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13 pages, 1262 KiB  
Systematic Review
Effect of Pilates on Pain and Health-Related Quality of Life in Fibromyalgia Patients: A Systematic Review and Meta-Analysis
by Chalisa Nithuthorn, Natapohn Chaipichit, Thammasorn Jeeraaumponwat, Mart Maiprasert and Piyameth Dilokthornsakul
J. Clin. Med. 2024, 13(23), 7447; https://doi.org/10.3390/jcm13237447 - 6 Dec 2024
Viewed by 427
Abstract
Background: Pilates is one of the non-pharmacological interventions for fibromyalgia (FM). However, its impacts on pain and health-related quality of life (HRQOL) in fibromyalgia patients (FMPs) are inconclusive. This study aimed to assess the effects of Pilates on pain and HRQOL among FMPs. [...] Read more.
Background: Pilates is one of the non-pharmacological interventions for fibromyalgia (FM). However, its impacts on pain and health-related quality of life (HRQOL) in fibromyalgia patients (FMPs) are inconclusive. This study aimed to assess the effects of Pilates on pain and HRQOL among FMPs. Methods: A systematic review and meta-analysis were conducted. Four databases—PubMed, ScienceDirect, Scopus, and Cochrane CENTRAL—along with one grey literature source, Google Scholar, were searched for randomized controlled trials comparing Pilates with other exercises or usual care in FMPs. The outcomes were pain and HRQOL. A meta-analysis was performed using a random-effects model. Results: Six studies were included (n = 265). We found that the effects of Pilates from each individual study on pain were inconsistent. Our pooled analysis of visual analog scale (VAS) scores demonstrated significant pain reduction (mean difference (MD), −0.71, 95%CI, −1.33 to −0.10, p = 0.023; (I2 = 29.3%, p = 0.226)). However, neither the algometric score (AS) nor tender point count (TPC) showed an insignificant difference (AS: MD, −0.43, 95%CI, −2.60 to 1.74, p = 0.700; (I2 = 0.0%, p = 0.654); TPC: MD, −0.16, 95%CI, −2.22 to 1.89, p = 0.520; (I2 = 0.0%, p = 0.515)). Regarding HRQOL, Pilates showed statistically significant improvements on the Fibromyalgia Impact Questionnaire (FIQ) (MD, −7.28, 95%CI, (−12.06 to −2.49), p = 0.003; (I2 = 95.7%, p < 0.001)). A sensitivity analysis of three RCTs (n = 176) based on the ACR 2010 supported this finding (MD, −7.68, 95% CI, −8.60 to −6.76, p < 0.001; (I2 = 0.0%, p = 0.832)) with non-important heterogeneity. Conclusions: Pilates may benefit FMPs. It could reduce pain and improve HRQOL. Given the small number of studies and the presence of data heterogeneity, future high-quality RCTs would provide a clearer conclusion. Full article
(This article belongs to the Special Issue Fibromyalgia: Updates on Diagnosis and Clinical Management)
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<p>PRISMA flow diagram of selected studies.</p>
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<p>A forest plot of meta-analyses (<b>a</b>) of the effects of Pilates on pain measured by the VAS, AS, and TPC in FMPs [<a href="#B21-jcm-13-07447" class="html-bibr">21</a>,<a href="#B22-jcm-13-07447" class="html-bibr">22</a>,<a href="#B23-jcm-13-07447" class="html-bibr">23</a>,<a href="#B25-jcm-13-07447" class="html-bibr">25</a>,<a href="#B26-jcm-13-07447" class="html-bibr">26</a>]; (<b>b</b>) of the effects of Pilates on HRQOL measured by the FIQ in FMPs [<a href="#B21-jcm-13-07447" class="html-bibr">21</a>,<a href="#B22-jcm-13-07447" class="html-bibr">22</a>,<a href="#B23-jcm-13-07447" class="html-bibr">23</a>,<a href="#B24-jcm-13-07447" class="html-bibr">24</a>,<a href="#B25-jcm-13-07447" class="html-bibr">25</a>]; and (<b>c</b>) of sensitivity analyses of the effects of Pilates on HRQOL measured by the FIQ in FMPs [<a href="#B21-jcm-13-07447" class="html-bibr">21</a>,<a href="#B23-jcm-13-07447" class="html-bibr">23</a>,<a href="#B24-jcm-13-07447" class="html-bibr">24</a>].</p>
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10 pages, 6976 KiB  
Article
A Study on the Development of Information and Communication Technology-Based Oral Functional Rehabilitation Exercise Program Content for Elderly People
by Yong-Keum Choi, Ji-Hye Yun, Hyun Lee, Eun-Gyeong Cha and Hyang-Ah Park
Healthcare 2024, 12(20), 2058; https://doi.org/10.3390/healthcare12202058 - 16 Oct 2024
Viewed by 875
Abstract
Background/Objectives: This study was conducted to develop information and communication technology (ICT)-based oral functional rehabilitation exercise (OFRE) program content to effectively improve the oral function of the elderly people. Methods: After selecting evidence-based effective OFRE items through systematic review, the final [...] Read more.
Background/Objectives: This study was conducted to develop information and communication technology (ICT)-based oral functional rehabilitation exercise (OFRE) program content to effectively improve the oral function of the elderly people. Methods: After selecting evidence-based effective OFRE items through systematic review, the final items were constructed through the validity evaluation of detailed items through an expert Delphi survey. The items were composed in a simple content form that can be performed directly and applied to ICT-based mobile applications. Results: The final content items consisted of an oral functional motor-ability measurement, oral Pilates videos, and games. The first is to measure the maximum opening amount before and after exercise, and the opening amount was designed to be measured by eating the fruit displayed on the screen by opening and closing the lips. The second one consisted of eight exercises in the video, and each exercise was to be performed at least three times a day, with a total of two sets. The third is a salivary secretion function exercise that stimulates the salivary glands to stimulate the user’s interest and enable them to perform oral movements on their own. It consists of a lip and respiratory muscle exercise that inflates the cheeks and bursts a balloon, and the image disappears when the word in the image presented on the screen is pronounced correctly. It consists of pronunciation exercises. Conclusions: This content development attempt can be expanded into new convergence research linked to ICT and can be used as basic data when developing related content as part of digital care for the elderly in the future. Full article
(This article belongs to the Section TeleHealth and Digital Healthcare)
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<p>The development process of ICT-based OFRE content.</p>
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<p>ICT-based OFRE content for measuring oral-function exercise ability using facial recognition.</p>
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<p>ICT-based content of OFRE Oral Pilates.</p>
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<p>ICT-based OFRE game content.</p>
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17 pages, 12841 KiB  
Article
Feasibility of a Novel Movement Preference Approach to Classify Case Complexity for Adults with Non-Specific Chronic Low Back Pain
by Boon Chong Kwok, Justin Xuan Li Lim and Pui Wah Kong
Appl. Sci. 2024, 14(19), 8616; https://doi.org/10.3390/app14198616 - 24 Sep 2024
Viewed by 559
Abstract
The non-specific nature of low back pain (LBP) poses challenges in its diagnosis and clinical management. Classifying case complexity with an exercise method may help overcome these challenges. The present study proposed a movement-based classification system based on Dance Medicine Australia (DMA) Clinical [...] Read more.
