Maryela de Oliveira Menacho

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 (SMDu2009=u2009–1.34; 95% confidence interval (CI) −2.80, 0.11; Pu2009=u20090.07) or pain between Pilates and control groups (SMDu2009=u2009–1.99; 95% CI −4.35, 0.37; Pu2009=u20090.10). Pilates and lumbar stabilization exercises presented no significant difference in functionality (mean difference (MD)u2009=u2009–0.31; 95% CI −1.02, 0.40; Pu2009=u20090.39) or pain (MDu2009=u2009–0.31; 95% CI −1.02, 0.40; Pu2009=u20090.39). 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.

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 coefficientu2009=u20090.8). 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)u2009=u200913.90; 95% confidence interval (CI) 4.31, 23.49; Pu2009=u20090.005). Conclusion: Facial exercise therapy is effective for facial palsy for the outcome functionality.

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.

Electromyographic Effect of Mat Pilates Exercise on the Back Muscle Activity of Healthy Adult Females

OBJECTIVEnThe purpose of this study was to examine back muscle activity during 3 traditional mat Pilates exercises.nnnMETHODSnEleven healthy female volunteers, aged between 18 and 30 years, participated in this cross-sectional study. Surface electromyography (sEMG) of lumbar extensor muscles was recorded simultaneously with kinematics data to identify the phases of movement. Three mat Pilates back exercises were compared: (1) swimming, (2) single leg kick with static prone back extension, and (3) double leg kick. Root mean square values of each muscle were recorded with 2 pairs of surface electrodes placed bilaterally on one lumbar extensor muscle (at L5). During phases of each exercise, sEMG signals were identified by video analysis. Electrical muscle activation was normalized by the maximal voluntary isometric contraction and used to compare back muscle activity among exercises. A 2-way repeated measures analysis of variance was performed to assess the differences in activation level during the exercises.nnnRESULTSnThe value of electrical muscle activity in the lumbar extensors ranged between 15% and 61% of MIVC for the 3 types of Pilates mat work exercise. The swimming exercise increased lumbar extensor activity (29% on average) in comparison to the other 2 Pilates conditions. Interestingly, the double leg kick exercise generated significantly more lumbar extensor activity (26% on average) than the single leg kick.nnnCONCLUSIONSnFor this group of participants, the swimming exercise increased muscle activation relative to the other 2 exercise modes.

Translation, cross-cultural adaptation and analysis of the psychometric properties of the lower extremity functional scale (LEFS): LEFS- BRAZIL

BACKGROUNDnThere is a lack of questionnaires in Brazilian Portuguese to evaluate patient-reported lower limb function.nnnOBJECTIVEnTo translate, cross-culturally adapt to the Brazilian population, and evaluate the psychometric properties of the Lower Extremity Functional Scale (LEFS).nnnMETHODnThe LEFS was translated by two independent assessors and back-translated to English. Then, the LEFS-Brazil was tested on 20 patients who answered the questionnaire in the cross-cultural adaptation phase. For the evaluation of the psychometric properties, 100 patients answered the questionnaire. The reliability was tested by two independent assessors. The Medical Outcomes Study 36-item from Health Survey (SF-36) was used as the criterion method for construct validity. The sensitivity to change was tested for four consecutive weeks.nnnRESULTSnThe internal consistency was α = 0.96. The intra-observer reliability was CCI (intraclass correlation coefficient) = 0.96 and CCI interobserver = 0.98; the Bland and Altman mean difference (d) intra-observer = -1.52 and d interobserver = 0.46. The correlation between the LEFS and SF-36 in the first week was the following: physical function r=0.82, physical role r=0.57, emotional role r=0.43 and mental health r=0.33. The LEFS was responsive when comparing the mean of the first week to the second, third and fourth weeks and comparing the second to the fourth week. The cut-off point was 11, and the area under the receiving operator curve was 0.96 95% CI [0.88;0.99], with sensitivity = 0.96, 1-specificity = 0 and standard error = 0.02.nnnCONCLUSIONnThe LEFS-Brazil is reliable, valid and responsive.

Electromyographic activity of selected trunk muscles in subjects with and without hemiparesis during therapeutic exercise.

The purpose of this study was to evaluate the trunk muscles activity of hemiparetic and control subjects during selected therapeutic exercises with surface electromyography (sEMG). The sEMG evaluation included 12 subjects presenting hemiparesis after having suffered a unilateral stroke and 12 apparently healthy subjects. A 16-channel sEMG system was used; data were band pass filtered from 20 to 450Hz. The signal was normalized through reference voluntary contraction (RVC) and presented in percentage. The exercises used in the evaluations were trunk flexion and trunk extension. Rectus abdominis presented greater activation on the paretic side of the experimental group than on the corresponding side of the control group (P=0.035) (Cohens d¯=0.94). During leg elevation, the non-paretic obliquus externus abdominis showed greater activation than in other exercises (P=0.019) (Cohens d¯=0.75). No inter-group differences were found for either erectus spinae activity or contraction onset. Experimental group subjects showed muscle activity alterations, principally in the rectus abdominis, indicating the occurrence of compensatory strategies.

