Use of a peanut ball, positioning and pelvic mobility in parturient women shortens labour and improves maternal satisfaction with childbirth: a randomised trial.

QUESTION: What is the effect of a protocol targeted at the various stages of labour - with a peanut ball, positioning and pelvic mobility - on the duration of labour, pain severity, fatigue, maternal outcomes, neonatal outcomes and satisfaction in parturients without analgesia? DESIGN: A randomised trial with concealed allocation, blinding of assessors and intention-to-treat analysis. PARTICIPANTS: One hundred women in active labour. INTERVENTION: The experimental group received the protocol targeted at the various stages of labour, with a peanut ball, positioning and pelvic mobility, whilst the control group received usual care. OUTCOME MEASURES: The primary outcomes were the duration of labour and pain severity. The secondary outcomes were maternal fatigue, mode of delivery, risk of perineal laceration, severity of perineal laceration, use of synthetic oxytocin, satisfaction with delivery, Apgar scores, admission of the neonate to an intensive care unit and resuscitation of the neonate in the delivery room. In the active phase of labour, the numerical rating scale and maternal perception of childbirth fatigue questionnaire were applied; they were taken again when the parturient had 8 to 10 cm of dilation. The numerical rating scale was also applied postpartum to evaluate satisfaction with childbirth. RESULTS: The use of the protocol with a peanut ball reduced the duration of active and expulsive phases and the total duration of labour, with mean differences of 82 minutes (95% CI 41 to 125), 8 minutes (95% CI 0 to 18) and 89 minutes (95% CI 45 to 132), respectively. Maternal satisfaction was better in the experimental group: mean between-group difference on the 10-point scale was 1.1 (95% CI 0.4 to 1.8). The effects on the other outcomes were either similar between groups or unclear. CONCLUSION: A protocol with a peanut ball, positioning and pelvic mobility reduced the duration of labour and improved maternal satisfaction with childbirth. REGISTRATION: RBR-74wcnjc.

Effects of 12-Weeks of Home-Based Exercise Training on Physical and Cognitive Function of Older Adults: Randomized Trial Comparing Virtual Versus Minimal Supervision in the Context of the Covid-19 Pandemic in Brazil.

Background: We investigated the effects of a 12-week home-based exercise program delivered with virtual or minimal supervision on the physical and cognitive function of community-dwelling older adults in the context of the COVID-19 pandemic in Brazil. Methods: The study was registered on the Brazilian Registry of Clinical Trials platform (code: RBR-8qby2wt). Thirty-eight older adults (81% female and 68±7 years old), non-disabled, and without cognitive impairment or dementia, were randomly assigned to a 12-week home-based exercise program: 1) virtual supervision (classes remotely delivered through video conference by trained staff), or 2) minimal supervision (once-weekly contact to touch base through standardized text messages). The participants initially performed two sets of 10 repetitions three times a week, with a 60-second interval. The volume and complexity of the exercises were progressively increased. (e.g., the number of sets increased to 3 and later to 4). At baseline and follow-up, we collected remote measurements of physical function (muscle strength and power, functional muscular fitness) and cognition (processing speed, inhibitory control, verbal fluency). Results: Participants in the minimal supervision home-based exercise group significantly improved the Stroop test (-1.6 sec, 95% CI = -3.20; -0.09). No significant between-group differences were observed for physical and cognitive outcomes. Conclusion: A home-based exercise program delivered with virtual or minimal supervision can produce similar effects, and may help to maintain physical and cognitive capabilities among healthy, high-functioning older adults who experienced mobility restrictions due to the COVID-19 pandemic in Brazil.

Adherence and dropout in exercise-based interventions in childhood obesity: A systematic review of randomized trials.

Our objective was to systematically examine the characteristics of exercise interventions on adherence and dropout in children and adolescents with obesity. PubMed, Embase, PsycINFO, Lilacs, Scielo, and The Cochrane Central Register of Controlled Trials and reference lists of relevant articles were searched. We included randomized controlled trials with exercise interventions for pediatric patients with obesity presenting data on dropout and/or adherence. Two reviewers screened the records independently for eligibility with disagreements being resolved by a third reviewer. Twenty-seven studies with 1268 participants were included. Because of high heterogeneity and poor reporting of adherence, it was not possible to perform a meta-analysis. Dropout prevalence was calculated, and subgroup analyses comparing different types of exercise and a meta-regression with potential moderators were performed. We found a dropout rate of 13%. Subgroup analyses did not identify significant differences. The duration of the exercise presented a moderating effect on dropout, suggesting that longer exercise sessions may lead to higher dropout in children and adolescents with obesity. Because of the poor adherence data, it is not clear which exercise characteristics may moderate adherence. To improve the quality of childhood obesity care, it is mandatory that future studies present adherence data. Systematic review registration: PROSPERO CRD42021290700.

