Effects of a Mat Pilates Exercise Program Associated with Photobiomodulation Therapy in Patients with Chronic Nonspecific Low Back Pain: A Randomized, Double-Blind, Sham-Controlled Trial.

OBJECTIVE: To investigate the effects of combining a Pilates program with photobiomodulation therapy (PBMT) in patients with chronic nonspecific low back pain (CNLBP). METHODS: Thirty-eight adults with CNLBP were randomly assigned to two groups: Pilates exercise + active PBMT (PIL + PBMT) or Pilates exercise + sham PBMT (PIL + SHAM). Both groups performed an 8-week mat Pilates program and received PBMT on their lumbar muscles 10 min before and after each session. The following variables were assessed before and after intervention: peak pain intensity, postural balance (i.e., center of the pressure [A-COP], velocity anteroposterior [Vel AP], and velocity mediolateral [Vel ML]), perceived disability (i.e., Oswestry Disability Index [ODI] and Roland Morris Disability Questionnaire [RMDQ]), and pain-related fear of movement (i.e., Tampa Scale of Kinesiophobia [TSK], Fear Avoidance Beliefs Questionnaire [FABQ], and Pain Catastrophizing Scale [PCS]). RESULTS: Postural balance variables showed no statistically significant differences (p > 0.05) across time or between groups. The groups showed similar (p < 0.05) reductions in peak pain intensity, ODI, RMDQ, and PCS scores, but no statistically significant difference (p > 0.05) in TSK and FABQ scores. CONCLUSION: The mat Pilates program reduced peak pain intensity, perceived disability, and pain catastrophizing in adults with CNLBP, but PBMT had no additional effect on these variables. Mat Pilates alone or combined with PBMT was not able to improve postural balance.

Effects of pilates exercises on strength, endurance and muscle power in older adults: Systematic review and meta-analysis.

INTRODUCTION: Pilates exercises have been used by the older adults and have shown potential to improve some components of physical fitness. OBJECTIVE: To verify the effects of Pilates on strength, endurance and muscle power in older adults. METHODS: The searches were performed in the databases: PubMed, EMBASE, CENTRAL, CINAHL, Web of Science, SPORTDiscus, LILACS and PEDro until September 2022, without filters that limited the date of publications or language. The studies included were: randomized clinical trials (RCTs); interventions that used Pilates; interventions with outcomes involving strength, endurance and/or muscle power; participants over 60 years old. RESULTS: 24 RCTs (1190 participants) were selected. There is low quality evidence that Pilates did not significantly improve muscle strength compared to the control group (Standardized Mean Difference (SMD) = 1.18 [95%CI -0.71, 3.08] I2 = 93%), and moderate quality compared to other exercises (SMD = 0.01 [CI95% -0.46, 0.48] I2 = 0%). Very low quality evidence shows that Pilates can improve muscular endurance of upper limbs compared to control group (Mean Difference (MD) = 4.87 [95%CI 2.38, 7.36] I2 = 88%) and lower limbs compared to other exercises (MD = 2.68 [CI95% 0.26, 5.10] I2 = 87%). It was not possible to perform muscle power analysis due to the reduced number of studies. CONCLUSION: Currently, it is not feasible to recommend Pilates exercises as a means to improve strength, endurance and muscle power in the older adults. More RCTs covering this topic are needed given the low quality of evidence available at this time.

Does kinesio tape alter muscle strength in athletes? - Systematic review and meta-analysis.

BACKGROUND: Kinesio tape (KT) is still a matter of debate and the results of studies that evaluated its effects on muscle strength in athletes are still contradictory and inconclusive. OBJECTIVES: To analyze randomized clinical trials (RCT) to compare the effects of KT on muscle strength with the control/placebo group among athletes with and without musculoskeletal injury. METHOD: The search involved the databases: PubMed, Web of Science, LILACS, PEDro, The Cochrane Library, Medline, Scopus, SPORTDiscus and Embase, without filter and included RCTs evaluating the effects of KT on muscle strength in athletes with or without musculoskeletal injury, comparing it to a control/placebo intervention. The following were excluded: studies with duplicate information; who used instruments for indirect assessment of muscle strength; involving a different population of athletes. Meta-analysis calculations were performed using post-intervention muscle strength data in the Review Manager (RevMan) program. RESULTS: 10 articles were eligible, among which 5 studies were included in the meta-analysis. In the primary analysis, no relevant clinical effect was found (immediate post-intervention <24h: Z = 1.97 CI95% = 0.35[0.00-0.70]; p = 0.05 I2 = 0% and late post-intervention ≥24h: Z = 1.47 CI95% = 0.59[-0.20-1.38]; p = 0.14 I2 = 69%) when comparing the KT group with the control/placebo groups for muscle strength of lower limbs in participants with and without musculoskeletal injury and in the subgroup analysis (including only individuals without injury), there was also no clinical effect (Z = 1.50, 95%CI = 0.31[-0.10-0.71] p = 0.13, I2 = 0%) of KT for muscle strength. CONCLUSIONS: KT does not contribute to muscle strength gain in athletes with and without musculoskeletal injuries. PROSPERO: CRD42020139822. (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139822) (29 July 2020).

Acute effect of static stretching and pilates stretching on the concentric muscle strength of the knee extensors and flexors.

INTRODUCTION: The effects of stretching exercises on muscle strength have been widely researched in the literature, however, there are no studies investigating the effects of Pilates stretching. OBJECTIVE: To compare the effects of static stretching and Pilates stretching on the concentric muscle strength of the knee extensors and flexors. METHOD: 102 trained young adults were randomized into three groups: static stretching (n = 33); Pilates stretching (n = 34); control (n = 35). Isokinetic evaluation of the knee extensor and flexor muscles was performed at 60°/s and 180°/s, pre and post acute intervention with stretching. Interventions in the static stretching and Pilates stretching groups occurred in 3 sets x 30 s for each body region considered (a-knee extensor muscles; b-knee flexor muscles). The control group did not perform any intervention. RESULTS: No difference (p > 0.05) was observed between the groups after the intervention. There was only a significant intragroup improvement for the control group on the isokinetic muscle strength of the knee flexors at 180°/s, with a moderate effect size, considering the entire sample (p = 0.040; d = 0.42) and when considering only male gender (p = 0.010; d = 0.60). CONCLUSION: Static stretching or Pilates stretching performed as a warm-up did not impair or enhance the concentric muscle strength performance of the knee extensors and flexors. In this way, both forms of stretching can be considered as preparatory exercises before muscle strength training.

