Efficacy of Liu-zi-jue in Patients with 2019 Novel Coronavirus Pneumonia (COVID-19): structured summary of a study protocol for a randomized controlled trial.

OBJECTIVES: Efficacy of conventional treatment plus the complementary therapy Liu-zi-jue (a mind-body exercise) to treat patients with mild COVID-19. TRIAL DESIGN: The study is a single-center 2 arm, randomized controlled trial with parallel-group design.

Acute chest pain and esophageal mucosal injury following an extreme yoga position Case report.

A young lady complained of the sudden onset of intense chest pain, in consequence of an extreme hyperextension of the back in a yoga position. At endoscopy a large lesion of the esophageal epithelium was detected, involving the middle third of the anterior wall of the esophagus. Other symptoms reported by the patient were dysphagia and odynophagia, depicting the typical features of intramural hematoma, also known as intramural dissection or intramural perforation of the oesophagus. The patient was managed conservatively and symptoms disappeared within a week. A barium swallow at six months reported normal findings. Different types of accidents occurring during yoga practice are reported in the literature, mainly involving musculoskeletal or nervous systems. Visceral lesions are exceptional and no similar cases have been reported in the literature. KEYWORDS: Acute chest pain, Esophageal lesion, Intramural hematoma, Management of esophageal lesion.

Load monitoring on Pilates training: a study protocol for a randomized clinical trial.

BACKGROUND: Currently there are campaigns to raise the awareness of the need to practice physical exercise with several objectives, mainly as a preventive measure. The Pilates method is a form of therapeutic exercise for maintaining and improving health. However, despite being popular, there is still no scientific evidence on the standardization and progression of the method. Therefore, the purpose of this study was to develop a protocol to monitor the progression of daily Pilates loads between the basic, intermediate, and advanced levels, as well as to analyze the effects of the method on psychometric, cardiorespiratory, and autonomic measures. METHODS/DESIGN: In total, 54 healthy men underwent 36 sessions of Pilates mat work. Before each training session, cardiorespiratory measures, pain (visual analogue scale), and a psychometric questionnaire were collected. Heart rate (HR), subjective perception of effort (SPE), and RR intervals were measured during the sessions and used later in the analysis of the progression of training load by monitoring the internal training load and heart rate variability. At the end of the sessions, cardiorespiratory measures, the visual analogue scale, and the psychometric questionnaire were measured again. After 15 min of rest, the final HR measurement was made and the participants noted the effort on the SPE scale. The psychometric, cardiorespiratory, and autonomic measures were evaluated before and after each of the 36 training sessions. DISCUSSION: This is a parallel randomized clinical trial of standardized Pilates training, with the aim of estimating training loads and measuring the efficacy of Pilates through clinical, cardiorespiratory, and autonomic outcomes. The protocol can easily be reproduced and could be used to support professionals in prescribing the method. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03232866 . Registered on 28 July 2017.

Constraint-Induced Movement Therapy in multiple sclerosis: Safety and three-dimensional kinematic analysis of upper limb activity. A randomized single-blind pilot study.

BACKGROUND: There are few evidences on safety of Constraint-Induced Movement Therapy (CIMT), as well as its effects in neurological conditions, including multiple sclerosis (MS). OBJECTIVE: To evaluate safety and effectiveness of a 2-week CIMT protocol on upper limb activity of progressive MS patients through a three-dimensional (3D) kinematic analysis. METHODS: In this randomized single-blind pilot study, we randomly allocated patients affected by progressive MS reporting a reduced use of one upper limb into two different groups: CIMT group (less affected limb blocked by a splint) and control group (undergoing bi-manual treatment). Primary outcome was CIMT safety. Furthermore, we assessed CIMT effects through clinical outcomes (hand grip strength, HGS, and 9 Hole Peg Test, 9HPT) and 3D kinematic analysis (normalized jerk, number of movement units, going phase duration, mean velocity, endpoint error). All evaluations were performed at baseline (T0) and after 2 weeks of treatment (T1) for both arms in both groups. RESULTS: Ten MS patients, mean aged 51.0±7.7 years, were randomly allocated in the 2 groups. After treatment, no differences were found in the blocked arm. Furthermore, CIMT group showed significant improvements in clinical and kinematic parameters. CONCLUSIONS: CIMT might be considered a safe and effective technique in MS patients.

