Biomarkers of post-match recovery in semi-professional and professional football (soccer).

High-level football (soccer) players face intense physical demands that result in acute and residual fatigue, impairing their physical performance in subsequent matches. Further, top-class players are frequently exposed to match-congested periods where sufficient recovery times are not achievable. To evaluate training and recovery strategies, the monitoring of players' recovery profiles is crucial. Along with performance and neuro-mechanical impairments, match-induced fatigue causes metabolic disturbances denoted by changes in chemical analytes that can be quantified in different body fluids such as blood, saliva, and urine, thus acting as biomarkers. The monitoring of these molecules might supplement performance, neuromuscular and cognitive measurements to guide coaches and trainers during the recovery period. The present narrative review aims to comprehensively review the scientific literature on biomarkers of post-match recovery in semi-professional and professional football players as well as provide an outlook on the role that metabolomic studies might play in this field of research. Overall, no single gold-standard biomarker of match-induced fatigue exists, and a range of metabolites are available to assess different aspects of post-match recovery. The use of biomarker panels might be suitable to simultaneously monitoring these broad physiological processes, yet further research on fluctuations of different analytes throughout post-match recovery is warranted. Although important efforts have been made to address the high interindividual heterogeneity of available markers, limitations inherent to these markers might compromise the information they provide to guide recovery protocols. Further research on metabolomics might benefit from evaluating the long-term recovery period from a high-level football match to shed light upon new biomarkers of post-match recovery.

Impact and control of the COVID pandemic in an elite sports club: Real Madrid / Impacto y control de la pandemia de COVID en atletas de un club deportivo de élite: Real Madrid

La incidencia y los factores de riesgo de mal pronóstico en pacientes con COVID son bien conocidos, así como las medidas de protección en poblaciones de alto riesgo. En cambio, el comportamiento epidemiológico y clínico de esta enfermedad en la población de deportistas de élite que son el paradigma de la buena salud, es poco conocido. Los datos sobre COVID en deportistas son escasos y se han centrado preferentemente en las consecuencias sobre el rendimiento deportivo de las medidas de confinamiento y en las consecuencias fisiopatológicas de los deportistas infectados.El Real Madrid es una gran institución deportiva de élite con instalaciones en la ciudad de Madrid donde entrenan diariamente 600 atletas. La incidencia de COVID durante un periodo de estudio de 671 días de observación en deportistas profesionales o amateurs que trabajan en la institución ha sido de 0,74 por cada 1.000 días de exposición. La enfermedad ha sido asintomática u oligosintomática en todos los atletas y no ha requerido ningún ingreso hospitalario.Los equipos no tuvieron que suspender ninguno de sus compromisos deportivos por COVID durante el periodo de estudio y no hubo evidencia de brotes de transmisión interna entre miembros de los diferentes equipos. (AU)

The incidence and risk factors for poor outcome in patients with COVID are well known, as are the protective measures in high-risk populations. In contrast, the epidemiological and clinical behavior of this disease in the population of elite athletes who are the paradigm of good health is poorly understood. Data on COVID in athletes are scarce and have focused preferentially on the consequences on sports performance of confinement measures and on the pathophysiological risks of infected athletes.Real Madrid is a large elite sports institution with facilities in the City of Madrid where 600 athletes train daily. The incidence of COVID during a study period of 671 days of observation in athletes, professional or amateur, working in the institution has been 0,74 per 1,000 days of exposure. The disease has been asymptomatic or oligosymptomatic in all athletes and did not require any hospital admissions.The different teams did not have to suspend any of its sportive commitments for COVID during the study period and there was no evidence of outbreaks of internal transmission between members of the different teams. (AU)

Compositional Aspects of Beverages Designed to Promote Hydration Before, During, and After Exercise: Concepts Revisited.

