Comparing the effects of aquatic exercises with or without high intensity on the functional status, muscular endurance, and performance of patients with chronic low back pain.

BACKGROUND: The prevalence of low back pain is lower when physical fitness (aerobic and muscular) is higher. Strength exercises are important for subjects with low back pain, but there are few studies on the inclusion of aerobic exercise in low back pain programs. The aim of this study was to compare the effects of aquatic exercises with or without high-intensity component on the functional status, lumbar and abdominal muscle endurance, and performance of subjects with chronic low back pain. METHODS: Forty-eight volunteers between 20 and 60 years old were randomly allocated to an experimental group AEDWR (aquatic exercises plus deep-water running group, N.=25) or to a control group AE (aquatic exercises only group, N.=23). The dependent variables included functional status (Repeated Sit-to-Stand test), lumbar (Sorensen test) and abdominal (One Minute Abdominal test) muscle endurance, and physical performance (Maximum Physical Fitness test), which were measured before and after the 9-week intervention and at 21 weeks of follow-up. RESULTS: Lumbar endurance was higher in the AEDWR group at the end of the treatment, with a mean difference (MD) of 43.2 seconds, 95% confidence intervals (CI) (9.6; 76.7), P=0.01, d̅=0.74, and better in the follow-up with MD=40.2 seconds, 95% CI (7.1; 73.3), P=0.02, d̅=0.71, than in the AE group. Participant performance also improved on the 9th week in the AEDWR group, with an MD=0.53 kgf, 95% CI (0.008; 0.98), P=0.02, d̅=0.60. CONCLUSIONS: The addition of deep-water running exercise to aquatic exercises improved lumbar muscle endurance and performance when compared with aquatic exercises only, and this effect was maintained during the follow-up to lumbar muscle endurance.

Assessment of measurement properties of the Brazilian-Portuguese version of the low back activity confidence scale (LoBACS) in patients with chronic low back pain.

The Low Back Activity Confidence Scale (LoBACS) assesses the self-efficacy to perform activities in individuals with chronic low back pain (CLBP). As self-efficacy appears to directly influence the patient's functional capacity and prognosis, it is important to develop a scale that evaluates this attribute to guide treatment strategy and monitor the clinical course of patients. This study aimed to evaluate the reliability, construct validity, and responsiveness of the Brazilian version of the LoBACS. The scale was applied to 112 male and female patients (age, 18-65 years) with specific and nonspecific CLBP. For evaluating the interobserver reliability, the scale was applied twice on the first evaluation day by two trained evaluators (A and B). Within 48-72 h of the first evaluation, assessor A reapplied the scale to evaluate intraobserver reliability (test-retest), which was analyzed by intraclass correlation coefficient (ICC). The first LoBACS applied in the baseline evaluation was also used to assess the construct validity of the scale by factor analysis. For responsiveness, the scale was applied 5 times at 2-week intervals and the change in scores was analyzed by the repeated measures ANOVA. Although factor analysis indicated three subscales, they did not present acceptable values of convergent and divergent validity. Reliability ranged from good to excellent, with ICC values of .90 (95% CI, .84; .93) and .85 (95% CI, .77; .91) for inter- and intraobserver variability for total score. Moreover, the total score was responsive in all comparisons, with no floor or ceiling effects. Thus, only the total score of the Brazilian version of LoBACS proved to be reliable, valid, and responsive.

Programa Academia da Saúde: um olhar quantitativo das adesões entre 2011 a 2017 / The Health Academy Program in Brazil: a quantitative view of adhesions between 2011 to 2017