Efficacy of educational instructions on pelvic floor muscle training in the treatment of urinary incontinence: Systematic review and meta-analysis.

OBJECTIVE: The present study aimed to investigate the efficacy of educational interventions on pelvic floor (PF) muscle training in the treatment of urinary incontinence (UI). METHODS: This is a systematic review of literature with meta-analysis, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). To do so, randomized clinical trials that performed educational interventions of PF, UI, and developed the training of PF muscles (TPFM) for incontinent women, performing group or individual comparisons, with control and experimental groups or with two or more experimental groups were selected. The search for papers was performed in the following databases: PubMed, Scopus, Embase, Web of Science, and SciELO, no specific publication date was chosen. The risk of bias was performed using the PEDro scale and the quality of the evidence was performed using GRADE. RESULTS: The review included six studies with 1003 participants. Most studies presented 5-8 points regarding risk of bias. Most of the studies were performed in the last 5 years, with women of various ages, high educational level and prevalence of UI of effort. The present study showed that offering educational instructions and guiding women on TPFM was capable of reducing urinary symptoms. When compared to control, significant between-group differences were found in the studies, in which the control group did not receive any kind of instructions or treatment (p < 0.05). The use of technologies through mobile apps was efficient in the treatment of incontinent women (p < 0.05). Performing TPFM individually or in groups did not present differences in the results, with both improving urinary symptoms. The meta-analysis presented a mean effect and a clinically important difference in three studies. CONCLUSION: The interventions involving instructions to TPFM associated to health education brought improvements to urinary symptoms.

Effects of an eight-week physical exercise program on low back pain and function in fruit workers: A randomized controlled trial.

BACKGROUND: Low back pain is prevalent in workers' health and functional performance. OBJECTIVE: To evaluate the effects of a physical exercise program on low back pain and disability in fruit workers. METHODS: This randomized controlled trial assigned 44 workers (37 ± 9 years) to two groups. The experimental group consisted of 10 men and 12 women with an average age of 38 (± 9) years, and the control group consisted of 8 men and 14 women with an average age of 36 (± 10) years. The experimental group (EG) performed a program of strength and flexibility exercises for eight weeks, twice a week. The control group (CG) received minimal care, with a booklet with guidelines for performing exercises. The primary outcomes included changes in perceived disability and the intensity of pain evaluated by the Rolland-Morris questionnaire and the Numerical Pain Scale, respectively. All outcomes were measured at baseline and after eight weeks of intervention. RESULTS: A significant difference was observed in the within-group analysis, with a mean reduction in pain intensity in the EG and CG of -4.55 (95%CI -7.01 to -2.09) and -3.81 (95%CI 1.72-5.90), respectively. For disability, a reduction of -4.45 (95% CI -8.89 to -0.02) was observed in the EG and of -4.43 (-7.38 to -1.48) in the CG. There were no significant differences in the between-groups analysis. CONCLUSIONS: The exercise program was not superior to using the educational booklet. However, both interventions showed substantial decreases in pain and disability levels.

Effects of two different dual-task training protocols on gait, balance, and cognitive function in community-dwelling older adults: a 24-week randomized controlled trial.