Hypohydration can impair aerobic performance and deteriorate cognitive function during exercise. To minimize hypohydration, athletes are recommended to commence exercise at least euhydrated, ingest fluids containing sodium during long-duration and/or high-intensity exercise to prevent body mass loss over 2% and maintain elevated plasma osmolality, and rapidly restore and retain fluid and electrolyte homeostasis before a second exercise session. To achieve these goals, the compositions of the fluids consumed are key; however, it remains unclear what can be considered an optimal formulation for a hydration beverage in different settings. While carbohydrate-electrolyte solutions such as sports drinks have been extensively explored as a source of carbohydrates to meet fuel demands during intense and long-duration exercise, these formulas might not be ideal in situations where fluid and electrolyte balance is impaired, such as practicing exercise in the heat. Alternately, hypotonic compositions consisting of moderate to high levels of electrolytes (i.e., ≥45 mmol/L), mainly sodium, combined with low amounts of carbohydrates (i.e., <6%) might be useful to accelerate intestinal water absorption, maintain plasma volume and osmolality during exercise, and improve fluid retention during recovery. Future studies should compare hypotonic formulas and sports drinks in different exercise settings, evaluating different levels of sodium and/or other electrolytes, blends of carbohydrates, and novel ingredients for addressing hydration and rehydration before, during, and after exercise.

A Maximal Incremental Test in Cyclists Causes Greater Peripheral Fatigue in Biceps Femoris.

Purpose: The aim of this study was to determine the changes in neuromuscular contractile properties in elite cyclists associated to the peripheral fatigue produced in a maximal incremental test in cycle ergometer. Methods: Forty-eight volunteers' well-trained male cyclists were evaluated during the competition season within a recovery microcycle. Tensiomyography was used before and after performing an incremental test until exhaustion in cycle ergometer to measure the radial muscle belly displacement of the vastus lateralis (VL), rectus femoris (RF), and biceps femoris (BF) on the dominant leg. Maximum radial muscle belly displacement (Dm), contraction time (Tc), delay time (Td), sustain time (Ts), and radial displacement velocity (Vrd) were measured. Mixed-design factorial analysis of variance was used to detect changes in the mechanical and neuromuscular characteristics after a maximal incremental exercise test. Results: The results show in the evaluated muscles a moderate-large decrease (p < .01, η2 = 0.06-0.51) in Tc, Td, Dm, Ts, and Vrd. This decrease occurs more sharply in the BF than in RF or VL. Conclusion: An incremental effort until exhaustion produces peripheral fatigue associated with a decrease in Dm, Tc, Td, Ts, and Vrd, being more pronounced in biceps femoris than in vastus lateralis and rectus femoris. Coaches can use these changes found in the contractile properties as a reference to detect the muscle fatigue degree that certain training models pose for the cyclist.

Effect of exercise intensity on the hepcidin response / Efecto del ejercicio intenso en la respuesta de la hepcidina

INTRODUCCIÓN: el sistema nervioso simpático modula muchas respuestas metabólicas y hormonales al ejercicio. No se conoce bien su influencia en los niveles séricos de la hormona hepcidina, un regulador clave del metabolismo del hierro, durante el ejercicio. MATERIAL Y MÉTODOS: este estudio examinó los efectos de la intensidad del ejercicio en la respuesta de la hepcidina y trató de relacionar las respuestas de catecolaminas y hepcidina al ejercicio. Quince ciclistas y triatletas entrenados realizaron una prueba de esfuerzo máximo con un cicloergómetro seguido de dos pruebas de intensidades diferentes (moderadas y altas) en orden aleatorio. Las dos pruebas consistieron en 30 minutos de ejercicio a una intensidad del 10% inferior al correspondiente al umbral ventilatorio (VT) (30-MI) o el punto de compensación respiratoria (RCP) (30-HI) Resultados y discusión: a pesar de la mayor cantidad de niveles de noradrenalina detectados después de la prueba de 30-MI versus la línea de base (p <0.01) y después de la prueba 30-HI versus 30-MI (p <0.01), la respuesta de la hepcidina no fue modificada por la intensidad del ejercicio. CONCLUSIÓN: dado que no pudimos relacionar la respuesta de la hepcidina a un ejercicio que se sabe que provoca un alto nivel de actividad suprarrenal, nuestros hallazgos sugieren que la intensidad del ejercicio, y por extensión la activación simpática, no modulan la respuesta de la hepcidina al ejercicio