O objetivo foi analisar a distribuição das adesões municipais ao Programa Academia da Saúde (PAS) no território nacional e o impacto da alteração do tipo de financiamento das obras no quantitativo de adesões. Foram utilizados dados secundários disponibilizados pelo Ministério da Saúde (MS) referentes às adesões ocorridas de 2011 a 2017 para compor as variáveis do estudo. Foram realizadas análises descritiva e inferencial, empregando-se o teste t pareado de Student para verificar diferenças entre adesões em diferentes anos e modalidades de financiamento (emenda parlamentar ­ EP e MS). Os resultados mostram que a maioria das macrorregiões apresentou mais de 50% de municípios participantes (municípios-PAS). As regiões Nordeste e Sudeste tiveram mais adesões, mas a região Norte destacou-se com o maior quantitativo de municípios-PAS proporcionalmente ao total de municípios. O período de maior expansão foi de 2011 a 2013. O número de adesões e municípios-PAS nos cinco anos de financiamento exclusivo por EP não superou o quantitativo aprovado de 2011 a 2012. Nos primeiros anos de financiamento por EP, ocorreu concentração das adesões nos mesmos municípios. Todas as macrorregiões apresentaram mais de 60% de obras concluídas, entretanto foi baixo o percentual de academias com custeio federal dentre as adesões aptas ao recebimento. Concluímos que o PAS está bem distribuído em todo o país, com diferentes situações de implantação. O período de maior expansão do programa foi em 2011 e 2012, quando as obras eram financiadas com recurso do MS. De 2013 a 2017, com financiamento exclusivo por EP, o quantitativo de adesões não superou o observado nos dois primeiros anos

This study aimed to analyze the adhesions of the Health Academy Program (HAP) in the country and the impact of the funding type alteration for the facilities building. Secondary data provided by the Minis-try of Health regarding the adhesions from 2011 to 2017 were used to compose the variables. Descriptive and inferential analyses were conducted, using the Student's paired t-test to verify differences between the number of adhesions to the HAP in different years and funding types. Most regions had more than 50% of participating municipalities. Northeast and Southeast presented greater adhesions numbers concerning the other regions, but the North was highlighted with the largest quantity proportional to the number of municipalities. The greatest expansion was from 2011 to 2013. The number of facilities and municipalities enrolled in the HAP during the years of exclusive funding by parliamentary amendments did not exceed the amount approved from 2011 to 2012. There was a concentration of adhesions in the same municipalities in 2012 and 2013 when the parliamentary amendments were included. In all regions, the rate of facility building completion was above 60%, however the percentage of facilities with the maintenance funding among those able to receive it is low. In conclusion, the HAP has been largely implemented in the country, with a variety of implementation status. From 2011 to 2012 occurred the greatest expansion of the HAP, period that the facilities where financed with funds from the Ministry of Health. In the others hand, from 2013 to 2017, with exclusive funding by EP, the number of facilities did not exceed that observed in the first two years

Effectiveness of additional deep-water running for disability, lumbar pain intensity, and functional capacity in patients with chronic low back pain: A randomised controlled trial with 3-month follow-up.

BACKGROUND: Aquatic exercise (AQE) programme is commonly used as an alternative to the chronic low back pain (CLBP) treatment. The addition of aquatic aerobic exercises to AQE may be beneficial to patients with CLBP. DESIGN: Randomised controlled trial. OBJECTIVES: To assess the effectiveness of AQE with the addition of aerobic exercise - deep-water running (DWR) - compared to exclusive AQE in improving disability, lumbar pain intensity, and functional capacity in patients with CLBP. METHODS: Fifty-four adult patients with CLBP were randomised either to the experimental group (AQE + DWR) or the control group (AQE). An assessor who was blinded to the group allocation performed both pre- and post-interventions assessments. Both treatments lasted 9 weeks, with a 3-month follow-up. The primary outcome was disability, as evaluated using the Roland Morris Disability Questionnaire. The secondary outcomes were pain and functional capacity; pain was assessed using a visual analogue scale (VAS), and functional capacity (travelled distance) was measured using the 6-min walk test (6WT). RESULTS: A significant difference in pain was observed between groups after intervention in favour of DWR (mean difference -1.3 cm [95% confidence interval (CI) -2.17 to -0.45], d‾ = 0.80 [95% CI 0.22 to 1.33]). CONCLUSION: Treatment with DWR was effective in the short term for achieving the desired outcome of pain reduction when compared with AQE only but not for disability and functional capacity.