Síndrome de atrapamiento funcional de la arteria poplítea en joven deportista de taekwondo / Functional popliteal artery entrapment syndrome in a young taekwondo athlete

La claudicación intermitente se define como fatiga, malestar o dolor en grupos musculares de las extremidades inferiores durante el esfuerzo, resultante de la isquemia inducida por el ejercicio. La arterioesclerosis es la causa más común en personas mayores, pero cuando la claudicación aparece en personas jóvenes debemos pensar en otras causas vasculares. Presentamos el caso de una deportista de élite de taekwondo de 24 años con dolor intenso en las pantorrillas durante el ejercicio físico, ya anteriormente intervenida mediante fasciotomía bilateral, en la que se diagnostica un atrapamiento de la arteria poplítea bilateral funcional. Se describen los resultados tras la cirugía mediante adhesiólisis de la arteria poplítea y sección proximal de las fibras profundas del gemelo interno bilateral, así como tras la infiltración de toxina botulínica en el gastrocnemio medial izquierdo. Es importante conocer las distintas causas de claudicación intermitente no arterioesclerótica para plantear el diagnóstico diferencial adecuado y poder orientar las pruebas diagnósticas o la derivación de los pacientes a los especialistas oportunos

Intermittent claudication is defined as fatigue, discomfort or pain in muscle groups of the lower limbs during exertion, resulting from exercise-induced ischaemia. Atherosclerosis is the most common cause in older people, but when claudication occurs in young people other vascular causes should be sought. We present the case of a 24-year-old elite Taekwondo athlete with severe pain in the calves during physical exercise, who had had previously undergone bilateral fasciotomy. The patient was diagnosed with functional bilateral popliteal artery entrapment. The results after surgery are described, with adhesiolysis of the popliteal artery and proximal section of the deep fibres of the bilateral internal gastrocnemius, as well as infiltration of botulinum toxin into the left medial gastrocnemius. It is important to be familiar with the various causes of non-atherosclerotic intermittent claudication in order to establish the appropriate differential diagnosis and guide diagnostic tests or patient referral to the appropriate specialists

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.

Riesgo de hipocalcemia aguda en paciente hipoparatiroidea postiroidectomía que practica ejercicio de resistencia: a próposito de un caso / Risk of acute hypocalcaemia in a patient after total thyroidectomy and during endurance exercise: A case report

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Effectiveness of meditative movement on COPD: a systematic review and meta-analysis.

BACKGROUND: The effectiveness of meditative movement (tai chi, yoga, and qigong) on COPD remained unclear. We undertook a systematic review and meta-analysis to determine the effectiveness of meditative movement on COPD patients. METHODS: We searched PubMed, Web of Science, EMBASE, and the Cochrane Center Register of Controlled Trials for relevant studies. The methods of standard meta-analysis were utilized for identifying relevant researches (until August 2017), quality appraisal, and synthesis. The primary outcomes were the 6-minute walking distance (6MWD), lung function, and dyspnea levels. RESULTS: Sixteen studies involving 1,176 COPD patients were included. When comparing with the control group, the 6MWD was significantly enhanced in the treatment group (3 months: mean difference [MD]=25.40 m, 95% CI: 16.25 to 34.54; 6 months: MD=35.75 m, 95% CI: 22.23 to 49.27), as well as functions on forced expiratory volume in 1 s (FEV1) (3 months: MD=0.1L, 95% CI: 0.02 to 0.18; 6 months: MD=0.18L, 95% CI: 0.1 to 0.26), and FEV1 % predicted (3 months: 4L, 95% CI: 2.7 to 5.31; 6 months: MD=4.8L, 95% CI: 2.56 to 7.07). Quality of life for the group doing meditative movement was better than the control group based on the Chronic Respiratory Disease Questionnaire dyspnea score (MD=0.9 units, 95% CI: 0.51 to 1.29) and fatigue score (MD=0.75 units, 95% CI: 0.42 to 1.09) and the total score (MD=1.92 units, 95% CI: 0.54 to 3.31). CONCLUSION: Meditative movement may have the potential to enhance lung function and physical activity in COPD patients. More large-scale, well-designed, multicenter, randomized controlled trials should be launched to evaluate the long-range effects of meditative movement.

Effect of an exercise-based cardiac rehabilitation program "Baduanjin Eight-Silken-Movements with self-efficacy building" for heart failure (BESMILE-HF study): study protocol for a randomized controlled trial.