INTRODUCTION: The sympathetic nervous system modulates many metabolic and hormonal responses to exercise. It is not well known its influence on serum levels of peptide hormone hepcidin, a key iron metabolism regulator, during exercise. MATERIAL AND METHODS: This study examined the effects of exercise intensity on the hepcidin response and treated to relate catecholamine and hepcidin responses to exercise. Fifteen trained cyclists and triathletes undertook a maximal stress test on a cycle ergometer followed by two different intensity tests (moderate and high) in random order. The two tests consisted of 30 min of exercise at an intensity 10% lower than that corresponding to the ventilatory threshold (VT) (30-MI) or the respiratory compensation point (RCP) (30-HI). RESULTS AND DISCUSSION: Despite higher norepinephrine levels detected after the 30-MI test versus baseline (p <0.01) and after the 30-HI test versus 30-MI (p <0.01), the hepcidin response was unmodified by the intensity of exercise. CONCLUSION: Given we were unable to relate the hepcidin response to an exercise known to elicit high sympatheticadrenal activity, our findings suggest that exercise intensity, and by extension the sympathetic activation, does not modulate the hepcidin response to exercise

Mechanical efficiency of high versus moderate intensity aerobic exercise in coronary heart disease patients: A randomized clinical trial.

BACKGROUND: Mechanical efficiency (ME) refers to the ability of an individual to transfer energy consumed by external work. A decreased ME, could represent an increased energy cost during exercise and may, therefore, be limited in terms of physical activity. This study aimed to compare the influence of two different exercise protocols: moderate continuous training (MCT) versus high intensity interval training (HIIT), as part of a cardiac rehabilitation program on ME values among coronary patients. METHODS: One hundred and ten coronary patients were assigned to either HIIT or MCT groups for 8 weeks. Incremental exercise tests in a cycle ergometer were performed to obtain VO2peak. Net energy expenditure (EE) and ME were obtained at intensities corresponding to the first (VT1) and second (VT2) ventilatory thresholds, and at VO2peak. RESULTS: Both exercise programs significantly increase VO2peak with a higher increase in the HIIT group (2.96 ± 2.33 mL/kg/min vs. 3.88 ± 2.40 mL/kg/min, for patients of the MCT and HIIT groups, respectively, p < 0.001). The ME at VO2peak and VT2 only significantly increased in the HIIT group. At VT1, ME significantly increased in both groups, with a greater increase in the HIIT group (2.20 ± ± 6.25% vs. 5.52 ± 5.53%, for patients of the MCT and HIIT groups, respectively, p < 0.001). CONCLUSIONS: The application of HIIT to patients with chronic ischemic heart disease of low risk re- sulted in a greater improvement in VO2peak and in ME at VT1, than when MCT was applied. Moreover, only the application of HIIT brought about a significant increase in ME at VT2 and at VO2peak.

Neuromuscular Parameters Predict the Performance in an Incremental Cycling Test.

The aim was to determine the predictive capacity of neuromuscular parameters on physiological predictors of performance related to pedaling power. The sample comprised fifty elite cyclists. On the same day, they were given a neuromuscular evaluation with tensiomyography (TMG) and then performed an effort test on a cycle ergometer until exhaustion. The TMG recorded the maximum radial muscle belly displacement, contraction time, delay time, derivative normalized response speed, and lateral symmetry. Peak power output (Wpeak·kg-1), effort time, maximum lactate concentration, power in the first lactate threshold, and power in the second lactate threshold were recorded in the effort test. Linear regression analysis was used to determine the explanatory capacity of neuromuscular parameters on potential cycling performance indicators. A higher Wpeak·kg-1 during a maximal incremental test on the cycle ergometer can be predicted moderately (R2=0.683; R2a=0.615; R=0.826; Std. Error=0.26017; p<0.001) by a longer rectus femoris contraction time and a greater radial muscle belly displacement of the vastus lateralis and vastus medialis as well as a slower normalized response speed of the biceps femoris. In conclusion, neuromuscular parameters can partially explain performance in a specific cycling test until exhaustion.

Effects of age, sex, sweat rate and environmental conditions on heart rate and perceived exertion in indoor cycling.

