Jefferson Rosa Cardoso

Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: Systematic review and meta-analysis

Objective: To perform a systematic review with meta-analyses that evaluates the effectiveness of the Pilates method on the pain and functionality outcome in adults with non-specific chronic low back pain. Data sources: The search was performed in the following databases: Medline, Embase, AMED, Cinahl, Lilacs, Scielo, SportDiscus, ProQuest, Web of Science, PEDro, Academic Search Premier and the Cochrane Central Register of Controlled Trials from 1950 to 2011; the following keywords were used: ‘Pilates’, ‘Pilates-based’, ‘back exercises’, ‘exercise therapy’, ‘low back pain’, ‘back pain’ and ‘backache.’ Review methods: The inclusion criteria were studies that assessed the effects of the Pilates method on patients with chronic low back pain. Results: Five studies met the inclusion criteria. The total number of patients was 71 in the Pilates group and 68 in the control group. Pilates exercise did not improve functionality (standardized mean difference (SMD = –1.34; 95% confidence interval (CI) −2.80, 0.11; P = 0.07) or pain between Pilates and control groups (SMD = –1.99; 95% CI −4.35, 0.37; P = 0.10). Pilates and lumbar stabilization exercises presented no significant difference in functionality (mean difference (MD) = –0.31; 95% CI −1.02, 0.40; P = 0.39) or pain (MD = –0.31; 95% CI −1.02, 0.40; P = 0.39). Conclusion: The Pilates method did not improve functionality and pain in patients who have low back pain when compared with control and lumbar stabilization exercise groups.

Association between soy and green tea (Camellia sinensis) diminishes hypercholesterolemia and increases total plasma antioxidant potential in dyslipidemic subjects

OBJECTIVE To evaluate the hypolipemic and antioxidant effects of soy and green tea alone and/or in association in dyslipidemic subjects. METHODS One hundred dyslipidemic individuals were allocated into four groups. The soy group ingested 50 g of soy (kinako) daily, and the green tea group ingested 3 g of green tea in 500 mL of water per day. A third group ingested 50 g of soy and 3 g of green tea daily, and the control group had a hypocholesterolemic diet. Evaluations were performed at baseline and after 45 and 90 d. Plasma levels of total cholesterol, high-density lipoprotein, and triacylglycerols were evaluated by automated methods. Low-density lipoprotein (LDL) cholesterol was calculated using the Friedewald equation. LDL was isolated by ultracentrifugation. Total plasma antioxidant capacity and plasma levels of total lipid hydroperoxides and those linked to LDL were evaluated by chemiluminescence. The results were expressed as median values and their 25th to 75th percentiles, with a 5% level of significance. RESULTS No significant difference occurred in LDL, high-density lipoprotein cholesterol, and triacylglycerol levels across groups. However, a statistically significant difference in total cholesterol occurred within the soy/green tea group 45 and 90 d after intervention. No statistically significant difference occurred in plasma levels of lipid hydroperoxides or those linked to LDL in any of the groups studied. All the groups that used soy and/or green tea presented increased total plasma antioxidant potential. CONCLUSION Soy and green tea, alone or in combination, increased the total antioxidant potential of hypercholesterolemic patients, whereas only the combination decreased total cholesterol levels.

Facial exercise therapy for facial palsy: systematic review and meta-analysis

The effectiveness of facial exercises therapy for facial palsy has been debated in systematic reviews but its effects are still not totally explained. Objective: To perform a systematic review with meta-analysis to evaluate the effects of facial exercise therapy for facial palsy. Data sources: A search was performed in the following databases: Cochrane Controlled Trials Register Library, Cochrane Disease Group Trials Register, MEDLINE, EMBASE, LILACS, PEDro, Scielo and DARE from 1966 to 2010; the following keywords were used: ‘idiopathic facial palsy’, ‘facial paralysis’, ‘Bell’s palsy’, ‘physical therapy’, ‘exercise movement techniques’, ‘facial exercises’, ‘mime therapy’ ‘facial expression’, ‘massage’ and ‘randomized controlled trials’. Review methods: The inclusion criteria were studies with facial exercises, associated or not with mirror biofeedback, to treat facial palsy. Results: One hundred and thirty-two studies were found but only six met the inclusion criteria. All the studies were evaluated by two independent reviewers, following the recommendations of Cochrane Collaboration Handbook for assessment of risk of bias (kappa coefficient = 0.8). Only one study presented sufficient data to perform the meta-analysis, and significant improvements in functionality was found for the experimental group (standardized mean difference (SMD) = 13.90; 95% confidence interval (CI) 4.31, 23.49; P = 0.005). Conclusion: Facial exercise therapy is effective for facial palsy for the outcome functionality.

