total energy expenditure per day) - were assessed using SenseWear® monitor for seven days. Descriptive statistics and between-groups comparisons were performed (α = 0.05). Results: The physical activity levels were significantly lower in individuals with stroke when compared to matched healthy individuals, considering all dimensions. The between-group differences in activity duration, frequency, and intensity were 74 minutes/day, 5,274 steps/day, and 2,134kJ/day, respectively. Conclusion: Individuals with stroke users of the Brazilian public health system have lower physical activity levels in different dimensions of physical activity than matched healthy individuals. The assessment of the physical activity level of post-stroke individuals is important for decision making in public health programs.

RESUMO Indivíduos acometidos pelo acidente vascular cerebral (AVC) tendem a manter um padrão sedentário de vida com nível de atividade física insuficiente, gerando limitações funcionais, restrição na participação e dificuldade de envolvimento em programas de exercícios. Compreender a preferência de exercícios desta população é importante para o entendimento dos fatores contextuais e a adequação de programas voltados à promoção de saúde e funcionalidade. Trata-se de um estudo transversal com amostra de conveniência, cujos objetivos foram identificar a preferência de exercícios de indivíduos na fase crônica do AVC usuários do Sistema Único de Saúde em Belo Horizonte, (MG), Brasil, e investigar a associação com o grau de comprometimento motor, velocidade de marcha, nível de atividade física e qualidade de vida. A preferência de exercícios foi avaliada pelo Questionário de Preferência de Exercícios(AVC)-Brasil. Foram entrevistados 24 indivíduos (59±15 anos) que reportaram preferência por exercícios realizados em ambientes controlados e ofertados em grupo. Os exercícios favoritos foram a caminhada e o treino de força muscular. Não houve correlação entre a preferência de exercícios e as variáveis investigadas. Identificar a preferência de exercícios desta população pode contribuir para uma melhor assistência à saúde fornecida pelos serviços públicos, além de aumentar a adesão desses indivíduos aos programas de promoção à saúde e funcionalidade.

Introduction Stroke is a leading health problem worldwide and an important cause of disability. Stroke survivors show low levels of physical activity, and increases in physical activity levels may improve function and health status. Therefore, the aims are to identify which interventions that have been employed to increase physical activity levels with stroke survivors, to verify their efficacy and to identify the gaps in the literature. Methods and analysis A systematic review of randomised controlled trials that investigated the efficacy of interventions aiming at increasing physical activity levels of stroke survivors will be conducted. Electronic searches will be performed in the MEDLINE, Physiotherapy Evidence Database (PEDro), Excerpta Medica (EMBASE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SCIELO) databases. Hand searches of the reference lists of the included studies or relevant reviews will also be employed. Two independent reviewers will screen all the retrieved titles, abstracts and full texts. A third reviewer will be referred to solve any disagreements. The quality of the included studies will be assessed by the PEDro Rating Scale. This systematic review will also include a qualitative synthesis. Meta-analyses will be performed, if the studies are sufficiently homogeneous. This review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The quality of the evidence regarding physical activity will be assessed, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Discussion This systematic review will provide information on which interventions are effective for increasing physical activity levels of stroke survivors. This evidence may be important for clinical decision-making and will allow the identification of gaps in the literature that may be useful for the definition of future research goals and the planning of new trials. Trial registration number CRD42016037750.

BACKGROUND Individuals with stroke have low physical activity levels and spend high amount of time in low-energy expenditure activities. OBJECTIVE To investigate the effects of aerobic treadmill training on physical activity levels and time spent in low-energy expenditure activities (primary outcomes), as well as on cardiorespiratory fitness, endurance, depression, mobility, quality of life and participation (secondary outcomes) after stroke. METHODS A randomized controlled trial, with 22 adults with chronic stroke was performed. Experimental group: aerobic treadmill training at 60-80% of heart rate reserve. CONTROL GROUP outdoor-overground walking below 40% of heart rate reserve. Both groups: three 40 min sessions/week over 12 weeks. Outcomes were measured at baseline, post-training, and 16-week follow-up. RESULTS No changes in the primary outcomes were found for any of the groups. The experimental group showed greater improvements in quality of life at 16-week follow-up (13 points;95% CI:3.5-23). Both groups improved depression (2.2 points;95% CI:0.01-4.3), endurance (Six-minute walk test:31 m;95% CI:5.6-57, Incremental shuttle-walk test:55 m;95% CI:3.8-107), and mobility (0.12 m/s;95% CI:0.02-0.2). CONCLUSION Aerobic treadmill training improved quality of life. Aerobic treadmill training or outdoor-overground walking improved depression, endurance and mobility. Further studies are needed to clarify the effects of aerobic training on physical activity levels and time spent in low-energy expenditure activities after stroke.

