Efficacy of non-surgical management and functional outcomes of partial ACL tears. A systematic review of randomised trials.

BACKGROUND: The incidence of anterior cruciate ligament (ACL) injuries represents a large burden of knee injuries in both the general and sporting populations, often requiring surgical intervention. Although there is much research on complete ACL tears including outcomes and indications for surgery, little is known about the short- and long-term outcomes of non-operative, physiotherapy led intervention in partial ACL tears. The primary aim of this study was to evaluate studies looking at the effectiveness of physiotherapy led interventions in improving pain and function in young and middle-aged adults with partial ACL tears. Additionally, the secondary aim was to evaluate the completeness of exercise prescription in randomised trials for physiotherapy led interventions in the management in partial ACL tears. METHODS: A comprehensive and systematic search was performed on six databases (Medline, CINAHL, EMBASE, PEDro, Scopus, SPORTDiscus and Cochrane). The search strategy consisted of two main concepts: (i) partial ACL tears, and (ii) non-operative management. 7,587 papers were identified by the search. After screening of eligible articles by two independent reviewers, 2 randomised studies were included for analysis. The same two reviewers assessed the completeness of reporting using the Toigio and Boutellier mechanobiological exercise descriptions and Template for Intervention Description and Replication (TIDieR) checklist. Group mean standard deviations (SD) for the main outcomes was extracted from both papers for analysis. Prospero Registration Number: CRD42020179892. RESULTS: The search strategy identified two studies; one looking at Tai Chi and the other Pilates. The analysis indicated that Tai Chi was significant in reducing pain scores and both Tai Chi and Pilates were found to increase Muscle Peak Torque Strength (MPTS) at 180 degrees. Furthermore, Tai Chi showed a significant increase in proprioception. CONCLUSIONS: Physiotherapy led interventions such as Pilates, and Tai Chi may improve pain, proprioception and strength in young and middle-aged adults with partial ACL tears, however full scale, high-quality randomised studies are required with long term outcomes recorded.

Development of a Pilates Teaching Framework from an international survey of teacher practice.

OBJECTIVE: Pilates is used increasingly in a variety of clinical settings. However, there is lack of clarity in the literature as to what is meant by the term. Teachers incorporating apparatus based on the designs of Joseph Pilates (1883-1967) into their practice refer to themselves as Comprehensive Teachers, and this group divides itself further into Classical and Contemporary practice. The aim of this research was to explore the meanings of these terms with Comprehensive Teachers and to develop a framework that reflects current views and practice. METHOD: Online international survey of Pilates Teachers through closed Facebook forums. Open questions were used to elicit views of the definition and practice of Pilates, and how standards should be set across the sector. RESULTS: Of 109 participants, 35% were based in the UK and 32% in the USA; 48% identified as Classical teachers, 32% as Contemporary, 5% as both and 15% as Matwork instructors. A thematic analysis of the qualitative data revealed agreement on the scope and content of Classical and Contemporary Comprehensive Pilates, however the discourse indicated there might be stereotyping about each other's practice. Classical teachers, for example, spoke of their own practice as authentic while Contemporary teachers used terms such as strict and inflexible for Classical practice. However, members of either group may incorporate both Classical and Contemporary approaches within their practice. We have designed a Pilates Teaching Framework to take into account the types of apparatus, the types of exercises and the order in which the exercises are executed. CONCLUSIONS: A framework that emphasises Pilates teaching rather than teacher practice is proposed for consistency and clarity when describing Pilates in professional and public contexts.

Pilates program design and health benefits for pregnant women: A practitioners' survey.

BACKGROUND: Little is known about recommendations for safe and appropriate instruction of Pilates exercises to women during pregnancy. The aim of this study was to examine Pilates practitioners' perspectives regarding Pilates program design for pregnant women. We also sought to elucidate their views on the potential benefits, restrictions and contraindications on Pilates in pregnancy. METHODS: A cross-sectional survey was performed. Pilates practitioners were invited to participate via email. Participants were surveyed about their experience and views on: screening processes in alignment with The American College of Obstetricians and Gynecologists (ACOG) (2002) guidelines; (ii) optimal exercise program features and (iii) physical and mental health benefits of Pilates for pregnant women. RESULTS: The survey was completed by 192 Pilates practitioners from a range of settings. Practitioners reported conducting formal screening (84%) for safety in pregnant women prior to commencing Pilates classes. Most did not routinely seek medical approval from the woman's general practitioner. Divergent views emerged regarding the safety and benefits of Pilates exercises in the supine position. Mixed opinions were also generated regarding the effects of spinal flexion exercises, single-leg stance exercises and breathing manoeuvres. There was little agreement on the optimal frequency or dosage of exercises. Views regarding absolute contraindications to exercise differed from The American College of Obstetricians and Gynecologists (ACOG) (2002) guidelines which cautioned about the dangers of persistent bleeding, premature labour, pre-eclampsia, placental praevia and incompetent cervix. The most frequent reported physical and psychological benefit of Pilates was improving pelvic floor strength (12%) and improved social wellbeing (23%). CONCLUSIONS: The study highlighted wide variations in practice for Pilates exercises with pregnant woman as well as low adherence to clinical practice guidelines. Further evidence is required to advise on appropriate screening and individualized Pilates programming, particularly for women with medical conditions during pregnancy.