Prevalência de respiradores bucais em crianças de idade escolar

The objective of this article is to identify the prevalence of mouth breathing in children from an elementary school. 496 questionnaires were answered by 1st and 4th grade childrens parents or sponsors in order to identify mouth-breathing. There were questions about habits, sleeping, behavior, eating, personal care and breathing. Mann-Whitney and the Chi-square tests were used to compare the variables between mouth-breathing and nose-breathing among the groups. To measure the exposure effect of the explanatory variables on mouth breathing, the test of logistic regression was used and its magnitude was calculated through Odds Ratio. The statistical significance was set at 5%, and the rate of returned questionnaires was 84.5%. The prevalence of the mouthbreathing over this population was 56.8%. The average age was 7 years old (6-9). There was no significant statistical difference between genders, considering 49.1% male and 50.9% female. The final model of logistic regression identified the variables dribble, sleeps well (negative association) and snores as factors that predict the occurrence of the mouth-breathing. The prevalence of mouthbreathing was similar to related in the literature. The variables dribble, sleeps well (negative association) and snores may be factors that predict the occurrence of mouth-breathing.Pretende-se identificar a prevalencia de respiradores bucais em criancas de uma escola do ensino fundamental. Foram aplicados 496 questionarios aos pais ou responsaveis das criancas de 1a a 4a serie de uma escola fundamental, para identificar respiradores bucais. O questionario incluia questoes sobre habitos, sono, comportamento, alimentacao, cuidados pessoais e respiracao. Para comparar as variaveis entre respiradores bucais e nasais, foi utilizado o teste de Mann-Whitney e qui-quadrado. Para medir o efeito da exposicao das variaveis explicativas sobre o desfecho primario, foi utilizada regressao logistica e sua magnitude foi calculada por meio do odds ratio. A significância estatistica foi estipulada em 5%. A taxa de devolucao dos questionarios foi de 84,5%. A prevalencia de respiracao bucal nessa populacao foi 56,8%. A mediana de idade foi sete anos (6-9). Nao houve diferenca estatisticamente significante entre os generos, 49,1% masculino e 50,9% feminino. O modelo final de regressao logistica identificou as variaveis baba, dorme bem (associacao negativa) e ronca como fatores que predizem a ocorrencia da respiracao bucal. A prevalencia de respiradores bucais foi semelhante a encontrada na literatura pesquisada. As variaveis babar, roncar e dormir bem (associacao negativa) podem predizer a ocorrencia da respiracao bucal.

Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery

OBJECTIVE To evaluate the occurrence and risk of pulmonary complications in children who underwent pre-and postoperative physiotherapeutic intervention in cardiac surgeries, as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention. METHODS A randomized controlled trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery. Patients were randomly assigned to the intervention group (G1) in which they underwent pre- and postoperative physiotherapy or to the control group (G2) in which they underwent only postoperative physiotherapy. Mann-Whitney and the Chi-square tests were used to compare the variables between the groups. The magnitude of the absolute risk was calculated by the number of patients needed to treat. Statistical significance was set at 5% (P<0.05). RESULTS 17 patients (25%) in G1, and 29 patients (43.3%) in G2 presented pulmonary complications (P= 0.025), pneumonia was the most frequent complication, and among the 17 patients in G1, seven (10.3%) developed pneumonia, six (8.8%) developed atelectasis, and four (5.9%) presented complications due to both complications. In G2, 13 patients (19.4%) developed pneumonia, eight (11.9%) developed atelectasis, and eight (11.9%) developed pneumonia associated with atelectasis. Absolute risk reduction for the primary outcome was of 18.3% and the number of needed to treat was 5.5. CONCLUSION Preoperative respiratory physiotherapy significantly reduced the risk of pulmonary complications in postoperative pediatric cardiac surgery.

Association between regular participation in sports and leisure time behaviors in Brazilian adolescents: A cross-sectional study

BackgroundThe belief that adolescents engaged in sports increase their overall physical activity level while simultaneously decreasing physical inactivity has been the foundation of many intervention programs in developing countries. The aim of this study was to analyze the association between regular participation in sports and both active behaviors and TV viewing during leisure time.MethodsA total of 1752 Brazilian adolescents (812 = male and 940 = female) participated in this study. Regular participation in sports, as well as active behaviors (exemplified by walking or cycling) and TV viewing during leisure time were assessed by means of a questionnaire. The chi-square test analyzed the association between sports practice and leisure time behaviors, and the Poisson regression with robust variance indicated the magnitude of these associations.ResultsThe prevalence of regular participation in sports was 14.8% (95% confidence interval 13.2% to 16.5%). After adjustment for all confounders, participation in sports was associated with, at the highest frequency, cycling (PR = 2.55 [1.80–3.60]) and walking (PR = 2.69 [1.98–3.64]) during leisure time. However, there was not an association between the participation in sports and frequency of TV viewing (PR = 1.28 [0.81–2.02]).ConclusionThis study presented data indicating that the regular participation in sports is positively associated with a higher frequency of physically active behaviors during leisure time. However, the results did not support the hypothesis that the engagement in sports necessarily decreases leisure time spent in TV viewing.

