Different Cryotherapy Modalities Demonstrate Similar Effects on Muscle Performance, Soreness, and Damage in Healthy Individuals and Athletes: A Systematic Review with Metanalysis.

BACKGROUND: There are extensive studies focusing on non-invasive modalities to recover physiological systems after exercise-induced muscle damage (EIMD). Whole-body cryotherapy (WBC) and Partial-body cryotherapy (PBC) have been recommended for recovery after EIMD. However, to date, no systematic reviews have been performed to compare their effects on muscle performance and muscle recovery markers. METHODS: This systematic review with metanalysis compared the effects of WBC and PBC on muscle performance, muscle soreness (DOMS), and markers of muscular damage following EIMD. We used Pubmed, Embase, PEDro, and Cochrane Central Register of Controlled Trials as data sources. Two independent reviewers verified the methodological quality of the studies. The studies were selected if they used WBC and PBC modalities as treatment and included muscle performance and muscle soreness (DOMS) as the primary outcomes. Secondary outcomes were creatine kinase and heart rate variability. RESULTS: Six studies with a pooled sample of 120 patients were included. The methodological quality of the studies was moderate, with an average of 4.3 on a 0-10 scale (PEDro). RESULTS: Both cryotherapy modalities induce similar effects without difference between them. CONCLUSION: WBC and PBC modalities have similar global responses on muscle performance, soreness, and markers of muscle damage.

Low Occurrence of Musculoskeletal Symptoms in Swimming? Musculoskeletal Symptoms and Sports Participation in Adolescents: Cross Sectional Study (ABCD-Growth Study).

The purpose of this paper was to identify the association between the occurrence of musculoskeletal symptoms (MS) and sports participation in adolescents. The sample included 193 adolescents (11 to 17 years of age; 131 boys and 62 girls). For this cross-sectional study, participants were categorized into four groups: "no-sports", "repetitive non-impact sports", "high-impact sports", and "odd-impact sports". A questionnaire was used, which defined MS as pain or any musculoskeletal complaint that led to restriction of current normal activities. In the entire sample, 112 adolescents reported at least one episode of MS during the recording, representing 58% of the sample. Our findings highlight that adolescents regularly engaged in odd-impact sports, such as martial arts, report a higher occurrence of MS than swimmers and adolescents who do not participate in any physical activity.

Photobiomodulation therapy applied during an exercise-training program does not promote additional effects in trained individuals: A randomized placebo-controlled trial.

BACKGROUND: Previous studies have shown positive results of photobiomodulation (PBM) for improving performance and accelerating post-exercise recovery. However, the effects of PBM in healthy individuals who underwent a neuromuscular adaptation training remain unclear. OBJECTIVE: To investigate the effects of PBM during a training program combining sprints and explosive squats exercises on clinical, functional, and systemic outcomes in trained healthy individuals compared to a placebo intervention and a control. METHODS: We conducted a randomized placebo-controlled trial. Healthy males were randomly assigned to three groups: active PBM (30 J per site), placebo, or control (passive recovery). The participants performed a six-week (12 sessions) of a training program consisting of a combination of sprints and squats with recovery applied between sprints and squats. To prevent the influence of the primary neuromuscular adaptation to exercise on the results, all participants had to participate in a period of six weeks of exercise training program. Functional, clinical, and psychological outcomes and vascular endothelial growth factor (VEGF) were assessed at baseline and after six weeks. Results are expressed as mean difference (MD) and 95% confidence intervals (CI). RESULTS: Thirty-nine healthy male volunteers (aged 18-30 years; body mass index 23.9 ±â€¯3 kg/m²) were recruited. There was no significant time by group interaction, and no significant effect of group, but there was a significant effect of time for maximal voluntary isometric contraction (primary outcome) (MD=22 Nm/kg; 95%CI: 3.9, 40) and for squat jump (MD=1.6 cm; 95CI%: 0.7, 2.5). There was no significant interaction (time*group), time, or group effect for the other outcomes. CONCLUSION: The addition of PBM to a combined training performed for six weeks in previously trained individuals did not result in additional benefits compared to placebo or no additional intervention.

Effects of different ischemic preconditioning occlusion pressures on muscle damage induced by eccentric exercise: a study protocol for a randomized controlled placebo clinical trial.

