Is the Combination of Aerobic Exercise with Mat Pilates Better than Mat Pilates Training Alone on Autonomic Modulation Related to Functional Outcomes in Hypertensive Women? Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND: Although mat Pilates (MP) has become popular, the effects of MP in hypertensive women (HW) are not entirely clear. Here, we investigated the effects of 16 weeks of MP training contrasted with MP supplemented with aerobic exercise (MP+AE) and compared with a non-intervention group on autonomic modulation, cardiorespiratory fitness, strength, flexibility, performance of functional tasks, QOL, anthropometric variables, clinical BP, and heart rate. METHODS: This is a three-arm, secondary analysis of an RCT. Sixty HW, aged 30 to 59 years, were allocated into: MP only (MP), MP+AE on a treadmill (MP+AE), and Control Group, without exercises. Assessments were performed before and after 16 weeks of training. RESULTS: The ANOVA shows differences in between-group comparisons in the SDNN, rMSSD, and SD1 in the heart rate variability analysis, with increases in rMSSD, SDNN, and SD1 only in the MP, and this result was not found in the MP+AE group (p < 0.05). Differences were observed in the between-group comparisons in time in the cardiorespiratory exercise test (CPX), flexibility, and the waist-to-hip ratio, with changes in the MP+AE, differences in QOL, and increments in the MP and MP+AE (p < 0.05). CONCLUSIONS: MP increased the indices that reflect vagal and global cardiac autonomic modulation. MP+AE improved the CPX performance, flexibility, QOL, and anthropometric variables. These results suggest that MP supplemented or not with AE has promising effects in HW.

The Effect of Mat Pilates Training Combined With Aerobic Exercise Versus Mat Pilates Training Alone on Blood Pressure in Women With Hypertension: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to determine the effects of mat Pilates (MP) versus MP plus aerobic exercise (AE) compared with the effects of no intervention on ambulatory blood pressure (BP) in women with hypertension. METHODS: This 3-arm, parallel-group randomized clinical trial assessed 60 women who had hypertension and were 30 to 59 years old. The intervention lasted 16 weeks, and the participants were allocated into 3 groups: MP only (MP group), MP with alternating bouts of AE on a treadmill (MP + AE group), and control group (CG) with no exercises. Primary outcomes were the effects of the interventions on ambulatory BP assessed in the 24-hour, awake, and asleep periods of analysis. RESULTS: A 2-way analysis of variance did not reveal statistically significant differences in between-group comparisons in the 24-hour period of analysis for systolic BP (CG vs MP = 3.3 [95% CI = -7.1 to 13.8]; MP vs MP + AE = 0.7 [95% CI = -4 to 5.4]; CG vs MP + AE = 4.0 [95% CI = -5.2 to 13.4]), diastolic BP (CG vs MP = 2.2 [95% CI = -5.6 to 10.0]; MP vs MP + AE = 1.1 [95% CI = -4.3 to 6.5]; CG vs MP + AE = 3.3 [95% CI = -3.8 to 10.4]), and heart rate (CG vs MP = 3.4 [95% CI = -2 to 8.8]; MP vs MP + AE = 2.0 [95% CI = -3.4 to 7.5]; CG vs MP + AE = 5.4 [95% CI = -0.8 to 11.8]). The awake and asleep periods of analyses also showed similar behavior and did not reveal statistically significant between-group differences. Furthermore, in the responsiveness analysis based on the minimal clinically important difference, no differences were observed between groups. CONCLUSION: The magnitudes of the decrease in systolic BP during the 24-hour period of analysis were -3 and -5.48 mm Hg for the MP and MP + AE groups, without differences for responsiveness between groups. The results suggest that MP supplemented with AE or not may be an alternative adjuvant treatment for women who have hypertension and are using antihypertension medication. IMPACT: Sixteen weeks of MP training reduced ambulatory BP in women who had hypertension. The MP + AE group displayed a BP reduction similar to that of the MP group. A reduction in ambulatory BP can decrease the risk of cardiovascular disease.