BACKGROUND: Indoor cycling sessions are usually guided by heart rate (HR) and rating of perceived exertion (RPE). This study was designed to examine the effects of sex, age, previous experience, use of a HR monitor, estimated sweat rate and room temperature and humidity increases on HR and RPE during indoor cycling sessions. METHODS: Measurements were made in 39 sessions performed by 300 experienced subjects. Sweat rate was categorized as SR1≥750 mL, SR2 400-749 mL, and SR3<400 mL; temperature increase as T1≤0.2 °C, T2 0.2-1.5 °C, and T3>1.5 °C; and humidity as H1≤2%, H2 2-15%, and H3>15%. Mean HR was determined for the sessions and RPE recorded at the start, middle and end of each session. RESULTS: Significant differences in HR were observed between SR1 and SR3 (148.22±12.17 vs. 141.73±17.39 bpm; P<0.05) and between T1 and T2 (141.01±16.38 vs. 146.95±15.29 bpm; P<0.05). The RPE was lower (P<0.05) for T1 than T2 or T3 in all recordings and for H1 than H2 or H3 at the session start and middle. CONCLUSIONS: Our results indicate that real (%HRmax) and perceived (RPE) intensity of exercise in an indoor cycling session are influenced by factors such as the estimated sweat rate, or the increase in temperature or relative humidity produced in the cycling room.

The QardioArm App in the Assessment of Blood Pressure and Heart Rate: Reliability and Validity Study.

BACKGROUND: Self-measurement of blood pressure is a priority strategy for managing blood pressure. OBJECTIVE: The aim of this study was to evaluate the reliability and validity of blood pressure and heart rate following the European Society of Hypertension's international validation protocol, as measured with the QardioArm, a fully automatic, noninvasive wireless blood pressure monitor and mobile app. METHODS: A total of 100 healthy volunteers older than 25 years from the general population of Ciudad Real, Spain, participated in a test-retest validation study with two measurement sessions separated by 5 to 7 days. In each measurement session, seven systolic blood pressure, diastolic blood pressure, and heart rate assessments were taken, alternating between the two devices. The test device was the QardioArm and the previously validated criterion device was the Omron M3. Sessions took place at a single study site with an evaluation room that was maintained at an appropriate temperature and kept free from noises and distractions. RESULTS: The QardioArm displayed very consistent readings both within and across sessions (intraclass correlation coefficients=0.80-0.95, standard errors of measurement=2.5-5.4). The QardioArm measurements corresponded closely to those from the criterion device (r>.96) and mean values for the two devices were nearly identical. The QardioArm easily passed all validation standards set by the European Society of Hypertension International Protocol. CONCLUSIONS: The QardioArm mobile app has validity and it can be used free of major measurement error.

[Not Available].

Introducción y objetivos: un dispositivo llamado FeelBreathe ® (FB) se ha diseñado, desarrollado y patentado para el entrenamiento de la musculatura inspiratoria (IMT). Para examinar los efectos de FB en la ventilación pulmonar y el intercambio gaseoso durante el ejercicio, se tomaron medidas de 27 voluntarios varones sanos entrenados (edad: 32,5 ± 7,2 años). Métodos: al inicio del estudio se midieron tanto la presión inspiratoria máxima estática (PIM) y la capacidad pulmonar mediante espirometría. Seguidamente, se realizó un test incremental en cicloergómetro para determinar el VO 2 pico. Cada sujeto, tres días más tarde, realizó aleatoriamente tres pruebas idénticas submáximas en cicloergómetro a una intensidad comprendida al 50% entre los umbrales ventilatorios bajo tres condiciones de respiración diferentes: a) respiración oronasal (ONB), b) respiración nasal (NB) y c) la respiración nasal a través del FB. Resultados: la prueba con FB mostró una ventilación minuto (VE) y una frecuencia respiratoria (BF) inferior que en las pruebas de NB, la cual a su vez tenía menor BF, pero similar VE que ONB (p < 0,001). A pesar de esto, FB obtuvo valores similares de VO 2 , cociente respiratorio (RER), frecuencia cardiaca (HR) y saturación de oxígeno capilar periférica (SpO2) en comparación con NB y ONB. Esto último puede ocurrir debido en parte al aumento del volumen tidal (VT) y el tiempo de expiración (Tex) en FB hasta el mismo nivel que en la prueba de NB, los cuales fueron un 15% y 14% en ambas pruebas, respectivamente, superiores a ONB (p < 0,001). El porcentaje de tiempo de inspiración (Ti/Tot) fue 7% mayor en la prueba de FB en comparación con NB y ONB (p < 0,001). Solamente en la prueba de FB se encontró un aumento de la presión final de la espiración de CO 2 (P ET CO 2 ) y la reducción de la presión final de la espiración de O 2 (P ET O 2 ) y la fracción de expiración de O 2 (FEO 2 ). Conclusiones: FeelBreathe es un nuevo dispositivo de restricción nasal que estimula los músculos inspiratorios para producir un patrón de respiración más eficiente durante el ejercicio en los seres humanos bien entrenados.