INTRODUCTION: Due to its greater generation of muscle strength and less metabolic demand, eccentric exercise has been widely used in rehabilitation and for improving physical fitness. However, eccentric exercise can induce muscle damage by providing structural changes and reduced muscle function, so even with the protection caused by the repeated bout effect from eccentric exercise, it is necessary to seek alternatives to reduce this damage caused by stress. Thus, ischemic preconditioning could represent an aid to reduce the damage muscle or increase the protective effect caused by eccentric exercise. OBJECTIVES: To compare the effects of ischemic preconditioning, using different occlusion pressures, on acute and delayed responses to perceptual outcomes, markers of muscle damage, and performance in post-eccentric exercise recovery. METHODS: A randomized controlled placebo clinical trial will be carried out with 80 healthy men aged 18 to 35 years who will be randomly divided into four groups: ischemic preconditioning using total occlusion pressure, ischemic preconditoning with 40% more than total occlusion pressure, placebo (10 mmHg), and control. The ischemic preconditioning protocol will consist of four cycles of ischemia and reperfusion of five minutes each. All groups will perform an eccentric exercise protocol, and assessments will be carried out before, immediately after, and 24, 48, 72, and 96 h after the end of the eccentric exercise to evaluate creatine kinase, blood lactate, perception of recovery using the Likert scale, being sequentially evaluated, pain by the visual analog scale, pain threshold using a pressure algometer, muscle thickness by ultrasound, muscle tone, stiffness and elasticity by myotonometry, vectors of cell integrity through electrical bioimpedance, and maximal voluntary isometric contraction using the isokinetic dynamometer. The trial was registered at ClinicalTrials.gov (NCT04420819). DISCUSSION: The present study aims to present an alternative technique to reduce muscle damage caused by eccentric exercise, which is easy to apply and low cost. If the benefits are proven, ischemic preconditioning could be used in any clinical practice that aims to minimize the damage caused by exercise, presenting an advance in the prescription of eccentric exercise and directly impacting on the results of post-exercise recovery. TRIAL REGISTRATION: ClinicalTrials.gov NCT04420819 . Registered on 19 May 2020; Last update 24 March 2021.

Reductions of cardiovascular and metabolic risk factors after a 14-week periodized training model in patients with knee osteoarthritis: a randomized controlled trial.

INTRODUCTION/OBJECTIVE: To evaluate the effects of a periodized circuit training (CT) compared with a conventional strength training (ST) and an educational protocol (EP) on body composition, metabolic parameters, muscle strength, pain, and physical performance in patients with knee osteoarthritis (KOA). METHOD: This study followed a randomized controlled trial design. A sample of sixty-one patients with KOA, 40-65 years old and BMI < 30 kg/m2, were randomly divided into three 14-week protocols: CT, ST, or EP. The CT performed whole body exercises organized in circuit, 3 times a week. The ST performed conventional resistance exercises also 3 times a week, and the EP joined in educational meetings twice a month. Body composition (dual-energy X-ray absorptiometry (DXA)); metabolic parameters (abdominal obesity, triglyceride, HDL, blood pressure and fasting glucose), knee maximal isometric voluntary contraction (MIVC) extension and flexion, performance-based tests (40-m walk test, 30-s chair test, and stair climb test), self-reported pain, stiffness, and physical function (WOMAC) and pain catastrophism were evaluated at baseline and follow-up. Repeated measures ANOVA were used to compare differences between groups (CTxSTxEP) at the different times of assessment (baseline × follow-up). When group-time interaction was found, a one-way ANOVA, followed by a Bonferroni post hoc test, was used to compare groups in each time point; while a paired t test was used to verify the time effect in each group. Additionally, the training effect was analyzed in terms of the percent change (Δ%). Effect size was calculated for post intervention (week 14) between groups. For all analyses a significance level of 5% was adopted (p < 0.05). RESULTS: The CT was the only protocol that presented significant lower body mass (p = 0.018; Δ% = - 1.4), fat mass (p = 0.017; Δ% = - 10.3), %fat mass (p < 0.001; Δ% = - 13.9), adipose indices (%fat trunk/%fat legs p = 0.031; Δ% = 7.8; fat mass/height2 p = 0.011; Δ% = - 15.1; trunk/limb fat mass p = 0.012; Δ% = - 8.2; visceral adipose tissue (VAT) volume (cm3) p = 0.039; Δ% = - 11.6; VAT area (cm2) p = 0.044; Δ% = - 12.2), blood pressure levels (SBP p = 0.042; Δ% = - 3.4 and DBP p = 0.001; Δ% = - 4.9), higher lean mass and HDL (p < 0.001; Δ% = 5.9) compared to baseline. CT and ST presented lower WOMAC pain, stiffness and physical function (p < 0.001; Δ% = - 64.0 for CT and p < 0.001; Δ% = 0.001; Δ% = - 46.4 for ST in WOMAC total score, pain catastrophizing (p < 0.001; Δ% = - 66.7 for CT and p < 0.001; Δ% = - 61.5 for ST) a higher functional performance (30 s chair test: p < 0.001; Δ% = 45.7 for CT and p < 0.001; Δ% = 26.9 for ST; 40 m walk test: p < 0.001; Δ% = 26.7 for CT and p < 0.001; Δ% = 12.5 for ST; stair climb test: p = 0.002; Δ% = - 33.9 for CT and p < 0.001; Δ% = - 18.8 for ST) and knee extension MIVC (p < 0.001; Δ% = 21.92 for CT and p < 0.001; Δ% = 30.25 for ST). CONCLUSION: A periodized CT model reduces visceral adipose tissue, SBP and DBP, and improves HDL, important cardiovascular and metabolic risk factors, in patients with KOA. Both trained groups (CT and ST) improve self-reported clinical symptoms, muscle strength, and physical performance in this sample. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov , NCT02761590 (registered on May 4, 2016). KEY POINTS: • A 14-week periodized circuit training reduces visceral adipose tissue, systolic and diastolic blood pressure, and improves HDL blood levels in patients with knee osteoarthritis. • Both periodized circuit training and conventional strength training improve clinical symptoms, functional performance and muscle strength in this sample.