Hemodynamic responses to strength exercise with blood flow restriction in small muscle groups / Respostas hemodinâmicas ao exercício de força com restrição de fluxo sanguíneo em pequenos grupos musculares

Abstract The aim of this study was to analyze the acute hemodynamic responses to strength exercise with blood flow restriction involving small muscle groups. The sample consisted of 10 male volunteers (22.6 ± 2.07 years, 1.78 ± 0.06 m, 76.32 ± 13.36 kg) who randomly performed two experimental protocols involving the elbow flexion exercise with the dominant arm: strength exercise of the elbow flexors with blood flow restriction (EFBFR) and strength exercise of the elbow flexors without blood flow restriction (EEF). A cross-over design with a seven to ten days interval between the experimental protocols was used. Systolic blood pressure (SBP), diastolic (DBP) and mean (MAP), pulse pressure (PP), heart rate (HR) and double product (DP) were evaluated at rest, immediately after exercise and at 15 minutes of recovery. SBP, DBP and MAP presented a significant increase (p <0.05) immediately after EFBFR when compared to the protocol without blood flow restriction, returning to rest values at the 15 minutes of recovery. DBP significantly reduced (p <0.05) in the recovery period only in the EFBFR experiment and HR increased post-effort in both experiments. The PP and DP did not change between the different times, regardless of the protocol.The results of the present study allow us to conclude that strength exercise with BFR involving small muscle groups was more efficient than exercise without BFR to promote acute changes in hemodynamic responses and that BFR did not represent a cardiovascular risk considering its effects on PP.

Resumo O presente estudo objetivou analisar as respostas hemodinâmicas agudas ao exercício de força com restrição do fluxo sanguíneo (RFS) realizado com pequenos grupos musculares. A amostra foi composta por 10 voluntários do sexo masculino (22,6 ± 2,07 anos, 1,78 ± 0,06 m, 76,32 ± 13,36 kg), que realizaram de forma aleatória os protocolos envolvendo o exercício de flexão da articulação do cotovelo, com membro dominante (rosca concentrada de bíceps) realizado com (ERFS) e sem restrição do fluxo sanguíneo (ESR). Utilizou-se o desenho cruzado, com intervalo de sete a dez dias entre os experimentos. Foram avaliadas: pressão arterial sistólica (PAS), diastólica (PAD) e média (PAM); pressão de pulso (PP), frequência cardíaca (FC) e duplo produto (DP), em repouso, imediatamente após o esforço, e após o esforço na fase de recuperação de 15 minutos. A PAS, PAD e PAM apresentaram elevação significativa (p <0,05) imediatamente após a realização do ERFS, quando comparadas ao protocolo sem restrição, retornando aos valores de repouso após a recuperação. A PAD reduziu significativamente (p <0,05) na recuperação, apenas no experimento ERFS e a FC elevou no pós-esforço em ambos os experimentos. A PP e o DP não sofreram alterações entre os diferentes momentos de avaliação, independentemente do protocolo. Os resultados do presente estudo permitem concluir que o exercício de força com RFS envolvendo pequenos grupos musculares foi mais eficiente que o exercício sem restrição para promover alterações agudas das respostas hemodinâmicas e que a RFS não representou um risco cardiovascular, considerando seus efeitos sobre a PP.

Reliability of ground reaction forces in the aquatic environment.

The aim of this study was to verify the reliability of the kinetic parameters of gait using an underwater force platform. A total of 49 healthy participants with a median age of 21years were included. The kinetic gait data were collected using a 0.6×0.6×0.1m aquatic force plate (Bertec®), set in a pool (15×13×1.30m) with a water depth of 1.20m and water temperature of 32.5°C. Participants walked 10m before reaching the platform, which was fixed to the ground. Participants were instructed to step onto the platform with their preferred limb and data from three valid attempts were used to calculate the average values. A 48-h interval between tests was used for the test-retest reliability. Data were analyzed using interclass correlation coefficients (ICC) and results demonstrated that reliability ranged from poor to excellent, with ICC scores of between 0.24 and 0.87 and mean differences between (d¯)=-0.01 and 0.002. The highest reliability values were found for the vertical (Fz) and the lowest for the mediolateral components (Fy). In conclusion, the force platform is reliable for assessing the vertical and anteroposterior components of power production rates in water, however, caution should be applied when using this instrument to evaluate the mediolateral component in this environment.