Effects of a nasal ventilator restriction device on lung ventilation and gas exchange during exercise in healthy subjects / Efectos de un dispositivo de restricción ventilatoria nasal sobre la ventilación pulmonar e intercambio gaseoso durante el ejercicio en personas sanas

Introduction and objectives: A device called FeelBreathe® (FB) has been designed, developed and patented for inspiratory muscle training (IMT). In order to examine the effects of FB on lung ventilation and gas exchange during exercise, 27 trained male healthy volunteers (age: 32.5 ± 7.2 years) were measured. Methods: Maximum static inspiratory pressure (PImax) and spirometry to determine lung capacity were measured at baseline. We continued with an incremental cycloergometer to determine the VO2 peak. Three days later, each subject performed randomly three identical submaximal cycloergometer tests at 50% between ventilatory thresholds under three different breathing conditions: a) oronasal breathing (ONB), b) nasal breathing (NB) and c) nasal breathing through the FB. Results: FB trial showed lower minute ventilation (VE) and breathing frequency (BF) than NB, which had lower BF, but similar VE than ONB (p < 0.001). The percentage of inspiration time (Ti/Tot) was 7% greater in FB compared to NB and ONB (p < 0.001). Increased end-tidal pressure of CO2 (PETCO2 ) and reduced end-tidal pressure of O2 (PETO2 ) and fraction of O2 expiration (FEO2 ) were found only in FB. Conclusions: FeelBreathe is a new nasal restriction device that stimulates the inspiratory muscles to produce a breathing pattern more efficiency during exercise in well-trained humans (AU)

Introducción y objetivos: un dispositivo llamado FeelBreathe® (FB) se ha diseñado, desarrollado y patentado para el entrenamiento de la musculatura inspiratoria (IMT). Para examinar los efectos de FB en la ventilación pulmonar y el intercambio gaseoso durante el ejercicio, se tomaron medidas de 27 voluntarios varones sanos entrenados (edad: 32,5 ± 7,2 años). Métodos: al inicio del estudio se midieron tanto la presión inspiratoria máxima estática (PIM) y la capacidad pulmonar mediante espirometría. Seguidamente, se realizó un test incremental en cicloergómetro para determinar el VO2 pico. Cada sujeto, tres días más tarde, realizó aleatoriamente tres pruebas idénticas submáximas en cicloergómetro a una intensidad comprendida al 50% entre los umbrales ventilatorios bajo tres condiciones de respiración diferentes: a) respiración oronasal (ONB), b) respiración nasal (NB) y c) la respiración nasal a través del FB. Resultados: la prueba con FB mostró una ventilación minuto (VE) y una frecuencia respiratoria (BF) inferior que en las pruebas de NB, la cual a su vez tenía menor BF, pero similar VE que ONB (p < 0,001). A pesar de esto, FB obtuvo valores similares de VO2 , cociente respiratorio (RER), frecuencia cardiaca (HR) y saturación de oxígeno capilar periférica (SpO2) en comparación con NB y ONB. Esto último puede ocurrir debido en parte al aumento del volumen tidal (VT) y el tiempo de expiración (Tex) en FB hasta el mismo nivel que en la prueba de NB, los cuales fueron un 15% y 14% en ambas pruebas, respectivamente, superiores a ONB (p < 0,001). El porcentaje de tiempo de inspiración (Ti/Tot) fue 7% mayor en la prueba de FB en comparación con NB y ONB (p < 0,001). Solamente en la prueba de FB se encontró un aumento de la presión final de la espiración de CO2 (PETCO2 ) y la reducción de la presión final de la espiración de O2 (PETO2 ) y la fracción de expiración de O2 (FEO2 ). Conclusiones: FeelBreathe es un nuevo dispositivo de restricción nasal que estimula los músculos inspiratorios para producir un patrón de respiración más eficiente durante el ejercicio en los seres humanos bien entrenados (AU)

Heart rate recovery normality data recorded in response to a maximal exercise test in physically active men.

