Collaborative Online International Learning in Physiology: A Case Study.

Internationalisation in higher education is essential, and although active learning methodologies are increasing and allow students to develop transversal skills, most still have a very local scope. In this context, the Collaborative Online International Learning (COIL) methodology is an interesting approach to benefit the students' development. It consists of an online program that involves creating multicultural teams to develop a specific learning project. Although this methodology is expanding, its use in physiology is still scarce. This paper aims to show an example of applying COIL methodology in physiology topics to enhance higher-education students' innovation and business skills. Our example project developed a sports-assessment service concept focused on physiology and biomechanics assessments. The program involved teams from Brazil, Germany, and Spain, comprising undergraduate and master students. Over seven weeks, these teams, mentored by professors and researchers, engaged in workshops covering COIL methodology, business model design, executive summary planning, economic analyses, and communication techniques. Key outcomes included learning new concepts, developing soft skills, building confidence in innovative solution proposals, and experiencing diverse cultures. Challenges faced were language barriers, scheduling, task complexity, and logistical issues. This experience confirms the effectiveness of incorporating programs using COIL methodology into educational curriculums. Doing so exposes physiology students to innovation, entrepreneurship, and business creation while strengthening their professional connections and opening up post-graduation opportunities.

The 2-Minutes Walking Test Is Not Correlated with Aerobic Fitness Indices but with the 5-Times Sit-to-Stand Test Performance in Apparently Healthy Older Adults.

The 2-minutes walking test (2-MWT) is a valid and reliable test that has a high correlation with the distance walked in the 6-minutes walking test (6-MWT). However, to date, no study has determined the relationship between 2-MWT performance and the aerobic fitness indices obtained during a maximal incremental test to confirm if this test is a valid surrogate of aerobic fitness in apparently healthy older adults. The main objective of this work was to identify the factors associated to the performance in the 2-MWT, including aerobic fitness, functional and spatial-temporal gait parameters. Seventeen elderly adults performed a maximal incremental cycling test to determine maximum oxygen consumption (VO2max) and ventilatory thresholds (VT1 and VT2), two static standing balance tests with open and close eyes, a 5-times sit-to-stand test (5-TSTS), a handgrip test, and a 2-MWT on three different days over 2 weeks. No correlations were found between aerobic fitness indices and the distance covered in 2-MWT, but significant moderate correlations were found between the distance covered in 2-MWT and the time to perform the 5-TSTS (rho = -0.49) and with stride length (rho = 0.52) during the test. In conclusion, the 2-MWT does not seem a good test to assess aerobic capacity while it showed to be associated to the 5-TSTS performance of the elderly.

The Use of Sensors to Prevent, Predict Transition to Chronic and Personalize Treatment of Low Back Pain: A Systematic Review.

Non-specific low back pain (NSLBP) is a highly prevalent condition that implies substantial expenses and affects quality of life in terms of occupational and recreational activities, physical and psychological health, and general well-being. The diagnosis and treatment are challenging processes due to the unknown underlying causes of the condition. Recently, sensors have been included in clinical practice to implement its management. In this review, we furthered knowledge about the potential benefits of sensors such as force platforms, video systems, electromyography, or inertial measure systems in the assessment process of NSLBP. We concluded that sensors could identify specific characteristics of this population like impaired range of movement, decreased stability, or disturbed back muscular activation. Sensors could provide sufferers with earlier diagnosis, prevention strategies to avoid chronic transition, and more efficient treatment approaches. Nevertheless, the review has limitations that need to be considered in the interpretation of results.

Are physical therapy interventions effective in improving sleep in people with chronic pain? A systematic review and multivariate meta-analysis.

Chronic pain exerts an enormous personal and economic burden, with sleep disturbances being one of the most reported problems by adults with chronic pain. The aim of this study was to analyse whether different physical therapy interventions could lead to improvements in sleep quality and pain intensity in individuals with chronic pain, as well as if there is any association. A systematic review and a univariate and multivariate meta-analysis were carried out according to the PRISMA guidelines. A search in PubMed, Scopus and Web of Science databases was performed. Six randomised controlled trials were included in the review and four of them were included in the meta-analysis; all of them with a moderate to high methodological quality. Data from adult participants with chronic pain after different physical therapy interventions was extracted. For the meta-analysis, the Insomnia Severity Index and the Numerical Rating Scale were considered. Results from the qualitative and quantitative analysis showed that most of the physical therapy interventions included had higher improvements in the intervention group than in the control group, although the effect size was not statistically significant (univariate for sleep quality: -0.08 [-0.34, 0.18], p = 0.46; univariate for pain intensity: -0.47 [-1.24, 0.30], p = 0.18; multivariate for both outcomes: -0.27). More studies are still needed to determine which physical therapy interventions are effective to improve sleep in people with chronic pain and if there are patients with specific characteristics who may benefit more than others.