Efeitos de diferentes programas de exercícios físicos sobre a composição corporal e a autonomia funcional de idosas com risco de fratura / Effects of different exercise programs on body composition and functional autonomy in elderly women with fracture risk

Com o envelhecimento, ocorre um decréscimo da autonomia funcional dos indivíduos, predispondo-os a quedas, sendo o exercício uma ferramenta para atenuar tais efeitos e melhorar a qualidade de vida desses indivíduos. O objetivo deste trabalho foi analisar os efeitos de diferentes programas de exercícios físicos sobre medidas antropométricas (MA) e autonomia funcional (AF) de idosas com risco de fratura. Quarenta idosas (com risco de fraturas) foram submetidas a 35 sessões (1h, 2 vezes/semana) de treinos de musculação (GM, n= 13), ou ginástica funcional (GF, n= 12) ou ginástica aeróbica (GA, n= 15). Foram avaliadas as MA e a AF antes e após os treinamentos. Não foram observadas melhoras nas MA após 35 sessões nos três grupos. Já a AF apresentou melhoras nos testes de levantar da posição sentada (p<0,001; Δ%=-15; magnitude do efeito=-0,76), levantar da posição em decúbito ventral (p<0,001; Δ%=-20; ME=-0,62) e no índice geral (p<0,001; Δ%=-10; magnitude do efeito=-0,68) no GM. No teste de caminhar 10m houve interação entre tempo x treino (p= 0,048), demonstrando maior magnitude do efeito no GM (Δ%=-6,0; magnitude do efeito=-0,50). Conclui-se que a musculação é mais eficiente na melhora da AF, quando comparada a ginástica funcional e aeróbica em idosas com risco de fraturas.

Functional autonomy can decrease with aging, predisposing the individuals to falls, exercise being a tool to mitigate these effects and improve the quality of life of these individuals. The aim of this study was to analyze the effects of different exercise programs on anthropometric measurements (AM) and functional autonomy (FA) in elderly women with fracture risk. Forty women (with fracture risk) underwent 35 sessions (1 hour, 2 times/week) strength training group (STG, n= 13) or functional group (FG, n= 12) or aerobics group (AG, n= 15). We have measured the AM and FA before and after training. No improvements in AM after 35 sessions were observed in the three groups. Since the FA showed improvement standing from a sitting position (p<0.001, Δ%=-15, effect size= -0.76), up from prone position (p<0.001, Δ%=-20, effect size=0.62) and general index (p<0.001, Δ=-10%, effect size=-0.68)] in STG. In walking 10m test was interaction between time x training (p=0.048), showing a greater effect size on STG (Δ%=-6,0, effect size=-0.50). We conclude that strength training is more effective in improving the FA when compared to functional and aerobics in elderly women with fracture risk.

Nível de atividade física, indicadores clínicos e qualidade de vida de pessoas vivendo com HIV/AIDS / Level of physical activity, clinical indicators and quality of life for people living with HIV/AIDS

A Síndrome da Imunodeficiência Adquirida (AIDS), transmitida pelo Vírus da Imunodeficiência Humana (HIV), é uma doença crônica com expectativa de vida cada vez mais ampliada para estas pessoas. A atividade física apresenta-se como uma ferramenta terapêutica na manutenção e melhora da saúde e da qualidade de vida da população vivendo com HIV/AIDS. No entanto, pouco se sabe acerca da influência da atividade física na saúde e na qualidade de vida desses indivíduos. Nesse sentido o objetivo do presente estudo foi associar o nível de atividade física, indicadores clínicos e qualidade de vida em pessoas vivendo com HIV/AIDS na região central do Estado do Rio Grande do Sul, Brasil. Para tanto, foram avaliados 72 indivíduos de ambos os sexos, quanto ao nível de atividade física, perfil socioeconômico, antropométrico, clínico e sua qualidade de vida. Como resultados, verificou-se que aproximadamente 72% da amostra era insuficientemente ativa fisicamente. O tempo de diagnóstico foi a única variável associada ao nível de atividade física (p = 0,04), com maior prevalência de fisicamente ativos (43,2%) entre os indivíduos com menor tempo de diagnóstico (≤ 84 meses). O domínio referente à função sexual foi o que apresentou maiores escores em todas as análises. Os indivíduos ativos fisicamente apresentaram maior escore (p = 0,015) apenas no domínio "preocupação com a medicação". Em conclusão, o tempo de diagnóstico, a função sexual e a preocupação com a medicação foram os únicos itens que apresentaram associação com o nível de atividade física em pessoas vivendo com HIV/AIDS.