Effects of the Mat Pilates Method on Body Composition: Systematic Review With Meta-Analysis.

BACKGROUND: The objective of this systematic review was to determine the efficacy of the mat Pilates method on body composition in healthy adult subjects compared with traditional exercise or control condition models. DESIGN: Systematic review with meta-analysis. DATA SOURCES: MEDLINE, EMBASE, SPORTDiscus, PEDro, SciELO, CINAHAL, and the Cochrane Library. RESULTS: A total of 10 eligible studies were selected for revision. The findings of this review demonstrated that the mat Pilates method was not more effective than the traditional exercise or control condition models for the analyzed variables (body mass index, lean mass, body fat percentage, and abdominal circumference). Moreover, in the exploratory analysis with older people, adults, and overweight/obese individuals, the mat Pilates method was also not superior for the analyzed outcomes. CONCLUSION: The findings of this study suggest that the mat Pilates method is no better than the control condition or other types of training to reduce body composition.

Phototherapy on Management of Creatine Kinase Activity in General Versus Localized Exercise: A Systematic Review and Meta-Analysis.

OBJECTIVE: The main focus of this systematic review was to determine the efficacy of phototherapy in the management of creatine kinase (CK) activity after exercise and furthermore to identify for which exercise model protocol phototherapy provides the best results. DESIGN: Meta-analysis comparing phototherapy with a control condition. SETTING: The MEDLINE, EMBASE, SPORTDiscus, PEDro, and CENTRAL databases were searched from their earliest records to October 03, 2016. Data were pooled in a meta-analysis and described as standardized mean difference (SMD) with 95% confidence intervals (CIs) using a random effects model. PARTICIPANTS: Healthy subjects (no restrictions were applied, eg, age, sex, and exercise level). INTERVENTION: Phototherapy (low-level laser therapy and/or light-emitting diode therapy) before or after exercise and a placebo or control condition. MAIN OUTCOME MEASURES: Creatine kinase activity (no restriction to any analysis, eg, serum, plasma, or capillary blood). RESULTS: Fourteen studies were included for review. The results revealed that phototherapy has a more positive effect than control condition in management of CK activity [SMD = 0.77, 95% CI (0.32 to 1.22); P = 0.0007; I = 72%]. In exploratory analysis, the results showed that phototherapy was effective only in the exercise protocol with localized exercise with large effect size [localized exercise: SMD = 0.89, 95% CI (0.26 to 1.51); P = 0.0002; I = 76%; general exercise: SMD = 0.61, 95% CI (-0.05 to 1.26); P = 0.07; I = 67%]. CONCLUSIONS: The available evidence suggest that phototherapy has beneficial effects on the management of CK activity and demonstrate a possible relationship based on damage caused by exercise, providing a greater effect in studies that used localized exercise.

Cardiovascular responses to low-intensity isometric handgrip exercise in coronary artery disease: effects of posture.

BACKGROUND: Coronary artery disease (CAD) lead to cardiovascular autonomic control disfunctions that can worsen exercise and/or posture adjustments. OBJECTIVES: To verify the cardiovascular responses to low-intensity isometric handgrip exercise performed in different postures in CAD patients. This study tested the hypothesis that the posture influences the cardiovascular responses during isometric handgrip exercise and that the presence of CAD leads to greater cardiovascular stress during this type of exercise. METHODS: We investigated cardiovascular responses to isometric handgrip exercise in 15 CAD patients (CADG) and 15 health matched-control (CG). The subjects performed isometric handgrip exercise at 30% of maximum voluntary contraction until exhaustion in SUPINE, SITTING and STANDING positions. Systolic arterial pressure, diastolic arterial pressure, mean blood pressure, heart rate, peripheral vascular resistance, cardiac output, stroke volume and double product were measured during rest (baseline), exercise (peak value) and recovery in the 1st minute (REC1). Delta PB (ΔPB, peak minus baseline) and PR1 (ΔPR1, peak minus REC1) were calculated. RESULTS: Higher ΔPB and ΔPR1 of systolic and mean arterial pressure and double product were observed in STANDING when compared to SITTING and/or SUPINE. CADG showed higher ΔPB of systolic and mean arterial pressure in all postures and higher ΔPR1 of strove volume in the SITTING. CONCLUSION: We concluded that the posture during isometric handgrip exercise influences the cardiovascular responses with STANDING leading to higher cardiovascular stress. CAD promoted higher arterial pressure responses however these responses were physiological and expected due to the presence of disease and type of exercise.