Reproducibility of skin temperature analyses by novice and experienced evaluators using infrared thermography.

Infrared thermography (IRT) has become popular in several areas of knowledge. However, the analyses of thermal images often request manual actions, and little is known about the effect of the evaluator's experience on analysis thermal images. Here, we determine the reproducibility of IRT images analysis performed by evaluators with different levels of experience. Eight evaluators (GE, group experienced, n = 4; GN, group novice, n = 4) analyzed thermograms from 40 healthy participants recorded before and after exercise to determine the mean, minimum, maximum, standard deviation, and range of skin temperature in the anterior thigh and posterior leg. Before and after exercise, mean temperature showed excellent reproducibility for both groups for the anterior thigh (ICC >0.98) and posterior leg (ICC >0.94), and maximum temperature showed excellent reproducibility for both groups in the posterior leg (ICC >0.91). The influence of experience level was not significant considering the anterior thigh. Similarly, experience level did not affect the mean, maximum, and standard deviation temperature determined for the posterior leg. For the posterior leg, minimum temperature presented lower values and the range was higher among novice evaluators. Mean skin temperature showed narrower 95% limits of agreement than minimum and maximum for both regions and moments. Caution is advised when temperature ranges and minimums are determined by different evaluators. We conclude that for IRT analysis by evaluators with different levels of experience, the mean and maximum temperatures should be prioritized due to their better reproducibility.

Effects of different hydration supports on stride kinematics, comfort, and impact accelerations during running.

BACKGROUND: Different supports for hydration can influence total body mass and affect running biomechanics. RESEARCH QUESTION: Do different hydration supports affect the perceived exertion and comfort, stride kinematics, and impact accelerations during running? METHODS: This was a crossover study design. Thirteen trail runners completed a treadmill running test divided into four different durations and randomized hydration supports conditions, lasting 8 min each at moderate intensity: A) waist bag (0.84 kg); B) medium load backpack (0.84 kg); C) full load backpack (3.40 kg); and D) a control condition without water support. Impact accelerations were measured for 30 s in 4, 6, and 8 min. The rate of perceived exertion and heart rate were registered on minutes 4 and 8. At the last minute of each condition, comfort perception was registered RESULTS AND SIGNIFICANCE: No condition affected the stride kinematics. Full load backpack condition reduced head acceleration peak (-0.21 g; p = 0.04; ES=0.4) and head acceleration magnitude (-0.23 g; p = 0.03; ES=0.4), and increased shock attenuation (3.08 g; p = 0.04; ES=0.3). It also elicited higher perceived exertion (p < 0.05; ES>0.8) being considered heavier (p < 0.01; ES > 1.1). The waist bag condition was more comfortable in terms of noise (p = 0.006; ES=1.3) and humidity/heat (p = 0.001; ES=0.8). The waist bag was the most comfortable support. On the other hand, the full backpack elicited lower comfort and was the only generating compensatory adjustments. These results may help to improve design of full load backpack aiming at comfort for runners.

Cost-Effectiveness of Upper Extremity Dry Needling in Chronic Stroke.

INTRODUCTION: Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions. OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of a single dry needling session in patients with chronic stroke. METHODS: A cost-effectiveness analysis was performed based on a randomized controlled clinical trial. The results obtained from the values of the EuroQol-5D questionnaire and the Modified Modified Ashworth Scale were processed in order to obtain the percentage of treatment responders and the quality-adjusted life years (QALYs) for each alternative. The cost analysis was that of the hospital, clinic, or health center, including the equipment and physiotherapist. The cost per respondent and the incremental cost-effectiveness ratio of each alternative were assessed. RESULTS: Twenty-three patients with stroke were selected. The cost of DN treatment was EUR 14.96, and the data analysis showed a favorable cost-effectiveness ratio of both EUR/QALY and EUR/responder for IG, although the sensitivity analysis using limit values did not confirm the dominance (higher effectiveness with less cost) of the dry needling over the sham dry needling. CONCLUSIONS: Dry needling is an affordable alternative with good results in the cost-effectiveness analysis-both immediately, and after two weeks of treatment-compared to sham dry needling in persons with chronic stroke.

Effect of fatigue strength exercise on anterior thigh skin temperature rewarming after cold stress test.