BACKGROUND: Despite a growing clinical interest in determining the heart rate recovery (HRR) response to exercise, the limits of a normal HRR have not yet been well established. PURPOSE: This study was designed to examine HRR following a controlled maximal exercise test in healthy, physically active adult men. METHODS: The subjects recruited (n = 789) performed a maximal stress test on a treadmill. HRR indices were calculated by subtracting the first and third minute heart rates (HRs) during recovery from the maximal HR obtained during stress testing and designated these as HRR-1 and HRR-3, respectively. The relative change in HRR was determined as the decrease in HR produced at the time points 1 and 3 min after exercise as a percentage of the peak HR (%HRR-1/HR(peak) and %HRR-3/HR(peak), respectively). Percentile values of HRR-1 and HRR-3 were generated for the study population. RESULTS: Mean HHR-1 and HHR-3 were 15.24 ± 8.36 and 64.58 ± 12.17 bpm, respectively, and %HRR-1/HR(peak) and %HRR-3/HR(peak) were 8.60 ± 4.70 and 36.35 ± 6.79%, respectively. Significant correlation was detected between Peak VO2 and HRR-3 (r = 0.36; p < 0.001) or %HRR-3/HR(peak) (r = 0.23; p < 0.001). CONCLUSIONS: Our study provides normality data for HRR following a maximal Ergometry test obtained in a large population of physically active men.

Acute effects of whole-body vibration on neuromuscular responses in older individuals: implications for prescription of vibratory stimulation.

The aim of this study was to analyze surface electromyography activity (sEMG) and rating of perceived exertion (RPE) responses in different muscles while standing on a vibrating platform producing oscillations of different frequencies and amplitudes. Twenty community-dwelling older adults (79.6 ± 3.2 years) took part in the research. Subjects were exposed to 12 different vibration treatments of 15 seconds separated by 1 minute of rest in random order to check the influence of frequency (25, 35, and 45 Hz) and amplitude (1 mm [low] and 3.1 mm [high]) vibration on sEMG signal and RPE. Additionally, the use of a soft pad was also examined for its influence on these measures. Three-factor analysis of variance for RPE and both lower and whole-body sEMGs revealed a significant amplitude main effect (p < 0.01), and soft mat effect (p < 0.01), and a significant frequency main effect (p < 0.01). The major findings were that sEMG and RPE increased with the acceleration of the vibration; moreover, the increments of sEMG were highly correlated with RPE. The results of this study suggest that using the RPE method after each exercise would allow exercise and health professionals to assess the intensity levels that correspond to the level of the vibratory program in older adults.

Effectiveness of the physical therapy Godelive Denys-Struyf method for nonspecific low back pain: primary care randomized control trial.

STUDY DESIGN: A simple blind, random controlled clinical trial. OBJECTIVE: To assess the effectiveness of physiotherapy treatment based on the muscular and articular chains Godelive Denys-Struyf (GDS) method for nonspecific low back pain (LBP) in primary care. SUMMARY OF BACKGROUND DATA: Despite a systematic review by the European COST ACTION B13 "Low back pain: guidelines for its management," there are still many unresolved questions regarding the effectiveness of the different physical therapy treatments used for LBP. SETTING: 21 physicians and physiotherapists in 7 Primary Care Centers and 6 researches in the Complutense University of Madrid (Spain). PARTICIPANTS: 137 patients diagnosed with nonspecific LBP. METHODS: The control group underwent 15 sessions of conventional physiotherapy in Primary Care Centers, and the experimental group received 15 GDS treatment sessions. Pain was evaluated by Visual Analogical Scale (VAS), functional disability by Oswestry questionnaire, and quality of life by the physical and mental components of SF-36 questionnaire. Outcome measures were assessed before treatment (A1), at the end of treatment (A2), and at 3 months (A3), and 6 months (A4) of follow-up. RESULTS: Repeated measures analysis of variance revealed that at the end of treatment and 3 months later, subjects in both groups showed less pain, reduced functional disability, and an improved quality of life, though improvements were greater in the GDS group.Six months after treatment, patients in the GDS group continued to show reduced pain (VAS(A4-A1) = -3.54, 95% CI: -4.18 to -2.90) while VAS scores in the control group returned to initial values (VAS(A4-A1) = 0.15, 95% CI: -0.36 to 0.67). CONCLUSION: Treatment of nonspecific LBP using the GDS method provides greater improvements in the midterm (6 months) in terms of the pain, functional ability, and quality of life perceived by patients than the conventional treatment based administered in primary care.