Background: Although alternating dual-task (ADT) training is functionally easier for older adults, a large part of the motor and cognitive tasks is simultaneously performed, especially during activities of daily living that require maintaining body balance. Objective: To evaluate the effects of mixed dual-task training on mobility, cognitive function, and balance in community-dwelling older adults. Methods: Sixty participants were randomly allocated at a 1:1 ratio into the experimental group-single motor task (SMT) and simultaneous dual task (SDT) interchangeably in stage 1 (for 12 weeks) and after strictly with SDT in stage 2 (the last 12 weeks)-or into the control group-only SMT and SDT interchangeably in stages 1 and 2. Gait parameters were acquired by two inertial sensors. Physical and cognitive performance were acquired by specific questionnaires. Generalized linear mixed models were used for analyzing interaction and main effects. Results: No between-group difference was observed for gait performance. Both protocols improved mobility (mean change ((MC) = 0.74)), dual-task effect (MC = -13.50), lower limb function (MC = 4.44), static (MC = -0.61), and dynamic balance (MC = -0.23), body sway (MC = 4.80), and cognitive function (MC = 41.69). Conclusion: Both dual-task training protocols improved these outcomes.

Trends in consuming alcoholic beverages among adolescents and young adults of school age: sexes differences.

OBJECTIVE: To analyze the tendency of alcoholic beverage consumption among adolescents and young adults at school age according to their sexes. METHODS: This is a trend research study in public schools of the municipality of Petrolina, between 2014 and 2016, with 3146 students aged between 12 and 24 years old. The instrument was constituted by socio-economic inquiry and the Youth Risk Behavior Survey. Trends were assessed using the Centers for Disease Control and Prevention recommended approach. The analyses were conducted using logistic regression, with a statistical significance of 0.05. RESULTS: Close to 56% of the adolescents had already tried some alcoholic beverage, most of which had contact after 13 years of age. The prevalence of binge drinking ranged between 17% and 25%. The percentage of girls who tried alcohol before 13 years old remained similar over the three years (p = 0.943). The prevalence of this behavior was stabilized at around 20%. There was a trend to decrease in the prevalence of boys who reported having tried alcohol before 13 years old (p = 0.014). The percentage of boys who reported involvement in binge drinking in the past 30 days remained stable at around 20% over the years (p = 0.951). The girls' data revealed a significant decrease in binge drinking (p = 0.019). CONCLUSIONS: The general analysis suggests a trend towards stabilization of consumption among boys, and an increase among girls.

Changes in Physical Functioning and Fall-Related Factors in Older Adults Due to COVID-19 Social Isolation.

Background: Social isolation has been one of the main measures for the prevention of COVID-19. It's possible that, in addition to the natural aging-related deficits, social isolation has accelerated the decline of the different components of physical and mental capacity in older adults. This study aimed to compare the functional capacity and concern about falling in older adults before and during COVID-19 social isolation. Method: This observational longitudinal study was carried out with 45 community dwelling older adults (mean age 65.6 ± 4.6 years, 88.8% women). Functional capacity and concerns about falling assessments were carried out before the COVID-19 pandemic, and between the 16th and 18th week of social isolation. All testes were face-to-face, except the second FES-I assessment, which took place via telephone call in order to minimize a prolonged person-to-person contact. Muscle strength, muscle power, functional mobility, functional muscle fitness, upper and lower body flexibility, dynamic balance, and Efficacy Scale were assessments. Results: Regarding functional capacity, there was 14% decline in muscle strength (p<.001), 7% in power (p=.001), 11% in functional mobility (p=.001), 20% in functional muscle fitness (p=.001), and 60% in upper body flexibility (p=.001) and 33% lower body flexibility (p=.003). The dynamic balance and the concern about falling showed no statistically significant differences. Conclusion: Thus, it can be concluded that there was a decline in older adults' functional capacity during COVID-19 social isolation.

Activation of upper limb muscles in subjects with scapular dyskinesis during bench-press and dumbbell fly on stable and unstable surfaces.

BACKGROUND: Scapular dyskinesis has been associated with shoulder dysfunctions, and changes in electromyographic (EMG) activity have been reported during the execution of some exercises. OBJECTIVE: To compare upper limb muscles EMG of asymptomatic subjects with and without scapular dyskinesis during bench-press and dumbbell fly exercise performed on different surface stability conditions. METHODS: Twenty-eight physically active men were allocated into two groups: Control group (n= 14) and Dyskinesis group (n= 14). The participants performed six repetitions lasting three seconds of the bench press and dumbbell fly exercises with 50% of one-repetition maximum (1RM) on a bench and a Swiss ball. The EMG activity of the pectoralis major, serratus anterior, upper and lower trapezius, anterior deltoid, biceps and triceps muscles were recorded. RESULTS: No differences were found between groups, regardless of exercise or surface type. Inserting the unstable surface in the supine exercise promoted a slight increase in upper trapezius EMG activity for the control [4.32 (95% CI: 1.04 to 7.60)] and dyskinesis [3.30 (95% CI: 0.34 to 6.27)] groups. CONCLUSIONS: There is no difference in upper limb muscle EMG activity between subjects with and without scapular dyskinesis. In addition, inserting unstable surfaces did not modify EMG activity.