BACKGROUND Impaired mobility is related to low physical activity (PA) levels observed after stroke. Therapeutic approaches, such as task-specific circuit training (TSCT), used to improve mobility in individuals with stroke, could also improve PA levels. OBJECTIVE To investigate the efficacy of TSCT, focused on both upper (UL) and lower (LL) limbs, in improving PA levels and mobility (primary outcomes), as well as muscle strength, exercise capacity, and quality of life (secondary outcomes) in subjects with stroke. METHODS A randomized controlled trial with 36 subjects with chronic stroke was conducted. Experimental group: TSCT, involving both UL and LL. CONTROL GROUP global stretching, memory exercises, and education sessions. Both groups received 60 minute sessions/week over 12 weeks. Outcomes were measured at baseline, post-intervention and 16 week follow-up. RESULTS No changes were found for primary and secondary outcomes (0.11≤p≤0.99), except for quality of life, which improved in the experimental group post-intervention and 16 week follow-up (p = 0.02). CONCLUSION TSCT focused on both UL and LL was not effective on PA levels and mobility of individuals with chronic stroke, however, improvements in quality of life were observed. Since this is the first study to investigate this combined training aimed at improving PA levels, future studies are necessary to better understand the impact of this type of intervention.

Objectives: This study had three aims: (1) to evaluate the relationships between the paretic knee extensor muscle strength and global lower-limb strength in individuals who had suffered a sub-acute/chronic stroke, (2) to determine whether global lower-limb strength, sex, body mass index, or age could predict knee extensor muscle strength, and 3) to investigate whether the results obtained via a Modified Sphygmomanometer Test (MST) would be similar to those obtained using a hand-held dynamometer. Methods: This was a cross-sectional study, performed at a research laboratory, at participants' homes, or at outpatient clinics. Forty-two individuals with a sub-acute stroke and 45 individuals with a chronic stroke participated. Maximum isometric strength of the paretic lower-limb muscles (i.e. hip, knee, and ankle flexors/extensors, hip abductors) was measured using the MST and a hand-held dynamometer. Results: Significant and high correlation coefficients were found between knee extensor muscle strength and global lower-limb strength as measured by the combined strength values of 6 lower limb muscle groups in individuals with sub-acute (0.81 <= r <= 0.88; p < 0.05) and chronic (0.82 <= r <= 0.85; p < 0.05) stroke. Step-wise multiple regression analysis revealed that only global lower-limb strength was retained in the model and accounted for 66-78% and 67-72% (p < 0.001) of the variance in knee extensor muscle strength at the sub-acute and chronic phases post-stroke, respectively. The results obtained via the MST were similar to those obtained using the hand-held dynamometer. Conclusion: Paretic knee extensor muscles strength, assessed using a MST or a hand-held dynamometer, indicates global lower-limb strength in individuals with a sub-acute or chronic stroke. (C) 2018 Associacao Brasileira de Pesquisa e Pos-Graduacao em Fisioterapia. Published by Elsevier Editora Ltda. All rights reserved.

BackgroundThe mean of 3 trials is commonly employed to report measures of muscle strength after a stroke. However, consistent and reliable results have been found for single trial dynamometric measures of grip, pinch, and trunk strength in individuals with stroke. Nevertheless, no studies were found that investigated whether only a single trial could be used for the assessment of the strength of both the upper and lower limb muscles.ObjectiveTo determine the best scoring method (one vs the means of 2 or 3 trials) to measure the strength of the upper and lower limb muscles in individuals with sub‐acute and chronic stroke.DesignCross‐sectional observational study.SettingResearch laboratory, participants' homes, and community‐based settings.ParticipantsFifty‐five individuals at the sub‐acute (mean age: 61 ± 13 years; 3.7 ± 0.7 months poststroke) and 59 at the chronic poststroke phases (mean age: 57 ± 130 years; 90 ± 71 months poststroke).Main Outcome MeasurementsBilateral maximum isometric strength measures of the shoulder, elbow, and wrist flexors/extensors; shoulder abductors; hip, knee, and ankle flexors/extensors; and hip abductors were obtained with a hand‐held dynamometer.MethodsAfter familiarization, 3 trials of maximal isometric strength were obtained for all evaluated muscle groups. One‐way analysis of variance was used to compare the results obtained with the first vs the means of 2 and 3 trials for all the assessed muscle groups.ResultsThe values provided by the different scoring methods were similar for all evaluated muscle groups in individuals with sub‐acute (.68 ≤ P ≤ .99) and chronic (.69 ≤ P ≤ .99) stroke.ConclusionsA single trial, after familiarization, may be used for measuring the strength of the upper and lower limb muscles with hand‐held dynamometers in individuals with sub‐acute and chronic stroke. This increases the clinical applicability of hand‐held dynamometers for strength measurement, as it reduces the assessment burden placed on the participants and therapists.Level of EvidenceIII

Post-stroke physical inactivity is explained by several factors related to the stroke, which have been suggested as the causes and consequences of functional declines and health problems. Therefore, it is important to increase physical activity levels and reduce the time spent in low-energy expenditure activities after a stroke. Since the maintenance of cardiorespiratory fitness is a significant predictor of physical activity levels post-stroke, it may be important to investigate whether aerobic training is effective in increasing physical activity levels and reducing the time spent in low-energy expenditure activities in this population. The efficacy of aerobic training on these variables is not well known. The primary objective of this trial will be to investigate the effects of aerobic treadmill training on physical activity levels and on time spent in low-energy expenditure activities in people with stroke. The secondary aim will be to evaluate the effects of the training on cardiorespiratory fitness, endurance, depression, mobility, quality of life, and participation.