Although dynamic thermography skin temperature assessment has been used in medical field, scientific evidence in sports is scarce. The aim of the study was to assess changes in anterior thigh skin temperature in response to a cold stress test after a strength exercise fatiguing protocol. Ten physically active adults performed a familiarization session and two strength exercise sessions, one with dominant and the other with non-dominant lower limb. Participants performed bouts of 10 concentric and eccentric contractions of leg extensions in an isokinetic device until reaching around 30% of force loss. Infrared thermographic images were taken at baseline conditions and after the fatigue level from both thighs after being cooled using a cryotherapy system. ROIs included vastus medialis, rectus femoris, adductor and vastus lateralis. Skin temperature rewarming was assessed during 180s after the cooling process obtaining the coefficients of the following equation: ΔSkin temperature = ß0 + ß1 * ln(T), being ß0 and ß1 the constant and slope coefficients, respectively, T the time elapsed following the cold stress in seconds, and ΔSkin temperature the difference between the skin temperature at T respect and the pre-cooling moment. Lower ß0 and higher ß1 were found for vastus lateralis and rectus femoris in the intervention lower limb compared with baseline conditions (p < 0.05 and ES > 0.6). Adductor only showed differences in ß0 (p = 0.01 and ES = 0.92). The regressions models obtained showed that ß0 and ß1 had a direct relationship with age and muscle mass, but an inverse relationship with the number of series performed until 30% of fatigue (R2 = 0.8). In conclusion, fatigue strength exercise results in a lower skin temperature and a faster thermal increase after a cold stress test.

Plantar pressure distribution during running with a self-customized foot orthosis in a home microwave.

The individualization of a custom-made foot orthosis could provide improvements in plantar loading distribution regarding a prefabricated one. However, not all runners can afford it because of its high cost. A new type of low-cost prefabricated foot orthoses with self-customization could be the solution. The aim of the study was to evaluate if self-customized prefabricated foot orthoses (SCFO) could improve plantar pressure distribution with respect to generic prefabricated ones without customization, during the intense prolonged running. Thirty healthy recreational runners performed two tests of 30 min running on a treadmill, each one with a foot orthosis condition, on different days. Mean peak pressure, pressure-time integral, relative pressure and stance time were measured at the beginning and at the end of the tests. Plantar pressure data were analyzed in nine foot regions. Two-way repeated-measures ANOVAs were performed. SCFO reduced relative pressure in metatarsals (P < 0.005) and lateral heel (P = 0.004), thanks to a greater involvement of arch area in mean peak pressure (medial: P = 0.006 and lateral: P = 0.019) and relative pressure (P < 0.001). In general, prolonged run increased pressures in forefoot, in both foot orthosis, but with lower values in metatarsals with SCFO (P < 0.022), which also helped reduce relative pressure in midfoot (P = 0.007) and medial heel (P = 0.035). Stance time was not modified in any case (P > 0.05). In conclusion, customization and better fit of a low-cost prefabricated foot orthosis can improve plantar pressure distribution during a prolonged run, being a good prevention mechanism for plantar overloading in healthy runners.

Footwear outsole temperature may be more related to plantar pressure during a prolonged run than foot temperature.

Objective. The temperature of the sole of the foot has been suggested as an alternative to the measurement of plantar pressure during running despite the scarce evidence about their relationship. The temperature of the footwear outsole could also be representative of plantar pressure distribution due to its less multifactorial dependence. The aim of the study was to determine if plantar pressure during a prolonged run could be related to plantar temperature, either of the sole of the foot or the footwear outsole.Approach. Thirty recreational runners (15 males and 15 females) performed a 30 min running test on a treadmill. Thermographic images of the sole of the foot and the footwear outsole were taken before and immediately after the test, and dynamic plantar pressure was measured at the end of the test. Pearson correlations and stepwise multiple linear regressions were performed.Main results.Plantar pressure percentage was related to a moderate correlation with plantar temperature percentage in forefoot and rearfoot (P < 0.05), showing a greater relationship with the footwear outsole than with the sole of the foot (r = 0.52-0.73 versusr = 0.40-0.61, respectively). Moreover, moderate correlations were also observed between footwear outsole and sole of the foot temperature variables, especially in rearfoot.Significance. Footwear outsole temperature may be better related to plantar pressure distribution than sole of the foot temperature, in the forefoot and rearfoot. The midfoot is the most sensitive and variable region to analyze, as it does not seem to have any relationship with plantar pressure.

Influence of infrared camera model and evaluator reproducibility in the assessment of skin temperature responses to physical exercise.

