Effects of a Resistance and Stretching Training Program on Forward Head and Protracted Shoulder Posture in Adolescents.

OBJECTIVE: The purpose of this study was to evaluate the effects of a 16-week resistance and stretching training program applied in physical education (PE) classes on forward head posture and protracted shoulder posture in Portuguese adolescents. METHODS: This prospective, randomized, controlled study was conducted in 2 secondary schools. One hundred and thirty adolescents (aged 15-17 years) with forward head and protracted shoulder posture were randomly assigned to a control or experimental group. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and Postural Assessment Software. The American Shoulder and Elbow Surgeons Shoulder Assessment was used to assess shoulder pain, and neck pain during the last month was self-reported with a single question. These variables were assessed before and after a 16-week intervention period. The control group (n = 46) attended the PE classes, whereas the exercise group (n = 84) received a posture corrective exercise program in addition to PE classes. RESULTS: A significant increase in cervical and shoulder angles was observed in the intervention group from pretest to posttest (P < .05). For the shoulder pain scores in both groups, there were no significant changes after the 16 weeks. CONCLUSIONS: A 16-week resistance and stretching training program decreased forward head and protracted shoulder postures in adolescents.

Intrarater and interrater reliability of photographic measurement of upper-body standing posture of adolescents.

OBJECTIVE: The purposes of this study were to determine the intrarater and interrater reliability of a photographic measurement of the sagittal postures of the cervical spine and shoulder, quantitatively characterize the postural alignment of the head and shoulders in the sagittal plane of Portuguese adolescents 15 to 17 years old in natural erect standing, and analyze differences in postural angles between sexes. METHODS: This cross-sectional study was conducted in 2 secondary schools in Portugal where 275 adolescent students (146 females and 129 males) aged 15 to 17 years were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and the Postural Assessment Software. RESULTS: For interrater reliability, all of the intraclass correlation coefficient (ICC) values for the 3 angles were higher than 0.85. For intrarater reliability, the ICC values for the sagittal head angle, shoulder angle, and cervical angle were 0.83, 0.78, and 0.66, respectively. Mean values of sagittal head, cervical, and shoulder angles were 17.2° ± 5.7°, 47.4° ± 5.2°, and 51.4° ± 8.5°, respectively. Anterior head carriage was demonstrated by 68% of the adolescents, whereas 58% had protraction of the shoulder(s). Males had significantly higher mean cervical and sagittal head angles. CONCLUSIONS: Forward head posture and protracted shoulders were common postural disorders in adolescents 15 to 17 years old, with females revealing a lower mean cervical angle. The intrarater and interrater evaluation of standing sagittal posture of the cervical spine and shoulders by photogrammetry was reliable.

Cross-cultural adaptation and validation of the Portuguese version of the Parental Supervision Attributes Profile Questionnaire.

OBJECTIVES: To cross-culturally adapt and validate the Portuguese version of the Parental Supervision Attributes Profile Questionnaire (PSAPQ). The PSAPQ is a measure of parental supervision, which has not been translated and adapted into any language other than English. METHODS: The Portuguese version was the result of forward/backward translations, consensus panels and pretesting. Reliability and internal consistency were assessed using Cronbach's α, intraclass correlation coefficient (ICC) and confirmatory factor analysis (CFA) in adults with different educational levels. RESULTS: Cronbach's α (α=0.70-0.79) and ICC (>0.75) were acceptable in three of four factors. The results of CFA (χ(2)/df=2.243; CFI=0.951; GFI=0.96; RMSEA=0.056; P(RMSEA ≤ 0.05)=0.222) suggest a good adjustment between the factors. CONCLUSIONS: The Portuguese version of PSAPQ showed acceptable psychometric properties. This study evidenced some vulnerabilities of the fate subscale, emphasising the need for further investigation of the effects of the educational level of the parents.

The Portuguese version of the Personal and Social Performance Scale (PSP): reliability, validity, and relationship with cognitive measures in hospitalized and community schizophrenia patients.

