Effect of physical exercise on the functional capacity of patients with liver cirrhosis: systematic review with meta-analysis.

In this paper, we verify the effect of physical exercise on the functional capacity of people diagnosed with liver cirrhosis (LC). Inclusion criteria were people with LC, at any stage of the disease, over 18 years of age, of either sex, who performed any type of physical exercise in comparison with any other intervention or no intervention, obtaining functional capacity as the outcome, of the controlled and randomized experimental studies. The search for articles was carried out in 11 databases. The descriptors considered for the search were physical exercise, functional capacity, LC, and their synonyms. Methodological quality and study bias were assessed using the Jadad scale and the risk of bias 2 scale, respectively. Review Manager 5.4 was used for the meta-analysis of the data. Functional capacity was considered a continuous variable. The difference in standardized means was considered as the effect measure. The random effect analysis model was used. The confidence level adopted was 0.05. The level of evidence of the meta-analysis result was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The 113 participants with LC, who belonged to the physical exercise group, had a standardized mean difference in functional capacity of 0.57 (0.01-1.13); p = 0.05, more than the 107 participants who were in the control situation. The level of evidence from the meta-analysis assessed through the GRADE was considered moderate. Physical exercise caused a significant increase of moderate clinical relevance in the functional capacity of patients diagnosed with LC.

Reliability of Time to Exhaustion Above the Power Output at VO2peak in Trained Mountain Bikers.

To our knowledge, no study has investigated the reliability of the time to exhaustion (TTE) test during constant-load trials in Olympic distance cross-country mountain bike (XCO-MTB) athletes. Thus, the aim was to analyze the reliability of the TTE test at intensities above peak oxygen uptake (VO2peak) in trained XCO-MTB athletes. Fifteen male XCO-MTB athletes (mean ± SD: age 31.5 ± 6.6 years, stature 174.0 ± 5.4 cm, body mass 67.2 ± 5.1 kg, VO2peak 64.5 ± 4.7 mL·kg-1·min-1) completed 2 TTE tests on the cycle ergometer with 4 different intensities above the maximal work rate in the incremental test (Wmax) (105%, 120%, 130%, and 140% of Wmax). There was moderate reliability between TTE tests at 105% (intraclass correlation coefficient (ICC) = 0.81, p ≤ 0.001; coefficient of variation (CV) = 9.1%; standard error of measurement (SEM) = 18.3%), and 120% (ICC = 0.88, p ≤ 0.001; CV = 6.6%; SEM = 9.3%) Wmax. For intensities of 130% (ICC = 0.53, p = 0.018; CV = 9.2%; SEM = 15.8%) and 140% (ICC = 0.56, p = 0.012; CV = 12.2%; SEM = 13.5%) Wmax, the reliability results proved to be questionable. In addition, no significant differences were found between the 2 TTE tests in all intensities (p > 0.05). Caution should be taken when assessing TTE above VO2peak or when using it as a performance indicator, given its moderate to questionable reliability.

The effects of hydrogymnastics on functional autonomy in elderly women: a meta-analysis

Aim: To Verify the effects of hydrogymnastics on functional autonomy in elderly women. Method: In November 2018, a systematic review of the literature was performed in the databases MEDLINE, SciELO, LILACS, PEDro, Cochrane, Web of Science, SPORTDiscus, SCOPUS e CINAHL. Two independent researchers selected randomized clinical trials, which evaluated the effects of hydrogymnastics over healthy elderly women performance on functional tests performance on functional tests. From each study they selected the number of participants in both experimental and control groups (EG and CG), age, intervention protocol, mean and standard deviation before and after the intervention for the following variables: legs and biceps muscular strength, posterior muscle chain extensibility, and agility - all of which compose the functional autonomy on Rikli and Jones test. We analyzed the methodological quality and the risk of bias through the Jadad Scale and the Cochrane tool respectively. We performed the data analysis through the random effects model and the mean difference between CG and EG. The analysis of the publication bias was done with Egger Test. Results: We found a total of 887 studies in the aforementioned databases, and five randomized clinical trials were included in the present meta-analysis. In spite of the evidence level is very low, the hydrogymnastics promoted an increase in agility and leg muscle strength in elderly women.(AU)