What is the exercise intensity of Pilates? An analysis of the energy expenditure, blood lactate, and intensity of apparatus and mat Pilates sessions.

BACKGROUND: Pilates is a form of exercise commonly used in rehabilitation settings that improves muscular fitness and flexibility. However, it is unknown whether the energy expenditure (EE) from Pilates sessions could also lead to the intensity suggested by health organizations to improve physical fitness. This study aimed to quantify and compare the intensity and the EE of two different Pilates sessions (mat and apparatus). METHODS: 18 healthy females (age: 22 ± 3 years; height: 1.6 ± 0.1m; body mass: 61.0 ± 10.0 kg; body mass index: 21 ± 3 kg/m2) performed two different sessions. Each session involved the performance of 15 exercises. Oxygen consumption (V˙O2) was measured continuously and then converted to EE in Kcal/min. Blood lactate, heart rate (HR), and blood pressure (BP) were also measured. A repeated measures two-way ANOVA (time X group) determined differences between sessions. Bonferroni's post hoc analysis was used to identify significant differences between measures. RESULTS: The Reformer apparatus and Mat sessions presented an EE of 2.59 ± 0.53 and 1.93 ± 0.26 kcal/min, respectively. V˙O2 was higher for the Reformer session (8.67 ± 1.15 ml/kg/min) when compared to Mat (6.44 ± 0.73 ml/kg/min). There was no significant increase in blood lactate, HR, and BP for either session above resting values. CONCLUSION: The Pilates sessions analyzed in this study elicit low cardiovascular stress, leading to low EE levels. However, a typical session performed on the Reformer apparatus presented a higher EE, V˙O2, and HR compared to the Mat Pilates session.

Reliability of measurements derived from the palpation method of a software for postural evaluation: does clinical experience matter? / Fidedignidade nas medidas derivadas do método de palpação de um software para avaliação postural: a experiência clínica importa?

Abstract The postural evaluation software (SAPO) has been used as a valuable tool for the analysis of postural alterations, however, such a tool depends on palpation performed by the evaluator. The aim of the present study was to evaluate the inter-and intra-examiner reliability of experienced and inexperienced examiners in measurements derived from the palpation method, and its possible influence on measurements obtained by SAPO. Nine evaluators participated in the study, which were divided into three groups according to experience with respect to palpation (GI: inexperienced group, GSE: semi-experienced group and GE: experienced group). Each evaluator performed the postural analysis of 10 volunteers, which were photographed in orthostatic position, following the SAPO recommendations. The intra-examiner reliability analysis indicated that all three groups had higher, good and moderate mean correlation values for each examiner than low correlations. In the inter-examiner reliability assessment, GE and GSE groups exhibited higher correlation values. The intra-class correlation coefficient, in the single-measure analysis, presented correlation coefficients <0.70 in 9 of the variables analyzed, indicating non-significant correlation. It was concluded that the measures analyzed by SAPO have high intra-examiner reliability. However, regarding inter-examiner reliability, the group composed of inexperienced evaluators presented lower values, suggesting that the experience time may have influenced the inter-examiner reliability regarding postural evaluation.