PURPOSE: Deficits in social functioning are a core feature of schizophrenia and are influenced by both symptomatic and neurocognitive variables. In the present study we aimed to determine the reliability and validity of the Portuguese version of the Personal and Social Performance (PSP) scale, and possible correlations with measures of cognitive functioning. METHODS: One-hundred and four community and inpatients with schizophrenia were assessed using measures of social functioning and symptom severity alongside measures of executive function, processing speed, and verbal memory. RESULTS: Convergent validity with the GAF in the four domains of the PSP varied from 0.357 to 0.899. Reliability was found to be satisfactory, with a Cronbach's alpha coefficient of 0.789. Inter-rater reliability in the four domains of the PSP varied from 0.430 to 0.954. Low-functioning patients (PSP < 70) were older, had longer duration of illness, were more symptomatic and had worse cognitive performances, as compared with high-functioning patients (PSP ≥ 70). In a regression model, deficits in social functioning were strongly predicted both by symptomatic and neurocognitive variables; these together accounted for up to 62% of the variance. CONCLUSIONS: The present study supports the reliability and validity of the Portuguese language version of the PSP and further supports the original measure. The co-administration of brief cognitive assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes in this group.

Is personal and social functioning associated with subjective quality of life in schizophrenia patients living in the community?

Subjective quality of life (QoL) and psychosocial functioning constitute important treatment outcomes in schizophrenia. We aimed to investigate the relationship between them in schizophrenia patients living in the community. Symptom severity and insight were assessed with the Positive and Negative Syndrome Scale (PANSS) in 76 community schizophrenia patients. Social functioning was measured with the Portuguese version of Personal and Social Performance (PSP) scale, and subjective QoL was measured with the Portuguese version of the WHO Quality of Life Measure-Abbreviated Version (WHOQOL-Bref). The majority of patients were single (78%) and unemployed/inactive (74%). Mean PSP total score was 55.5, and mean scores on WHOQOL-Bref domains ranged from 54.1 to 63.0. Greater symptom severity and worse insight were significantly associated with worse functioning in all PSP domains. Symptoms were more moderately correlated with QoL, with no significant correlations between QoL and positive symptoms and insight levels. Partial correlations controlling for symptom severity revealed no significant associations between social functioning and subjective QoL. Symptom severity may exert a greater influence on social functioning than on subjective QoL; however, social functioning was not associated with subjective QoL. The results suggest these constructs might be independent and should be assessed separately. A broader research approach, with increased attention to social and psychological factors, may help identify treatment targets to improve schizophrenia patients' social functioning and QoL.

Quality of life in bipolar type I disorder and schizophrenia in remission: clinical and neurocognitive correlates.

This cross-sectional study examined the relationships between clinical and neuropsychological variables and self-reported quality of life (QoL) in 30 euthymic bipolar I patients, 23 remitted schizophrenic patients, and 23 healthy controls. Participants were administered the World Health Organization Quality of Life Measure-Abbreviated Version (WHOQOL-BREF) to assess QoL. Moreover, a broad neuropsychological battery was also administered. Bipolar disorder (BD) and schizophrenia patients demonstrated significantly lower scores on the physical, psychological, and social domains of the WHOQOL-BREF compared with controls, but there were no significant differences between the two patient groups on those domains. More symptomatic BD patients reported worse QoL, especially in the physical and environmental domains, which was also associated with worse neurocognitive performance. In schizophrenic patients, neurocognitive performance was not associated with self-reported QoL, but more symptomatic patients reported lower QoL. Substantial impairments in QoL, similar in severity, were found in both patient groups. In patients with schizophrenia, QoL was more strongly related to levels of psychopathology, whereas in BD patients, both psychopathology and neurocognitive deficits were strongly associated with lower QoL. Clinical recovery is essential in schizophrenia and BD. The association between cognitive functioning and QoL in bipolar patients suggests that these patients may also benefit from psychological interventions addressed to improve cognitive deficits and enhance the functional recovery.

