Efeito de diferentes tempos de alongamento na flexibilidade da musculatura posterior da coxa

Muscle stretching is one of the most used techniques for increasing range of movement (ROM), but there is no consensus on how long it must last to increase flexibility. The aim of this study was to determine which stretching duration is most effective. Flexibility was assessed by measuring the popliteal angle (PA). Thirty mean age 21.1±2.9 year-old female volunteers were recruited and randomly divided into five groups (control, 15, 60, 90, and 120 seconds). All underwent a four-week passive stretching program at these different stretching lengths. Each was assessed as to flexibility by three clinical examiners who measured the PA. Data were statistically analysed, with significance level set at pO alongamento é uma das técnicas mais utilizadas para se obter aumento da amplitude de movimento (ADM), porém não há consenso sobre o tempo necessário de alongamento para aumentar a flexibilidade. O objetivo do estudo foi verificar qual tempo de duração de alongamento é mais eficaz, avaliando-se a flexibilidade pela mensuração do ângulo poplíteo (AP). Foram recrutadas 30 voluntárias com idade média de 21,1±2,9 anos, divididas aleatoriamente em cinco grupos (controle, 15, 60, 90 e 120 segundos), e submetidas a quatro semanas de alongamento passivo durante diferentes tempos, sendo avaliadas por três examinadores clínicos pelo teste do AP associado à ADM. Os dados foram submetidos a análise estatística, com nível de significância

Does photobiomodulation therapy combined to static magnetic field (PBMT-sMF) promote ergogenic effects even when the exercised muscle group is not irradiated? A randomized, triple-blind, placebo-controlled trial

Background: The direct application of photobiomodulation therapy (PBMT) using low-level laser therapy (LLLT) and light emitting diodes (LEDs) combined with a static magnetic field (sMF) (PBMT-sMF) to target tissues is shown to improve muscle performance and recovery. Studies have reported possible PBMT effects when a local distant to the target tissue is irradiated. Notably, the extent of these effects on musculoskeletal performance and the optimal site of irradiation remain unclear, although this information is clinically important since these aspects could directly affect the magnitude of the effect. Therefore, we investigated the effects of local and non-local PBMT-sMF irradiations on musculoskeletal performance and post-exercise recovery before an eccentric exercise protocol. Methods: This randomized, triple-blind (participants, therapists and assessors), placebo-controlled trial included 30 healthy male volunteers randomly assigned to the placebo, local, and non-local groups. Active or placebo PBMT-sMF was applied to 6 sites of the quadriceps muscle of both legs. An eccentric exercise protocol was used to induce fatigue. The primary outcome was peak torque assessed by maximal voluntary contraction (MVC). The secondary outcomes were delayed onset muscle soreness (DOMS) measured by visual analogue scale (VAS), muscle injury assessed by serum creatine kinase activity (CK), and blood lactate levels. Evaluations were performed before the eccentric exercise protocol (baseline), as well as immediately after and 1, 24, 48, and 72 h upon protocol completion. Results: Ten volunteers were randomized per group and analysed for all outcomes. Compared to the placebo and non-local groups, irradiation with PBMT-SMF led to statistically significant improvement (p < 0.05) with regard to all variables in the local group. The outcomes observed in the non-local group were similar to those in the placebo group with regard to all variables. The volunteers did not report any adverse effects. Conclusion: Our results support the current evidence that local irradiation of all exercised muscles promotes ergogenic effects. PBMT-sMF improved performance and reduced muscle fatigue only when applied locally to muscles involved in physical activity.publishedVersio

Effects and parameters of the photobiomodulation in experimental models of third-degree burn: systematic reviewanalysis / Efeitos e parâmetros da fotobiomodulação em modelos experimentais de queimadura de terceiro grau: revisão sistemática

This systematic review was performed to identify the role of photobiomodulation therapy in experimental models of third-degree burns used to induce oxidative stress. EMBASE, PubMed, and CINAHL databases were searched for studies published between January 2003 and January 2018 on the topics of photobiomodulation therapy and third-degree burns. Any study that assessed the effects of photobiomodulation therapy in animal models of third-degree burns was included in the analysis. A total of 17 studies were selected from 1182 original articles targeted on photobiomodulation therapy and third-degree burns. Two independent raters with a structured tool for rating the research quality critically assessed the articles. Although the small number of studies limits the conclusions, the current literature research indicates that photobiomodulation therapy can be an effective short-term approach to accelerate the healing process of third-degree burns, to increase and modulate the inflammatory process, to accelerate the proliferation of fibroblasts, and to enhance the quality of the collagen network. However, differences still exist in the terminology used to describe the parameters and the dose of photobiomodulation therapy