Comparação da fadiga eletromiográfica dos músculos paraespinhais e da cinemática angular da coluna entre indivíduos com e sem dor lombar

Subjects with low back pain have reduction in strength and endurance of the erector spinae muscles. The assessment of the fatigue and the endurance of these muscles is important, once it has been reported that individuals with low back pain develop a deficit in physical conditioning which influences on trunk strength and function. Moreover, the relationship between back muscles fatigue and trunk forward flexion is still unclear. The aims of this study were to compare fatigue between individuals with and without low back pain and to correlate the muscles fatigue with the angle of trunk forward flexion. The low back pain group consisted of ten low back pain subjects. The control group was composed by ten subjects with similar physical characteristics and without low back pain. Initially, the trunk forward flexion was evaluated with the Whistance angular method. The erector spinae fatigue was assessed at L1 and L5 by surface electromyography on two loads: 50 and 75% of maximal voluntary isometric contraction. The results indicated that the low back pain group presented a lower strength output during maximal voluntary isometric contraction (P < 0.004). Although the low back pain group has presented greater values of fatigue, there is no statistically significant difference between groups at L1 and L5. The correlation between muscles fatigue and trunk forward flexion angle have shown poor to moderate values (between r = -0.58 to 0.51). The results suggest that both groups present fatigue, however the low back pain group presented greater values. Moreover, it is not possible to predict fatigue by analysis of the trunk forward flexion angle.

The Electromyographic Activity of the Multifidus Muscles During the Execution of Two Pilates Exercises—Swan Dive and Breast Stroke—for Healthy People

OBJECTIVEnThe purpose of this study was to compare the multifidus electromyographic activity in healthy women during the performance of the same Pilates exercise under 2 conditions.nnnMETHODSnSixteen healthy, active, female practitioners of Pilates (mean age, 24.3; SD, 3.1 years) were assessed through surface electromyography during 2 Pilates exercises (swan dive and breast stroke). Muscle activity during the experimental tasks was recorded with 1 pair of electrodes placed bilaterally on the multifidi. Data were normalized to maximal activity recorded during dynamic activity.nnnRESULTSnThe mean of the maximal isometric voluntary contraction was 662.4 N (SD, 195). In the phase comparison, the multifidus was the most recruited on the concentric phase during both exercises, ball (P=.001) and reformer (P=.001). In the comparison between conditions, the reformer presented more activation on swan dive (P=.04) and breast stroke (P=.001). The percentages of muscle activation varied between 50% and 60%, and the greatest activation was made on the reformer condition.nnnCONCLUSIONnThe findings of this study show that Pilates exercises by healthy women, under different conditions, can cause changes to the multifidus muscle activation. The condition and the phase in which the muscle was more activated were the reformer and concentric phase, respectively, for both exercises. However, the results for the percentages of activation suggest that the intensity of recruitment may not be sufficient to strengthen muscle in healthy, trained subjects.

Comparison of the electromyographic activity of the anterior trunk during the execution of two Pilates exercises - teaser and longspine - for healthy people

This study compared abdominal electromyographic (EMG) activity during the performance of Pilates exercises. 16 females participated in the study. EMG signals of the rectus abdominis (RA) and external oblique (EO) were recorded during Longspine performed on the mat, Cadillac, and Reformer and the Teaser performed on the mat, Cadillac, and Combo-chair. Values were normalized by the EMG peak of a dynamic task and divided in concentric and eccentric phases. Longspine performed on the mat increased EO activity in the concentric phase more than on the Reformer and the Cadillac (Mean Difference (MD)=12.2%; 95% Confidence Interval (CI) [3.36; 21.04]; p=.04). Differences in the eccentric phase of the RA favored the mat compared to the Reformer (MD=5.20%; 95% CI [-0.55; 10.95]; p=.02). Significant differences in eccentric contraction of the RA were found for teaser exercise performed on the mat versus Cadillac (MD=1.1%; 95% CI [-4.13; 6.33]; p=.04) and the mat versus the Combo-chair (MD=6.3%; 95% CI [1.31; 11.29]; p=.005). Higher concentric activation values for the EO were found when the teaser exercise was performed on the Cadillac. Exercises performed on the mat required greater rectus abdominis activation.

Effects of walking and strength training on walking capacity in individuals with claudication: meta-analysis

CONTEXT: Over the past few years, several clinical trials have been performed to analyze the effects of exercise training on walking ability in patients with intermittent claudication (IC). However, it remains unclear which type of physical exercise provides the maximum benefits in terms of walking ability. OBJECTIVE: To analyze, by means of a meta-analysis, the effects of walking and strength training on the walking capacity in patients with IC. METHODS: Papers analyzing the effects of walking and strength training programs in patients with IC were browsed on the Medline, Lilacs, and Cochrane databases. Randomized clinical trials scoring >4 on the Physiotherapy Evidence Database (PEDro) scale and assessing claudication distance (CD) and total walking distance (TWD) were included in the review. RESULTS: Walking and strength training yielded increases in CD and TWD (P < 0.05). However, walking training yielded greater increases than strength training (P = 0.02). CONCLUSION: Walking and strength training improve walking capacity in patients with IC. However, greater improvements in TWD are obtained with walking training.