Setting qualitative performance parameters of elite surfing aerial manoeuvres with 360° rotation / Establecimiento de parámetros cualitativos de rendimiento de maniobras aéreas de surf de élite con rotación de 360 grados / Definição de parâmetros qualitativos de desempenho de manobras aéreas de surf de elite com rotação de 360 graus

El objetivo fue analizar parámetros de maniobras aéreas de surf de alto nivel, apoyando el entrenamiento específico y la prevención de lesiones. Utilizando análisis de video de maniobras aéreas completadas porsurfistas masculinos de top-5en 19 eventos durante las temporadas 2018y 2019del World Championship Tour, se seleccionaron (n=97): Frontside Air, Frontside Air Reverse 360, Backside Air y Backside Air Reverse 360.Se trata de una investigación de métodomixto. Tiene un análisis de tarea cualitativo, realizado a través del análisisen fases, considerando características clave de las acciones corporales y principios de movimiento. A través de la metodologíaobservacional (nomotético, puntual y multidimensional) se midió laaltura del aéreo, el ancho del BoS y los ángulos de flexión de la rodilla y del tobillo delanteros.Las referencias en el análisis cualitativo fueron: rotación de cabeza y tronco, triple flexión de miembros inferiores (preparación) y máspronunciada en larecuperación; flexión de cabeza, tronco y brazos desde el despegue (preparación) hasta el pico del vuelo (principal) provocando el desplazamiento anterosuperior del CoM; ampliación de la BoS para aéreos frontales (principal). El análisiscuantitivo permitió identificarlamedia dela altura del aéreo (169,60±52,85cm), del ancho de la base de sustentación (BoS) (79,17±13,72cm), y de los ángulos de flexión de la rodilla (113,78±19,90º) y del tobillo(32,74±14,51º)delanteros durante el aterrizaje. El análisis descriptivo puede contribuir al desarrollo de programas de formación específicos para la enseñanza y el aprendizaje, con el objetivo de mejorar el rendimiento de las maniobras aéreas. (AU)

Purpose was to analyse parameters of high-level surfing aerial manoeuvres, supporting specific training and injury prevention. Using video analysis ofaerials completed by top-5male surfersin 19 events during 2018and 2019 seasonsof the World Championship Tour, were selected (n=97): Frontside Air, Frontside Air Reverse 360, Backside Air and Backside Air Reverse 360. This is a mixed method research. Has a qualitative task analysis, carried out through phaseanalysis, considering key features from body actions and principles of movement. Through observational methodology (nomothetic, single point and multidimensional)was measured the aerial height, theBoS width, and flexion angles of front knee and front ankle.Qualitative analysis references were: rotation of the head and trunk, triple-flexion of the lower limbs (retraction) and more pronounced in the follow-through; head, trunk, and arms flexion fromthe take-off (retraction) to the peak of the flight (action) causing the anterosuperior CoM displacement; widening of the BoS for frontside aerials (action). Quantitative analysis allowed to identify the mean of aerial height (169.60±52.85cm), of base of support (BoS) width (79.17±13.72cm), and flexion anglesof front knee (113.78±19.90º) and front ankle (32.74±14.51º) during landing.Descriptive analysis may contribute to the development of specific training programs for teaching and learning, aiming to improve performance of aerial manoeuvres. (AU)