Infrared thermography (IRT) has been gaining in popularity in clinical and scientific research due to the increasing availability of affordable infrared cameras. This study aims to determine the similarity of measurement performance between three models of IRT camera during assessment of skin temperature before and after physical exercise. Three models of FLIR thermographic cameras (E60bx, Flir-One Pro LT, and C2) were tested. Thermal images were taken of the foot sole, anterior leg, and anterior thigh from 12 well-trained men, before and after a 30-min run on a treadmill. Image files were blinded and processed by three evaluators to extract the mean, maximum, and standard deviation of skin temperature of the region of interest. Time for data processing and rate of perceived effort was also recorded. Data processing was slower on the E60bx (CI95% E60 vs C2 [0.2, 2.6 min], p = 0.02 and ES = 0.6); vs. Flir-One [0.0, 3.4 min], p = 0.03 and ES = 0.6) and was associated with lower effort perception (E60 3.0 ± 0.1 vs. Flir-One 5.6 ± 0.2 vs C2 7.0 ± 0.2 points; p < 0.001 and ES > 0.8). The C2 and Flir-One cameras underestimated the temperature compared with the E60. In general, measuring mean temperature provided higher camera and examiner intra-class correlations than maximum and standard deviation, especially before exercise. Moreover, post exercise mean skin temperatures provided the most consistent values across cameras and evaluators. We recommend the use of mean temperature and caution when using more than one camera model in a study.

Pre-exercise skin temperature evolution is not related with 100 m front crawl performance.

During the transition between warm-up and competition there is a change in core, muscle and (eventually) skin temperature that may affect swimming performance. We have aimed to assess skin temperature evolution during transition phases of different durations before a typical front crawl effort and to investigate its relationship with performance. Following a standardized warm-up, nine adolescent male swimmers performed three maximal randomized 100 m maximum front crawl trials after 10, 20 and 45 min transition phases. Skin temperature, performance (time, stroke frequency, length and index, and propelling efficiency), heart rate, lactate and perceived effort were assessed. Data showed a skin temperature log increase over time (R2 > 0.96, p < 0.01) without differences from the 15 min with the following instants. Performance and psychophysiological variables were similar between transition phases. However, skin temperature at the end of the transition periods, i.e., just before the 100 m trials, was lower in the 10 min than the 20 and 45 min transitions (32.0 ± 0.6 vs 33.0 ± 0.4 and 33.5 ± 0.5 °C, respectively). The main finding was that no relevant relationships were observed between pre-test skin temperature and performance times (|r| < 0.6, p > 0.05) for the studied transition phases. We have concluded that transitions longer than 10 min will not present thermal changes and that, within the physiologic limits studied, pre-exercise skin temperature does not influence swimming performance.

Validation of ThermoHuman automatic thermographic software for assessing foot temperature before and after running.

The aim of the study was to evaluate an automatic thermographic software package (ThermoHuman®) for assessing skin temperature on the soles of the feet before and after running and to compare it with two manual definitions of the regions of interest (ROIs). 120 thermal images of the soles of the feet of 30 participants, at two measurement points (before and after running 30 min) and on two measurement days were analyzed. Three different models of thermographic image analyses were used to obtain the mean temperature of 9 ROIs: A) ThermoHuman (automatic definition of ROIs using ThermoHuman® software), B) Manual (manual delimitation of ROIs by proportion criteria), and C) Manual-TH (manual delimitation of ROIs in an attempt to replicate the regions analyzed by ThermoHuman). ThermoHuman resulted in an 86% reduction in time involved compared to manual delimitation. Fourteen of the 120 images (12%) presented some error in one or more of the ROI delimitations. Although the three procedures presented significant differences between them (53% in the comparison between ThermoHuman and Manual, 47% between ThermoHuman and Manual-TH, and 28% between Manual and Manual-TH), all differences had a small effect size (ES 0.2-0.4) or lower (ES < 0.2). Bland-Altman plots showed similar 95% limits of agreement between the three procedures before and after running. Intraclass correlation coefficient analysis of the three procedures presented excellent reliability (ICC>0.8). In conclusion, ThermoHuman® software was observed to be time-saving for image analysis with excellent reliability. Although results suggest that ThermoHuman® and manual methods are both valid in themselves, combining them is not recommended due to the differences observed between them.

Effect of prefabricated thermoformable foot orthoses on plantar surface temperature after running: A gender comparison.

