Thirty-two weeks of randomized interdisciplinary therapy or combined physical training promote similar improvements in anthropometric and biochemical parameters of obese women.

BACKGROUND: Obesity is a multicausal illness that generates large expenses to health systems and also for the families of obese individuals. It is important to note that obesity disrupts all systems, generating metabolic consequences that may be irreversible. Interdisciplinary therapy is recommended as the primary method for treating obesity. However, the cost of interdisciplinary treatment can be high due to the need for various professionals, from different areas of expertise. This study compares the effects of 32 weeks of physical training combined with interdisciplinary therapy on anthropometric and biochemical parameters in obese women. METHODS: Seventy-six subjects were randomized into two groups: Group Physical Exercise (EXE) and Group Interdisciplinary Treatment (INTER), being evaluated in the initial moment and after 32 weeks. 30 subjects completed the intervention and were evaluated (EXE: N.=13; INTER: N.=17). RESULTS: Psychobiological and biochemical variables were measured. EXE and INTER were similar before treatment and both showed significantly improvements in anthropometric and biochemical parameters after interventions, without difference between groups. CONCLUSIONS: The results confirmed the relevant role of physical training or the interdisciplinary therapy on metabolic profile of obese women. We realized that physical training can be incorporated into public or private health systems as an alternative strategy for obesity control, especially in locations that do not have the possibility of offering a complete interdisciplinary therapy.

Balance and postural control in basketball players / Equilíbrio e controle postural em atletas de basquetebol

Abstract Introduction: Basketball is one of the most popular sports involving gestures and movements that require single-leg based support. Dorsiflexion range of motion (DROM), balance and postural control may influence the performance of this sport. Objective: To compare and correlate measures of balance, postural control and ankle DROM between amateur basketball athletes and non-athletes. Methods: Cross-sectional study, composed by 122 subjects allocated into one control group (CG = 61) and one basketball group (BG = 61). These groups were subdivided into two other groups by age: 12-14 years and 15-18 years. The participants were all tested for postural balance with the Star Excursion Balance Test (SEBT), postural control with the Step-down test and DROM with the Weight-bearing lunge test (WBLT). Between-groups differences were compared using repeated-measures multivariate analysis of variance. Normalized reaching distances were analyzed and correlated with the WBLT and Step-down test. Results: There was no difference in the scores of WBLT (P = .488) and Step-down test (P =. 916) between the groups. Scores for the anterior reach (P = .001) and total score of SEBT (P = .030) were higher in BG. The values for the posterolateral (P = .001) and posteromedial reach (P = .001) of SEBT were higher in BG at the age of 15-18. The correlation between the anterior reach of the SEBT and WBLT was significant in BG between 12-14 years (r = 0.578, P = .008), and in the CG between 15-18 years (r = 0.608, P=.001). Conclusion: The balance was better in the BG, although adolescents between 15-18 years have better balance control for the posteromedial and posterolateral reaches of the SEBT.

Resumo Introdução: O basquetebol é um dos esportes mais praticados na atualidade, o qual envolve gestos e movimentos que exigem apoio unipodal. Amplitude de movimento de dorsiflexão (ADMD), equilíbrio e controle postural podem influenciar o desempenho deste esporte. Objetivo: Comparar e correlacionar medidas de equilíbrio, controle postural e ADMD de tornozelo entre atletas de basquetebol amadores e não-atletas. Métodos: Trata-se de um estudo transversal, composto por 122 participantes. Estes foram distribuídos em grupo controle (GC = 61) e grupo basquete (GB = 61). Cada grupo foi subdivido em outros dois, de acordo com a idade: 12-14 e 15-18 anos. Todos foram avaliados para equilíbrio postural com Star Excursion Balance Test (SEBT), controle postural com Step-down teste e ADMD foi testada com Weight-bearing lunge test (WBLT). As diferenças entre os grupos foram comparadas pelo teste de medidas repetidas e análise de variância multivariada. Distâncias normalizadas dos alcances no SEBT foram analisadas e correlacionados com o WBLT e Step-down test. Resultados: Não houve diferença entre os grupos nos escores do WBLT (P = .488) e Step-down test (P = .916). A pontuação para alcance anterior (P = .001) e escore total de SEBT (P = .030) foram maiores no GB. Os valores para alcance posterolateral (P = .001) e posteromedial (P = .001) do SEBT foram maiores no GB de 15-18 anos. A correlação entre distância anterior do SEBT e WBLT foi significativa no GB de 12-14 anos (r = 0.578, P = .008) e no GC de 15-18 anos (r = 0.608, P = .001). Conclusão: O equilíbrio foi melhor no GB, embora adolescentes de 15-18 anos possuam melhor controle de equilíbrio para alcances posteromedial e posterolateral do SEBT.