BACKGROUND: Exercise-based cardiac rehabilitation is a beneficial therapy for patients with chronic heart failure. The delivery of exercise-based cardiac rehabilitation should adopt an evidence-based approach, as well as be culturally appropriate and sensitive to individual needs and preferences. The Baduanjin Eight-Silken-Movements with Self-efficacy Building for Heart Failure (BESMILE-HF) program is the first to apply a traditional Chinese exercise, Baduanjin, as the core component in an exercise-based cardiac rehabilitation program. This trial aims to assess the efficacy, safety, and acceptability of the addition of the BESMILE-HF program to usual medications for patients with chronic heart failure. METHODS/DESIGN: The BESMILE-HF study is a mixed-design study. It includes a two-group, parallel, randomized controlled trial with 200 chronic heart failure patients, as well as a qualitative component. Patients will be randomized into either an intervention group receiving the 12-week BESMILE-HF program plus usual medications, or a control group receiving only usual medications. The primary outcomes are peak oxygen consumption assessed using a cardiopulmonary exercise test, and disease-specific quality of life using the Minnesota Living with Heart Failure Questionnaire. The secondary outcomes are: exercise performance, exercise self-efficacy, general quality of life, dyspnea and fatigue, depression, cardiac function, prognostic and inflammatory indicator levels, hospitalization, use of medications, and major adverse cardiac events. Assessments will be carried out at baseline, and at the 4th week, 8th week, and 12th week. The qualitative component will include a semi-structure interview describing patients' experiences with the intervention. DISCUSSION: This study can provide evidence for how to deliver a contextually adapted exercise-based cardiac rehabilitation program with the potential to be scaled up throughout China. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03180320 . Registered on 2 June 2017.

Diagnóstico de vigorexia e dismorfia muscular em universitários da área da saúde / Diagnosis of vigorexia and muscular dysmorphia in university of the healht area

Introdução: Sabe-se que a prática de exercício físico traz diversos benefícios à nossa saúde, como a melhora do metabolismo, prevenção de doenças e proporciona resistência muscular, contudo pode ser um fator de risco para o desenvolvimento de transtornos relacionados à imagem corporal. Diante disso vemos que essa distorção e insatisfação fazem com que ocorra o crescimento na prevalência de distúrbios alimentares, em ambos os sexos, assim havendo uma busca de um corpo que seja compatível ao padrão de beleza, podendo ocasionar bulimia, ortorexia, vigorexia (Dismorfia Muscular) e insatisfação corporal. Objetivo: Identificar a prevalência de Ortorexia e Vigorexia em universitários da área de saúde. Métodos: O Estudo foi do tipo transversal quantitativo descritivo, realizado com 104 universitários, de 18 a 40 anos, de uma Instituição de Ensino Superior (IES), com contribuição quantitativa. Coletaram-se dados antropométricos para determinação do estado nutricional por meio do Índice de Massa Corporal (IMC). O diagnostico de ortorexia foi feito a partir do instrumento elaborado por Bratman, para identificação da vigorexia utilizou-se um instrumento de medida de dismorfia muscular, desenvolvido e validado por Pope. Resultado: segundo o IMC, 67,3% dos universitários encontram- se em estado de eutrofia, da mesma forma, o percentual de gordura corporal apontou um percentual de 63,5 para peso adequado. Em relação à ortorexia, 13,8% dos homens e 24% (n=18) das mulheres foram classificados como fanáticos por saúde, enquanto os resultados do diagnostico de vigorexia indicaram que 76% das mulheres e 89,7% dos homens não possuem o transtorno. Conclusão: A vigorexia e ortorexia apresentaram prevalência elevada para diagnósticos positivos para os transtornos, na população estudada. É importante que os profissionais da área da saúde possam aproveitar desse tipo de informação para melhorar a compreensão e identificação desses transtornos