Effects of Pilates exercises on health-related quality of life in postmenopausal women: a systematic review and meta-analysis.

OBJECTIVE: To verify the effects of Pilates exercises on health-related quality of life (HRQoL) in postmenopausal women. METHODS: A systematic search was conducted in the following databases: PubMed, Embase, CENTRAL, CINAHL, Web of Science, LILACS, SportDiscus, Scielo, and PEDro. Randomized clinical trials (RCTs) that intervened with Pilates and had HRQoL as an outcome were eligible. The methodological quality of each RCT was assessed using the PEDro scale and the certainty of the evidence using the GRADE system. Meta-analyses were conducted by standardized mean difference (SMD). RESULTS: Initially, 760 records were located. After screening, 11 RCTs were included in the systematic review. Five studies presented low risk of bias (PEDro score ≥ 6). Evidence of very low to moderate certainty demonstrated significant effects in favor of Pilates exercises vs control groups for five of the nine HRQoL domains analyzed: bodily pain (SMD = 0.96), physical functioning (SMD = 0.85), social functioning (SMD = 0.45), role physical (SMD = 0.79), and role emotional (SMD = 0.61). Subgroup analyzes demonstrated that Pilates had a positive impact on more domains whens administered for ≥ 48 sessions (eight domains) vs < 48 sessions (three domains); and when administered on equipment (seven domains) vs mat (three domains). CONCLUSION: Pilates exercises, in general, allowed significant effects to improve HRQoL in postmenopausal women, especially when performed on equipment and when administered for at least 48 sessions. However, no analysis showed high certainty of evidence, and more RCTs of high methodological quality are needed to confirm these findings.

Effects of stretching in a pilates program on musculoskeletal fitness: a randomized clinical trial.

BACKGROUND: The scientific literature questions the impact of stretching exercises performed immediately before muscle strengthening exercises on different components of musculoskeletal physical fitness. Pilates is a physical exercise modality that typically uses stretching exercises preceding muscle-strengthening exercises. However, no studies have investigated the effects of stretching in a Pilates program on components of musculoskeletal fitness. The aim of the present study was to verify the effects of stretching in a Pilates exercise program on flexibility, strength, vertical jump height and muscular endurance. METHODS: Thirty-two sedentary young women were randomized into two groups: traditional Pilates (TP), who performed flexibility and muscle strengthening exercises (n = 16), and nontraditional Pilates (NTP), who only performed muscle-strengthening exercises (n = 16). Sessions took place 3 times a week for 8 weeks. The following tests were performed pre- and postintervention: 10-RM knee extensors, vertical jump, handgrip, 1-min sit-ups, Sorensen and sit-and-reach. The occurrence of adverse events was recorded throughout the intervention and compared between groups using odds ratio (OR). To compare the results of motor tests between groups, ANCOVA or Mann‒Whitney U test was used for parametric and nonparametric data, respectively. The data were analyzed by intention-to-treat. RESULTS: After intervention, the TP was superior to NTP for the sit-and-reach test, with a large effect size (d = 0.87; p = 0.035), with no differences between groups for the other tests. Intragroup comparisons showed significant differences (p < 0.05) for TP and NTP for improvement in 10-RM knee extensors and vertical jump measurements, while only TP showed significant intragroup improvement (p < 0.05) for the sit-and-reach test. A greater chance of experiencing pain or other discomfort as a result of exercise was shown by NTP (OR = 4.20, CI95% 0.69 to 25.26). CONCLUSION: Our findings demonstrated that stretching exercises performed at the beginning of sessions in a Pilates program did not impair or enhance the development of strength, vertical jump height and muscular endurance in young women. However, only the Pilates program with stretching improved flexibility and reduced the chances of adverse events such as musculoskeletal pain and other discomfort resulting from the exercise protocol. CLINICALTRIALS: GOV: NCT05538520, prospectively registered on September 16, 2022.

Comparative analysis of pelvic floor muscle training and Pilates in managing urinary incontinence among postmenopausal women: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: This study is aimed at comparing the effectiveness of pelvic floor muscle training (PFMT) and Pilates on the improvement of urinary incontinence (UI), strength, and endurance of the pelvic floor muscles (PFMs), and the impact of UI on the quality of life in postmenopausal women. METHODS: Forty postmenopausal women were randomly divided in to two groups: PFMT (n = 20) and Pilates (n = 20). The participants were followed for 12 weeks, three times a week on nonconsecutive days. UI was assessed using the pad test and the voiding diary, PFM strength and resistance using bidigital assessment and manometry, and the impact of UI on quality of life using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), before and after the 3-month treatment. RESULTS: There was a significant intra-group improvement in both groups for the pad test, mean daily urinary loss, and ICIQ-SF. The strength was significantly improved only in the PFMT group, and the endurance in both groups. Peak strength manometry was significantly improved only in the Pilates group, and the mean strength manometry in both groups. There was also an improvement in both groups for peak endurance manometry and mean endurance manometry. In the inter-group comparison, there was a significant improvement only in muscle strength, which was positive for group. CONCLUSIONS: There was no difference between Pilates and PFMT for the management of women in post-menopause with stress urinary incontinence, provided that voluntary contraction of the PFMs is performed. However, further randomized clinical trials need to be carried out.