Confiabilidade da medição do ângulo quadriciptal

A proposta deste estudo foi verificar a reprodutibilidade intrateste e a confiabilidade intertestes da mensuração clínica e radiológica do ângulo Q. Foram avaliadas 20 mulheres (40 joelhos), com idade média de 21±5 anos, por dois examinadores clínicos e um terceiro radiológico. As pessoas foram posicionadas na mesa radiológica em decúbito dorsal com um estabilizador podálico em U, com os membros inferiores relaxados. colhendo-se as mensurações clínicas e a tomada radiológica. Para a análise estatística foram utilizados os testes ANOVA, Coeficiente de Correlação Linear (R) e Coeficiente de Correlação Intraclasses (ICC), comníveis de significância de p&lt;0,05, R&gt;0,321 e ICC&gt;0,75. Na análise de variância obteve-se p=0,45 para intrateste, p=0,44 para intertestes, R = 0,42, enquanto o ICC intrateste foi de 0,81, o ICC intertestes de 0,89 e o ICC intra-sessão do intrateste, de 0,80. Considerando os dados obtidos, a metodologia proposta para mensuração clínica e radiológica do ânguloquadriciptal mostrou-se confiável, sendo comprovada sua reprodutibilidade intra e intertestes, podendo ser utilizada com segurança na prática clínica.This study was designed to assess intratest reproducibility and inter-test reliability of clinical and radiographic Q angle measurements. Subjects were 20 women (40 knees), 21±5 years old, whose Q angles were measured by two clinical examiners and one radiographic tester. Both measurements were taken on subjects laying supine on the radiography table with a Ushaped foot stabilizer; each subject was instructed to keep leg muscles relaxed. Data collected were subject to statistical analyses ANOVA, intraclass correlation coefficient (ICC), and R test, significance being respectively set at 5%, &gt;0.75, and &gt;0.321. Results showed intratest p=0.44, intertests p=0.45, intratest ICC=0.81, intertests ICC=0.89 and R=0.42. These findings suggest the methodology here proposed to measure Q angle is reliable and reproducible; it may hence be used in clinical practice

Effect of low-level laser therapy on pain, quality of life and sleep in patients with fibromyalgia: study protocol for a double-blinded randomized controlled trial

BACKGROUND: Low-level laser therapy (LLLT) has been widely used as adjuvant strategy for treatment of musculoskeletal disorders. The light-tissue interaction (photobiostimulation) promotes analgesic and anti-inflammatory effects and improves tissue healing, which could justify the recommendation of this therapy for patients with fibromyalgia, leading to an improvement in pain and possibly minimizing social impact related to this disease. The present study proposes to evaluate the effect of LLLT on tender points in patients with fibromyalgia, correlating this outcome with quality of life and sleep. METHODS/DESIGN: One hundred and twenty patients with fibromyalgia will be treated at the Integrated Health Center and the Sleep Laboratory of the Post Graduate Program in Rehabilitation Sciences of the Nove de Julho University located in the city of Sao Paulo, Brazil. After fulfilling the eligibility criteria, a clinical evaluation and assessments of pain and sleep quality will be carried out and self-administered quality of life questionnaires will be applied. The 120 volunteers will be randomly allocated to an intervention group (LLLT, n = 60) or control group (CLLLT, n = 60). Patients from both groups will be treated three times per week for four weeks, totaling twelve sessions. However, only the LLLT group will receive an energy dose of 6 J per tender point. A standardized 50-minute exercise program will be performed after the laser application. The patients will be evaluated regarding the primary outcome (pain) using the following instruments: visual analog scale, McGill Pain Questionnaire and pressure algometry. The secondary outcome (quality of life and sleep) will be assessed with the following instruments: Medical Outcomes Study 36-item Short-Form Health Survey, Fibromyalgia Impact Questionnaire, Berlin Questionnaire, Epworth Sleepiness Scale and polysomnography. ANOVA test with repeated measurements for the time factor will be performed to test between-groups differences (followed by the Tukey-Kramer post hoc test), and a paired t test will be performed to test within-group differences. The level of significance for the statistical analysis will be set at 5% (P ≤0.05). TRIAL REGISTRATION: The protocol for this study is registered with the Brazilian Registry of Clinical Trials – ReBEC (RBR-42gkzt

Efficacy of pre-exercise low-level laser therapy on isokinetic muscle performance in individuals with type 2 diabetes mellitus: study protocol for a randomized controlled trial