The non-specific nature of low back pain (LBP) poses challenges in its diagnosis and clinical management. Classifying case complexity with an exercise method may help overcome these challenges. The present study proposed a movement-based classification system based on Dance Medicine Australia (DMA) Clinical Pilates for patients with non-specific chronic LBP. To test the feasibility of the proposed system, 40 adults with non-specific chronic LBP were assessed on their movement preference (i.e., movement directions that can relieve pain or are pain-free) through the DMA Clinical Pilates method. The movement preferences could be a combination of each of the following movement directions: (1) flexion or extension, (2) left or right lateral flexion and/or (3) left or right rotation. For cases that had central or bilateral pain, the number of movement preferences identified was used to guide the classification. Using the proposed system, all 40 (100%) LBP cases were successfully classified into basic (n = 8, 20%), intermediate (n = 17, 42.5%), advanced (n = 8, 20%) or expert (n = 7, 17.5%) levels of complexity. In conclusion, this study has demonstrated that the proposed movement-based classification system was a feasible method for classifying case complexity in adults with non-specific chronic LBP. Future clinical intervention studies are needed to confirm if this classification system can enhance therapeutic outcomes in patients. Full article
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<p>Rotation exercise examples used to test rotation movement preference; (<b>a</b>) Right knee roll—mid-range trunk left flexion rotation; (<b>b</b>) Right attitude rotation—trunk left extension rotation; and (<b>c</b>) Left kneeling rotation—mid-range trunk left extension rotation.</p>
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<p>Case complexity classification system using the DMA Clinical Pilates approach.</p>
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<p>Participant assessment flowchart for case complexity classification.</p>
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11 pages, 1305 KiB  
Article
The Effects of Cervical Mobilization with Clinical Pilates Exercises on Pain, Muscle Stiffness and Head and Neck Blood Flow in Cervicogenic Headache: Randomized Controlled Trial
by Meltem Uzun, Mehmet Ali İkidağ, Yasemin Ekmekyapar Fırat, Nevin Ergun and Türkan Akbayrak
Medicina 2024, 60(6), 852; https://doi.org/10.3390/medicina60060852 - 23 May 2024
Viewed by 1542
Abstract
Background and Objectives: Physiotherapy approaches are used to eliminate the problems caused by cervicogenic headache (CHA), known as secondary headache associated with the structures of the upper cervical region. This study aimed to investigate the effects of cervical mobilization (CM) with clinical [...] Read more.
Background and Objectives: Physiotherapy approaches are used to eliminate the problems caused by cervicogenic headache (CHA), known as secondary headache associated with the structures of the upper cervical region. This study aimed to investigate the effects of cervical mobilization (CM) with clinical Pilates exercises (CPE) on pain, muscle stiffness and head–neck blood flow in CGH. Materials and Methods: A total of 25 patients participated in this randomized controlled study and were randomized into either the CM group or the CM+CPE group. All treatment methods were applied 3 days a week for 6 weeks. The outcome measure was headache intensity and frequency, the number of analgesics, muscle stiffness and vertebral artery (VA) and internal carotid artery (ICA) blood flow. Headache intensity was measured by a visual analogue scale, muscle stiffness by a myotonometer and blood flow by Doppler US. Evaluations were repeated after 6 weeks of treatment. Within-group comparisons were made by the Wilcoxon signed rank test, and between-group comparisons were made by the Mann–Whitney U test. Results: After treatments in the two groups, headache intensity and frequency and the number of analgesics decreased, the muscle stiffness of the suboccipital, upper trapezius and sternocleidomastoid (SCM) muscles decreased, and the blood flow of the ICA and VA increased (p < 0.05). There was a significant difference between the groups in terms of headache intensity (p = 0.025) and muscle stiffness in SKM (p = 0.044) in favor of the CM+CPE group. Conclusions: Non-pharmacological treatment approaches have an important role in CHA related to the upper cervical region. This study suggests that it would be beneficial to add CM in combination with CPE to the non-pharmacological treatment of patients with CHA. Full article
(This article belongs to the Section Sports Medicine and Sports Traumatology)
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<p>CONSORT Flow Diagram.</p>
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<p>Clinical Pilates Programme. (<b>A</b>) Upper Back Warm-up; (<b>B</b>) Dumb Waiter; (<b>C</b>) Chest Stretch; (<b>D</b>) Corkscrew; (<b>E</b>) Upper Body Rolls; (<b>F</b>) Arm Opening Level 1; (<b>G</b>) Double Leg Stretch Level 1; (<b>H</b>) Swan Dive Level 1–3; (<b>I</b>) Breast Stroke Prep 1 Level 2; (<b>J</b>) Spine Twist; (<b>K</b>) Cat Stretch; (<b>L</b>) Active Trapezius Stretch.</p>
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10 pages, 1200 KiB  
Article
The Effects of Online Home-Based Pilates Combined with Diet on Body Composition in Women Affected by Obesity: A Preliminary Study
by Francesca Greco, Maria Grazia Tarsitano, Loretta Francesca Cosco, Federico Quinzi, Katia Folino, Marco Spadafora, Moomna Afzal, Cristina Segura-Garcia, Samantha Maurotti, Roberta Pujia, Arturo Pujia, Pasqualina Buono and Gian Pietro Emerenziani
Nutrients 2024, 16(6), 902; https://doi.org/10.3390/nu16060902 - 21 Mar 2024
Viewed by 2013
Abstract
Diet and exercise intervention are the first strategies to counteract obesity. An online home-based exercise program may be a feasible approach in an obese population. Therefore, this study aimed to investigate the effects of twelve weeks of online Pilates plus diet on body [...] Read more.
