The program comprises the practice of resistance exercises for the main muscular groups, with free weights and with their own body weight against the action of gravity, the proposal consists of 3 weekly sessions, for 8 consecutive weeks.

Acromegaly

Muscle Dysfunction

Physical Activity

Exercise

Activities included overall stretching and strengthening (flexion, extension, adduction and abduction movements) and muscular endurance exercises (exercises involving open and closed kinetic chains), along with aerobic conditioning using a functional circuit.

Physical activity

Centro universitário augusto motta

Rehabilitation Program in Patients With Acromegaly

Impact of a Physical Rehabilitation Program on the Quality of Life of Patients With Acromegaly: a Non-randomized Clinical Trial.

Peripheral muscle strength and fatigue strength will be evaluated using an EMG -810 surface electromyograph and a DIN_TRO traction dynamometer. For the strength test, the muscle evaluated will be the femoral quadriceps, the patient will be instructed to perform the knee extension, with the highest possible isometric force. Your positioning will be seated with your hands crossed over the chest, with the upright trunk adjusted by the backrest in order to allow the angle of 90 ° for hip flexion. For analysis of fatigue strength, surface electromyography of the medial vastus muscle (VM) of the dominant lower limb will be used through the 8-channel surface electromyograph from the gross signal. The endurance test consists of a contraction sustained for 60 seconds using 50% of the highest MIVM obtained in the strength test.

For the execution of the TC6M, the patient will be previously oriented to use sneakers and comfortable clothing. Later it will be positioned in a corridor of 30 meters, demarcated every 3 meters and oriented to walk as fast as possible, but without running, for a total period of 6 minutes. Peripheral saturation of O2 (SpO2), heart rate (HR), modified Borg scale, blood pressure (BP) during the test will be checked. There will be two tests with a 30 minute interval between them. The distance selected will be the patient's best performance. This is based on reducing the learning effect. Subsequently, the data found will be associated with the forecast of Britto et al. (2013) according to age, height and body weight of each individual.

The Acromegaly Quality of Life Questionnaire (AcroQol) is a specific, simple and valid instrument for assessing quality of life in people suffering from acromegaly aged 18-70 years. It can be used in two different fields: in clinical trials of new drugs as well as in the follow-up of patients in clinical practice. This is particularly useful in evaluating the effects of intervention or treatment. The questionnaire is one-dimensional and contains 22 items divided into two scales: one that evaluates physical aspects (eight items) and another that evaluates the psychological aspects (14 items). The latter is also divided into two sub-scales: one evaluates physical appearance and another evaluates the impact of the disease on the patient's personal relationships (seven items each). The score is given from 1 to 5 where, the lower the score, the worse the quality of life.

The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale was developed for individuals with chronic diseases to evaluate health-related quality of life, treating fatigue as a multidimensional concept. This scale has been applied in different groups of patients with different types of dysfunctions. FACIT-F is a specific scale of evaluation of fatigue that has good representation of the individual's frame, considered as an instrument of easy application, and its use authorized by the author of the same. It will be answered by the researcher himself, with 13 questions ranging from 0 to 4, where the higher the score, the less fatigue. Your score goes from 0 to 52.

The Lower Extremity Functional Scale (LEFS) is a self-administered questionnaire for orthopedic assessment of lower limb integrity. It was developed according to the concepts of functionality and disability of the World Health Organization (WHO). This scale comprises 20 questions and each has a score that varies between the minimum of zero (extremely difficult) and the maximum of four points (without difficulty). The sum of all items can generate a maximum total of 80 points. Such a level of punctuation suggests a normal functional state, that is, the higher the value obtained, the higher the level of functionality of the individual. The LEFS scale is easy to apply and can be used at different levels of functionality and disability related to the lower limbs. It is usually used in initial evaluations, during treatment and thereafter, in order to establish new therapeutic goals for patients.

Body weight and height of patients will be measured using a Filizola® mechanical scale with a maximum capacity of 150 kilograms and a sensitivity of 100 grams and a stadiometer. Body mass index (BMI) will be calculated by dividing body mass by height squared.