Heart rate variability: are you using it properly? Standardisation checklist of procedures.

BACKGROUND: Heart rate variability is used as an assessment method for cardiac autonomic modulation. Since the Task Force's publication on heart rate variability in 1996, the European Heart Rhythm Association Position Paper in 2015 and a recent publication in 2017, attention has been paid to recommendations on using heart rate variability analysis methods, as well as their applications in different physiological conditions and clinical studies. This analysis has proved to be useful as a complementary tool for clinical evaluation and to assess the effect of non-pharmacological therapeutic interventions, such as physical exercise programmes, on cardiac autonomic modulation. OBJECTIVE: The aim of this article is to make recommendations and to develop a checklist of normalisation procedures regarding the use of heart rate variability data collection and analysis methodology, focusing on the cardiology area and cardiac rehabilitation. METHODS: Based on previous heart rate variability publications, this paper provides a description of the most common shortcomings of using the analysis methods and considers recommendations and suggestions on how to minimise these occurrences by using a specific checklist. CONCLUSIONS: This article includes recommendations and a checklist regarding the use of heart rate variability collection and analysis methods. This work could help improve reporting on clinical evaluation and therapeutic intervention results and consequently, disseminate heart rate variability knowledge.

A periodized training attenuates thigh intermuscular fat and improves muscle quality in patients with knee osteoarthritis: results from a randomized controlled trial.

OBJECTIVE: To analyze the influence of a 14-week periodized circuit training (CT) protocol on thigh intermuscular fat and muscle quality (force per unit area of lean tissue) in patients with knee osteoarthritis (KOA). DESIGN: Randomized controlled trial METHODS: Sixty-one selected participants with KOA grades 2 and 3, 40-65 years old, and BMI < 30 kg/m2 were randomized into three groups: CT, conventional strength training (ST), and educational protocol (EP). The CT and ST protocols consisted of 14-week training protocols conducted 3 times a week. The CT group performed exercises stratified as light, moderate, and intense, arranged progressively in a circuit model. The ST group performed conventional strength exercises, and the EP group participated in lectures twice a month about healthy lifestyles. Baseline and follow-up (week 0 and week 14) evaluations were conducted for thigh intermuscular fat (computed tomography), knee extension maximal isometric voluntary contraction (MIVC), and muscle quality (knee extension MIVC/muscle mass cross-sectional area). RESULTS: Only the CT group presented significant reductions in thigh intermuscular fat (p = 0.003) and significantly lower values in week 14 compared with the EP (p = 0.032). Both trained groups presented significant increases in muscle mass area (p=0.002 for CT and p=0.008 for ST) and increments in knee extension MIVC (p=0,033 for CT nd p=0.019 for ST) in week 14 compared with the EP and increases in muscle quality (p = 0.004 and 0.042). CONCLUSION: It can be concluded that a 14-week periodized CT protocol attenuates thigh intermuscular fat and improves muscle quality in patients with KOA. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02761590; https://clinicaltrials.gov/ct2/show/NCT02761590Key Points•Fourteen weeks of periodized circuit training attenuates thigh intermuscular fat in patients with knee osteoarthritis.•Circuit training is as effective as strength training for improving muscle mass, strength, and quality.

Association between lifestyle and musculoskeletal pain: cross-sectional study among 10,000 adults from the general working population.

BACKGROUND: Work-related musculoskeletal pain is a major cause of work disability and sickness absence. While pain is a multifactorial phenomenon being influenced by work as well as lifestyle, less is known about the association between specific lifestyle factors and the type of musculoskeletal pain. The aim of the study was to investigate if a dose-response association existed between lifestyle factors and musculoskeletal pain intensity in the low back and neck-shoulder. METHODS: Currently employed wage earners (N = 10,427) replied in 2010 to questions about work environment, lifestyle and health. Logistic regression analyses adjusted for various confounders tested the association of alcohol intake, physical activity, fruit and vegetable intake, and smoking (explanatory variables) with low back pain and neck-shoulder pain intensity (outcomes variables, scale 0-9, where ≥4 is high pain). RESULTS: The minimally adjusted model found that physical activity and fruit and vegetable intake were associated with lower risk of musculoskeletal pain, while smoking was associated with higher risk of musculoskeletal pain. In the fully adjusted model, physical activity ≥5 h per week was associated with lower risk of low back pain and neck-shoulder pain with risk ratios (RR) of 0.95 (95% CI 0.90-1.00) and 0.90 (95% CI 0.82-0.99), respectively. No association was found between alcohol intake and pain. CONCLUSION: Being physically active associated with lower risk of having musculoskeletal pain, while smoking habits and healthy eating were associated with higher pain when adjusting for age and gender. Considering the continuously increasing retirement age in many societies, initiatives to promote healthy habits should still be a political priority to help the workers to stay healthy and cope to their work.

