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.
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)
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
Sequential
Exercise
Other interventionThe 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.
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
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).
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).
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.
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.
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