Characteristics and prevalence of musculoskeletal injury in professional and non-professional ballet dancers

BACKGROUND: Ballet is a high-performance activity that requires an advanced level of technical skills. Ballet places great stress on tendons, muscles, bones, and joints and may act directly as a trigger of injury by overuse. OBJECTIVES: 1) to describe the main types of injuries and affected areas related to classical ballet and 2) to compare the frequency of musculoskeletal injuries among professional and non-professional ballet dancers, considering possible gender differences among the professional dancers. METHOD: A total of 110 questionnaires were answered by professional and non-professional dancers. The questionnaire contained items related to the presence of injury, the regions involved, and the mechanism of the injury. RESULTS: We observed a high frequency of musculoskeletal injuries, with ankle sprains accounting for 69.8% of injuries in professional dancers and 42.1% in non-professional dancers. Pirouettes were the most frequent mechanism of injury in professional dancers, accounting for 67.9% of injuries, whereas in the non-professional dancers, repetitive movement was the most common mechanism (28.1%). Ankle sprains occurred in 90% of the women's injuries, and muscle sprains occurred in 54.5% of the men's injuries. The most frequent injury location was the ankle joint in both sexes among the professional dancers, with 67.6% in women and 40.9% in men. CONCLUSIONS: The identification of the mechanism of injury and time of practice may contribute to better therapeutic action aimed at the proper function of the dancers' bodies and improved performance by these athletes.

Characteristics and prevalence of musculoskeletal injury in professional and non-professional ballet dancers.

BACKGROUND: Ballet is a high-performance activity that requires an advanced level of technical skills. Ballet places great stress on tendons, muscles, bones, and joints and may act directly as a trigger of injury by overuse. OBJECTIVES: 1) to describe the main types of injuries and affected areas related to classical ballet and 2) to compare the frequency of musculoskeletal injuries among professional and non-professional ballet dancers, considering possible gender differences among the professional dancers. METHOD: A total of 110 questionnaires were answered by professional and non-professional dancers. The questionnaire contained items related to the presence of injury, the regions involved, and the mechanism of the injury. RESULTS: We observed a high frequency of musculoskeletal injuries, with ankle sprains accounting for 69.8% of injuries in professional dancers and 42.1% in non-professional dancers. Pirouettes were the most frequent mechanism of injury in professional dancers, accounting for 67.9% of injuries, whereas in the non-professional dancers, repetitive movement was the most common mechanism (28.1%). Ankle sprains occurred in 90% of the women's injuries, and muscle sprains occurred in 54.5% of the men's injuries. The most frequent injury location was the ankle joint in both sexes among the professional dancers, with 67.6% in women and 40.9% in men. CONCLUSIONS: The identification of the mechanism of injury and time of practice may contribute to better therapeutic action aimed at the proper function of the dancers' bodies and improved performance by these athletes.

Hemodynamic responses during and after multiple sets of stretching exercises performed with and without the Valsalva maneuver.

OBJECTIVE: This study investigated the acute hemodynamic responses to multiple sets of passive stretching exercises performed with and without the Valsalva maneuver. METHODS: Fifteen healthy men aged 21 to 29 years with poor flexibility performed stretching protocols comprising 10 sets of maximal passive unilateral hip flexion, sustained for 30 seconds with equal intervals between sets. Protocols without and with the Valsalva maneuver were applied in a random counterbalanced order, separated by 48-hour intervals. Hemodynamic responses were measured by photoplethysmography pre-exercise, during the stretching sets, and post-exercise. RESULTS: The effects of stretching sets on systolic and diastolic blood pressure were cumulative until the fourth set in protocols performed with and without the Valsalva maneuver. The heart rate and rate pressure product increased in both protocols, but no additive effect was observed due to the number of sets. Hemodynamic responses were always higher when stretching was performed with the Valsalva maneuver, causing an additional elevation in the rate pressure product. CONCLUSIONS: Multiple sets of unilateral hip flexion stretching significantly increased blood pressure, heart rate, and rate pressure product values. A cumulative effect of the number of sets occurred only for systolic and diastolic blood pressure, at least in the initial sets of the stretching protocols. The performance of the Valsalva maneuver intensified all hemodynamic responses, which resulted in significant increases in cardiac work during stretching exercises.