The Acquired Immunodeficiency Syndrome (AIDS), transmitted by the Human Immunodeficiency Virus (HIV), is a chronic disease with a life expectancy increasingly expanded to their peoples. Physical activity is presented as a therapeutic tool in maintaining and improving the health and quality of life of people living with HIV / AIDS. However, little is known about the influence of physical activity on health and quality of life of these individuals. In this paper the aim to associate the level of physical activity with socioeconomic, anthropometry, clinical factors and quality of life of individuals living with HIV/AIDS in the central region of Rio Grande do Sul (RS) - Brazil. Were evaluated seventy-two subjects of both sexes and living with HIV/AIDS were evaluated regarding their socioeconomic status, anthropometry, clinical profile and quality of life. Results: Approximately 72% of the sample was classified as insufficiently active. "Time of contamination" was the only variable associated to physical activity (p = 0.04), with higher prevalence of physically active individuals (43.2%) among subjects with lower time of diagnosis (≤ 84 months). Domain regarding sexual function showed highest scores for all analysis. Physically active subjects had higher score on "concern with medication". In conclusion, the time of diagnosis, sexual function and concern about their medication were the only items that were associated with the level of physical activity among people living with HIV / AIDS.

Comportamento da frequência cardíaca em imersão nas situações de repouso e durante exercícios de hidroginástica / Heart rate behavior in immersion in cases of rest and during water exercises

INTRODUÇÃO: A frequência cardíaca é um parâmetro de fácil utilização para prescrição e controle da intensidade do exercício. Ao realizar um exercício no meio aquático ocorrem alterações fisiológicas significativas que devem ser compreendidas para a prescrição de exercícios, ocasionando assim os efeitos adaptativos adequados. OBJETIVO: Realizar uma revisão sistemática da literatura sobre o comportamento da frequência cardíaca em imersão nas situações de repouso e durante exercícios de hidroginástica e sobre os fatores que a influenciam. RESULTADOS: Os estudos envidenciam que a frequência cardíaca pode ser influenciada pela profundidade devido ao gradiente de pressão hidrostática exercido sobre o corpo, bem como à termorregulação diferenciada. Em repouso, a frequência cardíaca pode variar de acordo com as diferentes temperaturas da água, posições corporais e profundidades. No entanto, a magnitude do efeito de cada um desses fatores sobre a frequência cardíaca ainda não é bem definido. CONCLUSÃO: Durante a realização de exercícios de hidroginástica, essa variável é proporcional à velocidade de execução do exercício, à utilização de equipamento resistivo, à área projetada e ao grupo muscular envolvido e inversamente proporcional à profundidade.

INTRODUCTION: Heart rate is an easy parameter to control and prescribe exercise intensity. When performing an exercise in aquatic environment significant physiological changes occur; these changes must be understood to prescribe exercise, causing to appropriate adaptive effects. OBJECTIVE: To conduct a systematic review of literature on the behavior of heart rate by immersion in rest situations and during aquatics exercises, as well as understanding the factors that influence it. RESULTS: The results showed that heart rate may be influenced by the immersion due to the gradient of hydrostatic pressure exerted on the body and to different thermoregulation. At rest, the heart rate can change according to different water temperatures, body positions and depths of immersion. However, the magnitude of the effect of each factor on the heart rate has not been well defined. CONCLUSION: During aquatic exercise, this variable is proportional to the speed of execution, use of resistive equipment, projected area and the muscle group involved and inversely proportional to the depth of immersion.

Respostas bioquímicas e físicas ao treinamento realizado dentro e fora da água em atletas de futsal / Physical and biochemical responses to training performed in and out of the water in indoor soccer players