BACKGROUND: Type 2 diabetes, also known non-insulin-dependent diabetes, is the most prevalent type of the disease and involves defects in the secretion and action of insulin. The aim of the proposed study is to evaluate the efficacy of pre-exercise low-level laser therapy (LLLT) on muscle performance of the quadriceps femoris in individuals with type 2 diabetes. METHODS/DESIGN: A double-blind, randomized, controlled clinical trial will be carried out in two treatment phases. In the first phase, quadriceps muscle performance will be evaluated using an isokinetic dynamometer and the levels of creatine kinase and lactate dehydrogenase (biochemical markers of muscle damage) will be determined. The participants will then be allocated to four LLLT groups through a randomization process using opaque envelopes: Group A (4 Joules), Group B (6 Joules), Group C (8 Joules) and Group D (0 Joules; placebo). Following the administration of LLLT, the participants will be submitted to an isokinetic eccentric muscle fatigue protocol involving the quadriceps muscle bilaterally. Muscle performance and biochemical markers of muscle damage will be evaluated again immediately after as well as 24 and 48 hours after the experimental protocol. One week after the last evaluation the second phase will begin, during which Groups A, B and C will receive the LLLT protocol that achieved the best muscle performance in phase 1 for a period of 4 weeks. At the end of this period, muscle performance will be evaluated again. The protocol for this study is registered with the World Health Organization under Universal Trial Number U1111-1146-7109. DISCUSSION: The purpose of this randomized clinical trial is to evaluate the efficacy of pre-exercise LLLT on the performance of the quadriceps muscle (peak torque, total muscle work, maximum power and fatigue index – normalized by body mass) in individuals with DM-2. The study will support the practice of evidence-based to the use of LLLT in improving muscle performance in Individuals with DM-2. Data will be published after the study is completed

Amelioration of Cardiac Function and Activation of Anti-Inflammatory Vasoactive Peptides Expression in the Rat Myocardium by Low Level Laser Therapy

Low-level laser therapy (LLLT) has been used as an anti-inflammatory treatment in several disease conditions, even when inflammation is a secondary consequence, such as in myocardial infarction (MI). However, the mechanism by which LLLT is able to protect the remaining myocardium remains unclear. the present study tested the hypothesis that LLLT reduces inflammation after acute MI in female rats and ameliorates cardiac function. the potential participation of the Renin-Angiotensin System (RAS) and Kallikrein-Kinin System (KKS) vasoactive peptides was also evaluated. LLLT treatment effectively reduced MI size, attenuated the systolic dysfunction after MI, and decreased the myocardial mRNA expression of interleukin-1 beta and interleukin-6 in comparison to the non-irradiated rat tissue. in addition, LLLT treatment increased protein and mRNA levels of the Mas receptor, the mRNA expression of kinin B2 receptors and the circulating levels of plasma kallikrein compared to non-treated post-MI rats. On the other hand, the kinin B1 receptor mRNA expression decreased after LLLT. No significant changes were found in the expression of vascular endothelial growth factor (VEGF) in the myocardial remote area between laser-irradiated and non-irradiated post-MI rats. Capillaries density also remained similar between these two experimental groups. the mRNA expression of the inducible nitric oxide synthase (iNOS) was increased three days after MI, however, this effect was blunted by LLLT. Moreover, endothelial NOS mRNA content increased after LLLT. Plasma nitric oxide metabolites (NOx) concentration was increased three days after MI in non-treated rats and increased even further by LLLT treatment. Our data suggest that LLLT diminishes the acute inflammation in the myocardium, reduces infarct size and attenuates left ventricle dysfunction post-MI and increases vasoactive peptides expression and nitric oxide (NO) generation.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Nove Julho, UNINOVE, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, São Paulo, BrazilUniv São Paulo, Heart Inst InCor, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, São Paulo, BrazilCNPq: 477458/2009-2CNPq: 309715/2011-3CNPq: 479395/2012-8: 2009/54225-8Web of Scienc

Does stroke volume increase during an incremental exercise? A systematic review

Introduction: Cardiac output increases during incremental-load exercise to meet metabolic skeletal muscle demand. This response requires a fast adjustment in heart rate and stroke volume. The heart rate is well known to increase linearly with exercise loadhowever, data for stroke volume during incremental-load exercise are unclear. Our objectives were to (a) review studies that have investigated stroke volume on incremental load exercise and (b) summarize the findings for stroke volume, primarily at maximal-exercise load. Methods: A comprehensive review of the Cochrane Library's, Embase, Medline, SportDiscus, PubMed, and Web of Sci-ence databases was carried out for the years 1985 to the present. The search was performed between February and June 2014 to find studies evaluating changes in stroke volume during incremental-load exercise. Controlled and uncontrolled trials were evaluated for a quality score. Results: The stroke volume data in maximal-exercise load are inconsistent. There is evidence to hypothesis that stroke volume increases during maximal-exercise load, but other lines of evidence indicate that stroke volume reaches a plateau under these circumstances, or even decreases. Conclusion: The stroke volume are unclear, include contradictory evidence. Additional studies with standardized reporting for subjects (e.g., age, gender, physical fitness, and body position), exercise test protocols, and left ventricular function are required to clarify the characteristics of stroke volume during incremental maximal-exercise load.National Council for Scientific [479395/2012-8]Universidade Federal de São Paulo, Laboratório de Fisiologia e Fisiopatologia Cardíaca, São Paulo, SP, BrazilUniversidade Nove de Julho, Programa de Pós-Graduação em Biofotônica Aplicada a Ciências da Saúde, São Paulo, SP, BrazilLaboratorio de Fisiologia Transacional dos Programas de Pos Graduacao em Educacao Fisica e Ciências do En-velhecimento, São Paulo, SP, BrasilUniversidade Nove de Julho, Programa de Pós-Graduação em Medicina, São Paulo, SP, BrazilUniversidade Federal do Mato Grosso, Programa de Mestrado em Educação Física, Cuiabá, MT, BrazilUniversidade Federal de São Paulo, Laboratório de Fisiologia e Fisiopatologia Cardíaca, São Paulo, SP, BrazilNational Council for Scientific: 479395/2012-8Web of Scienc