Introduction: It is known that the practice of physical exercise brings several benefits to our health, such as improved metabolism, disease prevention and muscular endurance, but can be a risk factor for the development of disorders related to body image. In the face of this, we see that this distortion and dissatisfaction cause growth in the prevalence of eating disorders in both sexes, so there is a search for a body that is compatible with the beauty pattern, which can lead to bulimia, orthorexia, vigorexia (Muscular Dysmorphia) and body dissatisfaction. Objective: To identify the prevalence of Orthorexia and Vigorexia among university students. Methods: The study was of descriptive quantitative cross-sectional study, with 104 university students aged 18 to 40 years, from a Higher Education Institution (HEI), with quantitative contribution. Anthropometric data were collected to determine the nutritional status through the Body Mass Index (BMI). The diagnosis of orthorhexis was made using the instrument developed by Bratman to identify the use of a muscle dysmorphic instrument, which was developed and validated by Pope. Results: according to the BMI, 67.3% of university students are in a state of eutrophy, in the same way, the percentage of body fat pointed out a percentage of 63.5 for adequate weight. In relation to orthorexia, 13.8% of the men and 24% (n = 18) of the women were classified as health fanatics, while the results of the diagnosis of vigorexia indicated that 76% of the women and 89.7% of the men do not have the disorder. Conclusion: Vigorexia and orthorexia had a high prevalence for positive diagnoses for the disorders in the study population. It is important that health professionals can use this type of information to improve the understanding and identification of these disorders

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Muscle Activation During Pilates Exercises in Participants With Chronic Nonspecific Low Back Pain: A Cross-Sectional Case-Control Study.

OBJECTIVE: To determine the amplitude of the electromyographic activity of trunk muscles during Pilates exercises in women with and without chronic low back pain (LBP). DESIGN: Case-control study. SETTING: University physical therapy clinic. PARTICIPANTS: Women (N=60) divided into an LBP group and a control group. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Amplitude of the electromyographic activity (root mean square values) of the gluteus maximus and external oblique muscles collected during 3 Pilates exercises: Shoulder Bridge performed on the mat, and Hip Roll and Breathing performed in equipment. Pain intensity was assessed in the LBP group. RESULTS: The amplitude of the electromyographic activity was similar between groups (P≥.05). For both groups, the amplitude of the gluteus maximus was higher in the Shoulder Bridge exercise compared with the Hip Roll with 2 springs (control group: mean difference [MD]=.18; 95% confidence interval [CI], .05-.41; LBP group: MD=.29; 95% CI, .16-.31) and the Breathing exercise (control group: MD=-.40; 95% CI, -.55 to -.26; LBP group: MD=-.36; 95% CI, -.52 to -.20). The amplitude of the external oblique muscle was higher in the Shoulder Bridge compared with the Hip Roll with 2 springs (control group: MD=.13; 95% CI, .05-.21; LBP group: MD=.18; 95% CI, .03-.33). Pain intensity increased after exercises, but this increase was lower for the mat exercises. CONCLUSIONS: Similar muscle activation between groups was found. The findings suggest that mat exercises caused less pain and a greater difference in the amplitude of muscle activation compared with the equipment-based exercises.

Pilates for low back pain.