Evaluates the perception of the degree of effort, performed during the exercise. Currently, it is used in the modified form described with a score varying with scores between 0 where the level of perception of dyspnea (fatigue) or muscle fatigue is "none" until 10 where the level of perception of dyspnea (fatigue) or muscle fatigue is " maximum".

Data available in scientific environment.

Centro Universitário Augusto Motta

Rio de Janeiro State Research Supporting Foundation (FAPERJ)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.

After a physical therapy evaluation, the patient underwent a booklet-guided physical exercise program that lasted two months (3 times per week with a duration of 60 minutes per session). Activities included overall stretching and strengthening (flexion, extension, adduction and abduction movements) and muscular endurance exercises (exercises involving open and closed kinetic chains), along with aerobic conditioning using a functional circuit. The patient was evaluated at 3 different timepoints (baseline, after 8 weeks of training, and after a 4-week washout period with no treatment); thus, he served as his own control. The physiotherapist contacted the patient by phone weekly to follow the progression of the treatment. Throughout the application of the protocol, the patient regularly maintained his follow-up visits with the multidisciplinary team. Moreover, there was no change in pharmacological treatment throughout this period.

Patients who have suffered a moderate to severe traumatic brain injury, with confirmed intracranial damage.

Biological data will include standard blood test screening during hospitalization and 6 months follow-up, including tests to rule out other causes of fatigue: kidney, liver, thyroidal and pituitary status, haemoglobin, cortisol, B-12, D-vitamins and C-reactive protein (CRP).

Traumatic Brain Injury

Fatigue

Sunnaas Rehabilitation Hospital

Oslo University Hospital

Fatigue Following Moderate and Severe TBI

Development of Persistent Fatigue Following Moderate and Severe Traumatic Brain Injury - Exploration of General and Injury-specific Mechanisms.

A validated self-report questionnaire with norms available for the general Norwegian population, measuring primarily subjectively experienced functional consequences of fatigue. The scale provides a total average score of the nine Likert items ranging between 1-7, where 1 indicates little to no experienced functional limitations due to fatigue, and 7 indicates severe experienced functional limitations due to fatigue. The norms provide t-scores corrected for age, education and gender.

A validated self-report questionnaire with norms available for the general Norwegian population, with subscales for both mental and physical fatigue. The scale provides sum scores of mental (4 items), physical (7 items) and total fatigue, with individual items administered ranging between 0-3. High sum scores indicate higher degree of subjective fatigue. Norms provide t-scores corrected for gender and age on both subscales and the total score. In addition to the 11 items used to compute the subscale scores and the total score, two additional items address the longevity and extent of the subjective fatigue on a range between 0-3, where higher scores indicate longer duration of and more severe extent of the subjective fatigue problems.

Subscale of the questionnaire measuring subjectively experienced fatigue, which provides an average score using six symptom items and reported symptom distress on a scale between 0-4 for both "in general" and "in the last two days".

Self-reported subjective somatic symptom complaints. The questionnaire consists of 25 symptoms, and respondents are asked to rate the presence of each symptom on a scale of 0-4 "in general" and "in the last two days", thus providing a total of 50 responses. The responses provide average scores for the subscales of fatigue, gastrointestinal symptoms, musculoskeletal symptoms, cardio-vascular symptoms and a total average of subjective symptom distress.

Self-reported sleep disturbances. The questionnaire consists of seven items rated on a scale of 0-4, where a higher sum score indicates more severe sleep disturbances.

Self-reported sleepiness. The questionnaire consists of eight items rated on scale of 0-3, where a higher sum score indicates higher severity of problems relating to sleepiness.

Self-report questionnaire assessing behavioral inhibition and activation traits. The questionnaire provides separate sum scales for Behavioral Activation (13 items) and its subscales Reward Responsiveness (5 items), Fun Seeking (4 items) and Drive (4 items), and a total sum score for Behavioral Inhibition (7 items). Each item is rated by the respondent on a scale between 1-4.

Subjective reporting of pain-afflicted regions of the body, used to assess extent of pain.