Concern About Falling, Confidence in Balance, Quality of Life, and Depression Symptoms in Community-Dwelling Older Adults After a 24-week Dual-Task Training With Variable and Fixed Priority: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect of a 24-week dual-task training with progression from variable to fixed priority on the concern about falling, confidence in balance, quality of life, and depression symptoms in community-dwelling older adults. METHODS: A total of 60 participants (60-80 y.o.) were randomly allocated into a dual-task training group with progression from variable to fixed priority (experimental group) or into a dual-task training group with variable priority (control group). RESULTS: No between-group difference was observed after the intervention. A significant time effect showed a reduction in concern about falling [mean difference (MD) = -2.91)] and depression symptoms (MD = -1.66), an increase in the physical function (MD = 7.86), overall mental health (MD = 5.82), perception of vitality, energy, and less fatigue (MD = 10.45), general perception of overall health (MD = 6.81), and their health compared to the last year (MD = 11.89). CONCLUSION: The experimental protocol was not superior to the control one. However, both protocols improved these outcomes.

Efficacy of Creatine Supplementation Combined with Resistance Training on Muscle Strength and Muscle Mass in Older Females: A Systematic Review and Meta-Analysis.

Sarcopenia refers to the age-related loss of muscle strength and muscle mass, which is associated with a reduced quality of life, particularly in older females. Resistance training (RT) is well established to be an effective intervention to counter indices of sarcopenia. Accumulating research indicates that the addition of creatine supplementation (Cr) to RT augments gains in muscle strength and muscle mass, compared to RT alone. However, some evidence indicates that sex differences may alter the effectiveness of Cr. Therefore, we systematically reviewed randomized controlled trials (RCTs) investigating the efficacy of Cr + RT on measures of upper- and lower-body strength and muscle mass in older females. A systematic literature search was performed in nine electronic databases. Ten RCTs (N = 211 participants) were included the review. Overall, Cr significantly increased measures of upper-body strength (7 studies, n = 142, p = 0.04), with no effect on lower-body strength or measures of muscle mass. Sub-analyses revealed that both upper-body (4 studies, n = 97, p = 0.05) and lower-body strength (4 studies, n = 100, p = 0.03) were increased by Cr, compared to placebo in studies ≥ 24 weeks in duration. In conclusion, older females supplementing with Cr experience significant gains in muscle strength, especially when RT lasts for at least 24 weeks in duration. However, given the level of evidence, future high-quality studies are needed to confirm these findings.

Effects of Workplace-Based Intervention for Shoulder Pain: A Systematic Review and Meta-analysis.

The main objective of this study is to update the evidence related to the effectiveness of exercise and ergonomic interventions in the perception of shoulder pain intensity in workers considering the shoulder pain intensity and the minimum clinically important change in the analysis. The bibliographic search was conducted in seven databases (Cochrane, EMBASE, SciELO, PubMed, PEDro, Web of Science and Scopus) from March to April 2019. The study selection included randomized controlled trials (RCTs) involving workers with shoulder pain who underwent physical exercises, ergonomics, and combined interventions. To analyze the RCTs, the intensity of pain was divided into two subgroups < 3 and ≥ 3 (0-10 points scale). A total of 27 RCTs were included in the qualitative synthesis considering the perception scales of shoulder pain intensity and the PEDro scale score of assessment of RCTs quality and risk of bias. Within these, seven RCTs were included in the quantitative synthesis. The overall effectiveness of interventions was calculated using a meta-analysis method, and the associated measurement used as a mean difference. The meta-analysis revealed that exercise interventions in workers with shoulder pain > 3 presented a minimally clincially important difference (MCID), but with no difference in workers with pain < 3. The interventions with exercise in workers with pain ≥ 3 at baseline reported a beneficial effect in reducing shoulder pain intensity, and a MCID. However, there was no significant difference for workers with pain < 3 and the effects of ergonomic interventions are still uncertain to reduce shoulder pain in workers.