O objetivo foi analisar parâmetros de manobras aéreas de surf de alto nível, dando suporte ao treino específico e à prevenção de lesões. Através da análisede vídeode manobras aéreas concluídaspor surfistas masculinos do top-5,em 19 eventos durante as temporadas 2018 e 2019do World Championship Tour, foram selecionados (n=97): Frontside Air, Frontside Air Reverse 360, Backside Air e Backside Air Reverse 360.Esteé um estudo com um método misto. Temos uma análise da tarefa qualitativa, realizada através da análise por fases, considerando as principais características das ações corporais e dos princípios do movimento.Através da metodologia observacional (nomotético, pontual e multidimensional) foi medida a altura do aéreo, a largura do BoS e os ângulos de flexão do joelho e do tornozelodianteiros. As referências da análise qualitativa foram: arotação de cabeça e tronco, tripla flexão dos membros inferiores (preparação) e mais acentuada na finalização; flexão da cabeça, tronco e braços desde a descolagem (preparação) até o pico do voo (ação principal) causando o deslocamento antero-superior do CoM; alargamento da BoS paraaéreos frontais (ação principal). A análise quantitativa permitiu identificar a média da altura do aéreo (169,60±52,85cm), da largura da base de sustentação (BoS) (79,17±13,72cm) e dos ângulos de flexão do joelho(113,78±19,90º) e tornozelo (32,74±14,51º)dianteiros durante a aterragem. A análise descritiva pode contribuir para o desenvolvimento de programas de treino específicos para ensino e aprendizagem, visando melhorar o desempenho das manobras aéreas. (AU)

Normal width of the inter-recti distance in pregnant and postpartum primiparous women.

STUDY DESIGN: Longitudinal descriptive exploratory study. OBJECTIVES: Evaluate the normal width of the linea alba in first-time pregnant women during pregnancy and postpartum. BACKGROUND: There are normative values on the width of the linea alba for nulliparous women, but limited knowledge about the normal width of the inter-rectus distance (IRD) in pregnant and postpartum women. METHODS: Ultrasound images were recorded in 84 primiparous women, at 3 locations on the linea alba (2 cm below the umbilicus, and 2 and 5 cm above the umbilicus) and at 4 time points (gestational weeks 35-41 and 6th to 8th, 12th to 14th, and 24th to 26th weeks postpartum). The 20th and 80th percentiles were used to define the normal width of the linea alba. RESULTS: During pregnancy, the 20th and the 80th percentile corresponded to 49-79 mm below the umbilicus, 54-86 mm at 2 cm above the umbilicus and 44-79 mm at 5 cm above the umbilicus. At 6 months postpartum, the 20th and the 80th percentile corresponded to 9-21 mm at 2 cm below the umbilicus, from 17 to 28 mm at 2 cm above the umbilicus and from 12 to 24 mm at 5 cm above the umbilicus. CONCLUSION: Different normative values for the width of the linea alba were found at different locations of the anterior abdominal wall. In primiparous women, the IRD may be considered "normal" up to values wider than in nulliparous.

The Immediate Effects on Inter-rectus Distance of Abdominal Crunch and Drawing-in Exercises During Pregnancy and the Postpartum Period.

STUDY DESIGN: Longitudinal descriptive exploratory study. OBJECTIVES: To evaluate in primigravid women the immediate effect of drawing-in and abdominal crunch exercises on inter-rectus distance (IRD), measured at 4 time points during pregnancy and in the postpartum period. BACKGROUND: There is scant knowledge of the effect of different abdominal exercises on IRD in pregnant and postpartum women. METHODS: The study included 84 primiparous participants. Ultrasound images were recorded with a 12-MHz linear transducer, at rest and during abdominal drawing-in and abdominal crunch exercises, at 3 locations on the linea alba. The IRD was measured at 4 time points: gestational weeks 35 to 41, 6 to 8 weeks postpartum, 12 to 14 weeks postpartum, and 24 to 26 weeks postpartum. Separate 2-way, repeated-measures analyses of variance (ANOVAs) were performed for each exercise (drawing-in and abdominal crunch) and each measurement location to evaluate the immediate effects of exercises on IRD at each of the 4 time points. Similarly, 2-way ANOVAs were used to contrast the effects of the 2 exercises on IRD. RESULTS: Performing the drawing-in exercise caused a significant change in width of the IRD at 2 cm below the umbilicus, narrowing the IRD by a mean of 3.8 mm (95% confidence interval [CI]: 1.2, 6.4 mm) at gestational weeks 35 to 41, and widening the IRD by 3.0 mm (95% CI: 1.4, 4.6 mm) at 6 to 8 weeks postpartum, by 1.8 mm (95% CI: 0.6, 3.1 mm) at 12 to 14 weeks postpartum, and by 2.5 mm (95% CI: 1.4, 3.6 mm) at 24 to 26 weeks postpartum (P<.01). Performing the abdominal crunch exercise led to a significant narrowing of the IRD (P<.01) in all 3 locations at all 4 time points, with the exception of 2 cm below the umbilicus at postpartum weeks 24 to 26. The average amount of narrowing varied from 1.6 to 20.9 mm, based on time and location. CONCLUSION: Overall, there was a contrasting effect of the 2 exercises, with the abdominal crunch exercise consistently producing a significant narrowing of the IRD. In contrast, the drawing-in exercise generally led to a small widening of the IRD.

Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain.

Diastasis recti abdominis (DRA) is an impairment characterized by a midline separation of the rectus abdominis muscles along the linea alba. It has its onset during pregnancy and the first weeks following childbirth. There is scant knowledge on both prevalence and risk factors for development of the condition. The aim of this study was to investigate the prevalence of DRA at gestational week 35 and three timepoints postpartum, possible risk factors, and the relationship between DRA and lumbo-pelvic pain. Ultrasound images of inter rectus distance (IRD) were recorded in 84 healthy primiparous women, at three locations on the linea alba. The IRD was measured at: gestational week 35 and 6-8, 12-14, and 24-26 weeks postpartum. Diagnosis of DRA was defined as 16 mm at 2 cm below the umbilicus. Independent sample t-test and binary logistic regression was used to assess differences and risk factors in women with and without DRA and women with and without lumbo-pelvic pain. P < 0.05 was considered statistically significant. The prevalence of DRA decreased from 100% at gestational week 35-39% at 6 months postpartum. No statistically significant differences were found in prepregnancy body mass index (BMI), weight gain, baby's birth weight or abdominal circumference between women with and without DRA at 6 months postpartum. Women with DRA at 6 months postpartum were not more likely to report lumbo-pelvic pain than women without DRA. DRA is prevalent at 6 months postpartum, but is not linked with lumbo-pelvic pain.

Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements.

An increased inter-rectus distance (IRD) is a common condition in late pregnancy and in the postnatal period. The condition is difficult to assess. Palpation is the most commonly used method to assess IRD. To date there is scant knowledge of intra and inter-tester reliability of palpation to measure IRD and how palpation compares with ultrasound measurements. The aims of this study were: 1) evaluate intra and inter-rater reliability of abdominal palpation; 2) validate abdominal palpation of IRD measurements using ultrasound imaging as a reference. Two physiotherapists (PTs) conducted the palpation study in random order, blinded to each other's assessments. IRD was measured as finger widths between the two rectus abdominis (RA) muscles. Ultrasound images were recorded at the same locations as the palpation test. A blinded investigator measured the IRD offline. Palpation showed good intra-rater reliability between days expressed by a weighted Kappa (wK) higher than 0.7 for both physiotherapists, and moderate inter-rater reliability (wK = 0.534). Ultrasound was found to be more responsive for differences in IRD compared with values obtained by palpation. The intra-rater reliability was higher than the inter-rater reliability. Besides the difference in experience with palpation testing between the PTs, this result may be due to differences in finger width and/or the subjective interpretation of abdominal soft-tissues pressure. Ultrasound measures are highly sensitive to changes of IRD, which is not possible to replicate by palpation assessment using a finger width scale. Palpation has sufficient reliability to be used in clinical practice. However, ultrasound is a more accurate and valid method and is recommended in future research of IRD.

Lower limb body composition is associated to knee passive extension torque-angle response.