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.

A New Mathematical Approach to Explore the Post-exercise Recovery Process and Its Applicability in a Cold Water Immersion Protocol.

Micheletti, JK, Vanderlei, FM, Machado, AF, de Almeida, AC, Nakamura, FY, Netto Junior, J, and Pastre, CM. A new mathematical approach to explore the post-exercise recovery process and its applicability in a cold water immersion protocol. J Strength Cond Res 33(5): 1266-1275, 2019-The objective of this study was to propose a mathematical model to analyze the post-training recovery of perceptive, functional, metabolic, and autonomic parameters from the use of cold water immersion (CWI) through isolated and combined analysis. Following simulated training, 64 male soccer players were randomized into an experimental group (EG: CWI, 13 ± 1° C; 15 minutes) and a control group (CG: passive recovery; 15 minutes). Perceptive (soreness and perception of recovery), autonomic (heart rate variability [HRV]), metabolic (lactate concentration), and functional parameters (squat jump, T agility test, sprint test, 40-second test, and maximal voluntary isometric contraction) were analyzed before and at specific moments after training (without exceeding 2 hours after training). The variables were analyzed using the raw data, dichotomization of each variable (isolated analysis), and through a mathematical model using the combination of all parameters analyzed (combined analysis). The combined analysis did not demonstrate better efficacy of the EG compared with the CG (69.17 and 63.4%, p = 0.09). In the isolated analysis, a chance of the technique being better was observed in the metabolic parameter at 1 and 2 hours after training (odds ratio, 95% confidence interval = 3.75 [1.01-13.88] and 11.11 [1.25-98.49]), respectively, and in the autonomic parameter at 40-45 minutes after training (4.4 [1.09-17.67]). For the raw data, all parameters analyzed presented recovery by 2 hours after training for both groups. Based on the proposed mathematical model, it is concluded that CWI is not better than the control condition. However, considering the analysis of variables in isolation, the technique presents a better chance of recovery for blood lactate concentration and HRV.

Effects of training with elastic resistance versus conventional resistance on muscular strength: A systematic review and meta-analysis.

Given the practicality and low cost of using elastic resistance in training for different populations and its effectiveness in a range of outcomes, a comparison with conventional devices could clarify and quantify the benefits provided by both mode. To compare the effects of resistance training with elastic devices (tubes and Thera-Bands) and conventional devices (weight machines and dumbbells) on the outcome muscular strength. A search was performed in the databases PubMed/MEDLINE, EMBASE, PEDro (Physiotherapy Evidence Database), and CENTRAL (Cochrane Central Register of Controlled Trials) from the earliest records up to 20 December 2017. Data were pooled into a meta-analysis and described as standardized mean difference with a 95% confidence interval (registration number: CRD42016042152). Eight studies were included. The results of the meta-analysis demonstrated no superiority between the methods analyzed for lower limb (SMD = -0.11, 95% CI -0.40, 0.19, p = 0.48) or upper limb muscular strength (SMD=0.09; 95% CI -0.18, 0.35; p = 0.52) [corrected]. Elastic resistance training is able to promote similar strength gains to conventional resistance training, in different population profiles and using diverse protocols.

Specific interventions for prevention of muscle injury in lower limbs: systematic review and meta-analysis / Intervenções específicas para prevenção de lesão muscular em membros inferiores: revisão sistemática e meta-análise / Intervenciones específicas para la prevención de lesiones musculares en miembros inferiores: revisión sistemática y meta-análisis