Additional Functional Performance Gains After 24-Week Unstable Strength Training With Cognitive Training in Community-Dwelling Healthy Older Adults: A Randomized Trial.

The authors investigated the effects of unstable strength training (UST) without or with cognitive training (C+UST) on functional performance in community-dwelling older adults. A total of 50 participants were randomly assigned (1:1) to either 24 weeks of thrice-weekly UST (n = 25) or C+UST (n = 25). All participants performed moderate-intensity strength exercises using unstable surfaces, and C+UST participants simultaneously received cognitive training in addition to UST. Primary outcomes included measures of functional performance: single- and dual-task timed up and go tests. Secondary outcomes included dynamic balance, mobility, handgrip strength, flexibility, quality of life, and concern about falling. The authors observed similar improvements on functional performance through the interventions. The C+UST group experienced additional gains at completion (single-task timed up and go: -0.90 s, 95% confidence interval [-2.38, -0.03]; dual-task timed up and go: -4.80 s, 95% confidence interval [-8.65, -0.95]) compared with the UST group. Moreover, significant differences were observed in mobility (sitting-rising test: -1.34, 95% confidence interval [-2.00, -0.20]) at 24 weeks. Both exercise modes improved single-task functional performance, while adding cognitive-training-optimized dual-task functional performance gains.

Effects of Resistance Exercise with Instability on Cognitive Function (REI Study): A Proof-Of-Concept Randomized Controlled Trial in Older Adults with Cognitive Complaints.

BACKGROUND: Activities which simultaneously challenge both physical and cognitive function are promising strategies for promoting cognitive function. OBJECTIVE: To examine the effects of resistance exercise with instability and traditional resistance exercise compared with a health education control on cognitive function in older adults with cognitive complaints. METHODS: Sixty-seven participants were randomized to either 12 weeks of thrice-weekly resistance exercise (RE = 23), RE with instability (REI = 22), or a weekly health education control (CON = 22). At each training session, RE and REI participants performed seven exercises for three sets and 10-15 repetitions. REI participants performed each exercise using instability devices. The primary outcome was a composite score of global cognitive function. Secondary outcomes included composite scores for cognitive sub-domains and physical function. RESULTS: Most participants were women (REI: 77%; RE = 78%; CON = 77%; mean age of 71 years), and did not need transport to the intervention site. At completion, compared with CON, REI and RE did not significantly improve on global cognition or each cognitive sub-domain. Both exercise groups improved on the timed up and go (REI - CON: -1.6 s, 95% CI: [-2.6, -0.5]; RE - CON: -1.4 s, 95% CI: [-2.4, -0.5) and 1-RM (REI - CON: 24 kg, 95% CI: [11, 36]; RE - CON: 25 kg, 95% CI: [12, 37]). An exploratory contrast showed that compared with RE, REI promote greater gains on global cognition (2.20, 95% CI: [0.10, 4.31]) and memory (1.34; 95% CI: [0.15, 2.54]). CONCLUSION: REI did not substantially improve cognitive function but did promote physical function among older adults with cognitive complaints. However, compared with RE, REI improved global cognition and memory.

Dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults: A protocol for a randomized controlled trial : Variable- and fixed-priority dual-task for older adults.

BACKGROUND: Functional independence and safe mobility, especially in older people, mostly rely on the ability to perform dual tasks, particularly during activities with variable- and fixed-priority attention. The aim of this study is to compare the dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults. METHODS: This is an assessor- and participant-blinded, two-arm, randomized controlled trial with 60 community-dwelling male and female older adults between the ages of 60 and 80 years old. Participants will be randomly allocated into either the intervention group or the control group using a computer-generated permuted block randomization schedule. The intervention group will undertake a progressive dual-task training in which the participants will be progressively submitted to dual-task walking and postural balance exercises with variable- to fixed-priority instructions. The control group will be submitted to dual-task training with variable-priority attention exercises. Both groups will receive 48 sessions lasting for 60 min each over 24 weeks. The primary outcome will be the gait speed under single- and dual-task conditions. Secondary outcomes will include spatiotemporal gait parameters, functional balance, executive function, falls, quality of life, and depression symptoms. All the analyses will be based on the intention-to-treat principle. DISCUSSION: This is the first assessor- and participant-blinded, two-arm, randomized controlled trial with 6 months of intervention and an additional 6-month post-training follow up aiming to evaluate the effectiveness of training with progression from variable- to fixed-priority instructions on gait biomechanics, postural balance, falls episodes, executive functioning, and quality of life in community-dwelling older adults. If our hypotheses are confirmed, this training protocol can be implemented widely to improve gait speed and other functional activities and quality of life in community-dwelling older adults. This study protocol can be used to improve these functional aspects of community-dwelling older adults. This study may also contribute to future guidelines for the improvement of these clinical and biomechanical aspects in older people. TRIAL REGISTRATION: ClinicalTrials.gov Identifier - NCT03886805, Registered 22 March 2019.