Hemodynamic responses during and after multiple sets of stretching exercises performed with and without the Valsalva maneuver

OBJECTIVE: This study investigated the acute hemodynamic responses to multiple sets of passive stretching exercises performed with and without the Valsalva maneuver. METHODS: Fifteen healthy men aged 21 to 29 years with poor flexibility performed stretching protocols comprising 10 sets of maximal passive unilateral hip flexion, sustained for 30 seconds with equal intervals between sets. Protocols without and with the Valsalva maneuver were applied in a random counterbalanced order, separated by 48-hour intervals. Hemodynamic responses were measured by photoplethysmography pre-exercise, during the stretching sets, and post-exercise. RESULTS: The effects of stretching sets on systolic and diastolic blood pressure were cumulative until the fourth set in protocols performed with and without the Valsalva maneuver. The heart rate and rate pressure product increased in both protocols, but no additive effect was observed due to the number of sets. Hemodynamic responses were always higher when stretching was performed with the Valsalva maneuver, causing an additional elevation in the rate pressure product. CONCLUSIONS: Multiple sets of unilateral hip flexion stretching significantly increased blood pressure, heart rate, and rate pressure product values. A cumulative effect of the number of sets occurred only for systolic and diastolic blood pressure, at least in the initial sets of the stretching protocols. The performance of the Valsalva maneuver intensified all hemodynamic responses, which resulted in significant increases in cardiac work during stretching exercises. .

Hemodynamic responses of unfit healthy women at a training session with nintendo wii: a possible impact on the general well-being.

AIMS: The purpose of this study was assess the effect of a training session with Nintendo Wii® on the hemodynamic responses of healthy women not involved in regular physical exercise. METHOD: Twenty-five healthy unfit women aged 28 ± 6 years played for 10 minutes the game Free Run (Wii Fit Plus). The resting heart rate (RHR), systolic and diastolic blood pressures (SBP and DBP), and double (rate-pressure) product (DP) were measured before and after activity. The HR during the activity (exercise heart rate, EHR) was measured every minute. RESULTS: A statistically significant difference was observed between the RHR (75 ± 9 bpm) and the mean EHR (176 ± 15 bpm) (P < 0.001). The EHR remained in the target zone for aerobic exercise until the fifth minute of activity, which coincided with the upper limit of the aerobic zone (80% heart rate reserve (HRR) + RHR) from the sixth to tenth minute. The initial (110 ± 8 mmHg) and final (145 ± 17 mmHg) SBP (P < 0.01) were significantly different, as were the initial (71 ± 8 mmHg) and final (79 ± 9 mmHg) DBP (P < 0.01). A statistically significant difference was observed between the pre- (8.233 ± 1.141 bpm-mmHg) and post-activity (25.590 ± 4.117 bpm-mmHg) DP (P < 0.01). CONCLUSION: Physical exercise while playing Free Run sufficed to trigger acute hemodynamic changes in healthy women who were not engaged in regular physical exercise.

Flexibility of the elderly after one-year practice of yoga and calisthenics.

Flexibility training responses to distinct stretching techniques are not well defined, especially in the elderly. This study compared the flexibility of elderly individuals before and after having practiced hatha yoga and calisthenics for 1 year (52 weeks), at least 3 times/week. Sixty-six subjects (12 men) measured and assigned to 3 groups: control (n = 24, age = 67.7±6.9 years), hatha yoga (n = 22, age = 61.2±4.8 years), and calisthenics (n = 20, age = 69.0±5.8 years). The maximal range of passive motion of 13 movements in 7 joints was assessed by the Flexitest, comparing the range obtained with standard charts representing each arc of movement on a discontinuous and non-dimensional scale from 0 to 4. Results of individual movements were summed to define 4 indexes (ankle+knee, hip+trunk, wrist+elbow, and shoulder) and total flexibility (Flexindex). Results showed significant increases of total flexibility in the hatha yoga group (by 22.5 points) and the calisthenics group (by 5.8 points) (p < 0.01 for each) and a decrease in the control group (by 2.1 points) (p < 0.01) after one year of intervention. Between-group comparison showed that increases in the hatha yoga group were greater than in the calisthenics group for most flexibility indexes, particularly the overall flexibility (p <0.05). In conclusion, the practice of hatha yoga (i.e., slow/passive movements) was more effective in improving flexibility compared to calisthenics (i.e., fast/dynamic movements), but calisthenics was able to prevent flexibility losses observed in sedentary elderly subjects.