PURPOSE: People vary in flexibility regarding maximum joint angle, resistance to stretch and mechanical responses during stretching exercises. Body composition (BC) has been been mentioned as one of the factors for flexibility differences. The aim of this study was to determine how body composition and anthropometric measures of the lower limb is associated with passive knee extension (PKE) torque-angle (T-A) response. METHODS: Twenty-five male subjects with poor flexibility performed a maximal PKE repetition (velocity of 2°/s; 90 seconds in the static phase). Knee passive T-A, vastus medialis and semitendinosous electromyographic activity were recorded during the protocol. Viscoelastic stress relaxation (VSR) amplitude, knee passive stiffness (KPS), lower limb body composition assessed by dual energy x-ray absorptiometry, and anthropometry measures were determined. RESULTS: Thigh skeletal muscle and bone mass, as well as thigh perimeter, showed a moderated correlation with passive torque (r = 0.45; r = 0.6; r = 0.59, respectively), joint angle (r = 0.46; r = 0.5; r = 0.5), and VSR (r = 0.46; r = 0.49; r = 0.5). Thigh skeletal muscle was also correlated with KPS (r = 0.42). All these correlations were statistically significant (p < 0.05). CONCLUSIONS: Passive knee extension T-A was found to be moderately correlated with lower limb BC. In particular, thigh perimeter and skeletal muscle mass were associated with knee passive stiffness and viscoelastic stress relaxation. More research is needed to understand what influences joint maximum angle, resistance to stretch and mechanical response to stretching.

A moderate dose of caffeine ingestion does not change energy expenditure but decreases sleep time in physically active males: a double-blind randomized controlled trial.

Research on the effect of caffeine on energy expenditure (EE), physical activity (PA), and total sleep time (TST) during free-living conditions using objective measures is scarce. We aimed to determine the impact of a moderate dose of caffeine on TST, resting EE (REE), physical activity EE (PAEE), total EE (TEE), and daily time spent in sedentary, light, moderate, and vigorous intensity activities in a 4-day period and the acute effects on heart rate (HR) and EE in physically active males. Using a double-blind crossover trial (ClinicalTrials.gov ID: NCT01477294) with two conditions (4 days each with 3-day washout) randomly ordered as caffeine (5 mg/kg of body mass/day) and placebo (maltodextrin) administered twice per day (2.5 mg/kg), 30 nonsmoker males, low-caffeine users (<100 mg/day), aged 20-39, were followed. Body composition was assessed by dual-energy X-ray absorptiometry. PA was assessed by accelerometry, while a combined HR and movement sensor estimated EE and HR on the second hour after the first administration dose. REE was assessed by indirect calorimetry, and PAEE was calculated as [TEE - (REE + 0.1TEE)]. TST and daily food records were obtained. Repeated measures ANOVA and ANCOVA were used. After a 4-day period, adjusting for fat-free mass, PAEE, and REE, TST was reduced (p = 0.022) under caffeine intake, while no differences were found between conditions for REE, PAEE, TEE, and PA patterns. Also, no acute effects on HR and EE were found between conditions. Though a large individual variability was observed, our findings revealed no acute or long-term effects of caffeine on EE and PA but decreased TST during free-living conditions in healthy males.

Symptomatic remission in schizophrenia patients: relationship with social functioning, quality of life, and neurocognitive performance.

PURPOSE: To investigate whether symptomatic remission relates to better outcomes in schizophrenia. METHODS: Seventy-six schizophrenia patients were assessed using measures of cross-sectional symptomatic remission, social functioning, subjective quality of life (QoL), and cognition. RESULTS: Most patients (53; 69.7%) were not in remission. Remitted patients presented significantly better social functioning, better self-reported QoL, insight, and lower levels of depressive symptoms. They also showed a non-significant trend for better executive function, processing speed and verbal memory. CONCLUSIONS: Symptomatic remission may be a good indicator of better clinical status, social functioning and QoL, but not so much for cognitive functioning.