Effects Of A Rehabilitation Protocol On Muscle Strength, Muscle Fatigue And Postural Control In Post-Dengue And Chikungunya Patients

Effects Of A Rehabilitation Protocol On Muscle Strength, Muscle Fatigue And Postural Control In Post-Dengue And Chikungunya Patients: Non-Randomized Clinical Trial

Introduction: Dengue and Chikungunya arboviral diseases are considered major public health challenges in tropical regions due to high infection rates and the occurrence of musculoskeletal sequelae that impair strength, balance, and functionality. After the acute phase, symptoms such as fatigue, joint pain, muscle weakness, and postural instability are common, reducing quality of life and hindering social and occupational reintegration.Objective: To analyze the effects of a rehabilitation protocol on muscle fatigue, muscle strength, and postural control in post-Dengue and Chikungunya patients.Methods: This is a non-randomized clinical trial conducted at the Integrated Laboratory for Research and Care in Infectious and Sequelae Diseases (LabDIS/UEPA). Individuals of both sexes, aged over 18 years, with a confirmed diagnosis of Dengue and/or Chikungunya within the last five years will be included. Data collection will include a clinical interview, surface electromyography of the flexor carpi radialis, tibialis anterior, lateral and medial gastrocnemius muscles, hydraulic and electronic dynamometry, manovacuometry, and baropodometry. The rehabilitation protocol will consist of twenty supervised sessions of aerobic, anaerobic, and respiratory exercises.Expected Results: Improvements in muscle strength, muscle fatigue, and postural control are expected following the intervention.Conclusion: The findings may support physiotherapeutic strategies aimed at improving strength, fatigue, and balance, expanding knowledge on the neuromuscular and respiratory consequences of arboviral diseases, and contributing to the development of evidence-based rehabilitation protocols, with potential positive impacts on healthcare delivery and public health policies.

Study Overview

• Status: Not yet recruiting
• Conditions: Dengue; Chikungunya
• Intervention / Treatment: Other: Exercise

• Study Type: Interventional
• Enrollment (Estimated): 54
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Maria Cláudia V Almeida, Principal Investigator; Phone Number: +55 (91) 99102-9191; Email: maria.cv.almeid@aluno.uepa.br

Study Locations

• Brazil
  • Pará
    • Belém, Pará, Brazil, 66.087-670
      • Universidade Do Estado Do Pará
      • Contact: Márcio C de souza santos, Coordinator; Phone Number: +55 (91) 98134-9895; Email: marcio.clementino@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged 18 years or older
• Individuals of both sexes
• Residents of the 1st, 4th, or 11th Health Regions of the state of Pará
• Confirmed diagnosis of Dengue (DENV) and/or Chikungunya (CHIKV) infection by serological testing (ELISA or IgG/IgM)
• Diagnosis confirmed within the last 5 years
• Ability to provide written informed consent

Exclusion Criteria:

• Hemodynamic instability
• Musculoskeletal instability, including fractures or acute muscle injuries
• Cognitive deficits impairing the understanding of commands or study procedures
• History of balance disorders prior to Dengue or Chikungunya infection
• Obesity
• Blindness or low vision
• Hearing impairment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Intervention Group; Post-Dengue And Chikungunya Patients

Other: Exercise; The rehabilitation protocol will include 20 sessions, twice weekly. Anaerobic training will involve vertical chest press, lat pulldown, leg extension, and 180° leg press, with a prior 1RM test. Sessions 1-5 and 11-15: 3 sets of 12 reps at 55% 1RM; sessions 6-10 and 16-20: 3 sets of 15 reps at 55% 1RM. Aerobic training will be performed on a treadmill or cycle ergometer, progressing from 41-50% HRR (sessions 1-5), 51-60% (6-10), 61-70% (11-15), and 71-80% (16-20). Respiratory training will use the PowerBreathe® device: sessions 1-10 at 30% MIP with 10 repetitions, and sessions 11-20 at 40% MIP with 10 repetitions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Muscle fatigue assessed by surface electromyography	Surface electromyography (EMG) will be used to evaluate muscle activity and fatigue of the flexor carpi radialis, tibialis anterior, medial gastrocnemius, and lateral gastrocnemius muscles using the New Miotool Wireless® system. Muscle fatigue will be analyzed through Mean Frequency (MNF) slope during sustained isometric contraction	Baseline and immediately after completion of the intervention protocol

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Handgrip strength assessed by hydraulic dynamometry	Handgrip strength will be measured using a calibrated Crown® hydraulic hand dynamometer following the American Society of Hand Therapists (ASHT) recommendations. Maximal isometric grip strength will be recorded in kilogram-force (kgf).	Baseline and immediately after completion of the intervention protocol
Peripheral muscle strength assessed by electronic dynamometry	Maximum isometric muscle strength of wrist flexors/extensors and ankle dorsiflexors/plantar flexors will be assessed using the MedEOR Medtech® digital dynamometer. Strength values will be recorded in kilogram-force (kgf).	Baseline and immediately after completion of the intervention protocol
Postural control assessed by baropodometry	Postural control and plantar pressure distribution will be evaluated using the Footwork Pro AM³ pressure platform. Stabilometric variables will include center of pressure displacement, oscillation area, and postural sway under eyes-open and eyes-closed conditions.	Baseline and immediately after completion of the intervention protocol
Respiratory muscle strength assessed by manovacuometry	Respiratory muscle strength will be assessed using a digital manovacuometer (MVD300-U). Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) will be measured in cmH₂O.	Baseline and immediately after completion of the intervention protocol

Collaborators and Investigators

• Sponsor: Universidade do Estado do Pará

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): July 30, 2027

Study Registration Dates

• First Submitted: May 7, 2026
• First Submitted That Met QC Criteria: May 14, 2026
• First Posted (Actual): May 22, 2026

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 20, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Rehabilitation; Posture; Electromyography; Muscle Strength; Muscle Fatigue; Chikungunya Virus; dengue
• Additional Relevant MeSH Terms: Vector Borne Diseases; Mosquito-Borne Diseases; Infections; RNA Virus Infections; Virus Diseases; Arbovirus Infections; Flavivirus Infections; Flaviviridae Infections; Hemorrhagic Fevers, Viral; Alphavirus Infections; Togaviridae Infections; Dengue; Chikungunya Fever; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Exercise
• Other Study ID Numbers: 7.646.502

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: For statistical analysis purposes, the data may be shared with the study advisor.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No