Four NRS items ranging 0-10 questioning namely the strongest and weakest pain intensity within the two last weeks, pain intensity in general, and pain intensity presently.

Personality assessment questionnaire, providing t-scores for the personality traits Openness, Conscientiousness, Agreeableness, Extroversion and Neuroticism. Respondents answer items ranging between 0-4, and sum scores are converted into scaled t-scores using the official norms corrected for gender.

Questionnaire specifically developed to measure fatigue in patients with acquired brain injury. The questionnaire provides scores for quality of life with regards to cognition (7 items), perception of self (7 items), daily life & autonomy (7 items), social relations (6 items), emotional status (5 items) and physical problems (5 items), as well as a total score (37 items). The average subscale and total scores are recalculated to a scale ranging between 0 and 100, where lesser scores indicate reduced quality of life.

Six selected items from the Optimism subscale to measure optimism as a trait, where individual items are rated on a scale of 0-4, and a higher average score indicates a higher degree of trait optimism.

Three selected items from the questionnaire, where individual items are rated on a scale of 0-4, where a higher average scores indicate a higher degree of loneliness.

Self-reported common somatic, emotional and cognitive symptoms following head injury, rated on a scale of 0-4, where 0 = no problems, 1 = symptom no longer a problem, and the ratings of 2-4 indicating higher degree of symptom burden. Sum scales are calculated for responses in the range 2-4 on the subscales of somatic (9 items), emotional (4 items) and cognitive (3 items) symptoms, as well as a scale for total symptom burden (16 items).

Self-report measure of various resilience factors. The questionnaire consists of 33 items rated on a scale between 1-5, with sum scores provided for the subscales Self Perception (6 items), Future Perception (4 items), Social Competence (6 items), Family Cohesion (6 items), Social Resources (7 items) and Structured Style (4 items), where higher sum scores indicate a higher degree of resilience.

Neuropsychological test of verbal abstraction abilities.

Neuropsychological test of visual abstraction abilities and general intelligence.

Neuropsychological test of verbal comprehension and general intelligence.

Neuropsychological test of auditory attention and working memory.

Neuropsychological test of sustained attention, vigilance and impulsivity

Neuropsychological test of psychomotor speed and divided attention.

Neuropsychological test of psychomotor speed, divided attention and impulse inhibition.

Neuropsychological test of decision making and reward/punishment sensitivity.

Alcohol abuse screening tool consisting of four items where respondents are asked to indicate Yes or No to risk factors for alcohol abuse, with a sum score ranging between 0-4, where a higher score indicates higher risk of abuse. For this research project, additional questions are asked about whether these risk factors were also present premorbid to the injury.

Drug abuse screening tool consisting of four items where respondents are asked to indicate Yes or No to risk factors for drug abuse, with a sum score ranging between 0-4, where a higher score indicates higher risk of abuse. For this research project, additional questions are asked about whether these risk factors were also present premorbid to the injury.

Abbreviated research edition of the standardized inventory, used to assess depression and anxiety symptoms.

Self-reported negative life events last 12 months before injury, the first six months post-injury, and in the period between 6-12 months post-injury. Respondents are asked to indicate the presence or abscence of each of the 12 negative life events in these time periods, which provides a sum score of severe life events.

One NRS item administered in advance of neuropsychological assessment (point 1), and one following assessment (point 2). The NRS items range between 1-10, where lower scores indicate a lower degree of experienced fatigue. Difference scores are computed by subtracting point 1 from point 2, and is used to measure perception of fatigability in the test situation.

Interview for categorizing functional outcome following traumatic brain injury. The interview provides a total score between 1-8, with the following categories: 1 = dead, 2 = Vegetative state, 3 = Severe disability, lower level, 4 = Severe disability, higher level, 5 = Moderate disability, lower level, 6 = Moderate disability, higher level, 7 = Good restitution, lower level, 8 = Good restitution, higher level.

hypopituitarism/vermoeidheid

Rehabilitation Program in Patients With Acromegaly

Fatigue Following Moderate and Severe TBI

Cardiac and Skeletal Muscle Energy Metabolism in Abnormal Growth Hormone States

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