Abstract Introduction: Muscle injuries show an incidence associated with extreme stretching, or even a high-intensity eccentric contraction. Such injuries cause severe damage to athletes, including lower performance, withdrawal, and psychological distress. In this scenario, the study of effective preventive methods is an indispensable factor in the routine of professional athletes, to reduce the incidence of injuries. Objective: To verify the effectiveness of three different interventions (warm-up, neuromuscular training, and eccentric exercise) to prevent muscle injuries in the lower limbs. Method: We searched the Cochrane Library, EMBASE, SPORTDiscus, PEDro, and PubMed databases from the earliest records until January 20, 2018. The search was performed from word combinations such as clinical trial, muscle strain, injury prevention. The data related to the outcome of prevention were grouped in meta-analysis and described in Risk Ratio (RR) with 95% confidence interval. Results: Sixteen studies were included: five assessed eccentric exercise, three investigated neuromuscular training, and eight observed warm-up. The eccentric exercise (RR = 3.49, 95% CI 2.36, 5.16, p < 0.00001) and the neuromuscular training (RR = 2.73, 95% CI 2.03, 2.68, p < 0.00001) showed significant effects on the prevention of muscle injuries in lower limbs. On the other hand, warm-up (RR = 1.57, 95% CI 0.92, 2.7, p = 0.10) was irrelevant in reducing the incidence of injuries in the body segment investigated. Conclusion: The outcomes presented provide clinical relevance inherent in the field practices, with intrinsic potential for practical application in the management of specific preventive techniques.

Resumo Introdução: Lesões musculares apresentam incidência associada à alongamento extremo, ou ainda, a uma contração excêntrica de alta intensidade. Tais lesões, acarretam prejuízos graves aos atletas que incluem queda de rendimento, afastamento e transtornos psicológicos. Neste cenário, o estudo de métodos preventivos eficazes, constituem fator indispensável na rotina de atletas profissionais, a fim de, reduzir a incidência de lesões. Objetivo: Verificar a eficácia de três diferentes intervenções (aquecimento, treinamento neuromuscular e exercício excêntrico) para prevenção de lesões musculares em membros inferiores. Método: Foram pesquisadas as bases de dados Cochrane Library, EMBASE, Sports Discus, PEDro e PubMed desde os registros mais antigos até 20 de janeiro de 2018. A busca foi realizada a partir de combinações de palavras, como, clinical trial, muscle strain, injury prevention. Os dados relacionados ao desfecho prevenção foram agrupados em meta-análise e descritos em Risk Ratio (RR) com intervalo de confiança de 95%. Resultados: Foram incluídos 16 estudos. Destes, cinco avaliaram o exercício excêntrico, três investigaram o treino neuromuscular e oito observaram o aquecimento. O exercício excêntrico (RR = 3.49; 95% CI 2.36, 5.16; p < 0.00001) e o treino neuromuscular (RR = 2.73; 95% CI 2.03, 2.68; p < 0.00001) demonstram efeitos significativos na prevenção de lesões musculares em membros inferiores. Por outro lado, o aquecimento (RR = 1.57; 95% CI 0.92, 2.7; p = 0.10) mostrou-se irrelevante na diminuição da incidência de lesões no segmento corporal investigado. Conclusão: Os desfechos apresentados fornecem relevância clínica inerente as práticas de campo, com potencial intrínseco para aplicação prática no manejo de técnicas preventivas específicas.

Resumen Introducción: Lesiones musculares presentan incidencia asociada al estiramiento extremo, o, a una contracción excéntrica de alta intensidad. Tales lesiones, acarrean graves daños a los atletas que incluyen caída de rendimiento, alejamiento y trastornos psicológicos. En este escenario, el estudio de métodos preventivos eficaces, constituyen un factor indispensable en la rutina de atletas profesionales, a fin de reducir la incidencia de lesiones. Objetivo: Verificar la eficacia de tres diferentes intervenciones (calentamiento, entrenamiento neuromuscular y ejercicio excéntrico) para prevención de lesiones musculares en miembros inferiores. Método: Se ha investigado la base de datos Cochrane Library, EMBASE, Sports Discus, PEDRO y PubMed desde los registros más antiguos hasta el 20 de enero de 2018. La búsqueda se realizó a partir de combinaciones de palabras, como, trial trial, prevención de la prevención. Los datos relacionados con el desenlace de prevención se agruparon en metaanálisis y se describieron em Risk Ratio (RR) con un intervalo de confianza del 95%. Resultados: Se incluyeron 16 estudios. De ellos, cinco evaluaron el ejercicio excéntrico, tres investigaron el entrenamiento neuromuscular y ocho observaron el calentamiento. El ejercicio excéntrico (RR = 3.49, 95% CI 2.36, 5.16, p < 0.00001) y el entrenamiento neuromuscular (RR = 2.73, 95% CI 2.03, 2.68, p < 0.00001) demuestran efectos significativos en la prevención de lesiones musculares en miembros inferiores. Por otro lado, el calentamiento (RR = 1.57, 95% CI 0.92, 2.7, p = 0.10) se mostró irrelevante en la disminución de la incidencia de lesiones en el segmento corporal investigado. Conclusión: Los resultados presentados proporcionan relevancia clínica inherente a las prácticas de campo, con potencial intrínseco para aplicación práctica en el manejo de técnicas preventivas específicas.

Influence of a periodized circuit training protocol on intermuscular adipose tissue of patients with knee osteoarthritis: protocol for a randomized controlled trial.