BACKGROUND: Non-specific low back pain is a major health problem worldwide. Interventions based on exercises have been the most commonly used treatments for patients with this condition. Over the past few years, the Pilates method has been one of the most popular exercise programmes used in clinical practice. OBJECTIVES: To determine the effects of the Pilates method for patients with non-specific acute, subacute or chronic low back pain. SEARCH METHODS: We conducted the searches in CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro and SPORTDiscus from the date of their inception to March 2014. We updated the search in June 2015 but these results have not yet been incorporated. We also searched the reference lists of eligible papers as well as six trial registry websites. We placed no limitations on language or date of publication. SELECTION CRITERIA: We only included randomised controlled trials that examined the effectiveness of Pilates intervention in adults with acute, subacute or chronic non-specific low back pain. The primary outcomes considered were pain, disability, global impression of recovery and quality of life. DATA COLLECTION AND ANALYSIS: Two independent raters performed the assessment of risk of bias in the included studies using the 'Risk of bias' assessment tool recommended by The Cochrane Collaboration. We also assessed clinical relevance by scoring five questions related to this domain as 'yes', 'no' or 'unclear'. We evaluated the overall quality of evidence using the GRADE approach and for effect sizes we used three levels: small (mean difference (MD) < 10% of the scale), medium (MD 10% to 20% of the scale) or large (MD > 20% of the scale). We converted outcome measures to a common 0 to 100 scale when different scales were used. MAIN RESULTS: The search retrieved 126 trials; 10 fulfilled the inclusion criteria and we included them in the review (a total sample of 510 participants). Seven studies were considered to have low risk of bias, and three were considered as high risk of bias.A total of six trials compared Pilates to minimal intervention. There is low quality evidence that Pilates reduces pain compared with minimal intervention, with a medium effect size at short-term follow-up (less than three months after randomisation) (MD -14.05, 95% confidence interval (CI) -18.91 to -9.19). For intermediate-term follow-up (at least three months but less than 12 months after randomisation), two trials provided moderate quality evidence that Pilates reduces pain compared to minimal intervention, with a medium effect size (MD -10.54, 95% CI -18.46 to -2.62). Based on five trials, there is low quality evidence that Pilates improves disability compared with minimal intervention, with a small effect size at short-term follow-up (MD -7.95, 95% CI -13.23 to -2.67), and moderate quality evidence for an intermediate-term effect with a medium effect size (MD -11.17, 95% CI -18.41 to -3.92). Based on one trial and low quality evidence, a significant short-term effect with a small effect size was reported for function (MD 1.10, 95% CI 0.23 to 1.97) and global impression of recovery (MD 1.50, 95% CI 0.70 to 2.30), but not at intermediate-term follow-up for either outcome.Four trials compared Pilates to other exercises. For the outcome pain, we presented the results as a narrative synthesis due to the high level of heterogeneity. At short-term follow-up, based on low quality evidence, two trials demonstrated a significant effect in favour of Pilates and one trial did not find a significant difference. At intermediate-term follow-up, based on low quality evidence, one trial reported a significant effect in favour of Pilates, and one trial reported a non-significant difference for this comparison. For disability, there is moderate quality evidence that there is no significant difference between Pilates and other exercise either in the short term (MD -3.29, 95% CI -6.82 to 0.24) or in the intermediate term (MD -0.91, 95% CI -5.02 to 3.20) based on two studies for each comparison. Based on low quality evidence and one trial, there was no significant difference in function between Pilates and other exercises at short-term follow-up (MD 0.10, 95% CI -2.44 to 2.64), but there was a significant effect in favour of other exercises for intermediate-term function, with a small effect size (MD -3.60, 95% CI -7.00 to -0.20). Global impression of recovery was not assessed in this comparison and none of the trials included quality of life outcomes. Two trials assessed adverse events in this review, one did not find any adverse events, and another reported minor events. AUTHORS' CONCLUSIONS: We did not find any high quality evidence for any of the treatment comparisons, outcomes or follow-up periods investigated. However, there is low to moderate quality evidence that Pilates is more effective than minimal intervention for pain and disability. When Pilates was compared with other exercises we found a small effect for function at intermediate-term follow-up. Thus, while there is some evidence for the effectiveness of Pilates for low back pain, there is no conclusive evidence that it is superior to other forms of exercises. The decision to use Pilates for low back pain may be based on the patient's or care provider's preferences, and costs.

Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm.

INTRODUCTION AND HYPOTHESIS: The objective was to describe the intra-abdominal pressures (IAP) generated during Pilates Mat and Reformer activities, and determine whether these activities generate IAP above a sit-to-stand threshold. METHODS: Twenty healthy women with no symptomatic vaginal bulge, median age 43 (range 22-59 years), completed Pilates Mat and Reformer exercise routines each consisting of 11 exercises. IAP was collected by an intra-vaginal pressure transducer, transmitted wirelessly to a base station, and analyzed for maximal and area under the curve (AUC) IAP. RESULTS: There were no statistically significant differences in the mean maximal IAP between sit-to-stand and any of the Mat or Reformer exercises in the study population. Six to twenty-five percent of participants exceeded their individual mean maximal IAP sit-to-stand thresholds for 10 of the 22 exercises. When measuring AUC from 0 cm H2O, half the exercises exceeded the mean AUC of sit-to-stand, but only Pilates Reformer and Mat roll-ups exceeded the mean AUC of sit-to-stand when calculated from a threshold of 40 cm H2O (consistent with, for example, walking). CONCLUSION: Our results support recommending this series of introductory Pilates exercises, including five Mat exercises and six Reformer exercises to women desiring a low IAP exercise routine. More research is needed to determine the long-term effects of Pilates exercise on post-surgical exercise rehabilitation and pelvic floor health.

Spontaneous cerebrospinal fluid leak following a pilates class: a case report.