O objetivo deste estudo foi analisar os efeitos do treinamento físico em quadra e do treinamento físico em piscina (hidroginástica) sobre os índices bioquímicos relativos ao dano muscular e a aptidão física de atletas de futsal. Doze jogadores de futsal foram divididos em dois grupos: 1) grupo de treinamento em quadra (GTQ, n = 6) e 2) grupo de treinamento em piscina (GTP, n =6). Foram verificados os índices de capacidades aeróbicas e aneróbicas pelos testes de RAST e Yo-yo intermitent, o dano muscular pela creatina quinase (CK) e lactato desidrogenase (LDH) e os níveis de stress oxidativo pelos níveis de ácido tiobarbitúrico (TBARS) e atividade da catalase (CAT) antes e após 10 sessões de trainamento (p<0,05). Os resultados mostraram que ambos os grupos melhoraram a condição aeróbica após as 10 sessões de treinamento. Mas o GTP apresentou maior atividade da CAT em repouso e menores níveis de CK ao ser comparado com o GTQ na 10ª sessão de treino. Concluiu-se que o treino com hidroginástica parece ser uma alternativa interessante para a melhoria das capacidades físicas e para a proteção muscular durante a preparação física inicial de atletas de futsal.

The aim of this study was analyzed the effects of physical training on land and in water (water exercise) on the biochemical levels related to the damage and physical capacity of soccer players. Twelve soccer players were divided into two groups: 1) group training on land (GTL, n=6) and 2) group training in water (GTW, n=6). Levels of aerobic and anaerobic capacities by RAST and Yo-yo intermittent tests, damage by creatine kinase (CK) and lactate dehydrogenase (LDH), oxidative stress levels by thiobarbituric acid reactive substances (TBARS) and catalase activity (CAT) were evaluated before and after 10 sessions of physical training (p<0,05). The results showed that both groups increased their aerobic capacity after ten training sessions. The GTW presented higher CAT at rest and lower levels of CK to be compared with the GTL at the 10th training session. The conclusion is that training in water seems to be an interesting alternative to improve the physical capacities and to protect muscle during pre season training of indoor soccer players.

Comportamento de variáveis fisiológicas durante a aula de hidroginástica com mulheres / Behavior of physiological variables during a water gymnastics class in women

O objetivo deste estudo foi analisar o comportamento de variáveis fisiológicas e do Índice de Percepção de Esforço (IPE) durante os diferentes momentos da aula de hidroginástica. Foram estudadas 17 mulheres, universitárias (idade 23,06±2,05 anos) investigadasem duas etapas: 1) teste de esforço máximo na esteira (VO2pico e FCmáx); e 2) avaliação da composição corporal e realização da aula de hidroginástica (FC, VO2, [lac] e IPE). Utilizaram-se a estatística descritiva e ANOVA medidas repetidas, com o teste post hoc Student-Newman-Keuls (p<0,05). Os resultados mostraram que tanto a FC, quanto o VO2 apresentaram valores estatisticamente diferentes (p=0,000) nos três períodos da aula. Os valores de lactato sanguíneo apresentaram-se diferentes estatisticamente (p=0,001), somente quando foram comparados os valores obtidos no período inicial (1,55 mM) e principal (3,58 mM). O IPE médio foi de 11 e o gasto calórico total foi de 262,10 kcal. Conclui-se que as variáveis fisiológicas estudadas e o IPE apresentam uma variação significativa em função das três fases da aula de hidroginástica. Além disso, as intensidades de esforço (FC, VO2, [lac]) obtidas no período principal estão dentro dos padrões estabelecidos pela literatura para exercícios aeróbios. Dessa forma, pode-se supor que a prática regular de aulas de hidroginástica com esta estrutura, pode causar uma melhora da condição física de mulheres adultas jovens.

The aim of this study was to analyze the behavior of physiological variables and rating of perceived exertion (RPE) during the different phases of a water gymnastics class. Seventeen female university students (age: 23 ± 3.5 years) were evaluated in two steps: 1) incremental treadmill test (peak VO2 and HRmax); 2) assessment of body composition and achievement in the water gymnastics class (HR, VO2, [lac], and RPE). Descriptive statistics and repeated measures ANOVA with the post hoc Student-Newman-Keuls were used (p<0.05). The results showed that both HR and VO2 differed significantly (p=0.000) between the three phases of the class. Blood lactate only differed significantly (p=0.001) between the early (1.55 mM) and the main phase (3.58 mM). The mean RPE was 11 and total calorie expenditure was 262.10 kcal. In conclusion, the physiological variables studied and RPE vary significantly according to the phase of the water gymnastics class. In addition, the intensity of effort (HR, VO2 and [lac]) obtained for the main phase is within the parameters established in the literature for aerobic exercise. Thus, regular water gymnastics classes with this structure may improve the physical condition of young adult women.