Effects of Pilates exercises on cardiorespiratory fitness: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Randomized controlled trials (RCTs) suggest that Pilates improves cardiorespiratory fitness (CRF). However, there is a lack of systematic review studies on this topic. Our aim was to verify the effects of Pilates exercises on CRF in healthy adults. METHODS: A systematic literature search was performed in: PubMed, Embase, CENTRAL, CINAHL, Web of Science, SPORTDiscus, LILACS, and PEDro (search on January 12, 2023). Methodological quality was assessed using the PEDro scale. A meta-analysis was performed using the standardized mean difference (SMD). The quality of evidence was rated by the GRADE system. RESULTS: In total, 12 RCTs were eligible (569 participants). Only three studies presented high methodological quality. Very low to low quality evidence showed that: a) Pilates was superior to control groups (SMD = 0.96 [CI95% 0.39 to 1.54] n = 457, studies = 12), even when only high methodological quality studies were included (SMD = 1.14 [CI95% 0.25 to 2.04] n = 129, studies = 3); b) to be effective, Pilates needed to be performed for ≥1440 min; c) the effects were significant regardless of the form of Pilates application (mat or equipment); d) Pilates was not different from other exercises regarding the effects on CRF. CONCLUSION: Pilates had a large effect on CRF, provided that it was administered for at least 1440 min (equivalent to 2x-week for three months or 3x-week for two months). However, due to the low quality of the evidence, these results should be interpreted with caution.

Effectiveness of whole-body vibration on bone mineral density in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials.

The present study observed significant effects of whole-body vibration (WBV) on bone mineral density (BMD) in postmenopausal women, with high-quality evidence for high-frequency, low-magnitude, and high-cumulative-dose use. The aim was to update a previous systematic review with meta-analysis to observe the effects of WBV on BMD in postmenopausal women. For the meta-analysis, the weighted mean difference between WBV and control groups, or WBV and conventional exercise, was used for the area of bone mineral density (aBMD) of the lumbar spine, femoral neck, total hip, trochanter, intertrochanter, and Ward's area, or volumetric trabecular bone mineral density (vBMDt) of the radius and tibia. Methodological quality was assessed using the PEDro scale and the quality of evidence using the GRADE system. In total, 23 studies were included in the systematic review and 20 in the meta-analysis. Thirteen studies showed high methodological quality. WBV compared with control groups showed significant effects on aBMD in the primary analysis (lumbar spine and trochanter), sensitivity (lumbar spine), side-alternating vibration (lumbar spine and trochanter), synchronous vibration (lumbar spine), low frequency and high magnitude (lumbar spine and trochanter), high frequency and low magnitude (lumbar spine), high frequency and high magnitude (lumbar spine, trochanter, and Ward's area), high cumulative dose and low magnitude (lumbar spine), low cumulative dose and high magnitude (lumbar spine and trochanter), and positioning with semi-flexed knees (trochanter). Of these results, only high frequency associated with low magnitude and high cumulative dose with low magnitude showed high-quality evidence. At this time, considering the high quality of evidence, it is possible to recommend WBV using high frequency (≈ 30 Hz), low magnitude (≈ 0.3 g), and high cumulative dose (≈ 7000 min) to improve lumbar spine aBMD in postmenopausal women. Other parameters, although promising, need to be better investigated, considering, when applicable, the safety of the participants, especially in vibrations with higher magnitudes (≥ 1 g).

Progressive tension protocol for muscle strength with Kinesio tape in runners - double-blind randomized clinical trial / Protocolo de tensão progressiva para força muscular com Kinesio tape em corredores - ensaio clínico randomizado duplo-cego

Abstract Introduction Kinesio tape (KT), although frequently used in sports, is still a matter of debate, and the results of studies that evaluated its effects on muscle strength (MS) in athletes are still inconclusive and contradictory. Objective To evaluate the effect of a progressive KT tension protocol on knee MS in runners over an eight-week intervention. Methods Clinical trial involving 49 runners of both sexes randomized into two groups: KT (KT with progressive tension protocol) and placebo (KT without tension). The MS of knee flexors and extensors was evaluated by isokinetic dynamometer (60º/s and 90º/s) at four moments: (1) without KT; (2) with KT and without tension; (3) without KT (after 8 weeks after of intervention); (4) with KT and with tension (after 8 weeks after of intervention). Inter- and intra-group comparisons were made. The significance level adopted was 95% (p < 0.05). Results There were no significant differences in MS between the groups at any of the evaluated moments. There was a statistically significant difference in MS (60º/s) in both groups (KT and placebo) when comparing moments 4 and 2 for knee flexors, and in the placebo group between moments 4 and 2 and moments 4 and 3 for knee extensors. Conclusion The progressive tension protocol of KT was not able to intervene in the SM gain of knee flexors and extensors of runners in inter and intragroup comparisons.

Resumo Introdução A Kinesio tape (KT), apesar de muito utilizada na prática esportiva, ainda é motivo de debate e os resultados de estudos que avaliaram seus efeitos na força muscular (FM) em atletas ainda são inconclusivos e contraditórios. Objetivo Avaliar o efeito de um protocolo de tensão progressiva KT na FM do joelho em corredores ao longo de uma intervenção de oito semanas. Métodos Ensaio clínico envolvendo 49 corredores de ambos os sexos randomizados em dois grupos: KT (KT com protocolo de tensão progressiva) e placebo (KT sem tensão). A FM dos flexores e extensores do joelho foi avaliada por dinamômetro isocinético (60º/s e 90º/s) em quatro momentos: (1) sem KT; (2) com KT e sem tensão; (3) sem KT (após 8 semanas); (4) com KT e com tensão (pós-protocolo 8 semanas). Comparações inter e intragrupos foram feitas. O nível de significância adotado foi de 95% (p < 0,05). Resultados Não houve diferenças signi-ficativas na FM entre os grupos em nenhum dos momentos avaliados. Houve diferença estatisticamente significante na FM (60º/s) em ambos os grupos (KT e placebo, quando comparados os momentos 4 e 2 para flexores de joelho, e no grupo placebo entre os momentos 4 e 2 e os momentos 4 e 3 para extensores de joelho. Conclusão O protocolo de tensão progressiva de KT não foi capaz de intervir no ganho de FM de flexores e extensores de joelho de corredores em comparações inter e intragrupos.

Effects of photobiomodulation and deep water running in patients with chronic non-specific low back pain: a randomized controlled trial.