Effect of stretching with and without muscle strengthening exercises for the foot and hip in patients with plantar fasciitis: A randomized controlled single-blind clinical trial.

OBJECTIVE: To compare the effect of stretching with and without muscle strengthening of the foot alone or foot and hip on pain and function in patients with plantar fasciitis. DESIGN: Single blind randomized controlled trial. METHOD: Eighty-three patients with plantar fasciitis were allocated to one of three treatment options for an eight-week period: Foot Exercise Group (FEG - extrinsic and intrinsic foot muscles), Foot and Hip Exercise Group (FHEG - abductor and lateral rotator muscles) and Stretching Alone Exercise Group (SAEG). MAIN MEASURES: A visual analog scale for pain, the Foot and Ankle Outcome Score and the Star Excursion Balance Test. All evaluations were performed before treatment and after the last treatment session. RESULTS: Improvements were found in all groups regarding the visual analog scale, the pain, activities of daily living, sports and recreation, quality of life (p < 0.001) and other symptoms (p < 0.01) subscales of the Foot and Ankle Outcome Score as well as posterolateral movement, posteromedial movement and composite score (p < 0.001) on the Star Excursion Balance Test. No time-group interactions were found for any of the variables (p > 0.05). CONCLUSIONS: All three exercise protocols analyzed led to improvements at eight-week follow-up in pain, function and dynamic lower limb stability in patients with plantar fasciitis.

Functional aerobic exercise capacity limitation in adolescent idiopathic scoliosis.

BACKGROUND CONTEXT: Exercise limitation has been described in patients with adolescent idiopathic scoliosis (AIS); however, whether the walking performance is impaired in these patients should be elucidated. PURPOSE: Thus, we aimed to evaluate the physiologic responses to the incremental shuttle walk test (ISWT) in patients with AIS. STUDY DESIGN/SETTING: Cross-sectional study. PATIENT SAMPLE: Twenty-nine patients with AIS and 20 healthy adolescents aged between 11 and 18 years old. OUTCOME MEASURES: Oxygen uptake (VO2), incremental shuttle walk distance (ISWD), ΔVO2/Δwalking velocity, ΔHR/ΔVO2, ΔVE/ΔVCO2, and linearized Δtidal volume (VT)/ΔlnVE, forced expiratory volume in the first second of expiration (FEV1), and forced vital capacity (FVC). METHODS: We performed two ISWTs, and the data used were acquired in the second test. We also evaluated the lung function and respiratory muscle strength through spirometry test and manovacuometry, respectively. All authors confirm that there are no conflicts of interest. To compare the means or medians of variables between patients and healthy subjects, we used the unpaired t test or Mann-Whitney U test, respectively. The correlations were assessed by Pearson or Spearman coefficients according to the distribution of the studied variables. The probability of alpha error was set at 5% for all analyses. RESULTS: Adolescent idiopathic scoliosis patients showed significant lower values of ISWD, VO2, and ventilation at the end of the ISWT, as well as lower FEV1 and FVC; they also presented significantly shallower slope of ΔVT/ΔlnVE, whereas VO2 related significantly with ISWD (r=0.80), FVC (r=0.78), FEV1 (r=0.73), and ΔVT/ΔlnVE (r=0.58). CONCLUSIONS: Adolescent idiopathic scoliosis correlated to walking limitation and was associated to reduced pulmonary function and worse breathing pattern during exercise. Our results suggest that walking-based aerobic exercises should be encouraged in these patients.