Diet and exercise intervention are the first strategies to counteract obesity. An online home-based exercise program may be a feasible approach in an obese population. Therefore, this study aimed to investigate the effects of twelve weeks of online Pilates plus diet on body composition in individuals affected by obesity. Thirty-five females were randomly assigned to a home-based Pilates group (PG, n = 18) or a group without intervention (control group, CG, n = 17). All participants followed a Mediterranean diet. The PG followed a twelve-week online Pilates Matwork program (three times/week; 180 min/week), while the CG was not involved in any structured physical exercise program. Body composition and handgrip strength were evaluated at baseline (T0) and after the intervention (T1). A significant group × time interaction (p < 0.05) was found for the fat mass percentage (pFM). Specifically, the pFM was significantly lower at T1 than at T0 in the PG. Significant group × time interactions for fat-free mass (p < 0.05), appendicular skeletal muscle mass (p < 0.05), and skeletal muscle mass (p < 0.01) were found. All these variables were significantly higher at T1 than at T0 in the PG (p < 0.05). Home-based Pilates combined with diet intervention may represent an effective strategy to improve body composition in terms of fat mass reduction and muscle mass gain in adults affected by obesity. Full article
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<p>Study design flowchart. PG, Pilates group; CG, control group; T<sub>0</sub>, baseline; T<sub>1</sub>, after twelve weeks of intervention.</p>
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<p>The mat Pilates program adopted in this study. RPE, rate of perceived exertion; reps, repetitions.</p>
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<p>Results of outcome measures. T<sub>0</sub>, baseline; T<sub>1</sub>, after 12 weeks of intervention. * Denotes significant differences between T<sub>0</sub> and T<sub>1</sub>.</p>
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14 pages, 542 KiB  
Article
Optimization of Postural Control, Balance, and Mobility in Children with Cerebral Palsy: A Randomized Comparative Analysis of Independent and Integrated Effects of Pilates and Plyometrics
by Ragab K. Elnaggar, Rodrigo Ramirez-Campillo, Alshimaa R. Azab, Saud M. Alrawaili, Mshari Alghadier, Mazyad A. Alotaibi, Ahmed S. Alhowimel, Mohamed S. Abdrabo, Mohammed F. Elbanna, Ahmed M. Aboeleneen and Walaa E. Morsy
Children 2024, 11(2), 243; https://doi.org/10.3390/children11020243 - 15 Feb 2024
Cited by 1 | Viewed by 2529
Abstract
The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. [...] Read more.
The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12–18 years) were randomized to PsCS (n = 27), PlyoML (n = 27), or a combined intervention (n = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability—LoS), balance, and mobility (Community Balance and Mobility Scale—CB&M; Functional Walking Test—FWT; Timed Up and Down Stair test—TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward (p = 0.006 and 0.033, respectively), forward (p = 0.015 and 0.036, respectively), paretic (p = 0.017 and 0.018, respectively), and non-paretic directions (p = 0.006 and 0.004, respectively)], and this was also the case for overall LoS (p < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M (p = 0.037 and p = 0.002, respectively), FWT (p = 0.012 and p = 0.038, respectively), and TUDS (p = 0.046 and p = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP. Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
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<p>A comprehensive flowchart illustrating the participants’ flow and retention through the study phases.</p>
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18 pages, 1413 KiB  
Article
The Effects of Pilates Exercise Training Combined with Walking on Cardiorespiratory Fitness, Functional Capacity, and Disease Activity in Patients with Non-Radiologically Confirmed Axial Spondylitis
by Eleni Zaggelidou, Athina Theodoridou, Vassiliki Michou, Helen Gika, George Panayiotou, Theodoros Dimitroulas and Evangelia Kouidi
J. Funct. Morphol. Kinesiol. 2023, 8(4), 140; https://doi.org/10.3390/jfmk8040140 - 4 Oct 2023
Viewed by 2845
Abstract
The objective of the study was to examine the effects of Pilates exercise training combined with walking on cardiorespiratory fitness, functional capacity, and disease activity in patients with non-radiologically confirmed axial spondylitis (nr-axSpA). Thirty patients with nr-axSpA (seven women (90%), with a mean [...] Read more.