Can the Use of Unstable Surfaces and Instruction for Conscious Abdominal Contraction Increase the EMG Activity of the Periscapular Muscles During the Dynamic Push-Up?

CONTEXT: It is believed that conscious abdominal contraction (CAC) during exercise encourages greater periscapular activation through existing myofascial connections. On the other hand, it is postulated that the use of unstable surfaces would promote greater neuromuscular demand. OBJECTIVE: To analyze the effect of CAC on periscapular muscle activity during push-up plus exercise on stable and unstable surfaces and to evaluate the correlation between electromyographic (EMG) activity of the serratus anterior (SA) and abdominal oblique muscles. DESIGN: Repeated-measures design in a single group, pre-post CAC. SETTING: Biomechanics laboratory. PARTICIPANTS: Twenty-three male volunteers without a history of lesions in the upper limbs participated in the study. MAIN OUTCOME MEASURES: Five repetitions of push-ups on stable and unstable surfaces were performed with and without instruction for CAC. The normalized amplitude of the EMG activity was obtained from the muscles of the upper, middle, and lower trapezius, SA upper (SA_5th) and lower (SA_7th) portions, external oblique (EO), and internal oblique. RESULTS: CAC increased the activity of the EO, internal oblique, middle trapezius, and SA (P < .05) in both surfaces. The use of the unstable surface increased the EMG activity of the EO, SA_7th, and middle trapezius and decreased the EMG activity of the SA_5th. However, all changes observed in EMG signals were of low magnitude, with effect sizes lower than 0.45. There was a weak correlation between the EMG activity of the EO and SA_5th (r = .24) and a strong correlation between the EO and SA_7th (r = .70). CONCLUSION: The isolated use of CAC or unstable surface during push-up seems to present no practical relevance, but the combined use of these strategies may increase activation of the SA_7th and middle trapezius muscles.

Static Stretching Intensity Does Not Influence Acute Range of Motion, Passive Torque, and Muscle Architecture.

CONTEXT: Although stretching exercises are commonly used in clinical and athletic practice, there is a lack of evidence regarding the methodological variables that guide the prescription of stretching programs, such as intensity. OBJECTIVE: To investigate the acute effects of different stretching intensities on the range of motion (ROM), passive torque, and muscle architecture. DESIGN: Two-group pretest-posttest design. SETTING: Laboratory. PARTICIPANTS: Twenty untrained men were allocated into the low- or high-intensity group. MAIN OUTCOME MEASURES: Subjects were evaluated for initial (ROMinitial) and maximum (ROMmax) discomfort angle, stiffness, viscoelastic stress relaxation, muscle fascicle length, and pennation angle. RESULTS: The ROM assessments showed significant changes, in both groups, in the preintervention and postintervention measures both for the ROMinitial (P < .01) and ROMmax angle (P = .02). There were no significant differences for stiffness and viscoelastic stress relaxation variables. The pennation angle and muscle fascicle length were different between the groups, but there was no significant interaction. CONCLUSION: Performing stretching exercises at high or low intensity acutely promotes similar gains in flexibility, that is, there are short-term/immediate gains in ROM but does not modify passive torque and muscle architecture.

Effects of a 12-Week Chronic Stretch Training Program at Different Intensities on Joint and Muscle Mechanical Responses: A Randomized Clinical Trial.