Prevalence and factors associated with thoracic alterations in infants born prematurely.

OBJECTIVE: To determine the prevalence of thoracic musculoskeletal alterations and associated factors in infants born prematurely. METHODS: This was a cross sectional study with infants in the first year of age, born prematurely with birth weight < 2,000 g, who were followed up at the Premature Clinic from February, 2007 to December, 2008. Exclusion criteria were: major congenital malformations as defined by the Centers for Disease Control and Prevention (CDC), grade III/IV intraventricular hemorrhage, or periventricular leucomalacia. Physical examinations performed independently by two physiotherapists were used to assess shoulder elevation and thoracic retractions. Comparisons between groups were performed using the chi-squared test or Fisher's exact test for categorical variables, and Mann-Whitney's test or Student's t-test were used for continuous variables. Interobserver reliability between the two physiotherapists was assessed by the kappa coefficient. Variables associated with these thoracic musculoskeletal alterations were studied by univariate and multiple logistic analyses. Statistical differences were considered significant when p < 0.05. This study was approved by the ethical committee of the institution, and parents/guardians signed an informed consent. RESULTS: 121 infants with a gestational age of 31.1 ± 2.8 weeks and birth weight of 1,400 ± 338 g were included. Thoracic alterations were detected by Physiotherapist 1 in 81 (66.9%) infants, and in 83 (68.6%) by Physiotherapist 2 (kappa coefficient = 0.77). By multivariate logistic regression analysis, factors associated with thoracic musculoskeletal alterations were: respiratory distress syndrome (odds ratio [OR] = 3.246, 95% confidence interval [CI]: 1.237-8.732), bronchopulmonary dysplasia (OR = 11.138, 95% CI: 1.339-92.621), and low length/age ratio (OR = 4.571, 95% CI: 1.371-15.242). CONCLUSION: The prevalence of thoracic alterations was high in infants born prematurely, and was associated with pulmonary disease and low length/age ratio.

Prevalence and factors associated with thoracic alterations in infants born prematurely / Prevalência e fatores associados às alterações torácicas em lactentes nascidos prematuros

OBJECTIVE: To determine the prevalence of thoracic musculoskeletal alterations and associated factors in infants born prematurely. METHODS: This was a cross sectional study with infants in the first year of age, born prematurely with birth weight < 2,000 g, who were followed up at the Premature Clinic from February, 2007 to December, 2008. Exclusion criteria were: maj or congenital malformations as defined by the Centers for Disease Control and Prevention (CDC), grade III/IV intraventricular hemorrhage, or periventricular leucomalacia. Physical examinations performed independently by two physiotherapists were used to assess shoulder elevation and thoracic retractions. Comparisons between groups were performed using the chi-squared test or Fisher's exact test for categorical variables, and Mann-Whitney's test or Student's t-test were used for continuous variables. Interobserver reliability between the two physiotherapists was assessed by the kappa coefficient. Variables associated with these thoracic musculoskeletal alterations were studied by univariate and multiple logistic analyses. Statistical differences were considered significant when p < 0.05. This study was approved by the ethical committee of the institution, and parents/guardians signed an informed consent. RESULTS: 121 infants with a gestational age of 31.1 ± 2.8 weeks and birth weight of 1,400 ± 338 g were included. Thoracic alterations were detected by Physiotherapist 1 in 81 (66.9%) infants, and in 83 (68.6%) by Physiotherapist 2 (kappa coefficient = 0.77). By multivariate logistic regression analysis, factors associated with thoracic musculoskeletal alterations were: respiratory distress syndrome (odds ratio [OR] = 3.246, 95% confidence interval [CI]: 1.237-8.732), bronchopulmonary dysplasia (OR = 11.138, 95% CI: 1.339-92.621), and low length/age ratio (OR = 4.571, 95% CI: 1.371-15.242). CONCLUSION: The prevalence of thoracic alterations was high in infants born prematurely, and was associated with pulmonary disease and low length/age ratio.