The objective of the study was to examine the effects of Pilates exercise training combined with walking on cardiorespiratory fitness, functional capacity, and disease activity in patients with non-radiologically confirmed axial spondylitis (nr-axSpA). Thirty patients with nr-axSpA (seven women (90%), with a mean age of 46.07 ± 10.48 years old and C-reactive protein (CRP) 2.26 ± 2.14 mg/L) were randomly divided into two groups: A (n1 = 15 patients) and B (n2 = 15 patients). Group A followed a 6-month home-based Pilates exercise training program, while Group B remained untrained until the end of the study. A cardiopulmonary exercise test (CPET), timed up and go test (TUG), five times sit-to-stand test (5×STS), sit-and-reach test (SR), back scratch test for the right (BSR) and the left arm (BSL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Disease Activity Score (ASDAS) were applied to all patients, both at the beginning and at the end of the study. After 6 months, Group A showed higher values in exercise time by 37.41% (p = 0.001), higher peak oxygen uptake (VO2peak) by 25.41% (p = 0.01), a higher ratio between oxygen uptake and maximum heart rate (VO2/HRmax) by 14.83% (p = 0.04), and higher SR by 18.70% (p = 0.007), while lower values were observed in TUG by 24.32% (p = 0.001), 5×STS by 12.13% (p = 0.001), BASDAI score by 20.00% (p = 0.04) and ASDAS score by 23.41% (p = 0.03), compared to Group B. Furthermore, linear regression analysis showed a positive correlation in Group A between BASDAI and 5×STS (r = 0.584, p = 0.02), BASDAI and TUG (r = 0.538, p = 0.03), and ASDAS and 5×STS (r = 0.538, p = 0.03), while a negative correlation was found between BASDAI and VO2peak (r = −0.782, p < 0.001), ASDAS and SR (r = −0.548, p = 0.03), and ASDAS and VO2peak (r = −0.659, p = 0.008). To sum up, cardiorespiratory fitness, functional capacity, and disease activity improved after a long-term Pilates exercise training program in patients with nr-axSpA. Full article
(This article belongs to the Special Issue Advances in Musculoskeletal Physiotherapy)
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<p>The Pilates exercise program.</p>
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<p>CONSORT diagram of the study design.</p>
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<p>Linear regression analysis between functional capacity and disease activity indicators. The (<b>a</b>–<b>c</b>) scatter charts represent the correlation between the Bath Anky-losing Spondylitis Disease Activity Index (BASDAI) and timed up and go test (TUG), 5 times sit-to-stand test (5×STS), and maximum oxygen consumption (VO2peak). The (<b>d</b>–<b>f</b>) scatter charts represent the correlation between the Ankylosing Spondylitis Disease Activity Score (ASDAS) and 5×STS and the correlation between sit-and-reach test (SR) and VO2peak.</p>
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28 pages, 2684 KiB  
Article
How Schroth Therapists Vary the Implementation of Schroth Worldwide for Adolescents with Idiopathic Scoliosis: A Mixed Methods Study
by Rosemary Marchese, Emre Ilhan and Verity Pacey
J. Clin. Med. 2023, 12(18), 6063; https://doi.org/10.3390/jcm12186063 - 19 Sep 2023
Cited by 1 | Viewed by 3223
Abstract
(1) Background: Schroth is a type of physiotherapeutic scoliosis specific exercise (PSSE) prescribed to adolescents with idiopathic scoliosis (AIS). Studies have investigated the effectiveness of Schroth but are yet to elucidate how Schroth is applied clinically and the factors that influence their prescription. [...] Read more.
(1) Background: Schroth is a type of physiotherapeutic scoliosis specific exercise (PSSE) prescribed to adolescents with idiopathic scoliosis (AIS). Studies have investigated the effectiveness of Schroth but are yet to elucidate how Schroth is applied clinically and the factors that influence their prescription. (2) Methods: A mixed methods design was used comprising an anonymous survey and semi-structured interviews of Schroth therapists who treated AIS and who were publicly listed on the Barcelona Scoliosis Physical Therapy School or the International Schroth 3-dimensional Scoliosis Therapy School websites. The survey included 64 questions covering demographics, session and treatment characteristics, and whether therapists included other treatment modalities in their clinical practice. A convenience sample of survey participants were invited to participate in a semi-structured interview to further explore the factors that influenced their prescription of Schroth for AIS. Results from the survey were analyzed descriptively (n, %), whereas inductive thematic analysis was used for the interviews. (3) Results: of the 173 survey respondents (18% response rate), most were from Europe and North America (64.0%), female (78.6%), physiotherapists (96.0%), and worked in private settings (72.3%). Fifty-two per cent of participants used other types of PSSE as an adjunct to Schroth, the Scientific Exercise Approach to Scoliosis (SEAS) being the most frequently used (37.9%). Non-PSSE methods were used ‘at some point’ as an adjunct by 98.8% of participants, including massage and other soft tissue techniques (80.9%), Pilates (46.6%), and Yoga (31.5%). The Schroth techniques used by all survey respondents included breathing and pelvic corrections. Seven participants were interviewed, but data saturation was achieved after only four interviews. Thematic analysis revealed four, inter-related broad themes describing the factors that influenced Schroth prescription for AIS: (1) the adolescent as a whole, including physical, emotional and mental characteristics, and patient goals, (2) family, including parent relationship with the adolescent and the motivation of parents in regard to Schroth, (3) the systems within which the treatment was being offered, such as vicinity to the clinic and the presence of financial insurance support, and (4) therapist characteristics, such as their training and experience. (4) Conclusions: Schroth therapists worldwide use a variety of adjunctive methods to treat AIS. Therapists prescribing Schroth exercises to AIS consider the complex interplay of intra-, inter- and extra-personal factors in clinical practice. These considerations move beyond the three components of evidence-based practice of research, patient preferences, and clinical expertise, towards a systems-based reflection on exercise prescription. Full article
(This article belongs to the Special Issue Spine Rehabilitation in 2022 and Beyond)
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<p>Flowchart of participant inclusion through the study: Part 1, a survey of Schroth therapists’ application of Schroth for adolescents with idiopathic scoliosis (AIS), Part 2, an interview of Schroth therapists to explore the factors that influence their application of Schroth worldwide.</p>
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<p>The characteristics and training background of Schroth therapists and their application of Schroth for adolescents with idiopathic scoliosis including. This figure shows the proportion of Schroth therapists that implement the recommendations for physiotherapeutic scoliosis specific exercises (PSSE) as per <sup>a</sup> SOSORT guidelines. <sup>a</sup> SOSORT is the International Society of Scoliosis Orthopedic and Rehabilitation Treatment. <sup>b</sup> PSSE is physiotherapeutic scoliosis specific exercises.</p>
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<p>Cues, corrections, and techniques that are implemented by Schroth therapists worldwide when delivering Schroth exercise prescription to adolescents with idiopathic scoliosis.</p>
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<p>Strategies to adjust exercise difficulty of the exercise program that are implemented by Schroth therapists worldwide when delivering Schroth exercise prescription to adolescents with idiopathic scoliosis.</p>
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<p>Factors affecting prescription and attendance at the clinic when Schroth therapists are delivering Schroth exercise prescription to adolescents with idiopathic scoliosis. * Stiffness of the curve, as defined by ability of the hump to reduce in size with particular movements. ** Hypermobility was defined by Beighton’s score 6 or more out of 9. *** Muscle tightness was described as a positive Thomas test or straight leg raise &lt;90 degrees. ADHD is attention deficit hyperactivity disorder.</p>
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<p>Support material provided to adolescents with idiopathic scoliosis by Schroth therapists worldwide, implementing Schroth to these patients.</p>
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<p>Compliance monitoring techniques used by Schroth therapists worldwide when delivering Schroth to adolescents with idiopathic scoliosis.</p>
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<p>The Schroth journey for the adolescent with idiopathic scoliosis (AIS) can be convoluted and not straightforward. The journey can often change. This figure demonstrates how the adolescent may start off their Schroth exercise prescription along one path, for example with exercises and no bracing, and then that may change where bracing is implemented. Child: the adolescent with idiopathic scoliosis. Boat: the parents/guardians. Paddle: the therapist directing the journey. Water system: the system that needs to be navigated along the journey, which can change (the Schroth journey can be challenging to navigate, and treatment can change with time).</p>
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14 pages, 569 KiB  
Systematic Review
Comparability of the Effectiveness of Different Types of Exercise in the Treatment of Achilles Tendinopathy: A Systematic Review
by Aikaterini Pantelis Sivrika, Eleni Papadamou, George Kypraios, Demetris Lamnisos, George Georgoudis and Dimitrios Stasinopoulos
Healthcare 2023, 11(16), 2268; https://doi.org/10.3390/healthcare11162268 - 11 Aug 2023
Cited by 3 | Viewed by 4485
Abstract
Achilles tendinopathy (AT) is a common condition both in athletes and the general population. The purpose of this study is to highlight the most effective form of exercise in managing pain-related symptoms and functional capacity as well as in a return to life [...] Read more.
