Effects of promoting a healthy lifestyle in patients with systemic lupus erythematosus on cardiovascular risk: the randomized controlled clinical trial Living well with lupus

O lúpus eritematoso sistêmico (LES) é uma doença reumática autoimune caracterizada por uma variedade de sintomas, como, por exemplo, lesões de pele, artrite, distúrbios renais, distúrbios neurológicos, ou alterações hematológicas. Pacientes com LES apresentam uma alta prevalência de doenças cardiovasculares, sendo essas as principais causas de morbidade e mortalidade na doença. Intervenções de estilo de vida (prática de atividade física e intervenções nutricionais) são estratégias não farmacológicas que têm um grande potencial para melhorar a saúde cardiovascular desses pacientes. Dessa forma, o objetivo do presente estudo foi investigar os efeitos de uma intervenção de estilo de vida em fatores de risco cardiometabólicos em pacientes com LES. As pacientes foram aleatoriamente alocadas em dois grupos: grupo intervenção ou controle. A intervenção teve uma duração de 6 meses, com o foco na mudança no estilo de vida, por meio da recomendação personalizada de atividade física (estruturada e não estruturada) e mudanças no consumo e estrutura alimentar. Antes e ao final da intervenção, foram realizadas as seguintes avaliações: (1) escore de risco cardiometabólico (desfecho primário), (2) antropometria e gordura visceral, (3) capacidade aeróbia, (4) pressão arterial, (5) coletas sanguíneas, função endotelial, e (7) nível de atividade física e consumo alimentar. Na análise por intenção de tratar, não houve interação significante entre grupo e tempo nos parâmetros de risco cardiovascular, composição corporal, fatores cardiometabólicos, marcadores inflamatórios, marcadores de estresse oxidativo, parâmetros do teste de exercício cardiopulmonar e função endotelial. Houve uma interação no marcador inflamatório de velocidade de hemossedimentação (VHS), mas não foi observada diferença significativa na análise de post hoc (DME: 2,2; 95%IC: -12,6;8,2; p=0,94). Na análise per protocol, não houve diferença significante na interação grupo e tempo na maioria dos parâmetros, apenas na interação no IMC e no marcador inflamatório de VHS, mas ambos desfechos não mantiveram diferença significativa na análise de post hoc [IMC (DME: 0,8; 95%IC: -1,6;3,2; p=0,8); VHS (DME: -1,7; 95%IC: -12,6;9,2; p=0,97)]. Não foram observadas diferenças também quando analisados os subgrupos aderentes e não aderentes. Pode-se concluir que após 24 semanas de uma intervenção pautada na mudança do estilo de vida em pacientes com LES, não foram observadas diferenças significativas na interação do desfecho primário e desfechos secundáriosSystemic lupus erythematosus (SLE) is an autoimmune rheumatic disease characterized by a variety of symptoms, such as skin lesions, arthritis, kidney disorders, neurological disorders, or hematological changes. Patients with SLE have a high prevalence of cardiovascular diseases, which are the main causes of morbidity and mortality in the disease. Lifestyle interventions (physical activity and nutritional interventions) are non-pharmacological strategies that have great potential to improve the cardiovascular health of these patients. Thus, the aim of the present study was to investigate the effects of a lifestyle intervention on cardiometabolic risk factors in patients with SLE. The patients were randomly allocated into two groups: intervention group or control group. The intervention lasted for 6 months, focusing on lifestyle change, through personalized recommendations for physical activity (structured and non-structured) and changes in dietary consumption and structure. Before and after the intervention, the following assessments were performed: (1) cardiometabolic risk score (primary outcome), (2) anthropometry and visceral fat, (3) aerobic capacity, (4) blood pressure, (5) blood collections, (6) blood flow and endothelial function, and (7) physical activity level and dietary consumption. In the intention-to-treat analysis, there was no significant interaction between group and time in cardiovascular risk parameters, body composition, cardiometabolic factors, inflammatory markers, oxidative stress markers, cardiopulmonary exercise test parameters, and endothelial function. There was an interaction in the inflammatory marker erythrocyte sedimentation rate (ESR), but no significant difference was observed in post hoc analysis (estimate mean difference (EMD): 2.20; 95%CI: -12.62 to 8.20; p=0.94). In the per-protocol analysis, there was no significant difference in the interaction between group and time in most parameters, except for the interaction in body mass index (BMI) and ESR, but both outcomes did not maintain significant differences in post hoc analysis [BMI (EMD: 0.80; 95%CI: -1.62 to 3.22; p=0.81); ESR (EMD: -1.69; 95%CI: -12.57 to 9.18; p=0.97)]. There were no differences observed when analyzing adherent and non-adherent subgroups. It can be concluded that after 24 weeks of a lifestyle intervention in patients with SLE, no significant differences were observed in the interaction of the primary and secondary outcome