Photobiomodulation therapy (PBM) is often used to treat musculoskeletal disorders such as chronic non-specific low back pain (NSCLBP) as it can have positive effects on biomarkers-creatine kinase (CK) and serum cortisol levels-related to stress caused by physical exercise, such as deep water running (DWR) or by pain. The aim of this study was to evaluate the effects of the combination of PBM and aquatic exercise (DWR) on the intensity of pain, disability, 6-min walk test adapted (6WTA), and on cortisol and creatine kinase (CK) levels in a population with NSCLBP. The participants were allocated into three groups: TGPBM (Photobiomodulation and Training Group), TGPLA (Placebo Photobiomodulation and Training Group), and the GPBM (Photobiomodulation Group). Information regarding anthropometric data, blood pressure, and heart rate were collected, and the questionnaires were applied: IPAQ-Short Form, Oswestry Disability Index, and the Visual Analog Scale for Pain. The submaximal exercise test (6WTA) was performed. Blood was collected for analysis of cortisol and CK levels. The training sessions were performed twice a week, for 4 weeks. In the intragroup comparisons, there were statistically significant changes in the TGPBM and GPBM groups in the outcomes pain intensity, disability (reductions in both groups), and in cortisol (increased in the TGPBM and reduced in the GPBM); in the TGPLA group, there was a statistically significant reduction only in the outcome of pain intensity. In the intergroup comparison, in the comparison between TGPBM and TGPLA, there was a statistically significant difference in the level of cortisol, as well as in the comparison between TGPBM and GPBM, in which there was a statistically significant difference for this same outcome (cortisol) and for the 6WTA outcome. The effects of the combination of PBM and aquatic exercise have positive effects on reducing pain intensity, disability, and cortisol levels, but its effects on other variables (6WTA and CK) are too small to be considered significant. Trial registration number: NCT03465228-April 3, 2019; retrospectively registered (ClinicalTrials.gov).

Atividade física, aptidão física e dor lombar em adultos jovens: revisão sistemática de evidências observacionais / Physical activity, physical fitness and low back pain in young adults: systematic review of observational evidence

Introdução: Dor lombar caracteriza-se como um importante problema de saúde pública desde idades jovens. Dentre as variáveis que podem impactar nesta ocorrência encontra-se atividade física e aptidão física, contudo os resultados dos diferentes estudos observacionais sobre a temática apresentam inconsistências. Objetivo: Verificar associação entre atividade física, aptidão física e dor lombar em adultos jovens. Métodos: Foi realizada revisão sistemática de estudos observacionais, na qual atividade física e aptidão física foram variáveis de exposição e dor lombar desfecho. As buscas foram realizadas nas bases de dados: Pubmed, Web of Science, Science Direct, Lilacs, Scielo, PEDRo e Central. Resultados: No total, oito estudos foram incluídos. Um estudo dentre quatro identificou que atividade física vigorosa aumenta as chances de dor lombar. Para força muscular, dois de cinco estudos verificaram associação entre menor força de tronco e maior chance de dor lombar, enquanto para flexibilidade nenhum resultado foi observado. Baixa aptidão cardiorrespiratória se associou com dor lombar em um dentre dois estudos. Para composição corporal, dois de três estudos acharam associação contraditória com IMC. Conclusão: Em vista dos resultados apresentados pelos estudos incluídos na revisão sistemática, não foi identificada nenhuma evidência consistente de associação entre atividade física, aptidão física e dor lombar em adultos jovens. (AU)

Effects of Pilates Exercise on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-analysis.

BACKGROUND AND PURPOSE: Despite the popularity of Pilates exercises among postmenopausal women, few studies have devoted attention to verifying the effects of the technique on bone mineral density (BMD), and, to date, no systematic review and meta-analysis have been conducted on this topic. Our objective was to conduct a systematic review and meta-analysis of randomized controlled trials examining the effect of Pilates on BMD. METHODS: Randomized controlled trials were considered eligible, with follow-up of 6 months and more, which verified the effects of Pilates exercise on the BMD of postmenopausal women. The calculations of the meta-analysis were performed through the weighted mean difference between the Pilates exercise and control groups, through the absolute change between pre- and postintervention in the areal bone mineral density. RESULTS: Three randomized controlled trials met the inclusion criteria and were included in the meta-analysis. Only 1 study presented satisfactory methodological quality. Pilates exercises did not offer significant effects to improve areal bone mineral density of the lumbar spine (0.019 g/cm2 [95% confidence interval (CI), -0.018 to 0.057], P = .32), total hip (0.012 g/cm2 [95% CI, -0.002 to 0.027], P = .10), or femoral neck (0.000 g/cm2 [95% CI, -0.021 to 0.022], P = .97). CONCLUSIONS: Pilates exercises had no significant effects on BMD in postmenopausal women. However, the few studies included in the meta-analysis and the low methodological quality of the majority of the studies do not allow safe extrapolation of the results at this time. More robust randomized controlled trials with high methodological quality are needed so that the results of this meta-analysis can be confirmed.

Hiit, resistance training, and risk factors in adolescents: a systematic review / Hiit, treinamento resistido e fatores de risco em adolescentes: uma revisão sistemática / Hiit, entrenamiento resistido y factores de riesgo en adolescentes: una revisión sistemática

ABSTRACT It has been shown that combined physical exercise is an efficient non-pharmacological approach in the context of public health, since it has demonstrated satisfactory results in the prevention, treatment and control of various morbidities. Therefore, it is essential to systematize current knowledge to enable professionals involved in the prescription of physical exercise to do so based on evidence. Thus, the objective of this study was to perform a systematic review of randomized clinical trials to verify changes in cardiometabolic risk factors induced by high-intensity interval training (HIIT) and resistance training (RT) in adolescents. The systematic search was performed in the following databases: Pubmed, ScienceDirect, Cochrane, LILACS and Scielo. Initially 933 studies were identified, then two researchers eliminated duplications and manuscripts that did not meet the eligibility criteria. Thus, two articles were included that met these criteria: a randomized clinical trial conducted with adolescents (10 to 19 years) of both sexes, an intervention lasting for at least four weeks, which prescribed HIIT and RT in the same session or not, and evaluation of at least one cardiometabolic risk factor. The results demonstrated that eight to 12 weeks of HIIT and RT without nutritional intervention were effective in significantly reducing waist circumference and body fat percentage. However, data pertinent to the efficacy of this combination on risk of developing type 2 diabetes mellitus and arterial hypertension are controversial. In view of the above, it is ascertained from the included studies that the combination of HIIT and RT has the potential to reduce cardiometabolic risk factors in adolescents; therefore, further studies should be conducted to determine the effectiveness of this prescription of physical exercise. Level of Evidence II; Systematic review of Level II or Level I Studies with discrepant results.