Ejercicio físico, calidad de vida y salud de diabéticos tipo 2 / Physical exercise, quality of life and health of type 2 diabetes / Exercício físico, qualidade de vida e diabetes tipo 2

El objetivo de este estudio fue comparar los efectos de diferentes tipos de ejercicios físicos, desarrollados durante 24 semanas, relacionados con la calidad de vida y salud de individuos con diabetes mellitus tipo 2. Fueron seleccionados 24 individuos inactivos de ambos sexos, con un promedio de edad de 60.41 años. Los individuos fueron divididos aleatoriamente en tres grupos: ejercicio aeróbico, ejercicio resistido y ejercicio de flexibilidad. Los instrumentos utilizados fueron una ficha de registros sobre anamnesis clínica, una ficha de registro de control diario, El Physical Activity Readiness Questionnaire (PAR-Q 1 y 2), cuestionario de calidad de vida relacionada a la salud SF-36 (Medical Outcomes Study 36 - Item Short-Form Health Survey) y las lipoproteínas de alta y baja densidad por medio de análisis bioquímico. Solamente en el ejercicio aeróbico fueron observadas alteraciones significativas en la concentración de lipoproteínas de alta y baja densidad. En relación a la calidad de vida, el ejercicio aeróbico contribuyó de manera significativa en los dominios de capacidad funcional, vitalidad y salud mental. El ejercicio resistido reveló significancia en los dominios de vitalidad y salud mental. Los resultados demostraron que la prescripción de ejercicio físico consiste en una herramienta fundamental en el control de la diabetes, mientras que el ejercicio aeróbico proporcionó un efecto positivo en la calidad de vida y salud de diabéticos tipo 2, siendo fundamental apoyo psicológico para estos pacientes a lo largo de su vida

The aim of this study was to compare the effects of different types of physical exercises developed or 24 weeks-related quality of life and health of individuals with diabetes mellitus type 2. Were selected 24 individuals inactive men and women, with an average of age of 60.41 years. The subjects were randomly divided into three groups: aerobic exercise, resistance exercise and flexibility exercise. The instruments used were a form of records on clinical history, a registration of daily monitoring, the Physical Activity Readiness Questionnaire (PAR-Q 1 and 2), health-related quality of life related to health SF-36 (Medical Outcomes Study 36 - item Short-Form Health Survey) lipoproteins and high and low density by means of biochemical analysis. Only aerobic exercise were observed significant alterations in lipoprotein concentration and higher density. Regarding quality of life, aerobic exercise contributed significantly in the domains of functional capacity, vitality and mental health. The resistance exercise revealed significance in the domains of vitality and mental health. The results showed that the prescription of physical exercise is an essential tool in the management of diabetes, while aerobic exercise provided a positive effect on quality of life and health of type 2 diabetes, and essential psychological support for these patients throughout his life

O objectivo deste estudo foi comparar os efeitos de diferentes tipos de exercício físico desenvolvidos visando 24 semanas de qualidade de vida e saúde para indivíduos com diabetes mellitus tipo 2. Foram seleccionados 24 indivíduos inactivos homens e mulheres, com média de idade de 60,41 anos. Os sujeitos foram divididos aleatoriamente em três grupos: exercício aeróbio, exercício de resistência e exercício de flexibilidade. Os instrumentos utilizados foram uma ficha de registo de história clínica, uma de registo de monitorização diário, o Questionário de Prontidão para a Actividade Física (PAR-Q 1 e 2), um Questionário de Qualidade de Vida relacionada com a saúde SF-36 (Medical Outcomes Study 36 - Item Short-Form Health Survey) e as de alta e baixa densidade por meio de análise bioquímica. Somente no exercício aeróbio foram observadas alterações significativas na concentração e densidade de lipoproteína. Em relação à qualidade de vida, o exercício aeróbio contribuiu significativamente nos domínios da capacidade funcional, vitalidade e saúde mental. O exercício de resistência revelou significância nos domínios da vitalidade e saúde mental. Os resultados mostraram que a prescrição do exercício físico é uma ferramenta essencial no controlo da diabetes, enquanto o exercício aeróbio proporcionou um efeito positivo na qualidade de vida e saúde, bem como um apoio psicológico essencial para estes pacientes ao longo da sua vida

Interrater reliability of a Pilates movement-based classification system.