OBJETIVO: Determinar a prevalência e os fatores associados às alterações torácicas musculoesqueléticas em lactentes nascidos prematuros. MÉTODOS: Estudo transversal com lactentes no primeiro ano de vida, nascidos prematuros com peso < 2000 g e acompanhados em um ambulatório de seguimento de prematuros, de fevereiro/2007 a dezembro/2008. Foram excluídas crianças com malformações maiores definidas pelo CDC ou com hemorragia peri-intraventricular grau III/IV ou leucomalácia periventricular. Duas fisioterapeutas realizaram o exame físico, avaliando, de modo independente, a elevação de ombros e as retracões da caixa torácica. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição, sendo solicitada assinatura do Termo de Consentimento pelos pais. As variáveis numéricas foram comparadas pelo teste t ou Mann-Whitney. O grau de concordância entre as avaliações das fisioterapeutas foi obtido pelo coeficiente kappa e as variáveis associadas às alterações torácicas foram estudadas por regressão logística univariada e múltipla. Considerou-se significante p < 0,05. RESULTADOS: Foram estudados 121 lactentes com idade gestacional de 31,1 ± 2,8 semanas e peso ao nascer de 1400 ± 338 g. A fisioterapeuta 1 detectou alterações torácicas em 81 (66,9%) lactentes e a fisioterapeuta 2 em 83 (68,6%) (coeficiente kappa = 0,77). Os fatores associados às alterações musculoesqueléticas foram: síndrome do desconforto respiratório no período neonatal (OR=3,246; IC 95%: 1,237-8,732), ter apresentado displasia broncopulmonar (OR=11,138; IC 95%: 1,339-92,621) e relação comprimento para a idade alterada (OR=4,571; IC 95%: 1,371-15,242). CONCLUSÃO: A prevalência de alterações torácicas foi alta em lactentes nascidos prematuros e associou-se a doença pulmonar no período neonatal e baixa relação comprimento/idade.

Photogrammetry: an accurate and reliable tool to detect thoracic musculoskeletal abnormalities in preterm infants.

OBJECTIVE: To analyse the accuracy and reproducibility of photogrammetry in detecting thoracic abnormalities in infants born prematurely. DESIGN: Cross-sectional study. SETTING: The Premature Clinic at the Federal University of São Paolo. PARTICIPANTS: Fifty-eight infants born prematurely in their first year of life. OUTCOME MEASURES: Measurement of the manubrium/acromion/trapezius angle (degrees) and the deepest thoracic retraction (cm). Digitised photographs were analysed by two blinded physiotherapists using a computer program (SAPO; http://SAPO.incubadora.fapesp.br) to detect shoulder elevation and thoracic retraction. Physical examinations performed independently by two physiotherapists were used to assess the accuracy of the new tool. RESULTS: Thoracic alterations were detected in 39 (67%) and in 40 (69%) infants by Physiotherapists 1 and 2, respectively (kappa coefficient=0.80). Using a receiver operating characteristic curve, measurement of the manubrium/acromion/trapezius angle and the deepest thoracic retraction indicated accuracy of 0.79 and 0.91, respectively. For measurement of the manubrium/acromion/trapezius angle, the Bland and Altman limits of agreement were -6.22 to 7.22° [mean difference (d)=0.5] for repeated measures by one physiotherapist, and -5.29 to 5.79° (d=0.75) between two physiotherapists. For thoracic retraction, the intra-rater limits of agreement were -0.14 to 0.18cm (d=0.02) and the inter-rater limits of agreement were -0.20 to -0.17cm (d=0.02). CONCLUSION: SAPO provided an accurate and reliable tool for the detection of thoracic abnormalities in preterm infants.