RESUMO Tem sido evidenciado que o exercício físico combinado é uma abordagem não farmacológica eficiente no âmbito da saúde pública, uma vez que tem demonstrado resultados satisfatórios na prevenção, tratamento e controle de diversas morbidades. Portanto, é essencial a sistematização do conhecimento atual para que profissionais envolvidos na prescrição de exercícios físicos possam fazê-lo baseados em evidências. Dessa forma, o objetivo do presente estudo foi realizar uma revisão sistemática de ensaios clínicos randomizados para verificar as alterações dos fatores de risco cardiometabólicos induzidas pelo treinamento intervalado de alta intensidade (HIIT) e treinamento resistido (TR) em adolescentes. A busca sistemática foi realizada nas seguintes bases de dados: Pubmed, ScienceDirect, Cochrane, LILACS e Scielo. Inicialmente foram identificados 933 estudos, em seguida, dois pesquisadores eliminaram as duplicações e os manuscritos que não atenderam aos critérios de elegibilidade. Assim, foram incluídos dois artigos que atenderam aos critérios de inclusão: ensaio clínico randomizado conduzido com adolescentes (10 a 19 anos) de ambos os sexos, intervenção com duração de, pelo menos, quatro semanas, que prescreveu HIIT e TR na mesma sessão ou não, e avaliação de, pelo menos, um fator de risco cardiometabólico. Os resultados demonstraram que oito a 12 semanas de HIIT e TR, sem intervenção nutricional, foram eficazes para reduzir significativamente a circunferência da cintura e o percentual de gordura. Entretanto, os dados pertinentes à eficácia dessa combinação sobre o risco de desenvolvimento de diabetes mellitus tipo 2 e hipertensão arterial são controversos. Diante do exposto, verifica-se, a partir dos estudos incluídos, que a combinação de HIIT e TR tem o potencial de reduzir fatores de risco cardiometabólicos em adolescentes, portanto, novos estudos devem ser realizados para determinar a efetividade dessa prescrição de exercícios físicos. Nível de Evidência II; Revisão sistemática de Estudos de Nível II ou Nível I com resultados discrepantes.

RESUMEN Se ha evidenciado que el ejercicio físico combinado es un enfoque no farmacológico eficiente en el ámbito de la salud pública, ya que ha demostrado resultados satisfactorios en la prevención, tratamiento y control de diversas morbilidades. Por lo tanto, es esencial la sistematización del conocimiento actual, para que los profesionales involucrados en la prescripción de ejercicios físicos puedan hacerlo basándose en evidencias. De esta forma, el objetivo del presente estudio fue realizar una revisión sistemática de ensayos clínicos aleatorizados para verificar los cambios de los factores de riesgo cardiometabólicos inducidos por el entrenamiento en intervalos de alta intensidad (HIIT) y entrenamiento resistido (ER) en adolescentes. La búsqueda sistemática se realizó en las siguientes bases de datos: Pubmed, ScienceDirect, Cochrane, LILACS y Scielo. Inicialmente se identificaron 933 estudios, luego dos investigadores eliminaron las duplicaciones y los manuscritos que no cumplieron los criterios de elegibilidad. Así, se incluyeron dos artículos que cumplieron estos criterios de inclusión: ensayo clínico aleatorizado conducido con adolescentes (10 a 19 años) de ambos sexos, intervención con una duración de al menos cuatro semanas, que prescribió HIIT y ER en la misma sesión o no, y evaluación de al menos un factor de riesgo cardiometabólico. Los resultados demostraron que ocho a 12 semanas de HIIT y ER, sin intervención nutricional, fueron eficaces para reducir significativamente la circunferencia de la cintura y el porcentaje de grasa. Sin embargo, los datos pertinentes sobre la eficacia de esta combinación sobre el riesgo de desarrollar diabetes mellitus tipo 2 e hipertensión arterial son controvertidos. Delante de lo expuesto se verifica, a partir de los estudios incluidos, que la combinación de HIIT y ER tiene el potencial de reducir factores de riesgo cardiometabólicos en adolescentes, por lo tanto, deben ser realizados nuevos estudios para determinar la efectividad de esa prescripción de ejercicios físicos. Nivel de evidencia II; Revisión sistemática de Estudios de Nivel II o Nivel I con resultados discrepantes.

Comparação entre duas modalidades terapêuticas sobre o equilíbrio postural e medo de quedas em mulheres na pós-menopausa: um ensaio clínico randomizado e controlado / Comparison between two therapeutic modalities on postural balance and fear of falling in postmenopausal women: a randomized and controlled clinical trial

Resumo Objetivo: Comparar os efeitos do Pilates vs. vibração de corpo inteiro (VCI) e nenhuma intervenção sobre o equilíbrio postural e medo de quedas em mulheres na pós-menopausa. Métodos: Ensaio clínico Mono-cego, com 51 participantes randomizadas em três grupos (Pilates, VCI, ou Controle). Avaliações foram realizadas para o equilíbrio postural estático por intermédio da plataforma de força, equilíbrio postural dinâmico pelo teste Timed Up & Go e medo de quedas pela Falls Efficacy Scale-International (FES-I). Pilates e VCI foram administrados três vezes na semana, por seis meses. Resultados: Após a intervenção, nenhuma diferença (p> 0.05) foi observada para o equilíbrio postural estático, contudo, para a maior parte das variáveis, Pilates e VCI demonstraram um grande tamanho de efeito (d> 0.80) quando comparados ao grupo controle. Para o equilíbrio postural dinâmico, Pilates e VCI promoveram uma melhora significativa (p= 0.032) comparados ao grupo controle. Para o medo de quedas não houve diferença entre os grupos (p= 0.055) pós-intervenção. Conclusão: Tendo em vista a representatividade clínica evidenciada pelas medidas de tamanho de efeito, Pilates e VCI podem ser recomendados para melhora do equilíbrio postural estático e dinâmico em mulheres na pós-menopausa. Contudo, em relação ao medo de quedas, essas modalidades terapêuticas necessitam de melhor investigação.

