Effects of aquatic exercises in patients after total hip arthroplasty: A systematic review.

BACKGROUND: Total hip arthroplasty (THA) is a surgical procedure that can alter physical function and quality of life. OBJECTIVES: The aim was to verify the effects of aquatic exercises compared with exercises on land, control or other modalities, in patients undergoing THA on the primary outcomes: self-reported physical function, quality of life and pain; and secondary outcomes: muscle strength, functional capacity and gait. DESIGN: Systematic review that followed the PRISMA Statement and PROSPERO registered. The search was performed in the following databases: Web of Science, Embase, Medline, Cinahl, Lilacs, SPORTDiscus, Cochrane Library, Scopus, SciELO, and PEDro, from 1945 to 2022. The risk of bias assessment was performed using the Risk of Bias 2 (RoB2) from the Cochrane Collaboration. RESULTS: Three randomized controlled trials (RCTs) were included, with a total of 364 participants. In the selection process, two publications from the same study were found. The RoB2 assessment classified one RCT as "high risk of bias" and the others as "low risk of bias". Therefore, the analysis of the results considered only studies with a low risk of bias. For the self-reported physical function outcome, evaluated by WOMAC, improvement was observed in favor of aquatic exercises, when started on the 14th postoperative day. Pain improved after 24th week postoperative, in favor of exercise (effect size between 0.2 and 0.4). Quality of life, verified only by one RCT, improved at each time point evaluated (effect size between 0.01 and 0.10). The functional capacity showed no difference between the groups. This was the first systematic review to assess the benefits of aquatic exercises specifically in THA and it was possible to infer that the exercises initiated after 14 days of postoperative are safer. The protocol should include proprioceptive, coordination, and resistance exercises. The session can last around 30 min and is held three times a week. CONCLUSION: Decision making for treatment in the postoperative of THA may include aquatic exercises as a safe and efficacious alternative to improve self-reported physical function, pain, quality of life, and muscle resistance.

Comparing the effects of aquatic exercises with or without high intensity on the functional status, muscular endurance, and performance of patients with chronic low back pain.

BACKGROUND: The prevalence of low back pain is lower when physical fitness (aerobic and muscular) is higher. Strength exercises are important for subjects with low back pain, but there are few studies on the inclusion of aerobic exercise in low back pain programs. The aim of this study was to compare the effects of aquatic exercises with or without high-intensity component on the functional status, lumbar and abdominal muscle endurance, and performance of subjects with chronic low back pain. METHODS: Forty-eight volunteers between 20 and 60 years old were randomly allocated to an experimental group AEDWR (aquatic exercises plus deep-water running group, N.=25) or to a control group AE (aquatic exercises only group, N.=23). The dependent variables included functional status (Repeated Sit-to-Stand test), lumbar (Sorensen test) and abdominal (One Minute Abdominal test) muscle endurance, and physical performance (Maximum Physical Fitness test), which were measured before and after the 9-week intervention and at 21 weeks of follow-up. RESULTS: Lumbar endurance was higher in the AEDWR group at the end of the treatment, with a mean difference (MD) of 43.2 seconds, 95% confidence intervals (CI) (9.6; 76.7), P=0.01, d̅=0.74, and better in the follow-up with MD=40.2 seconds, 95% CI (7.1; 73.3), P=0.02, d̅=0.71, than in the AE group. Participant performance also improved on the 9th week in the AEDWR group, with an MD=0.53 kgf, 95% CI (0.008; 0.98), P=0.02, d̅=0.60. CONCLUSIONS: The addition of deep-water running exercise to aquatic exercises improved lumbar muscle endurance and performance when compared with aquatic exercises only, and this effect was maintained during the follow-up to lumbar muscle endurance.

Effectiveness of additional deep-water running for disability, lumbar pain intensity, and functional capacity in patients with chronic low back pain: A randomised controlled trial with 3-month follow-up.

BACKGROUND: Aquatic exercise (AQE) programme is commonly used as an alternative to the chronic low back pain (CLBP) treatment. The addition of aquatic aerobic exercises to AQE may be beneficial to patients with CLBP. DESIGN: Randomised controlled trial. OBJECTIVES: To assess the effectiveness of AQE with the addition of aerobic exercise - deep-water running (DWR) - compared to exclusive AQE in improving disability, lumbar pain intensity, and functional capacity in patients with CLBP. METHODS: Fifty-four adult patients with CLBP were randomised either to the experimental group (AQE + DWR) or the control group (AQE). An assessor who was blinded to the group allocation performed both pre- and post-interventions assessments. Both treatments lasted 9 weeks, with a 3-month follow-up. The primary outcome was disability, as evaluated using the Roland Morris Disability Questionnaire. The secondary outcomes were pain and functional capacity; pain was assessed using a visual analogue scale (VAS), and functional capacity (travelled distance) was measured using the 6-min walk test (6WT). RESULTS: A significant difference in pain was observed between groups after intervention in favour of DWR (mean difference -1.3 cm [95% confidence interval (CI) -2.17 to -0.45], d‾ = 0.80 [95% CI 0.22 to 1.33]). CONCLUSION: Treatment with DWR was effective in the short term for achieving the desired outcome of pain reduction when compared with AQE only but not for disability and functional capacity.

Velocity-specific knee strength between professional and under-17 female volleyball players.