BACKGROUND: The objective of this study is to analyze the influence of a 14-week periodized circuit training protocol on patients with knee osteoarthritis (OA), in randomized intervention groups, on thigh intermuscular adipose tissue (interMAT), body composition, systemic inflammation, cartilage degradation, and its repercussion on pain, functional performance and quality of life. METHODS: This study presents a protocol for a randomized controlled trial. Sixty selected participants diagnosed with knee OA grades II and III, 40-65 years old and BMI < 30 kg/m2, will be randomly divided into three groups:periodized circuit training, strength training, and educational protocol. The circuit training and strength training protocols consist of 14-week training protocols conducted 3 times a week. The circuit training group will perform selected exercises previously stratified as light, moderate, and intense, arranged progressively in a circuit model, the strength group will perform regular strength exercises, and the educational protocol group will participate in a 14-week protocol with lectures twice a month about healthy lifestyles. Baseline and follow-up evaluations will be conducted for thigh interMAT (computed tomography), body composition (DXA), inflammation (IL-1ß, IL-6, IL-10, TNF-α, leptin, and adiponectin), and joint degradation biomarkers (uCTX-II and sCOMP), performance-based tests (30s Chair Stand Test, 40 m Fast-paced Walk Test and Stair Climb Test), quadriceps and hamstring maximal isometric voluntary contraction (MIVC), and questionnaires (WOMAC and pain catastrophizing scale). Repeated measures ANOVA will be used to compare differences between groups (circuit training X strength training X educational protocol) at the different times of assessment (baseline x follow-up or baseline x during protocol x follow-up) for each of the dependent variables. When significant main effects were found, the pots hoc Bonferroni test will be used to identify statistical differences. A significance level of 5% (p < 0.05) will be adopted. DISCUSSION: This will be the first randomized controlled trial to assess the effects of a circuit training protocol on patients with knee OA on thigh intermuscular adipose tissue (interMAT). Given the prevalence and impact of OA and the widespread availability of this intervention, assessing the efficacy of a low-cost, non-pharmacological, and non-invasive treatment for knee OA patients has the potential for immediate and high clinical impact. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02761590 , registered in May 4, 2016.

Test-retest reliability of knee extensors endurance test with elastic resistance.

BACKGROUND: Reliable clinical tests capable of measuring resistance are important tools for rehabilitation. One alternative that has recently increased in popularity is the use of elastic tubes, which stand out for being easy to handle, low cost, practical, and feasible. OBJECTIVE: Analyze the test-retest reliability of the knee extensors muscle fatigue resistance test (FRT) with elastic tubes. METHODS: A total of 116 healthy young males, aged between 18 and 30 years old, participated in the study. Participants performed three pre-test stages: orientation, load presentation, and familiarization with equipment, lasting two weeks. Subsequently, they performed the FRT on two occasions (test and retest), with an interval of seven days. The reliability analyzes were performed using the intraclass correlation coefficient (ICC) with 95% confidence interval and typical measurement error (TME), also expressed as coefficient of variation (CV%). RESULTS: The findings regarding the reliability of the test demonstrated satisfactory values (time: ICC = 0.66; 95%CI [0.50; 0.76]; CV(%) = 9.34; repetition: ICC = 0.61; 95%CI [0.46; 0.73], CV(%) = 13.66; rhythm: ICC = 0.52; 95%CI [0.35; 0.67], CV(%) = 10.29. CONCLUSION: From the findings presented, it is concluded that the proposed clinical test with elastic tubes demonstrates evidence of acceptable values.

Effects of massage as a recuperative technique on autonomic modulation of heart rate and cardiorespiratory parameters: a study protocol for a randomized clinical trial.

BACKGROUND: Recuperative techniques have been used to anticipate and potentiate recovery. The massage is one of the most widely used in sports. Among the ways to demonstrate the recovery of the organism is the resumption of autonomic modulation of heart rate, which can be analyzed in situations that cause disturbances in the behavior of the cardiovascular system with the objective of verifying the responsiveness of the autonomic nervous system (ANS). Recovery can be assessed through heart rate variability (HRV) which analyzes the oscillations in consecutive heartbeats, thus allowing an important non-invasive alternative for the study of modulation of the ANS. The objective of the study will be to measure the effects of massage as a recuperative technique on the autonomic modulation of heart rate and cardiorespiratory parameters at different moments of application. METHODS: This is a randomized, cross-over clinical trial. Forty men aged 18 to 30 years, healthy and physically active according to the International Physical Activity Questionnaire will participate in the study. Participants will be randomized into groups, which will perform the five interventions of the study at randomized moments, one intervention per session: Intervention 1: control; Intervention 2: participants will receive the massage protocol; Intervention 3: performance of the stress protocol; Intervention 4: participants will perform the stress protocol and immediately after receive the massage; Intervention 5: participants will perform the stress protocol and 1 h after conclusion of the protocol will receive the massage. The sessions will occur with an interval of 1 week between them and, due to the technique used, blinding participants and therapists is not possible. The primary outcome measure is HRV that will be measured 2 h after the conclusion of each intervention, and secondary outcome measures, which include heart rate, respiratory rate, blood pressure, oxygen saturation, and individual touch perception, will be measured at specific moments in the course of each intervention. DISCUSSION: The implementation and use of this standardized protocol should provide important and reliable information regarding the use of massage in post-exercise recovery, with the identification of its effects on the ANS and the best timing and form of massage application. The data obtained in the present study will provide subsidies for the best management of application of the technique in sports clinical practice, considering periods of training and, mainly, of competitions. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03094676 . Pre-results. 12 March 2018.