Achilles tendinopathy (AT) is a common condition both in athletes and the general population. The purpose of this study is to highlight the most effective form of exercise in managing pain-related symptoms and functional capacity as well as in a return to life activities, ensuring the quality of life of patients with AT, and creating a protocol to be used in rehabilitation. We conducted a systematic review of the published literature in Pubmed, Scopus, Science Direct, and PEDro for Randomised Controlled Trials concerning interventions that were based exclusively on exercise and delivered in patients 18–65 years old, athletes and non-athletes. An amount of 5235 research articles generated from our search. Five met our inclusion criteria and were included in the review. Research evidence supports the effectiveness of a progressive loading eccentric exercise program based on Alfredson’s protocol, which could be modified in intensity and pace to fit the needs of each patient with AT. Future research may focus on the optimal dosage and load of exercise in eccentric training and confirm the effectiveness of other type of exercise, such as a combination of eccentric–concentric training or heavy slow resistance exercise. Pilates could be applied as an alternative, useful, and friendly tool in the rehabilitation of AT. Full article
(This article belongs to the Special Issue New Advances in the Treatment of Chronic Musculoskeletal Pain)
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<p>PRISMA flow diagram.</p>
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15 pages, 6022 KiB  
Systematic Review
Effects on Sleep Quality of Physical Exercise Programs in Older Adults: A Systematic Review and Meta-Analysis
by Lilian Solis-Navarro, Olga Masot, Rodrigo Torres-Castro, Matías Otto-Yáñez, Carles Fernández-Jané, Mireia Solà-Madurell, Andrea Coda, Erika Cyrus-Barker, Mercè Sitjà-Rabert and Laura Mónica Pérez
Clocks & Sleep 2023, 5(2), 152-166; https://doi.org/10.3390/clockssleep5020014 - 23 Mar 2023
Cited by 14 | Viewed by 8644
Abstract
Background: Given the beneficial effects of exercise in different populations and the close relationship between healthy ageing and sleep quality, our objective was to determine if physical exercise delivered through a structured program improves sleep quality in older adults. Methods: Embase, PubMed/MEDLINE, Web [...] Read more.
Background: Given the beneficial effects of exercise in different populations and the close relationship between healthy ageing and sleep quality, our objective was to determine if physical exercise delivered through a structured program improves sleep quality in older adults. Methods: Embase, PubMed/MEDLINE, Web of Science, and Cochrane Register of Clinical Trials (CENTRAL) were searched to 15 January 2023. Studies that applied physical exercise programs in older adults were reviewed. Two independent reviewers analysed the studies, extracted the data, and assessed the quality of evidence. Results: Of the 2599 reports returned by the initial search, 13 articles reporting on 2612 patients were included in the data synthesis. The articles used interventions based on yoga (n = 5), multicomponent exercise (n = 3), walking (n = 2), cycling (n = 1), pilates (n = 1), elastic bands (n = 1), and healthy beat acupunch (n = 1). In the intervention group, we found significant improvement in Pittsburgh sleep quality index of −2.49 points (95% CI −3.84 to −1.14) in comparison to the control group (p = 0.0003) and sleep efficiency measured with objective instruments (MD 1.18%, 95% CI 0.86 to 1.50%, p < 0.0001). Conclusion: Our results found that physical exercise programs in older adults improve sleep quality and efficiency measured with objective instruments. Full article
(This article belongs to the Section Human Basic Research & Neuroimaging)
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<p>Study selection process.</p>
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<p>Risk of bias summary. Legend: Red (−) = high risk of bias; Yellow (?) = unknown risk of bias; Green (+) = low risk of bias.</p>
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<p>Risk of bias summary.</p>
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<p>Forest plot for sleep quality.</p>
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<p>Forest plot for PSQI.</p>
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<p>Forest plot for sleep quality by duration time.</p>
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<p>Forest plot for sleep quality by duration time including intermediate assessment points.</p>
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<p>Forest plot for sleep quality by setting.</p>
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<p>Forest plot for sleep efficiency. Subjective and objective measures.</p>
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<p>Forest plot for sleep efficiency. Objective measures.</p>
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21 pages, 1149 KiB  
Review
Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A Systematic Review
by Joht Singh Chandan, Kirsty R. Brown, Nikita Simms-Williams, Nasir Z. Bashir, Jenny Camaradou, Dominic Heining, Grace M. Turner, Samantha Cruz Rivera, Richard Hotham, Sonica Minhas, Krishnarajah Nirantharakumar, Manoj Sivan, Kamlesh Khunti, Devan Raindi, Steven Marwaha, Sarah E. Hughes, Christel McMullan, Tom Marshall, Melanie J. Calvert, Shamil Haroon and Olalekan Lee Aiyegbusiadd Show full author list remove Hide full author list
Int. J. Environ. Res. Public Health 2023, 20(4), 3477; https://doi.org/10.3390/ijerph20043477 - 16 Feb 2023
Cited by 24 | Viewed by 6127
Abstract
Background: Post-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection. Non-pharmacological treatments for these symptoms are poorly understood. This review summarises the evidence for the effectiveness of non-pharmacological treatments for PVS. Methods: We conducted [...] Read more.
