Facultad de Ciencias de la Salud

Vibratory platforms (VPs) and unstable footwear (UF) have both shown benefits on balance in some populations. However, there is no evidence about the combined effects of using UF while training on an VP in healthy and physically active young people. We aimed to evaluate the effects of wearing unstable footwear (UF) while training on a whole-body VP on balance in healthy, physically active young people. 23 participants were randomized into groups assigned UF (n = 11) or stable footwear (SF; n = 12). Both groups followed the same training program on an VP with the assigned footwear type twice a week for 12 weeks. The training consisted of performing 8 isometric exercises for progressively longer periods and higher oscillation amplitudes (15–60 s, 1–3 mm), at a fixed vibration frequency (20 Hz). The main outcomes were the antero-posterior and medio-lateral velocities of the center of pressure (COP) recorded using a plantar pressure corridor at baseline, post-treatment and 1-month follow-up. We found a statistically significant difference in the antero-posterior velocity during the monopodal test in the UF group between the different time-points (χ2(2) = 13.282, p = 0.001). Mediolateral COP velocity ranking during the bipodal test was lower for UF than for SF group (U = 19.50, z = − 2.86, p = 0.003) at follow-up. The traditional vibratory platform training does not seem to be effective to improve static balance in physically active young people, however, adding UF provided slightly greater effect.

Critical medical and surgical advances have led to a shift in the care and management of children with congenital heart disease (CHD). These patients present with muscle deconditioning, which negatively influences their response to exercise, functional capacities, and quality of life. This study evaluates the influence of a cardiopulmonary rehabilitation program (CPRP) on the function of peripheral musculature of children with CHD. A single-center prospective cohort study was designed. Fifteen CHD subjects, between 12 and 16 years of age, with reduced aerobic capacity on a cardiopulmonary exercise test, were included in a three-month, 24-session CPRP. Measurements of the subjects’ handgrip strength, biceps brachii and quadriceps femoris strength, and triceps surae fatigue process were collected at the beginning of the program, after completion, and six months after the end of the intervention. A substantial and statistically significant improvement was observed in the subjects’ handgrip strength (kg) (p < 0.001), biceps brachii and quadriceps femoris strength (N) (p < 0.001), as well as triceps surae fatigue process (repetitions) (p = 0.018), with a maintenance of the results six months after the intervention. These results suggest that a CPRP could potentially improve the peripheral muscle function of children with CHD. Additional research is needed to confirm and expand on this hypothesis.

Critical surgical and medical advances have shifted the focus of congenital heart disease (CHD) patients from survival to achievement of a greater health-related quality of life (HRQoL). HRQoL is influenced, amongst other factors, by aerobic capacity and respiratory muscle strength, both of which are reduced in CHD patients. This study evaluates the influence of a cardiopulmonary rehabilitation program (CPRP) on respiratory muscle strength and functional capacity. Fifteen CHD patients, ages 12 to 16, with reduced aerobic capacity in cardiopulmonary exercise testing (CPET) were enrolled in a CPRP involving strength and aerobic training for three months. Measurements for comparison were obtained at the start, end, and six months after the CPRP. A significant improvement of inspiratory muscle strength was evidenced (maximum inspiratory pressure 21 cm H2O, 23%, p < 0.01). The six-minute walking test showed a statistically and clinically significant rise in walked distance (48 m, p < 0.01) and a reduction in muscle fatigue (1.7 out of 10 points, p = 0.017). These results suggest CPRP could potentially improve respiratory muscle function and functional capacity, with lasting results, in children with congenital heart disease, but additional clinical trials must be conducted to confirm this finding.

The aim of the present clinical trial is to evaluate the effectiveness of neuromuscular versus classical strength-resistance training as part of a cardiac rehabilitation programme in patients following acute coronary syndrome. The study is designed as a double-blinded, randomised, and controlled clinical trial. Thirty participants suffering from acute coronary syndrome who meet our inclusion criteria will be recruited by a private tertiary hospital. The intervention group will follow 20 sessions of a cardiac rehabilitation programme divided into two parts: aerobic training and neuromuscular strength-resistance training. The control group will complete the same aerobic training as well as a classical strength-resistance training workout programme. The primary outcome of the study will be the mean difference in change from baseline in the Incremental Shuttle Walking Test. The secondary outcomes will be the cardiorespiratory fitness of the patients (assessed by means of the Chester Step Test), lower-limb performance (assessed with the 30-Second Chair Stand Test and Single- Leg Squat Test), lower-limb strength (hip flexor handheld dynamometry), sexual dysfunction assessment (Sex Health Inventory for Men) and quality of life (EQ-5D-5L). This work will provide evidence for the effectiveness of a neuromuscular versus a classic strength-training programme in terms of cardiorespiratory fitness, lower-limb performance capacities and quality of life, in cardiac patients. The data obtained could lead to more effective and functional workouts which, in turn, may enhance the speed at which these patients can return to their everyday activities of life and improve the efficiency of their movement patterns and heart responses. Furthermore, patients may find neuromuscular workout routines more motivating and engaging, thus encouraging them to adopt healthier lifestyle patterns.