BACKGROUND: Many studies have investigated isokinetic performance in volleyball players but not through surface maps. OBJECTIVES: The goals of this study were to assess velocity-specific isokinetic knee extensor-flexor muscle strength and to compare the isokinetic knee extensor-flexor muscles between professional (PRO) and under-17 (U17) female volleyball players. METHOD: This cross-sectional laboratory study was developed with two groups: PRO (n = 12), medianage = 21.3 years, and U17 (n = 9), medianage = 15 years. Peak torque, total work, mean power, angle of peak torque, hamstring-quadriceps torque ratio (H-Q ratio) and torque-angle-velocity surface maps were analysed from knee extension-flexion at 60, 120 and 300 degrees per second (°/s). RESULTS: Significant differences were identified for extensor peak torque between PRO x = 202.3 Newton metre (N·m) (standard deviation [SD] = 24.4) and U17 x = 141.6 N·m (30.1) at 60 °/s (p < 0.001; d = 2.21) as well as flexor peak torque (PRO x = 75.7 N·m [10.3] and U17 x = 57.7 N·m [11.4]) at 120 °/s (p < 0.001; d = 1.65) for the dominant limb. There were also significant group differences for total work and mean power at all velocities for extension and flexion. Surface maps demonstrated higher torque at lower speeds for both groups with smaller torque changes across velocities for flexion. CONCLUSION: Different groups of female volleyball players showed contrasting concentric knee muscle strength across isokinetic velocities. CLINICAL IMPLICATIONS: These results demonstrate the importance of specific strength training for different age groups, even within the same sport, and provide insight into muscle strength.

ISOKINETIC MUSCLE PERFORMANCE AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A CASE-CONTROL STUDY.

BACKGROUND: and Purpose: Knee muscle strength deficits have been reported in individuals who have undergone anterior cruciate ligament reconstruction (ACLR). Isokinetic testing is a valid way to assess muscle strength. Some isokinetic variables, including the range of motion in the phases to attain a specific velocity, load range (sustained specific velocity), time to achieve deceleration, and qualitative analysis of the torque-angle velocity relationship, may contribute to understanding recovery of these individuals after surgery. Thus, the purpose of this study was to compare the load range (LR), time to attain velocity (TTAV), deceleration time (DT) phases, total range of motion (ROM), peak torque/body mass (PT/BM), angle of peak torque (AngPT) during LR and torque-angle-velocity relationships (TAV3D) between post ACLR and matched control subjects.Study design: Case-control. METHODS: Seven men who underwent ACLR and seven matched controls were evaluated from four to six months after surgery. Testing was performed on a Biodex System 4 isokinetic dynamometer in concentric mode at 60, 120 and 300 °/s, for knee flexion and extension. RESULTS: Statistically significant differences were seen for extension ROM at 60 °/s where ROM was greater in the control group. PT/BM for extensors was also significantly greater in controls by 20 % compared to ACLR at 60 and 120 °/s. PT/BM for flexors was significantly greater for controls at 60 °/s (∼15 %). TAV3D showed differences in torque and, specifically, the control group sustained knee flexion torque for a greater range of motion when compared to the ACLR group. CONCLUSION: The ACL group presented with lower ROM and PT/BM, therefore exhibiting worse muscle performance in comparison to the control group.Level of Evidence: 3.

Effect of the Pilates method on physical conditioning of healthy subjects: a systematic review and meta-analysis.

INTRODUCTION: Physical conditioning consists of a variety of health-related attributes and Pilates exercises are described as a form of this conditioning. The objective of this systematic review was to determine the effect of the Pilates method on health and ability outcome of the physical conditioning of healthy individuals. EVIDENCE ACQUISITION: The search was performed in the following databases: Medline, Cinahl, Embase, Lilacs, Scielo, Web of Science, PEDro, Cochrane Controlled Trials Register Library, Scopus, Science Direct and Google Scholar. (1950-2014). Included studies were randomized controlled trials (RCTs) that assessed the effects of the Pilates method on healthy subjects. EVIDENCE SYNTHESIS: Nine RCTs met the inclusion criteria. Pilates improved abdominal muscular endurance when compared with no exercises (mean difference [MD]=9.53%; 95% CI: 2.41, 16.43; P=0.009), however, there was no difference in flexibility (MD=4.97; 95% CI: -0.53, 10.47; P=0.08). Some positive effects (up to 6 months) of the Pilates practice were found in some RCTs' results as follows: Improvement of dynamic balance, quality of life and back muscle flexibility. CONCLUSIONS: The results indicate the Pilates exercises performed on the mat or apparatus 2 to 3 times a week, for 5 to 12 weeks, improves abdominal muscular endurance (on average, 10 more abdominals curls in 1-minute sit-up test) for both genders, when compared to no exercises.

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

BACKGROUND: There is a lack of questionnaires in Brazilian Portuguese to evaluate patient-reported lower limb function. OBJECTIVE: To translate, cross-culturally adapt to the Brazilian population, and evaluate the psychometric properties of the Lower Extremity Functional Scale (LEFS). METHOD: The 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. RESULTS: The 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. CONCLUSION: The LEFS-Brazil is reliable, valid and responsive.

The electromyographic activity of the multifidus muscles during the execution of two pilates exercises--swan dive and breast stroke--for healthy people.

OBJECTIVE: The 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. METHODS: Sixteen 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. RESULTS: The 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. CONCLUSION: The 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.

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

BACKGROUND: There is a lack of questionnaires in Brazilian Portuguese to evaluate patient-reported lower limb function. OBJECTIVE: To translate, cross-culturally adapt to the Brazilian population, and evaluate the psychometric properties of the Lower Extremity Functional Scale (LEFS). METHOD: The 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. RESULTS: The 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 () intra-observer = -1.52 and 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. CONCLUSION: The LEFS-Brazil is reliable, valid and responsive. .

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

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