INTRODUCTION: A spinal cerebrospinal fluid leak is the most common cause of spontaneous intracranial hypotension which is an uncommon but increasingly recognized cause of headache. This article describes the first reported case of pilates being associated with a spontaneous spinal cerebrospinal fluid leak whilst also highlighting the key information about spontaneous cerebrospinal fluid leaks that will be useful to the general clinician. CASE PRESENTATION: We present the case of a 42-year-old Caucasian woman who developed a low-pressure headache following a pilates class. A computed tomography scan of her head demonstrated bilateral chronic subdural hematomas and cerebellar descent. Magnetic resonance imaging of her spine revealed the presence of extensive extradural cerebrospinal fluid collections. She responded to conservative management and repeat neuroimaging after symptom resolution revealed no abnormalities. CONCLUSIONS: Awareness and early recognition of spontaneous intracranial hypotension is important to prevent unnecessary investigations and delay in treatment. Pilates may be a risk factor for the development of a spontaneous cerebrospinal fluid leak.

The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.

BACKGROUND: This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2002 and previously updated in 2004 and 2007.Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres, including the Epley manoeuvre. OBJECTIVES: To assess the effectiveness of the Epley manoeuvre for posterior canal BPPV. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 January 2014. SELECTION CRITERIA: Randomised controlled trials of the Epley manoeuvre versus placebo, no treatment or other active treatment for adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike test). The primary outcome of interest was complete resolution of vertigo symptoms. Secondary outcomes were conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test and adverse effects of treatment. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We included 11 trials in the review with a total of 745 patients.Five studies compared the efficacy of the Epley manoeuvre against a sham manoeuvre, three against other particle repositioning manoeuvres (Semont, Brandt-Daroff and Gans) and three against a control (no treatment, medication only, postural restriction). Patients were treated in hospital otolaryngology departments in eight studies and family practices in two studies. All patients were adults aged 18 to 90 years old, with a sex ratio of 1:1.5 male to female.There was a low risk of overall bias in the studies included. All studies were randomised with six applying sealed envelope or external allocation techniques. Eight of the trials blinded the assessors to the participants' treatment group and data on all outcomes for all participants were reported in eight of the 11 studies. Complete resolution of vertigo Complete resolution of vertigo occurred significantly more often in the Epley treatment group when compared to a sham manoeuvre or control (odds ratio (OR) 4.42, 95% confidence interval (CI) 2.62 to 7.44; five studies, 273 participants); the proportion of patients resolving increased from 21% to 56%. None of the trials comparing Epley versus other particle repositioning manoeuvres reported vertigo resolution as an outcome. Conversion of Dix-Hallpike positional test result from positive to negative Conversion from a positive to a negative Dix-Hallpike test significantly favoured the Epley treatment group when compared to a sham manoeuvre or control (OR 9.62, 95% CI 6.0 to 15.42; eight studies, 507 participants). There was no difference when comparing the Epley with the Semont manoeuvre (two studies, 117 participants) or the Epley with the Gans manoeuvre (one study, 58 participants). In one study a single Epley treatment was more effective than a week of three times daily Brandt-Daroff exercises (OR 12.38, 95% CI 4.32 to 35.47; 81 participants). Adverse effects Adverse effects were infrequently reported. There were no serious adverse effects of treatment. Rates of nausea during the repositioning manoeuvre varied from 16.7% to 32%. Some patients were unable to tolerate the manoeuvres because of cervical spine problems. AUTHORS' CONCLUSIONS: There is evidence that the Epley manoeuvre is a safe, effective treatment for posterior canal BPPV, based on the results of 11, mostly small, randomised controlled trials with relatively short follow-up. There is a high recurrence rate of BPPV after treatment (36%). Outcomes for Epley manoeuvre treatment are comparable to treatment with Semont and Gans manoeuvres, but superior to Brandt-Daroff exercises.

Influence of population and exercise protocol characteristics on hemodynamic determinants of post-aerobic exercise hypotension.

Due to differences in study populations and protocols, the hemodynamic determinants of post-aerobic exercise hypotension (PAEH) are controversial. This review analyzed the factors that might influence PAEH hemodynamic determinants, through a search on PubMed using the following key words: "postexercise" or "post-exercise" combined with "hypotension", "blood pressure", "cardiac output", and "peripheral vascular resistance", and "aerobic exercise" combined only with "blood pressure". Forty-seven studies were selected, and the following characteristics were analyzed: age, gender, training status, body mass index status, blood pressure status, exercise intensity, duration and mode (continuous or interval), time of day, and recovery position. Data analysis showed that 1) most postexercise hypotension cases are due to a reduction in systemic vascular resistance; 2) age, body mass index, and blood pressure status influence postexercise hemodynamics, favoring cardiac output decrease in elderly, overweight, and hypertensive subjects; 3) gender and training status do not have an isolated influence; 4) exercise duration, intensity, and mode also do not affect postexercise hemodynamics; 5) time of day might have an influence, but more data are needed; and 6) recovery in the supine position facilitates systemic vascular resistance decrease. In conclusion, many factors may influence postexercise hypotension hemodynamics, and future studies should directly address these specific influences because different combinations may explain the observed variability in postexercise hemodynamic studies.