Fiabilidad de un método de análisis para medir el desplazamiento del diafragma mediante visualización directa con videofluoroscopia / Reliability of an Analysis Method for Measuring Diaphragm Excursion by Means of Direct Visualization with Videofluoroscopy

Objetivo: El objetivo de este estudio fue verificar la reproducibilidad por parte de dos observadores diferentesde un método de análisis de las mediciones del desplazamiento del diafragma con el empleo deuna visualización directa con videofluoroscopia.Pacientes y métodos: Se estudió a 29 niños de ambos sexos y de entre 5 y 12 años, con respiración oral. Laevaluación del desplazamiento del diafragma se dividió en tres partes: videofluoroscopia con grabaciónmediante VHS en las posiciones de bipedestación, sedestación y decúbito supino; digitalización de lasimágenes; y medición de la distancia entre las cúpulas diafragmáticas durante un ciclo de respiración,con el empleo de los programas informáticos Adobe Photoshop 5.5 y Adobe Premiere PRO 6.5.Resultados: Los coeficientes de correlación intraclase mostraron una excelente reproducibilidad en todaslas posturas, con valores de los coeficientes situados siempre por encima de 0,94. La media de las medicionesdel desplazamiento de las cúpulas diafragmáticas realizadas por dos observadores fue similar(p < 0,05), con la excepción del desplazamiento diafragmático derecho en posición de sedestación y eldesplazamiento diafragmático izquierdo en posición de bipedestación (p < 0,05). Conclusión: Este estudiopuso de manifiesto que la evaluación del desplazamiento diafragmático mediante videofluoroscopia esuna medición reproducible cuando se comparan los resultados obtenidos por dos investigadores adecuadamentepreparados para ello. Este hecho indica que la técnica evaluada puede ser difundida y puedenaplicarla otros profesionales de la asistencia sanitaria(AU)

Objective: The purpose of this study was to verify the reproducibility between two different observersof an analysis method for diaphragmatic displacement measurements using direct visualization withvideofluoroscopy.Patients and methods: 29 mouth breathing children aged 5 to 12 years from both genders were analyzed.The diaphragmatic displacement evaluation was divided in three parts: videofluoroscopy with VHSrecording in standing, sitting, and dorsal positions; digitalization of the images; and measurement of thedistance between diaphragmatic domes during a breathing cycle using Adobe Photoshop 5.5 and AdobePremiere PRO 6.5 software.Results: The intraclass correlation coefficients presented excellent reproducibility in all positions, withcoefficients always above 0.94. Mean of the measurements of the diaphagramatic domes displacementdone by the two observers were similar (P < .05), with the exception of right diaphragmatic displacementin the seated position and left diaphragmatic displacement in the standing position (P < .05).Conclusion: This study demonstrated that the evaluation of diaphragmatic displacement via videofluoroscopyis a reproducible measurement when two trained investigators are compared. This fact indicatesthat the present technique can be disseminated and performed by other healthcare professionals(AU)

Reliability of an analysis method for measuring diaphragm excursion by means of direct visualization with videofluoroscopy.

OBJECTIVE: The purpose of this study was to verify the reproducibility between two different observers of an analysis method for diaphragmatic displacement measurements using direct visualization with videofluoroscopy. PATIENTS AND METHODS: 29 mouth breathing children aged 5 to 12 years from both genders were analyzed. The diaphragmatic displacement evaluation was divided in three parts: videofluoroscopy with VHS recording in standing, sitting, and dorsal positions; digitalization of the images; and measurement of the distance between diaphragmatic domes during a breathing cycle using Adobe Photoshop 5.5 and Adobe Premiere PRO 6.5 software. RESULTS: The intraclass correlation coefficients presented excellent reproducibility in all positions, with coefficients always above 0.94. Mean of the measurements of the diaphagramatic domes displacement done by the two observers were similar (P<.05), with the exception of right diaphragmatic displacement in the seated position and left diaphragmatic displacement in the standing position (P<.05). CONCLUSION: This study demonstrated that the evaluation of diaphragmatic displacement via videofluoroscopy is a reproducible measurement when two trained investigators are compared. This fact indicates that the present technique can be disseminated and performed by other healthcare professionals.