O treinamento resistido reduz a dor em mulheres com fibromialgia

Resistance training (RT) is an intervention strategy for the treatment of fibromyalgia (FM) that has low cost, easy access, easy application and a positive effect on general health maintenance. Objective: To investigate the effect of four weeks of RT on pain in patients with FM. Method: This is a non-randomized controlled clinical trial with fifty-four women with FM (age: 53.74 ± 8.54 years). Patients were allocated to the intervention group (n= 33) and the control group (n= 21). The intervention consisted of a four-week supervised RT program. For pain assessment, an algometer and a visual analogue scale were used. To assess differences after the intervention, ANOVA two-way was used. Results: Patients in the intervention group had a significant reduction in pain perception and increased pain threshold, but there was no difference when compared to the control group. Conclusions: The practice of RT for four weeks reduces the pain of patients with FM; however, no significant differences were found with the control group. For this reason, the significant results of this study should be considered with caution, reinforcing the need for further studies.O treinamento resistido (TR) é uma estratégia de intervenção para o tratamento da fibromialgia (FM) que possui baixo custo, fácil acesso, fácil aplicação e efeito positivo na manutenção geral da saúde. Objetivo: Investigar o efeito de quatro semanas de TR na dor de pacientes com FM. Método: Trata-se de um ensaio clínico controlado não randomizado com cinquenta e quatro mulheres com FM (idade: 53,74 ± 8,54 anos). As pacientes foram alocadas no grupo intervenção (n= 33) e no grupo controle (n= 21). A intervenção consistiu em quatro semanas de um programa de TR supervisionado. Para a avaliação da dor foi utilizado um algômetro e a escala visual analógica. Para avaliar as diferenças após a intervenção, foi utilizada a ANOVA de dois fatores. Resultados: Os pacientes do grupo intervenção tiveram redução significativa da percepção da dor e aumento do limiar de dor, mas não houve diferença quando comparados ao grupo controle. Conclusão: A prática do TR por quatro semanas reduz a dor de pacientes com FM, entretanto, não foram encontradas diferenças significativas com o grupo controle. Por esse motivo, os resultados significativos deste estudo devem ser considerados com cautela, reforçando a necessidade de novos estudos

Correction: A Rehabilitation Program for Individuals With Chronic Low Back Pain: Protocol for a Randomized Clinical Trial

BACKGROUND: Low back pain (LBP) is the leading cause of disability worldwide. Physical exercise, as a treatment, is beneficial for the improvement of quality of life in patients with LBP, and it is widely accepted. OBJECTIVE: We aimed to develop a protocol for a feasibility study that is designed to compare the effectiveness of different interventions in reducing pain, functional, and psychosocial factors among patients with chronic LBP after 8 weeks of randomization. METHODS: This is a study protocol for a randomized controlled trial that will consist of individuals with chronic LBP who are aged between 18 and 65 years. Participants will be allocated, through block randomization, to one of the following groups: the motor control exercises (MCEs), pain education, MCEs+pain education, and usual care groups. The primary outcome will be pain intensity, and the secondary outcomes will be the pressure pain threshold, which will be measured with a digital algometer; LBP-related disability; fears and beliefs; the fear of movement; quality of life; mood states; and levels of depression and anxiety. The trial was approved by the ethics committee for research involving human beings of the Federal University of Pelotas (reference number: 5.717.390) in September 2022, and it will be conducted until August 2023. RESULTS: The researchers are being trained to apply the questionnaires and carry out the interventions. Patient recruitment will begin at the end of 2022 and results are expected to be achieved by August 2023. CONCLUSIONS: Our trial will provide preliminary data regarding the feasibility and safety of MCEs and pain education for patients with LBP. It will also provide preliminary outcome data that can be used to identify the most efficient intervention and the level of health care that should be implemented in public health services. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials U1111-1221-4106; https://ensaiosclinicos.gov.br/rg/RBR-2xx2r2/ INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/3134

Health coaching strategies for weight loss: a systematic review and meta-analysis.

Health coaching has emerged as a potential supporting tool for health professionals to overcome behavioural barriers, but its efficacy in weight management remains unclear. We conducted a systematic review and meta-analysis to synthesize and evaluate the quality of evidence supporting the use of self-reported health coaching for weight loss. Seven electronic databases (PubMed, Web of Science, Scopus, Cochrane, Psyinfo, VHL, and Scielo) were independently searched from inception to May 2020. This review was conducted in accordance with PRISMA guidelines and quality of evidence was assessed using GRADE recommendations. Any study that investigated a self-reported health coaching intervention with the goal of inducing weight loss in individuals of any age, health or training status was considered for inclusion. Quantitative data were analysed using multi-level hierarchical meta-regression models conducted within a Bayesian framework. Six hundred and fifty-three studies were screened and 38 were selected for inclusion. The quality of evidence supporting outcomes based on the entire evidence base was very low and studies were deemed to have high risk of bias. Meta-analysis of controlled studies provided evidence of an effect favouring coaching compared to usual care, but was trivial in magnitude (ES0.5: -0.09; 95%CrI: -0.17, -0.02). The multilevel extension of Egger’s regression-intercept test indicated the existence of publication bias, while a sensitivity analysis based only on those studies deemed to be of high-quality provided no evidence of an effect of coaching on weight loss (ES0.5: -0.04; 95%CrI: -0.12, 0.09). Considered collectively, the results of this investigation indicate that the available evidence is not of sufficient quality to support the use of self-reported health coaching as a health care intervention for weight loss