Elastic Tubing Resistance Training and Autonomic Modulation in Subjects with Chronic Obstructive Pulmonary Disease.

This study addresses evidence concerning elastic tubing resistance training (ET) on autonomic modulation in patients with chronic obstructive pulmonary disease (COPD). Autonomic dysfunction is common in COPD and contributes to the development of arrhythmias and sudden death. Along with autonomic dysfunction, muscle dysfunction is related to functional limitations and prognosis of the disease. This study investigated the effects of ET on autonomic modulation, muscle strength, and walking distance in COPD. Subjects were divided into two groups, ET (n = 20; 66,5 ± 8,9 y; 25,5 ± 3,5 kg/m2; FEV1/FVC: 50,3 ± 11,0) and conventional training (n = 19; 66,0 ± 6,9; 27,1 ± 4,3; FEV1/FVC: 55,05 ± 9,56). Both groups undertook 24 sessions for 60 minutes, 3 times in a week. The significance level was p ≤ 0,05. Autonomic modulation was evaluated using heart rate variability in the time (rMSSD, ms) and frequency domain (HF, ms). Strength for upper and lower limbs was measured using dynamometry and walking distance was measured using a 6-minute walking test. There were no significant differences in the outcomes between groups. There was an increment to rMSSD [(16,7 ± 11,0 versus 20,8 ± 14,9) versus (14,2 ± 10,0 versus 17,4 ± 12,1)], HF [(141,9 ± 191,3 versus 234,9 ± 335,7) versus (94,1 ± 123,5 versus 177,6 ± 275,5)], shoulder abduction [(50,1 ± 19,6 versus 56,9 ± 20,4) versus (50,5 ± 19,0 versus 56,9 ± 19,3)], knee flexion [(101,9 ± 34,0 versus 116,8 ± 43,3) versus (98,6 ± 21,5 versus 115,1 ± 30,8)], and walking test [(433,0 ± 84,8 versus 468,9 ± 90,8) versus (397,4 ± 99,8 versus 426,3 ± 101,6)] after training for ET and conventional training, respectively. In conclusion, ET improves autonomic modulation in COPD with additional benefits for strength and cardiorespiratory capacity similar to conventional training.

Cross-cultural adaptation and measurement properties testing of the Iconographical Falls Efficacy Scale (Icon-FES).

BACKGROUND: The Iconographical Falls Efficacy Scale (Icon-FES) is an innovative tool to assess concern of falling that uses pictures as visual cues to provide more complete environmental contexts. Advantages of Icon-FES over previous scales include the addition of more demanding balance-related activities, ability to assess concern about falling in highly functioning older people, and its normal distribution. OBJECTIVE: To perform a cross-cultural adaptation and to assess the measurement properties of the 30-item and 10-item Icon-FES in a community-dwelling Brazilian older population. METHODS: The cross-cultural adaptation followed the recommendations of international guidelines. We evaluated the measurement properties (i.e. internal consistency, test-retest reproducibility, standard error of the measurement, minimal detectable change, construct validity, ceiling/floor effect, data distribution and discriminative validity), in 100 community-dwelling people aged ≥60 years. RESULTS: The 30-item and 10-item Icon-FES-Brazil showed good internal consistency (alpha and omega >0.70) and excellent intra-rater reproducibility (ICC2,1=0.96 and 0.93, respectively). According to the standard error of the measurement and minimal detectable change, the magnitude of change needed to exceed the measurement error and variability were 7.2 and 3.4 points for the 30-item and 10-item Icon-FES, respectively. We observed an excellent correlation between both versions of the Icon-FES and Falls Efficacy Scale - International (rho=0.83, p<0.001 [30-item version]; 0.76, p<0.001 [10-item version]). Icon-FES versions showed normal distribution, no floor/ceiling effects and were able to discriminate between groups relating to fall risk factors. CONCLUSION: Icon-FES-Brazil is a semantically and linguistically appropriate tool with acceptable measurement properties to evaluate concern about falling among the community-dwelling older population.