There is a lack of evidence about the effect of different type of foot orthoses on plantar surface temperature. Moreover, that effect could be different depending on gender due to anatomical and physiological differences between men and women. The aim of the study was to analyze the effect of a prefabricated thermoformable foot orthosis on plantar surface temperature after running and taking gender differences into account. Thirty recreational runners (15 males, mean (standard deviation): 28 (7) years, 69.7 (6.5) kg, 1.74 (0.05) cm and 22.9 (1.7) kg/m2; and 15 females: 35 (7) years, 55.2 (6.9) kg, 1.63 (0.06) cm and 20.6 (1.9) kg/m2) carried out a maximum incremental test as pre-test, and two running tests on a treadmill at the laboratory wearing previously randomized different foot orthoses (thermoformable and prefabricated generic). The plantar surface temperature of the dominant foot sole in ten regions of interest was assessed before and immediately after 30-min running at 75% of VO2max. The use of thermoformable foot orthoses produced lower temperatures only in men after the run in medial heel (P = 0.033, ES = 0.7), which then disappeared in temperature variation (after - before) (P = 0.910). Regarding gender, women showed lower temperatures before the run in both orthosis conditions (P < 0.039, ES > 0.8), but no differences in temperatures after the run (P = 0.910) in comparison with men. Moreover, absolute temperatures after running were always greater than before the run (P < 0.001, ES > 5.0). In conclusion, the thermoformable foot orthoses do not modify plantar surface temperature after running in healthy runners of either gender, compared to prefabricated generic foot orthoses. Although women present lower baseline plantar temperatures than men, these differences disappear after exercise.

Acute effect of induced asymmetrical running technique on foot skin temperature.

The aim of the study was to evaluate skin temperature of the soles of the feet before and after a provoked asymmetrical running. Seventeen recreational male runners performed two 15 min running tests in the same session. In the first test, participants performed running without modifying their running technique (control condition). In the second running test, they repeated the same protocol using an ankle weight of 1.5 kg in the non-dominant ankle (asymmetrical condition). Rate of perceive exertion, heart rate and spatio-temporal parameters were measured during the running tests. Skin temperature was measured with an infrared camera before and after each condition. Generally, comparing both lower limbs, non-preferred limb (with the ankle weight) had lower contact time (p < 0.001 and ES > 0.8), higher stride length (p < 0.05 and ES > 0.3) and higher stride frequency in asymmetrical condition (p < 0.01 and ES > 0.4). However, no differences were observed on skin temperature between both feet in the two conditions in any of the regions of interest assessed (p > 0.05). Although the asymmetry generation model used provoked technical asymmetries in spatio-temporal parameters during running, no thermal asymmetries were observed between preferred and non-preferred sole of the foot. These results suggested the lower importance of mechanical than physiological mechanisms on skin temperature during running.

Effect of custom-made and prefabricated foot orthoses on kinematic parameters during an intense prolonged run.

Foot orthoses are one of the most used strategies by healthy runners in injury prevention and performance improvement. However, their effect on running kinematics throughout an intense prolonged run in this population is unknown. Moreover, there is some controversy regarding the use of custom-made versus prefabricated foot orthoses. This study analysed the effect of different foot orthoses (custom-made, prefabricated and a control condition) on spatio-temporal and angular (knee flexion and foot eversion) kinematic parameters and their behaviour during an intense prolonged run. Twenty-four recreational runners performed three similar tests that consisted of running 20 min on a treadmill at 80% of their maximal aerobic speed, each one with a different foot orthosis condition. Contact and flight time, and stride length and stride rate were measured every 5 min by an optical measurement photoelectric cell system. Knee flexion and foot eversion kinematic parameters were measured by two high-speed cameras. No significant differences were found between the different foot orthoses in any of the time points studied and between the interaction of foot orthosis and behaviour over time, in any of the variables studied (P > 0.05). The use of custom-made and prefabricated foot orthoses during an intense prolonged run does not produce changes in spatio-temporal and kinematic parameters in healthy runners. These results suggest that a healthy runner maintains its ideal movement pattern throughout a 20 minute prolonged run, regardless the type of foot orthosis used.

Relationship between foot eversion and thermographic foot skin temperature after running.

The main instruments to assess foot eversion have some limitations (especially for field applications), and therefore it is necessary to explore new methods. The objective was to determine the relationship between foot eversion and skin temperature asymmetry of the foot sole (difference between medial and lateral side), using infrared thermography. Twenty-two runners performed a running test lasting 30 min. Skin temperature of the feet soles was measured by infrared thermography before and after running. Foot eversion during running was measured by kinematic analysis. Immediately after running, weak negative correlations were observed between thermal symmetry of the rearfoot and eversion at contact time, and between thermal symmetry of the entire plantar surface of the foot and maximum eversion during stance phase (r=-0.3 and p=0.04 in both cases). Regarding temperature variations, weak correlations were also observed (r=0.4 and p<0.05). The weak correlations observed in this study suggest that skin temperature is not related to foot eversion. However, these results open interesting future lines of research.