Resumo O Software de avaliação postural (SAPO) vem sendo utilizado como uma ferramenta valiosa para a análise das alterações posturais, porém tal ferramenta depende da palpação realizada pelo examinador. O objetivo do presente estudo foi avaliar a fidedignidade inter e intraexaminadores experientes e inexperientes nas medidas derivadas do método de palpação, e sua possível influência sobre as medidas obtidas pelo SAPO. Participaram do estudo nove avaliadores, divididos em três grupos de acordo com a experiência com relação a palpação (GI: grupo inexperiente, GSE: grupo semi experiente e GE: grupo experiente). Cada avaliador realizou a análise postural de 10 voluntários, os quais foram fotografados em posição ortostática, seguindo as recomendações do SAPO. A análise da fidedignidade intraexaminadores indicou que os três grupos apresentaram valores de correlação em média mais altos, bons e moderados, do que correlações baixas. Na avaliação da fidedignidade interexaminadores os grupos GE e GSE exibiram valores de correlação mais altos. O coeficiente de correlação intraclasse, na análise de medida única, apresentou índices de correlação <0,70 em 9 das variáveis analisadas, indicando correlação não considerável. Concluiu-se que as medidas analisadas pelo SAPO possuem uma alta fidedignidade intraexaminadores. No entanto, em relação a fidedignidade interexaminadores o grupo composto por examinadores inexperientes com relação a palpação apresentou valores mais baixos, sugerindo que o tempo de experiência dos examinadores pode ter influenciado na fidedignidade interexaminadores da avaliação postural.

Application of Pilates principles increases paraspinal muscle activation.

OBJECTIVE: To analyze the effect of Pilates principles on the EMG activity of abdominal and paraspinal muscles on stable and unstable surfaces. METHODS: Surface EMG data about the rectus abdominis (RA), iliocostalis (IL) and lumbar multifidus (MU) of 19 participants were collected while performing three repetitions of a crunch exercise in the following conditions: 1) with no Pilates technique and stable surface (nP + S); 2) with no Pilates technique and unstable surface (nP + U); 3) with Pilates technique and stable surface (P + S); 4) with Pilates and unstable surface (P + U). The EMG Fanalysis was conducted using a custom-made Matlab(®) 10. RESULTS: There was no condition effect in the RA iEMG with stable and unstable surfaces (F(1,290) = 0 p = 0.98) and with and without principles (F(1,290) = 1.2 p = 0.27). IL iEMG was higher for the stable surface condition (F(1,290) = 32.3 p < 0.001) with Pilates principles (F(1,290) = 21.9 p < 0.001). The MU iEMG was higher for the stable surface condition with and without Pilates principles (F(1,290) = 84.9 p < 0.001).

Efeitos da reeducação postural global em desvios posturais e seus benefícios nos sintomas de incontinência urinária de esforço / Effects of the global postural reeducation on postural changes and symptoms of stress urinary incontinence

Este objetivou avaliar os efeitos do método da Reeducação Postural Global (RPG) sobre as alterações posturais e dos sintomas da incontinência urinária de esforço (IUE), em mulheres menopausadas. Treze pacientes (59,2 ± 8,9 anos de idade) com diagnóstico clínico de IUE foram submetidos à análise urodinâmica, avaliação da função dos músculos do assoalho pélvico (MAP) e avaliação postural, pré e pós programa de RPG. A análise da qualidade de vida também foi obtida pré e pós intervenção com RPG (questionário ICIQ-SF). O tratamento com RPG foi composto por 12 sessões de 30 minutos de duração, frequência semanal de uma vez por semana, com a realização da postura "rã no chão". Em adição, alongamento da musculatura anterior do corpo e assoalho pélvico também foi realizada. Após a intervenção observou-se a diminuição da quantidade e frequência de perda de urina, sendo que a maioria das pacientes reportou episódios diários de perda urinária antes da intervenção. Perdas urinárias menores que uma vez por semana foram reportadas ao final do tratamento. Reduções nos sintomas da IUE foram acompanhadas por melhora da função urinária e aumento da força dos MAP. Ademais, o programa com exercícios de RPG melhorou os índices da avaliação postural, quando dados individuais foram analisados; grande parte das pacientes estudadas melhorou o índice da curvatura cifótica e o alinhamento do quadril após intervenção. Os exercícios de RPG podem ser um meio eficaz para o tratamento dos sintomas da IUE, pois melhora a função contrátil do assoalho pélvico, proporcionalmente a uma melhora na postura da pelve e redução dos sintomas de IUE (AU).