Abstract To compare the effects of Pilates vs. whole body vibration (WBV) and no treatment controls on postural balance and fear of falling in postmenopausal women. Method: Single-blind randomized clinical trial, with 51 participants randomized into three groups (Pilates, WBV, or control). Evaluations were performed of static postural balance on a force platform, dynamic postural balance by the Timed Up & Go test, and fear of falling by the Falls Efficacy Scale-International (FES-I). Pilates and WBV were performed three times a week for six months. Results: After the intervention, no difference (p>0.05) was observed for static postural balance, however, for the majority of variables, Pilates and WBV demonstrated a large effect size (d>0.80) when compared to control. For dynamic postural balance and risk of falls, Pilates and WBV showed a significant (p=0.032) improvement compared to the control. Fear of falling did not change (p=0.055) between groups over time. Conclusion: In view of the clinical representativeness evidenced by the effect sizes, Pilates and WBV can be recommended to improve postural balance in postmenopausal women. However, in relation to fear of falling, these therapeutic modalities require further investigation.

Determinants of lifestyle associated with metabolic syndrome in Brazilian adolescents / Determinantes del estilo de vida asociado con el síndrome metabólico en adolescentes brasileños

Background: metabolic syndrome (MetS) has been diagnosed in adolescents. However, it remains uncertain which determinants of lifestyle are independently associated with its occurrence. Objective: to verify the association between lifestyle determinants (physical activity, sedentary behavior and food consumption) and MetS, by controlling demographic indicators and anthropometric nutritional status in a sample of adolescents from the southern region of Brazil. Subjects and methods: a school-based cross-sectional study involving 1,035 adolescents (565 girls and 470 boys) aged 12 to 20 years. Anthropometric measurements were performed and a questionnaire was applied with structured questions. MetS was identified according to criteria proposed by the International Diabetes Federation. The data were treated using bivariate analysis and hierarchical multiple regression. Results: the overall prevalence of MetS was equivalent to 4.5% (95% CI: 3.8 to 5.4). Multivariate analysis showed a significant association between MetS and age (OR = 1.34 [95% CI, 1.09 to 1.80]) and economic class (OR = 1.35 [95% CI: 1.08 to 1.86]). Among the determinants of lifestyle, high recreational screen time (OR = 1.32 [95% CI: 1.07 to 1.94]) and low fruit/vegetable intake (OR = 1.23 [95% CI: 1.01 to 1.87]) were independently associated with MetS. Likewise, obesity (OR = 1.62 [95% CI: 1.28 to 2.47]) was significantly associated with the outcome. Conclusion: in view of the significant association with MetS, intervention strategies should be designed to reduce recreational screen time and encourage fruit/vegetable consumption, especially among older adolescents, with a high economic class and obesity status

Introducción: el síndrome metabólico (SMet) se ha diagnosticado en adolescentes, sin embargo, sigue siendo incierto qué determinantes del estilo de vida se pueden asociar de forma independiente con su aparición. Objetivo: verificar la asociación entre determinantes del estilo de vida (actividad física, comportamiento sedentario y consumo de alimentos) y SMet mediante el control de indicadores demográficos y el estado nutricional antropométrico en una muestra de adolescentes de la región sur de Brasil. Sujetos y métodos: estudio transversal con 1.035 adolescentes (565 chicas y 470 chicos) de 12 a 20 años. Se midieron valores antropométricos y se aplicó un cuestionario con preguntas estructuradas. El SMet se identificó de acuerdo con los criterios propuestos por la International Diabetes Federation. Los datos fueron tratados mediante análisis bivariado y regresión múltiple jerarquizada. Resultados: la prevalencia general de SMet fue del 4,5% [IC 95%: 3,8-5,4]. El análisis multivariado mostró una asociación significativa entre SMet y edad (OR = 1,34 [IC 95%: 1,09-1,80]) y clase económica (OR = 1,35 [IC 95%: 1,08-1,86]). Entre los determinantes del estilo de vida, el alto tiempo de pantalla en actividad recreativa (OR = 1,32 [IC 95%: 1,07-1,94]) y la baja ingesta de frutas/vegetales (OR = 1,23 [IC 95%: 1,01-1,87]) se asociaron de forma independiente con el SMet. Del mismo modo, la obesidad (OR = 1,62 [IC 95%: 1,28-2,47]) se asoció significativamente con el SMet. Conclusión: en vista de la asociación significativa con el SMet, las estrategias de intervención deben diseñarse para reducir el tiempo de pantalla recreativo y fomentar el consumo de frutas y verduras, especialmente entre los adolescentes mayores, de clase económica más alta y obesos

Determinants of lifestyle associated with metabolic syndrome in Brazilian adolescents.