OBJECTIVE: To determine the interrater reliability for identification of a specific movement pattern using a Pilates Classification system. METHOD: Videos of 5 subjects performing specific movement tasks were sent to raters trained in the DMA-CP classification system. RESULTS: Ninety-six raters completed the survey. Interrater reliability for the detection of a directional bias was excellent (Pi = 0.92, and K(free) = 0.89). Interrater reliability for classifying an individual into a specific subgroup was moderate (Pi = 0.64, K(free) = 0.55) however raters who had completed levels 1-4 of the DMA-CP training and reported using the assessment daily demonstrated excellent reliability (Pi = 0.89 and K(free) = 0.87). CONCLUSION: The reliability of the classification system demonstrated almost perfect agreement in determining the existence of a specific movement pattern and classifying into a subgroup for experienced raters. There was a trend for greater reliability associated with increased levels of training and experience of the raters.

Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092).

Effectiveness of brief/minimal contact self-activation interventions that encourage participation in physical activity (PA) for chronic low back pain (CLBP >12 weeks) is unproven. The primary objective of this assessor-blinded randomized controlled trial was to investigate the difference between an individualized walking programme (WP), group exercise class (EC), and usual physiotherapy (UP, control) in mean change in functional disability at 6 months. A sample of 246 participants with CLBP aged 18 to 65 years (79 men and 167 women; mean age ± SD: 45.4 ± 11.4 years) were recruited from 5 outpatient physiotherapy departments in Dublin, Ireland. Consenting participants completed self-report measures of functional disability, pain, quality of life, psychosocial beliefs, and PA were randomly allocated to the WP (n = 82), EC (n = 83), or UP (n = 81) and followed up at 3 (81%; n = 200), 6 (80.1%; n = 197), and 12 months (76.4%; n = 188). Cost diaries were completed at all follow-ups. An intention-to-treat analysis using a mixed between-within repeated-measures analysis of covariance found significant improvements over time on the Oswestry Disability Index (Primary Outcome), the Numerical Rating Scale, Fear Avoidance-PA scale, and the EuroQol EQ-5D-3L Weighted Health Index (P < 0.05), but no significant between-group differences and small between-group effect sizes (WP: mean difference at 6 months, 6.89 Oswestry Disability Index points, 95% confidence interval [CI] -3.64 to -10.15; EC: -5.91, CI: -2.68 to -9.15; UP: -5.09, CI: -1.93 to -8.24). The WP had the lowest mean costs and the highest level of adherence. Supervised walking provides an effective alternative to current forms of CLBP management.

Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial.

BACKGROUND: People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK) provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect.This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of: 1 Establishing the effectiveness of core stability training; 2 Comparing core stability training with standardised physiotherapy exercise; 3 Exploring underlying mechanisms of change associated with this intervention METHODS: This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control). All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12), the Functional Reach (forwards and lateral), a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC) Scale. In addition, ultrasound imaging of the abdominal muscles will be performed before and after intervention to assess changes in abdominal musculature at one of the four centres (Plymouth). DISCUSSION: This pragmatic trial will assess the effect of these exercise programmes on ambulatory people with MS. It may not be possible to extrapolate the conclusions to those who are non-ambulatory. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01414725.

Calidad de la información sobre ejercicios en las páginas de Internet dirigida a sobrevivientes de cáncer de seno / Quality of the information on exercise found on websites aimed at breast cancer survivors

Objetivo. Describir la calidad de la información acerca de ejercicios en Internet dirigida a sobrevivientes de cáncer de seno. Método. El diseño del estudio es exploratorio descriptivo. Se evaluó la calidad de la información acerca de ejercicios en un total de 40 páginas de Internet: se utilizaron 3 instrumentos para evaluar la calidad de la información: Discern, InEje (calidad de la información de ejercicios) y FRES/Huertas. Resultados. Los porcentajes de los promedios obtenidos con respecto a la puntuación máxima posible para cada instrumento fueron: Discern 62,67%, InEje 15,23%, y FRES/Huertas 56,51%. Conclusión. La evidencia sugiere que es necesario mejorar la calidad de la información sobre ejercicios de las páginas de Internet en inglés y español para sobrevivientes de cáncer de seno (AU)

Goal: To analyze the changes produced by therapeutic massage on systemic autonomic activity by analyzing the modification of cardiac autonomic activity. Material and methods: A comparative study was performed on 15 women on the variability of heart rate variability (HRV) (RR interval) obtained by photoplethysmography for 2 20-minute sessions: control and massage. HRV was measured at 4 different times for periods of 5 minutes each. The massage session consisted of effleurage massage and wide-ranging sliding pressure. In addition, the participants had to fill out the well-being visual analogue scale (Well Being VAS) questionnaire immediately after the control and massage session. Results: The paired Student’s t-test was used to compare the results obtained. Pearson correlation coefficient was used to quantify the relationship existing between the different times in each one of the parameters. A statistically significant increase was observed in HRV (total power) as well as an increase in parasympathetic activity in the massage session during the last 5 minutes (relative to baseline) compared to control session. However, this response tends to decrease 5 minutes after its interruption/timeout. Finally, the Well Being VAS score shows a significant increase after the massage. However, its gain is not correlated to the changes in the physiological variables. Conclusions: The massage applied on healthy subjects affects the autonomic nervous system (AU)