This study aimed to evaluate the global postural reeducation effects on the stress urinary incontinence(SUI)symptoms. Thirteen menopaused women (59.2 ± 8.9 years old) with diagnosis for SUI undertake urodynamic analysis, pelvic floor muscles (PFM) function and postural indexes evaluation pre and post12-sessions GPR program, consisted of 30-min sessions once a week. A life style quality evaluation (questionnaire ICIQ-SF) was further obtained pre and post GPR intervention. The sessions of GPR exercises included "frog on the ground" type-exercises. After GPR intervention there were reductions in the quantity and frequency of urine loss; most patients reported daily episodes of urine loss before the GPR program, however urine loss was lower than once a week at the end of the GPR program. Reductions of the SUI symptoms occurred together with improvements in urinary function and PFM performance. The GPR program improved postural indexes when individual data were analyzed, as several patients improved the kyphosis curvature index and hip alignment. Improvements in UIE symptoms and postural indexes occurred together with an improved life style quality reported by patients. These results suggest that GPR may be an alternative for the SUI treatment in menopaused women (AU).

A rotação do voluntário e a calibração influenciam as medidas mensuradas por meio da fotogrametria / Influence on the rotation and the calibration at the measures of the evaluation postural software (SAPO)

Uma forma de obter informações quantitativas durante a avaliação postural é por meio da fotogrametria, que permite analisar a medida da posição, comprimento, ângulo e alinhamento de segmentos corporais. Para o uso confiável da avaliação postural é preciso identificar e discutir as fontes de erro de medição, pois para inferir as alterações posturais por causa de uma lesão, disfunção ou tratamento fisioterápico é preciso proceder a avaliação adequadamente. O estudo tem como objetivo verificar o efeito do posicionamento do voluntário e calibração nas medidas de angulares oferecidas pelo Software para Avaliação Postural (SAPO), a hipótese inicial é que o posicionamento e a calibração afetam as medidas oferecidas. Foram realizadas 28 fotos de um manequim com alinhamento perpendicular e rodado a 4º, 8º e 12º para a direita e para a esquerda. O manequim foi posicionado ao lado de quatro fios de prumo, sendo dois localizados ao lado do manequim, um 40cm posterior e outro 40cm anterior. Análise de variância foi usada. O nível de significância foi p<0,05. Os resultados indicam que a medida sem rotação do manequim tem o menor erro de mensuração e menor dispersão dos erros (1,4±0,20). A rotação para esquerda e para a direita apresentam maior erro do que a ausência de rotação (-12º: 2,3±0,30; -8º: 2,3±0,70; -4º: 2,2±0,70; 12º: 2,0±0,30; 8º: 2,5±10,1; 4º: 2,2±1,00). O erro é menor na calibração padrão (1,4±0,20) comparada com a calibração em 50cm ao lado (1,5±0,30), 1m posterior (1,7±0,30) e anterior (1,7±0,30). Concluiu-se que quanto maior a rotação do voluntário maior os erros, a calibração influenciou nas medidas oferecidas pelo SAPO.

A way to obtain quantitative information in the postural evaluation is with the photogrammetry, wich allows analyse measures of position, length, angle and alignment of body segments. To a reliable postural evaluation software, it is necessary to identify and discuss the sources of the errors, because to inform postural changes that occurs after an injury, physical therapy evaluation must proceed properly. The aim of the study is verify the effect of the subject’s positioning and calibration at the angle measured by SAPO, the initial hypothesis is that the position and calibration affect the measures offered. It was shot 28 pictures from a model, with a perpendicular alignment and 4o, 8o and 12o rotation to the right and left side. The model was positioned beside four plumbs line, two by its side, other 40cm before and the other one 40 cm after. The analysis of variance was ran. The significance level was p<0.05. The results indicate that data without model’s rotation presented the smallest error and dispersion (1.4±0.20). The left and right rotation showed more errors than no rotation (-12º: 2.3±0.30; -8º: 2.3±0.70; -4º: 2.2±0.70; 12º: 2.0±0.30; 8º: 2.5±10,15; 4º: 2.2±1.00). The error is fewer for the standard calibration (1.4±0.20) compared to the side calibration in 50cm (1.5±0.30), 1m before (1.7±0.30) and after (1.7±0.30). In conclusion the more the subject’s rotation, the more the errors and the calibration are for the postural evaluation offered by SAPO.