Background: Post-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection. Non-pharmacological treatments for these symptoms are poorly understood. This review summarises the evidence for the effectiveness of non-pharmacological treatments for PVS. Methods: We conducted a systematic review to evaluate the effectiveness of non-pharmacological interventions for PVS, as compared to either standard care, alternative non-pharmacological therapy, or placebo. The outcomes of interest were changes in symptoms, exercise capacity, quality of life (including mental health and wellbeing), and work capability. We searched five databases (Embase, MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) published between 1 January 2001 to 29 October 2021. The relevant outcome data were extracted, the study quality was appraised using the Cochrane risk-of-bias tool, and the findings were synthesised narratively. Findings: Overall, five studies of five different interventions (Pilates, music therapy, telerehabilitation, resistance exercise, neuromodulation) met the inclusion criteria. Aside from music-based intervention, all other selected interventions demonstrated some support in the management of PVS in some patients. Interpretation: In this study, we observed a lack of robust evidence evaluating the non-pharmacological treatments for PVS, including Long COVID. Considering the prevalence of prolonged symptoms following acute viral infections, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological treatments for patients with PVS. Registration: The study protocol was registered with PROSPERO [CRD42021282074] in October 2021 and published in BMJ Open in 2022. Full article
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<p>PRISMA study selection [<xref ref-type="bibr" rid="B15-ijerph-20-03477">15</xref>].</p>
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<p>Risk of bias [<xref ref-type="bibr" rid="B13-ijerph-20-03477">13</xref>,<xref ref-type="bibr" rid="B90-ijerph-20-03477">90</xref>,<xref ref-type="bibr" rid="B91-ijerph-20-03477">91</xref>,<xref ref-type="bibr" rid="B92-ijerph-20-03477">92</xref>,<xref ref-type="bibr" rid="B93-ijerph-20-03477">93</xref>] (Legend: +: Low risk, -: High risk &amp; ?: Unclear risk).</p>
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15 pages, 5419 KiB  
Systematic Review
Efficacy of Pilates on Pain, Functional Disorders and Quality of Life in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis
by Zhengze Yu, Yikun Yin, Jialin Wang, Xingxing Zhang, Hejia Cai and Fenglin Peng
Int. J. Environ. Res. Public Health 2023, 20(4), 2850; https://doi.org/10.3390/ijerph20042850 - 6 Feb 2023
Cited by 12 | Viewed by 9735
Abstract
Background: Chronic low back pain (CLBP) is a common health problem. Pilates is a unique exercise therapy. This meta-analysis aims to evaluate the efficacy of Pilates on pain, functional disorders, and quality of life in patients with chronic low back pain (CLBP). Methods: [...] Read more.
Background: Chronic low back pain (CLBP) is a common health problem. Pilates is a unique exercise therapy. This meta-analysis aims to evaluate the efficacy of Pilates on pain, functional disorders, and quality of life in patients with chronic low back pain (CLBP). Methods: PubMed, Web of Science, CNKI, VIP, Wanfang Data, CBM, EBSCO, and Embase were searched. Randomized controlled trials of Pilates in the treatment of CLBP were collected based on the inclusion and exclusion criteria. The meta-analysis was performed using RevMan 5.4 and Stata 12.2. Results: 19 randomized controlled trials with a total of 1108 patients were included. Compared with the controls, the results showed the following values: Pain Scale [standard mean difference; SMD = −1.31, 95%CI (−1.80, −0.83), p < 0.00001], Oswestry Disability Index (ODI) [mean difference; MD = −4.35, 95%CI (−5.77, −2.94), p < 0.00001], Roland–Morris Disability Questionnaire (RMDQ) [MD = −2.26, 95%CI (-4.45, −0.08), p = 0.04], 36-item Short-Form (SF-36) (Physical Function (PF) [MD = 5.09, 95%CI (0.20, 9.99), p = 0.04], Role Physical (RP) [MD = 5.02, 95%CI (−1.03, 11.06), p = 0.10], Bodily Pain (BP) [MD = 8.79, 95%CI (−1.57, 19.16), p = 0.10], General Health (GH) [MD = 8.45, 95%CI (−5.61, 22.51), p = 0.24], Vitality (VT) [MD = 8.20, 95%CI(−2.30, 18.71), p = 0.13], Social Functioning (SF) [MD = −1.11, 95%CI (−7.70, 5.48), p = 0.74], Role Emotional (RE) [MD = 0.86, 95%CI (−5.53, 7.25), p = 0.79], Mental Health (MH) [MD = 11.04, 95%CI (−12.51, 34.59), p = 0.36]), Quebec Back in Disability Scale (QBPDS) [MD = −5.51, 95%CI (−23.84, 12.81), p = 0.56], and the sit-and-reach test [MD = 1.81, 95%CI (−0.25, 3.88), p = 0.09]. Conclusions: This meta-analysis reveals that Pilates may have positive efficacy for pain relief and the improvement of functional disorders in CLBP patients, but the improvement in quality of life seems to be less obvious. Registration: PROSPERO CRD42022348173. Full article
(This article belongs to the Special Issue Musculoskeletal Injuries, Rehabilitation and Impact on Public Health)
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<p>Study selection represented by a PRISMA flowchart.</p>