Influence of population and exercise protocol characteristics on hemodynamic determinants of post-aerobic exercise hypotension

Due to differences in study populations and protocols, the hemodynamic determinants of post-aerobic exercise hypotension (PAEH) are controversial. This review analyzed the factors that might influence PAEH hemodynamic determinants, through a search on PubMed using the following key words: “postexercise” or “post-exercise” combined with “hypotension”, “blood pressure”, “cardiac output”, and “peripheral vascular resistance”, and “aerobic exercise” combined only with “blood pressure”. Forty-seven studies were selected, and the following characteristics were analyzed: age, gender, training status, body mass index status, blood pressure status, exercise intensity, duration and mode (continuous or interval), time of day, and recovery position. Data analysis showed that 1) most postexercise hypotension cases are due to a reduction in systemic vascular resistance; 2) age, body mass index, and blood pressure status influence postexercise hemodynamics, favoring cardiac output decrease in elderly, overweight, and hypertensive subjects; 3) gender and training status do not have an isolated influence; 4) exercise duration, intensity, and mode also do not affect postexercise hemodynamics; 5) time of day might have an influence, but more data are needed; and 6) recovery in the supine position facilitates systemic vascular resistance decrease. In conclusion, many factors may influence postexercise hypotension hemodynamics, and future studies should directly address these specific influences because different combinations may explain the observed variability in postexercise hemodynamic studies.

Indications, benefits, and risks of Pilates exercise for people with chronic low back pain: a Delphi survey of Pilates-trained physical therapists.

BACKGROUND: The effectiveness of Pilates exercise for treating people with chronic low back pain (CLBP) is yet to be established. Understanding how to identify people with CLBP who may benefit, or not benefit, from Pilates exercise and the benefits and risks of Pilates exercise will assist in trial design. OBJECTIVES: The purpose of this study was to establish a consensus regarding the indications, contraindications, and precautions of Pilates exercise and the potential benefits and risks of Pilates exercise for people with CLBP. METHODS: A panel of 30 Australian physical therapists experienced in the use of Pilates exercise were surveyed using the Delphi technique. Three electronic questionnaires were used to collect participant opinions. Answers to open-ended questions were analyzed thematically, combined with research findings, and translated into statements about Pilates exercise. Participants then rated their level of agreement with statements using a 6-point Likert scale. Consensus was achieved when 70% of panel members agreed or disagreed with an item. RESULTS: Thirty physical therapists completed the 3 questionnaires. Consensus was reached on 100% of items related to the benefits, indications, and precautions of Pilates exercise, on 50% of items related to risks, and on 56% of items related to contraindications. Participants agreed that people who have poor body awareness and maladaptive movement patterns may benefit from Pilates exercise, whereas those with pre-eclampsia, unstable spondylolisthesis, or a fracture may not benefit. Participants also agreed that Pilates exercise may improve functional ability, movement confidence, body awareness, posture, and movement control. LIMITATIONS: The findings reflect the opinions of only 30 Australian physical therapists and not all health professionals nationally or internationally. These findings, therefore, need to be verified in future research trials. CONCLUSIONS: These findings contribute to a better understanding of the indications, contraindications, and precautions of Pilates exercise and the benefits and risks of Pilates exercise for people with CLBP. This information can assist in design of future trials examining the effectiveness of Pilates exercise.

Practice of yoga may cause damage of both sciatic nerves: a case report.

Sciatic nerve traumatic damage very rarely occurs bilaterally. We describe the case of a 67-year-old woman who reported a bilateral traumatic lesion of the sciatic nerve during practice of yoga. Nerve conduction studies showed a bilateral sciatic nerve neuropathy, mostly affecting the peroneal component. Lumbar plexus MRI documented regular anatomical features of the main principal nerve roots with bilateral T2 signal alteration of roots L4, L5 and S1 that extended into the sciatic nerves showing both increase in size, probably related to chronic injury of nerves, and an alteration in diffusion signal that suggested a recent acute overlapped process.