Effectiveness of phototherapy incorporated into an exercise program for osteoarthritis of the knee: study protocol for a randomized controlled trial

BACKGROUND: Osteoarthritis is a chronic disease with a multifactor etiology involving changes in bone alignment, cartilage, and other structures necessary to joint stability. There is a need to investigate therapeutic resources that combine different wavelengths as well as different light sources (low-level laser therapy and light-emitting diode therapy) in the same apparatus for the treatment of osteoarthritis. The aim of the proposed study is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for individuals with osteoarthritis of the knee. METHODS/DESIGN: A double-blind, controlled, randomized clinical trial will be conducted involving patients with osteoarthritis of the knee. Evaluations will be performed using functional questionnaires before and after the treatment protocols, in a reserved room with only the evaluator and participant present, and no time constraints placed on the answers or evaluations. The following functional tests will also be performed: stabilometry (balance assessment), dynamometry (muscle strength of gluteus medius and quadriceps), algometry (pain threshold), fleximeter (range of motion), timed up-and-go test (functional mobility), and the functional reach test. The participants will then be allocated to three groups through a randomization process using opaque envelopes: exercise program, exercise program + phototherapy, or exercise program + placebo phototherapy, all of which will last for eight weeks. DISCUSSION: The purpose of this randomized clinical trial is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for osteoarthritis of the knee. The study will support the practice based on evidence to the use of phototherapy in individuals with a diagnosis of osteoarthritis of the knee. Data will be published after the study is completed. TRIAL REGISTRATION: The protocol for this study has been submitted to Clinical Trials, registration number NCT02102347, on 29 March 2014

Superpulsed low-level laser therapy protects skeletal muscle of mdx mice against damage, inflammation and morphological changes delaying dystrophy progression.

Aim: To evaluate the effects of preventive treatment with low-level laser therapy (LLLT) on progression of dystrophy in mdx mice. Methods: Ten animals were randomly divided into 2 experimental groups treated with superpulsed LLLT (904 nm, 15 mW, 700 Hz, 1 J) or placebo-LLLT at one point overlying the tibialis anterior muscle (bilaterally) 5 times per week for 14 weeks (from 6th to 20th week of age). Morphological changes, creatine kinase (CK) activity and mRNA gene expression were assessed in animals at 20th week of age. Results: Animals treated with LLLT showed very few morphological changes in skeletal muscle, with less atrophy and fibrosis than animals treated with placebo-LLLT. CK was significantly lower (p = 0.0203) in animals treated with LLLT (864.70 U.l−1, SEM 226.10) than placebo (1708.00 U.l−1, SEM 184.60). mRNA gene expression of inflammatory markers was significantly decreased by treatment with LLLT (p<0.05): TNF-α (placebo-control = 0.51 µg/µl [SEM 0.12], - LLLT = 0.048 µg/µl [SEM 0.01]), IL-1β (placebo-control = 2.292 µg/µl [SEM 0.74], - LLLT = 0.12 µg/µl [SEM 0.03]), IL-6 (placebo-control = 3.946 µg/µl [SEM 0.98], - LLLT = 0.854 µg/µl [SEM 0.33]), IL-10 (placebo-control = 1.116 µg/µl [SEM 0.22], - LLLT = 0.352 µg/µl [SEM 0.15]), and COX-2 (placebo-control = 4.984 µg/µl [SEM 1.18], LLLT = 1.470 µg/µl [SEM 0.73]). Conclusion: Irradiation of superpulsed LLLT on successive days five times per week for 14 weeks decreased morphological changes, skeletal muscle damage and inflammation in mdx mice. This indicates that LLLT has potential to decrease progression of Duchenne muscular dystrophy