INTRODUCTION: Background: metabolic syndrome (MetS) has been diagnosed in adolescents. However, it remains uncertain which determinants of lifestyle are independently associated with its occurrence. Objective: to verify the association between lifestyle determinants (physical activity, sedentary behavior and food consumption) and MetS, by controlling demographic indicators and anthropometric nutritional status in a sample of adolescents from the southern region of Brazil. Subjects and methods: a school-based cross-sectional study involving 1,035 adolescents (565 girls and 470 boys) aged 12 to 20 years. Anthropometric measurements were performed and a questionnaire was applied with structured questions. MetS was identified according to criteria proposed by the International Diabetes Federation. The data were treated using bivariate analysis and hierarchical multiple regression. Results: the overall prevalence of MetS was equivalent to 4.5% (95% CI: 3.8 to 5.4). Multivariate analysis showed a significant association between MetS and age (OR = 1.34 [95% CI, 1.09 to 1.80]) and economic class (OR = 1.35 [95% CI: 1.08 to 1.86]). Among the determinants of lifestyle, high recreational screen time (OR = 1.32 [95% CI: 1.07 to 1.94]) and low fruit/vegetable intake (OR = 1.23 [95% CI: 1.01 to 1.87]) were independently associated with MetS. Likewise, obesity (OR = 1.62 [95% CI: 1.28 to 2.47]) was significantly associated with the outcome. Conclusion: in view of the significant association with MetS, intervention strategies should be designed to reduce recreational screen time and encourage fruit/vegetable consumption, especially among older adolescents, with a high economic class and obesity status.

INTRODUCCIÓN: Introducción: el síndrome metabólico (SMet) se ha diagnosticado en adolescentes, sin embargo, sigue siendo incierto qué determinantes del estilo de vida se pueden asociar de forma independiente con su ocurrencia. Objetivo: verificar la asociación entre determinantes del estilo de vida (actividad física, comportamiento sedentario y consumo de alimentos) y SMet mediante el control de indicadores demográficos y el estado nutricional antropométrico en una muestra de adolescentes de la región sur de Brasil. Sujetos y métodos: estudio transversal con 1.035 adolescentes (565 chicas y 470 chicos) de 12 a 20 años. Se midieron valores antropométricos y se aplicó un cuestionario con preguntas estructuradas. El SMet se identificó de acuerdo con los criterios propuestos por la International Diabetes Federation. Los datos fueron tratados mediante análisis bivariado y regresión múltiple jerarquizada. Resultados: la prevalencia general de SMet fue del 4,5% [IC 95%: 3,8-5,4]. El análisis multivariado mostró una asociación significativa entre SMet y edad (OR = 1,34 [IC 95%: 1,09-1,80]) y clase económica (OR = 1,35 [IC 95%: 1,08-1,86]). Entre los determinantes del estilo de vida, el alto tiempo de pantalla en actividad recreativa (OR = 1,32 [IC 95%: 1,07-1,94]) y la baja ingesta de frutas/vegetales (OR = 1,23 [IC 95%: 1,01-1,87]) se asociaron de forma independiente con el SMet. Del mismo modo, la obesidad (OR = 1,62 [IC 95%: 1,28-2,47]) se asoció significativamente con el SMet. Conclusión: en vista de la asociación significativa con el SMet, las estrategias de intervención deben diseñarse para reducir el tiempo de pantalla recreativo y fomentar el consumo de frutas y verduras, especialmente entre los adolescentes mayores, de clase económica más alta y obesos.

Effects of Whole-Body Vibration Versus Pilates Exercise on Bone Mineral Density in Postmenopausal Women: A Randomized and Controlled Clinical Trial.

BACKGROUND AND PURPOSE: Decreased bone mineral density (BMD) is a common condition in postmenopausal women that can be managed with impact activities. Among the activities studied are the whole-body vibration (WBV) and muscle-strengthening exercises. The purpose of this study was to compare the effects of WBV versus Pilates exercise on BMD in postmenopausal women. METHODS: In this study, 51 postmenopausal women were randomized into 3 groups: vibration (n = 17), Pilates (n = 17), and control (n = 17). Outcomes were the areal bone mineral density (aBMD) (lumbar spine, femoral neck, total hip, trochanter, intertrochanter, and ward's area) assessed by dual-energy x-ray absorptiometry at baseline and follow-up. The interventions were performed 3 times a week for 6 months, totaling 78 sessions. The analysis was performed with intention-to-treat and covariance analyses adjusted for baseline outcomes. RESULTS: After 6 months, 96.1% of the participants completed the follow-up. The analyses demonstrated significant mean between-group differences in favor of the interventions: vibration versus control, for the aBMD of the lumbar spine (0.014 g/cm; 95% confidence interval [CI], 0.006-0.022; P = .018, d = 1.21) and trochanter (0.018 g/cm; 95% CI, 0.006-0.030; P = .012, d = 1.03); and Pilates versus control, for the aBMD of the lumbar spine (0.016 g/cm; 95% CI, 0.007-0.025; P = .008, d = 1.15) and trochanter (0.020 g/cm; 95% CI, 0.010-0.031; P = .005, d = 1.28). CONCLUSION: In postmenopausal women, 3 weekly sessions of WBV or Pilates administered for 6 months provided an equal effect on BMD.

Physical activity, cardiorespiratory fitness and metabolic syndrome in adolescents / Atividade física, aptidão cardiorrespiratória e síndrome metabólica em adolescentes / Actividad física, capacidad cardiorrespiratoria y el síndrome metabólico en adolescentes

ABSTRACT Introduction: Metabolic Syndrome (MetS) has been associated with sedentary behavior, low levels of physical activity and of cardiorespiratory fitness. However, in adolescents the results are conflicting. Objective: To measure the association between sedentary behavior, physical activity, cardiorespiratory fitness and MetS in a representative sample of adolescents. Methods: The sample consisted of 1,035 adolescents (565 girls and 470 boys) between 12 and 20 years of age. Sedentary behavior was treated through recreational screen time, while information equivalent to physical activity was considered through the Physical Activity Questionnaire for Adolescents. The maximal oxygen uptake (VO2max), estimated through PACER performance, was used as an indicator of cardiorespiratory fitness. MetS was identified using the criteria of the International Diabetes Federation. Results: Adolescents of both sexes identified with MetS had significantly longer recreational screen time and lower VO2max than their unidentified MetS peers. Scores equivalent to the level of physical activity undertaken by adolescents identified and not identified with MetS were statistically similar. Probabilistically, adolescents with high recreational screen time and low VO2max had, respectively, 79% [OR = 1.79; 95% CI 1.10 - 2.82] and 95% [OR = 1.95; 95% CI 1.20 - 3.09] greater odds of being identified with MetS. Conclusion: The findings indicate consistent and significant associations between longer recreational screen time, low VO2max values and high prevalence of MetS, which suggests specific interventions designed to help minimize cardiometabolic risk exposure from a very early age. Level of Evidence III; Prognostic Studies - Investigating the Effect of a Patient's Characteristics on the Disease Outcome.