Influence of knee position on the postural stability index registered by the Biodex Stability System

The importance of knee position for bodily stability is described by some authors, however Biodex Stability System (BSS) trials have not been used to assess the reliability and effects of different knee positions. The purposes of this study were to test the reliability of BSS indices using two knee positions in the measurement protocol (either permitting slight knee flexion or maintaining them locked in total extension) and to compare the BSS indices between these two knee positions. The measurements were taken of the Overall Stability Index (OSI), Anterior-Posterior Stability Index (APSI) and Medial-Lateral Stability Index (MLSI) during a 30s protocol which gradually and automatically increased in difficulty among 21 healthy female subjects (22.8+/-1.0 years old). The subjects performed four trials which, without visual feedback, permitted knee flexion as well as four trials which did not, in a randomized order. The first two trials in each set were used for familiarization only. Permitting slight flexion yielded better reliability results (OSI Intra-class Correlation Coefficient [ICC]=0.93, APSI ICC=0.90, MLSI ICC=0.89) than maintaining the knee in total extension (OSI ICC=0.88, APSI ICC=0.87, MLSI ICC=0.79), with good agreement in the Bland and Altman test. Moreover, permitted knee flexion in BSS presented better balance stability values for OSI (P=0.001) and APSI (P=0.024), however the MLSI did not present significant difference between positions (P=0.345).

The peroneus reaction time during sudden inversion test: systematic review.

The purpose of the study was to determine whether peroneal reaction time is influenced by ankles impairment in subjects with ankle injury assessed by surface electromyography. The studies were identified by electronic research by two independent reviewers at the following databases: MEDLINE (1966-2009), EMBASE (1980-2009), LILACS (1982-2009), CINAHL (1982-2009) and, SPORTDiscus (1975-2009). Studies were divided into following groups: I--subjects with injury (paired by the opposite limb); II--subjects with or without injury (paired by limbs from different subjects) and III--subjects with or without injury (other situations). Studies that used the sudden ankle inversion test were selected. As result, 25 articles were included. The comparison of the reaction time paired by the opposite limb, showed a statistically significant difference in favor of the injured ankles (standardized mean difference--SMD=0.40; IC 95% [0.01;0.79], P=0.05). The comparison paired by limbs from different subjects presented a statistically significant difference, in favor of the injured ankles (SMD=3.49; IC 95% [1.26;5.71], P=0.002). The effect size measured was 0.54 and 1.61, respectively. The greater reaction time delay showed in the subjects with ankle injury compared to that of asymptomatic subjects should be taken into consideration.

Aquatic exercise & balneotherapy in musculoskeletal conditions.

This is a best-evidence synthesis providing an evidence-based summary on the effectiveness of aquatic exercises and balneotherapy in the treatment of musculoskeletal conditions. The most prevalent musculoskeletal conditions addressed in this review include: low back pain, osteoarthritis, fibromyalgia and rheumatoid arthritis. Over 30 years of research demonstrates that exercises in general, and specifically aquatic exercises, are beneficial for reducing pain and disability in many musculoskeletal conditions demonstrating small to moderate effect sizes ranging between 0.19 and 0.32. Balneotherapy might be beneficial, but the evidence is yet insufficient to make a definitive statement about its use. High-quality trials are needed on balneotherapy and aquatic exercises research especially in specific patient categories that might benefit most.

Influence of the gastrocnemius muscle on the sit-and-reach test assessed by angular kinematic analysis

BACKGROUND The sit-and-reach test (SRT) used to measure low back and hamstring flexibility is more adequate when combined with hip joint angle (HJA) measurement. It is supposed that shortening of the gastrocnemius muscle could affect the SRT results. OBJECTIVES The purposes of the study were to investigate the relationship between the HJA and SRT and to verify the influence of the gastrocnemius. METHODS This is a cross-sectional study on healthy subjects. Two hundred subjects took part in the study: 100 males and 100 females aged 21.2 years (SD=1.7). The materials used were a sit-and-reach box with an adapted door to evaluate the influence of the gastrocnemius and a digital camera. Skin markers were positioned on the anterior superior iliac spine and greater trochanter. Two pictures were taken in the final position of the test, one with the door closed (with ankle dorsiflexed - DF) and the other with the door opened (with ankle plantarflexed - PF). RESULTS Moderate correlation was found between the HJA and SRT for DF and PF (r=0.48 e 0.44). The HJA with DF and PF were 95.5 masculine+/-18.6 masculine and 99.7 masculine+/-18 masculine (P<0.001), respectively. CONCLUSIONS Angular kinematic analysis is a reliable technique to measure the HJA. The results demonstrated the influence of the gastrocnemius; thus we suggest that the SRT be performed with free ankle joint mobility.