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<p>Résumé of results of risk of bias assessment.</p>
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<p>Punctuation of risk of bias tool [<xref ref-type="bibr" rid="B12-ijerph-20-02850">12</xref>,<xref ref-type="bibr" rid="B18-ijerph-20-02850">18</xref>,<xref ref-type="bibr" rid="B19-ijerph-20-02850">19</xref>,<xref ref-type="bibr" rid="B20-ijerph-20-02850">20</xref>,<xref ref-type="bibr" rid="B21-ijerph-20-02850">21</xref>,<xref ref-type="bibr" rid="B22-ijerph-20-02850">22</xref>,<xref ref-type="bibr" rid="B23-ijerph-20-02850">23</xref>,<xref ref-type="bibr" rid="B36-ijerph-20-02850">36</xref>,<xref ref-type="bibr" rid="B45-ijerph-20-02850">45</xref>,<xref ref-type="bibr" rid="B46-ijerph-20-02850">46</xref>,<xref ref-type="bibr" rid="B47-ijerph-20-02850">47</xref>,<xref ref-type="bibr" rid="B48-ijerph-20-02850">48</xref>,<xref ref-type="bibr" rid="B49-ijerph-20-02850">49</xref>,<xref ref-type="bibr" rid="B50-ijerph-20-02850">50</xref>,<xref ref-type="bibr" rid="B51-ijerph-20-02850">51</xref>,<xref ref-type="bibr" rid="B52-ijerph-20-02850">52</xref>,<xref ref-type="bibr" rid="B53-ijerph-20-02850">53</xref>,<xref ref-type="bibr" rid="B54-ijerph-20-02850">54</xref>,<xref ref-type="bibr" rid="B55-ijerph-20-02850">55</xref>].</p>
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<p>Meta-analysis of the effect of Pilates on Pain Scale in CLBP patients [<xref ref-type="bibr" rid="B12-ijerph-20-02850">12</xref>,<xref ref-type="bibr" rid="B18-ijerph-20-02850">18</xref>,<xref ref-type="bibr" rid="B19-ijerph-20-02850">19</xref>,<xref ref-type="bibr" rid="B20-ijerph-20-02850">20</xref>,<xref ref-type="bibr" rid="B21-ijerph-20-02850">21</xref>,<xref ref-type="bibr" rid="B22-ijerph-20-02850">22</xref>,<xref ref-type="bibr" rid="B23-ijerph-20-02850">23</xref>,<xref ref-type="bibr" rid="B36-ijerph-20-02850">36</xref>,<xref ref-type="bibr" rid="B43-ijerph-20-02850">43</xref>,<xref ref-type="bibr" rid="B45-ijerph-20-02850">45</xref>,<xref ref-type="bibr" rid="B48-ijerph-20-02850">48</xref>,<xref ref-type="bibr" rid="B49-ijerph-20-02850">49</xref>,<xref ref-type="bibr" rid="B50-ijerph-20-02850">50</xref>,<xref ref-type="bibr" rid="B51-ijerph-20-02850">51</xref>,<xref ref-type="bibr" rid="B52-ijerph-20-02850">52</xref>,<xref ref-type="bibr" rid="B54-ijerph-20-02850">54</xref>,<xref ref-type="bibr" rid="B55-ijerph-20-02850">55</xref>].</p>
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<p>Meta-analysis of the effect of Pilates on ODI in CLBP patients [<xref ref-type="bibr" rid="B12-ijerph-20-02850">12</xref>,<xref ref-type="bibr" rid="B19-ijerph-20-02850">19</xref>,<xref ref-type="bibr" rid="B20-ijerph-20-02850">20</xref>,<xref ref-type="bibr" rid="B46-ijerph-20-02850">46</xref>,<xref ref-type="bibr" rid="B50-ijerph-20-02850">50</xref>,<xref ref-type="bibr" rid="B51-ijerph-20-02850">51</xref>,<xref ref-type="bibr" rid="B52-ijerph-20-02850">52</xref>,<xref ref-type="bibr" rid="B53-ijerph-20-02850">53</xref>,<xref ref-type="bibr" rid="B55-ijerph-20-02850">55</xref>].</p>
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<p>Meta-analysis of the effect of Pilates on RMDQ in CLBP patients [<xref ref-type="bibr" rid="B20-ijerph-20-02850">20</xref>,<xref ref-type="bibr" rid="B23-ijerph-20-02850">23</xref>,<xref ref-type="bibr" rid="B36-ijerph-20-02850">36</xref>,<xref ref-type="bibr" rid="B48-ijerph-20-02850">48</xref>,<xref ref-type="bibr" rid="B49-ijerph-20-02850">49</xref>,<xref ref-type="bibr" rid="B51-ijerph-20-02850">51</xref>,<xref ref-type="bibr" rid="B54-ijerph-20-02850">54</xref>].</p>
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<p>Meta-analysis of the effect of Pilates on eight dimensions of SF-36 in CLBP patients [<xref ref-type="bibr" rid="B45-ijerph-20-02850">45</xref>,<xref ref-type="bibr" rid="B46-ijerph-20-02850">46</xref>,<xref ref-type="bibr" rid="B48-ijerph-20-02850">48</xref>,<xref ref-type="bibr" rid="B53-ijerph-20-02850">53</xref>].</p>
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<p>Meta-analysis of the effect of Pilates on QBPDS in CLBP patients [<xref ref-type="bibr" rid="B47-ijerph-20-02850">47</xref>,<xref ref-type="bibr" rid="B53-ijerph-20-02850">53</xref>].</p>
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<p>Meta-analysis of the effect of Pilates on the sit-and-reach test in CLBP patients [<xref ref-type="bibr" rid="B21-ijerph-20-02850">21</xref>,<xref ref-type="bibr" rid="B48-ijerph-20-02850">48</xref>,<xref ref-type="bibr" rid="B53-ijerph-20-02850">53</xref>].</p>
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6 pages, 692 KiB  
Opinion
Role of Mind–Body Fitness in Obesity
by Alexios Batrakoulis
Diseases 2023, 11(1), 1; https://doi.org/10.3390/diseases11010001 - 21 Dec 2022
Cited by 11 | Viewed by 3597
Abstract
Various mind–body fitness modalities such as Pilates, yoga, Tai Chi, and Qigong have become an accepted part of the physical activity, exercise, and leisure sector, serving several populations eligible for meditative movement activities. However, no robust evidence is present in the current literature [...] Read more.