Análise da excreção urinária de hidroxiprolina e do nível de dor em sujeitos com lombalgia após alongamento na hidrocinesioterapia / Urinary excretion of hydroxyproline analysis and pain in subjects with low back pain after stretching in hydrotherapy

Hidroxiprolina (HP) e da lombalgia, através de um programa de hidrocinesioterapia, enfatizando o alongamento em água aquecida a 34°C. Participaram do estudo 8 policiais militares do Estado do Rio de Janeiro, do sexo masculino, entre 25 e 45 anos; todos com sintomatologia de lombalgia de causa idiopática e com encaminhamento médico à hidrocinesioterapia. O estudo realizou-se no Centro de Fisiatria e Reabilitação da Polícia Militar do Rio de Janeiro. A piscina onde foi realizada a intervenção media 12 x 6 m, 1,20 de profundidade, com a água a 34°C. A intervenção consistiu de dez sessões de hidrocinesioterapia, duas vezes por semana. Durante cada sessão de 50 minutos, foram realizados os seguintes exercícios: 5 minutos de aquecimento – caminhada; 40 minutos de exercícios específicos – bicicleta em suspensão com flutuador na região axilar; e 5 minutos de alongamento de paravertebrais, bíceps femural, glúteo médio e máximo, tensor da fascia lata, quadrado lombar e tríceps sural. A dor lombar foi mensurada através da escala CR-10 de Borg, antes e após as dez sessões do tratamento, e o nível de HP através do protocolo HPROLI 2h. Os resultados demonstraram que os níveis de HP, antes e depois do tratamento, foram iguais a 53,3 ± 22,6 e 31,6 ± 11,3 mg/d, respectivamente. O teste t de Student apresentou valor para t igual a 3,93, para p = 0,008 demonstrando haver diferença significativa entre HP antes e após a hidrocinesioterapia. Os níveis de dor mensurados, antes e depois do tratamento, foram iguais a 5 ± 2 e 2 ± 1, respectivamente. O teste de Wilcoxon apresentou valor para Z igual a 2,20, para p = 0,03 demonstrando haver diferença significativa entre estes níveis antes e após a hidrocinesioterapia. Conclui-se que o método de alongamento utilizado na hidrocinesioterapia, em pacientes com lombalgia, promoveu redução dos níveis de HP e dor lombar.

The aim of this study was to measure excretion levels of hidroxyproline (HP) in subjects with low back pain through a hydrotherapy program, emphasizing the stretching in warm water 34°C. The subjects of the study were 8 military policemen of the state of Rio de Janeiro, between 25 and 45 years old, all of them with idiopathic low back pain and recommendation to practice hydrotherapy. The intervention was in the Physical Medicine and Rehabilitation Center of Military Policy of Rio de Janeiro. The swimming pool measured 12 x 6 m, with 1,20 of depth and water temperature of 34°C. The intervention consisted of ten sessions of hydrotherapy, twice a week. The exercise program, with 50 minutes each session, was as follows: 5 minutes of walking, 40 minutes of specific exercises – float suspension bicycle in the axillar area and 5 minutes of stretching of paravertebral, biceps femuralis, gluteus maximus and medius, tensor faciae latae muscle, lumbar quadrate and triceps surae. The low back pain was measured by Borg scale CR-10 before the 1st session of the intervention and after the last one, as well as HP level using HPROLI 2h protocol. The results showed that HP levels before and after treatment was 53.3 ± 22.6 and 31.6 ± 11.3 mg/d, respectively. The t Student test showed t 3.93, and for p = 0.008 showing a significant difference between HP levels before and after hydrotherapy. The low back pain before and after treatment was 5 ± 2 and 2 ± 1, respectively. The Wilconxon test showed Z 2,20 and for p = 0,03 and with significant difference between these levels before and after hydrotherapy. One concludes that the stretching method used by hydrotherapy in patients with low back pain promoted reduction in HP levels and low back pain.