CONTEXT: Stretching intensity is an important variable that can be manipulated with flexibility training. However, there is a lack of evidence regarding this variable and its prescription in stretching programs. OBJECTIVE: To investigate the effects of 12 weeks of knee flexor static stretching at different intensities on joint and muscle mechanical properties. DESIGN: A randomized clinical trial. SETTING: Laboratory. PARTICIPANTS: A total of 14 untrained men were allocated into the low- or high-intensity group. MAIN OUTCOME MEASURES: Assessments were performed before, at 6 week, and after intervention (12 wk) for biceps femoris long head architecture (resting fascicle length and angle), knee maximal range of motion (ROM) at the beginning and maximal discomfort angle, knee maximal tolerated passive torque, joint passive stiffness, viscoelastic stress relaxation, knee passive torque at a given angle, and affective responses to training. RESULTS: No significant differences were observed between groups for any variable. ROM at the beginning and maximal discomfort angle increased at 6 and 12 weeks, respectively. ROM significantly increased with the initial angle of discomfort (P < .001, effect size = 1.38) over the pretest measures by 13.4% and 14.6% at the 6- and 12-week assessments, respectively, and significantly improved with the maximal discomfort angle (P < .001, effect size = 1.25) by 15.6% and 18.8% from the pretest to the 6- and 12-week assessments, respectively. No significant effects were seen for muscle architecture and affective responses. Initial viscoelastic relaxation for the low-intensity group was lower than ending viscoelastic relaxation. CONCLUSION: These results suggest that stretching with either low or high discomfort intensities are effective in increasing joint maximal ROM, and that does not impact on ROM, stiffness, fascicle angle and length, or affective response differences.

Effect of 24-week strength training on unstable surfaces on mobility, balance, and concern about falling in older adults.

OBJECTIVE: To evaluate the effects of 24 weeks of strength training on stable (ST) and unstable surfaces (UST) on the functional mobility, balance, and concern about falling in healthy older adults, younger than 70. DESIGN: A single-center randomized clinical trial. PARTICIPANTS: Sixty-four older adults (58 females and 6 males; 68 years) were randomized into control, ST, or UST groups. INTERVENTIONS: Both ST and UST intervention groups received a core muscle, upper, and lower limb moderate-intensity strength exercises using stable and unstable surfaces. The classes were performed three times per week over a 24-week period. The control group did not receive any type of active intervention. MEASUREMENTS: The primary outcome measures were the dynamic balance (Berg Balance Scale (BBS)) and functional mobility (timed up and go (TUG) test). The secondary outcomes included the sitting and rising test (SRT) and Falls Efficacy Scale-International (FESI) scores. RESULTS: There was a significant improvement in balance performance (BBS = +4 points) after 24 weeks of both ST (+1.22; 95% CI, -0.19 to 2.63) and UST (+2.26; 95% CI, 0.83-3.70) compared with the control group. Additionally, compared with the control, only UST experienced functional mobility gains (TUG = -2.44; 95% CI, -4.41 to -0.48; SRT = +1.12; 95% CI, 0.08-2.17) and decreased concern about falling (FESI = -4.41; 95% CI, -9.30 to -0.27). CONCLUSION: Long-term ST with and without unstable devices was effective to improve dynamic balance in older adults. Furthermore, the effects of UST were extended to functional mobility gains and reduced concern about falling.

Reliability of the Closed Kinetic Chain Upper Extremity Stability Test in young adults.

OBJECTIVE: To analyze the reliability indicators of CKCUEST, and to investigate how many sessions are necessary to find a stable score. DESIGN: Reliability study. SETTING: Biomechanics laboratory. PARTICIPANTS: The sample consisted of 36 healthy young adults, of both genders. MAIN OUTCOME MEASURES: The subjects performed four CKCUEST with a minimum interval of three days between evaluations. The number of touches in each execution was counted, and then the average values of the number of rings, normalized score and power were calculated. RESULTS: The CKCUEST presented ICC ranging from 0.77 to 0.92 (mean number of touches), 0.80 to 0.94 (normalized score) and 0.91 to 0.98 (power). The Bland-Altman plots showed the presence of systematic error for all measures, as also confirmed by the ANOVA analysis. The scores increased every session for both genders. The boys' scores stabilized in the third session. However, the girls' scores did not stabilize. CONCLUSION: The CKCUEST presents excellent reliability; however, there is the presence of systematic error between measurements. It is necessary to perform at least three sessions to obtain reliable data for male participants, and the female results were not conclusive.