Influência da resolução e da distância da câmera nas medidas feitas pelo software de avaliação postural (sapo) / Influence of the camera resolution and distance in the measures made by the postural assessment software (sapo

O erro na medida de um sistema de avaliação da postura está relacionado com a digitalização, a resolução da câmera, a distância da câmera em relação ao voluntário estudado, entre outros. Estes erros somam-se no procedimento metodológico e muitos deles não são possíveis evitar, porém devem ser conhecidos e quantificados. OBJETIVO: Quantificar o erro na medida realizada pelo SAPO (Software para avaliação postural) em diferentes situações experimentais. MÉTODOS: Foram realizadas 16 fotos de um manequim de 1,40m articulado nos planos anterior, posterior, lateral direita e lateral esquerda com câmeras de 3,2 e 12,0 megapixels, posicionadas a 3,0m e a 5,0m de distância do manequim. Para a quantificação do erro, foram calculadas as diferenças das medidas obtidas por meio do SAPO com as medidas feitas diretamente no manequim. Apenas um avaliador realizou o registro das imagens, porém a digitalização no software dos pontos demarcados no manequim foi realizada por três digitalizadores, sendo dois inexperientes e um experiente. RESULTADOS: Os valores médios das medidas horizontais, verticais, angulares e de distância são próximos de zero, embora algumas variáveis angulares apresentem valores maiores, como nas medidas de ângulo Q direito e esquerdo. A câmera com resolução de 3,2 megapixels posicionada a 3m apresentou o menor erro. CONCLUSÃO: O SAPO é um método acurado para uso clínico; são necessários estudos para verificar a influência do plano de posicionamento do voluntário em relação à câmera, o efeito do reposicionamento e da palpação nas medidas oferecidas pelo software.

Error in measurement of a posture evaluation system is related to the digitalization, camera resolution and distance in relation to the volunteer studied, among others. These errors are summed up during the process and many of them are not possible to be avoided; however, they must be known and quantified. OBJECTIVE: to quantify the error of the positions measured by SAPO (Software para avaliação postural) in different experimental situations. METHODS: 16 photos of a 1.40m tall articulated mannequin were taken at the anterior, posterior, right lateral and left lateral planes with 3.2 and 12.0 megapixels resolution cameras, at 3.0m and 5.0m from the model. To quantify the error, the differences between the measurements obtained by SAPO and the ones made directed on the mannequin were calculated. RESULTS: the mean values of the horizontal, vertical, angular and distance measurements are close to zero; however, some angles were larger for the left and right measurements. The 3.2 megapixel digital camera located 3 m away showed the lowest error. The digitalization position is not influenced by the experience of the evaluators. CONCLUSION: SAPO is an accurate method for clinical use. Further studies are necessary to verify the effect of the position plane of the volunteer in relation to the camera, the effect of the relocation and the measurement palpation provided by the software.

Estudo eletromiográfico dos Mm. multífidos na coluna lombar e torácica durante a fase de apoio da marcha / Electromyographic study of the multifidus in the lumbar and thoracic spine during the stance phase

The airn of this study was to analyze multifidus muscles, since they are related to several disorders of the spine. The electromyographic study reveals that multifidus muscles in the lumbar and thoracic spine present a simultaneous activity on the right and left sides of the spine during the stance phase. Nevertheless, the coefficient of variation shows that less variation occurs in the lumbar muscles ipsilateral to the lower limb of the stance, and in the thoracic muscles contralateral to the stance limb. Our results suggest that multifidus muscles play a stabilizing role and are also related to spine rotation.