Various mind–body fitness modalities such as Pilates, yoga, Tai Chi, and Qigong have become an accepted part of the physical activity, exercise, and leisure sector, serving several populations eligible for meditative movement activities. However, no robust evidence is present in the current literature supporting the efficacy of these meditative movement activities on health, fitness, and well-being markers among obese adults. Interestingly, the feasibility and safety of mind–body fitness programs in this cohort are still questionable. However, the limited available data show the beneficial role of such alternative exercise options in improving numerous physical fitness and cardiometabolic health-related indicators. The major role of mind–body fitness in obese individuals is to promote muscle control, body functionality, flexibility, and balance while reducing physical limitations, chronic pain, and stress through sessions integrating body postures, efficient breathing patterns, meditation, and relaxation. Such a bodily movement-based approach may be associated with increased physical performance and improved cardiometabolic as well as mental health. However, data on anthropometric characteristics, body composition and cardiovascular disease risk factors modification are somewhat equivocal. Future studies are needed to investigate a wider spectrum of physical fitness and cardiometabolic health parameters, since obese people are likely to demonstrate poor functional capacity, impaired glucose control, lipid disorder, and abnormal blood pressure levels. Full article
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<p>The psychophysiological effects of mind–body fitness interventions in overweight and obese individuals. MHR: maximum heart rate; QoL: quality of life; RPE: rating of perceived exertion [<a href="#B17-diseases-11-00001" class="html-bibr">17</a>,<a href="#B18-diseases-11-00001" class="html-bibr">18</a>,<a href="#B25-diseases-11-00001" class="html-bibr">25</a>,<a href="#B30-diseases-11-00001" class="html-bibr">30</a>,<a href="#B39-diseases-11-00001" class="html-bibr">39</a>].</p>
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13 pages, 363 KiB  
Article
Effects of a 12-Week Pilates Program on Functional Physical Fitness and Basal Metabolic Rate in Community-Dwelling Middle-Aged Women: A Quasi-Experimental Study
by Chien-Hsiao Su, Hsuen-Ying Peng, Cheng-Wen Tien and Wen-Ching Huang
Int. J. Environ. Res. Public Health 2022, 19(23), 16157; https://doi.org/10.3390/ijerph192316157 - 2 Dec 2022
Cited by 2 | Viewed by 3270
Abstract
Background: The aging society worldwide carries public and inevitable issues. Aging is accompanied by multiple diseases, and the health impacts challenge healthcare and social systems. In addition to medical treatment, exercise has been recognized as an effective strategy not only for disease prevention [...] Read more.
Background: The aging society worldwide carries public and inevitable issues. Aging is accompanied by multiple diseases, and the health impacts challenge healthcare and social systems. In addition to medical treatment, exercise has been recognized as an effective strategy not only for disease prevention and alleviation, but also for multiple health benefits on health promotion. The purpose of this study was to investigate the effects of a suitable Pilates exercise intervention program on health maintenance and benefits in community-dwelling middle-aged women with a quasi-experimental design. Methods: We recruited healthy middle-aged community-dwelling women who had not regularly exercised in the previous three months. The participants were assigned to the experimental (n = 22) and control (n = 23) groups based on a quasi-experimental design. The experimental group participated in a mat-based Pilates exercise class twice a week (1 h/session) throughout the 12-week intervention, whereas there was no intervention for the control group. Body composition, basal metabolic rate, and functional physical fitness—comprising cardiovascular capacity, flexibility, muscular strength of upper limbs, muscular strength of lower limbs, core strength, agility, static balance, and dynamic balance—were assessed as primary outcomes in both groups before and after the intervention. Results: There were no significant differences in any of the dependent variables between the two groups before the exercise intervention. After the 12-week intervention, body composition, including body mass index, body fat (−1.5 to 3%), and basal metabolic rate (+10.6%), and functional fitness, including flexibility (+3.5%), core strength (+31.5%), lower-limb strength (+13.5%), agility (+7.3%), and balance (+4.2%), improved significantly in the experimental group relative to the control group (p < 0.05). Moreover, the improvement in physical fitness in lower-limb strength, agility, and balance for fall prevention also demonstrated higher clinical significance than the control. Conclusions: This 12-week mat-based Pilates exercise program significantly improved body composition, basal metabolic rate, and functional physical fitness in community-dwelling middle-aged women. The beneficial effects of Pilates exercise programs may thus promote improved health in the middle-aged female population, with practical implications for communities. Full article
(This article belongs to the Special Issue 2nd Edition: Sports and Health)
12 pages, 588 KiB  
Article
Characteristics of Fitness-Related Injuries in The Netherlands: A Descriptive Epidemiological Study
by Ellen Kemler, Lisa Noteboom and Anne-Marie van Beijsterveldt
Sports 2022, 10(12), 187; https://doi.org/10.3390/sports10120187 - 22 Nov 2022
Cited by 8 | Viewed by 3421
Abstract
Although general information is available, specifically detailed information on gym-based fitness-related injuries in the general recreational fitness population is lacking. The aim of our study was to obtain more insight into injuries occurring as a result of gym-based fitness activities. A descriptive online [...] Read more.
Although general information is available, specifically detailed information on gym-based fitness-related injuries in the general recreational fitness population is lacking. The aim of our study was to obtain more insight into injuries occurring as a result of gym-based fitness activities. A descriptive online epidemiological study was conducted in November 2020. The survey was distributed by a market research agency to members of their research panel. A total of 494 Dutch fitness participants aged ≥ 18 years (mean 38.9; 59% male) who had sustained a fitness-related injury in the preceding 12 months were included in the study. Most injuries occurred during strength training, individual cardio exercise, yoga/Pilates, cardio exercise in group lessons, and CrossFit. The shoulder, leg, and knee were the most common injured body parts; 73.1% of the injuries occurred during unsupervised gym-based fitness activities, and 46.2% of the injuries occurred during one specific exercise or when using a specific fitness device: running (e.g., on the treadmill) (22.8%); bench press (11.8%); or squats (9.6%). Overuse or overload (n = 119), missteps and sprains (n = 48), or an incorrect posture or movement (n = 43) were most often mentioned as causes of injury. Conclusions: Most self-reported gym-based fitness-related injuries occur during strength training and individual cardio exercise. Special attention should be given to the shoulder during strength training and to the lower extremities during cardio exercise. Injury prevention interventions should be able to be carried out without supervision. Full article
(This article belongs to the Special Issue Sports Injury: Prevention and Rehabilitation)
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<p>Flow chart of this study. * Respondent activities were not considered to be gym-based fitness activities.</p>
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<p>Main fitness activities of the athletes and the activity during injury.</p>
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