RESUMO Introdução: Síndrome Metabólica (SMet) tem sido associada ao comportamento sedentário, baixos níveis de atividade física e de aptidão cardiorrespiratória. No entanto, em adolescentes, os resultados são conflitantes. Objetivo: Dimensionar a associação entre comportamento sedentário, prática de atividade física, aptidão cardiorrespiratória e SMet em uma amostra representativa de adolescentes. Métodos: A amostra foi composta por 1.035 adolescentes (565 moças e 470 rapazes), entre 12 e 20 anos de idade. Comportamento sedentário foi tratado mediante tempo de tela recreativo, enquanto informações equivalentes à prática de atividade física foram consideradas por intermédio do Physical Activity Questionnaire for Adolescents. Volume máximo de oxigênio (VO2Máx), estimado por intermédio do PACER, foi empregado como indicador de aptidão cardiorrespiratória. SMet foi identificada através dos critérios da International Diabetes Federation. Resultados: Adolescentes de ambos os sexos identificados com SMet apresentaram significativamente maior tempo de tela recreativo e menor VO2Máx que seus pares não identificados com SMet. Escores equivalentes à prática de atividade física de adolescentes identificados e não-identificados com SMet foram estatisticamente similares. Probabilisticamente, adolescentes com elevado tempo de tela recreativo e baixo VO2Máx demonstraram, respectivamente, 79% [OR = 1,79; IC95% 1,10 - 2,82] e 95% [OR = 1,95; IC95% 1,20 - 3,09], com maiores chances de serem identificados com SMet. Conclusão: Os achados sinalizam para associações consistentes e significativas entre maior tempo de tela recreativo, baixos valores de VO2máx e elevada prevalência de SMet, o que sugere intervenções específicas que possam auxiliar na minimização de exposições aos riscos cardiometabólicos desde as idades mais precoces. Nível de Evidência III; Estudos Prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.

RESUMEN Introducción: El síndrome metabólico (SMet) se ha asociado con el comportamiento sedentario, los bajos niveles de actividad física y la aptitud cardiorrespiratoria. Sin embargo, en los adolescentes, los resultados son conflictivos. Objetivo: Dimensionar la asociación entre comportamiento sedentario, práctica de actividad física, aptitud cardiorrespiratoria y SMet en una muestra representativa de adolescentes. Métodos: La muestra fue constituida por 1.035 adolescentes (565 niñas y 470 Niños), entre 12 y 20 años de edad. El comportamiento sedentario fue tratado por el tiempo de pantalla recreativa, mientras que las informaciones equivalentes a la actividad física fueron consideradas por intermedio del Physical Activity Questionnaire for Adolescents. El volumen máximo de oxígeno (VO2máx), estimado a través del PACER, fue empleado como indicador de la aptitud cardiorrespiratoria. SMet fue identificado a través de los criterios de la International Diabetes Federation. Resultados: Los adolescentes de ambos sexos identificados con SMet presentaron significativamente mayor tiempo de pantalla recreativa y menor VO2máx que sus pares no identificados con SMet. Las puntuaciones equivalentes a la actividad física de adolescentes identificados y no identificados con SMet fueron estadísticamente similares. Probabilísticamente, los adolescentes con mayor tiempo de pantalla recreativa y VO2máx más bajo mostraron, respectivamente, el 79% [OR = 1,79; IC95% 1,10 - 2,82] y 95% [OR = 1,95; IC95% 1,20 - 3,09] más posibilidades de ser identificados con SMet. Conclusión: Los hallazgos señalan para asociaciones consistentes y significativas entre el mayor tiempo de pantalla recreativa, bajos valores de VO2máx y alta prevalencia de SMet, lo que sugiere intervenciones específicas que puedan auxiliar en la minimización de exposición a los riesgos cardiometabólicos desde las edades más tempranas. Nivel de evidencia III; Estudios pronósticos - Investigación del efecto de característica de un paciente sobre el desenlace de la enfermedad.

Performance of anthropometric indicators as predictors of metabolic syndrome in Brazilian adolescents.

BACKGROUND: It is not clear which is the best anthropometric indicator to predict metabolic syndrome (MetS) in adolescents. Our objective was to identify the predictive power, with respective cut-off points, of anthropometric indicators associated with the quantity and distribution of body fat for the presence of MetS and to determine the strength of the association between the proposed cut-off points and MetS in adolescents. METHODS: The sample consisted of 1035 adolescents (565 girls and 470 boys) aged between 12 and 20 years. Four anthropometric indicators were considered: waist circumference (WC), body mass index (BMI), waist-height ratio (WHtR), and conicity index (C-Index). MetS was defined according to the criteria of the International Diabetes Federation. Predictive performance was described through analysis of Receiver Operating Characteristic (ROC) curves with a 95% confidence interval. The most accurate cut-off points were identified through sensitivity, specificity and Area Under the Curve (AUC) values. RESULTS: The four anthropometric indicators presented significant AUCs close to 0.70. At younger ages (12-15 years) the girls presented a statistically greater capacity to discriminate MetS; however, at more advanced ages (16-20 years) both sexes presented similar AUCs. Among the anthropometric indicators investigated, regardless of sex and age, the WHtR showed the highest discriminant value for MetS, while the C-Index demonstrated a significantly lower capacity to predict MetS. The AUCs equivalent to WC and BMI did not differ statistically. The proposed cut-off points for WHtR (12-15 years = 0.46, 16-20 years = 0.48) presented the highest values of sensitivity and specificity, between 60% and 70%, respectively. CONCLUSION: Considering that the best AUC was found for WHtR, we suggest the use of this anthropometric indicator, with the cut-off points presented herein, for the prediction of MetS in adolescents with characteristics similar to the study sample.