Background: Flexion-relaxation response of the lumbar erector spinae has been previously studied after different interventions such as exercise programs or spinal manipulation, in subjects with chronic low back pain. The objective of the study was to investigate the effects of an isolate myofascial release protocol on erector spinae myoelectric activity and lumbar spine kinematics in chronic low back pain. Methods: Thirty-six participants, with nonspecific chronic low back pain, were randomized to myofascial release group (n=18) receiving four sessions of myofascial treatment, each lasting 40 minutes, and to control group (n=18) receiving a sham myofascial release. Electromyographic and kinematic variables as well as pain and disability questionnaires were analyzed. Findings: There was a bilateral reduction of the flexion relaxation ratio in individuals receiving myofascial release and who did not show myoelectric silence at baseline (right difference M = .34, 95% CI [0.16, 0.33], p ≤ .05 and left difference M = .45, 95% CI [0.16, 0.73], p ≤ .05). There was also a significant reduction in pain in the myofascial release group (difference M = −9.1, 95% CI [−16.3, −1.8], p ≤ .05) and disability (difference M = −5.6, 95% CI [−9.1, −2.1], p ≤ .05), compared with control group. No significant differences between groups were found for the kinematic variables. Interpretation: The myofascial release protocol contributed to the normalization of the flexion- relaxation response in individuals who did not show myoelectric silence before the intervention, and also showed a significant reduction in pain and disability compared with the sham group.

Introduction: Impact force generates acceleration waves that travel through the body, and possible relationships may be exist between these acceleration waves and injuries. Several studies have analyzed the impact forces on the lower limb in healthy subjects wearing unstable shoes, but there is not accelerometric study analyzing the transmission of these impact forces along the locomotive system. The aim of the present study is to compare the acute effects of wearing unstable shoes (US) vs traditional shoes (TS), on maximum vertical acceleration, impact attenuation, cadence and stride length during gait. Methods: Fourty-three asymptomatic adults participated in the cross-sectional study. Subjects underwent gait analysis with simultaneously collecting heel and tibia peak acceleration, impact magnitude and acceleration rate, as well as shock attenuation and stride parameters (stride length, stride rate). Results: The results showed that wearing US increased cadence (10.99 steps/min; p<0.01), and decreased stride length (0.04 m; p<0.01). Additionally, an increase in maximum tibia peak acceleration, tibia impact magnitude and tibia acceleration rate were reported in the US condition compared to the TS condition, with a decrease of tibia attenuation in the US (p<0.05). Conclusion: Regarding shockwave transmission of ground reaction forces, a lower shock attenuation from the heel to the tibia was reported in the US vs TS condition. Bearing this in mind, it should be pointed that, while it is not yet clear if increased tibia acceleration is harmful to the musculoskeletal system, the US should be used with caution. / Introducción: La fuerza de impacto genera ondas de aceleración que viajan a través del cuerpo, pudiendo existir una relación entre estas ondas y determinados tipos de lesión. Varios estudios han analizado las fuerzas de impacto en el miembro inferior, en sujetos sanos empleando calzado inestable, pero no existen estudios que analicen la transmisión de las aceleraciones a lo largo del aparato locomotor. El objetivo del presente estudio es comparar los efectos agudos del uso de calzado inestable (US) frente al calzado tradicional (TS), sobre la aceleración máxima vertical, la atenuación del impacto, la cadencia y la longitud de la zancada durante la marcha. Método: Cuarenta y tres adultos asintomáticos participaron en el estudio transversal. Los sujetos fueron analizados durante la marcha con la recogida simultánea de la aceleración máxima del talón y la tibia, la magnitud del impacto y la ratio de aceleración, así como la disminución del impacto y determinados parámetros durante la zancada (longitud, frecuencia). Resultados: Los resultados mostraron que el uso de US aumentó la cadencia (10,99 pasos/min; p<0,01) y disminuyó la longitud de la zancada (0,04 m; p<0,01). Adicionalmente, se muestra un aumento en la aceleración máxima, la magnitud del impacto y la ratio de aceleración en la tibia con el calzado US en comparación con la condición de TS, con una disminución en la tibia en los US (p<0.05). Conclusión: La disminución del impacto desde el talón hasta la tibia en la condición de US frente a TS fue menor. Teniendo esto en cuenta, debe señalarse que aunque no está claro si el aumento de la aceleración de la tibia es perjudicial para el sistema musculoesquelético, los US deberían ser empleados con precaución.

Unstable shoe was developed as a walking device to strengthen the lower extremity muscles and reduce joint loading. A large number of studies have reported in asymptomatic adults increased electromyography (EMG) activity throughout the gait cycle in most of the lower limb muscles. However, no previous studies have explored the effects of wearing unstable shoes on trunk muscle activity in patients with chronic low back pain (CLBP). Therefore, the aim of the present study was to compare trunk muscle activity during gait using an unstable shoe and a conventional flat control shoe in patients with CLBP. Thirty-five CLBP patients (51.1±12.4 yrs.; 26±3.8 kg/m2; 9.3±5.2 Roland Morris Disability Questionnaire score) were recruited from the Orthopedic Surgery Service at the Hospital to participate in this cross-sectional study. All participants underwent gait analysis by simultaneously collecting surface electromyography (EMG) data from erector spinae (ES), rectus abdominis (RA), obliquus internus (OI) and obliquus externus (OE) muscles, while walking on a treadmill with flat control shoes and experimental unstable shoes. The results showed significantly higher %EMG activity in ES (mean difference: 1.8%; 95% confidence interval [CI] 1.3 to 2.2), RA (mean difference: 1.5%; 95% CI 0.3 to 2.7), and OI (mean difference: 1.5%; 95% CI 0.2 to 2.8) in the unstable shoes condition compared to the flat shoes condition. Based on these findings, the use of unstable shoes may have potential implications in promoting spine stability, particularly in improving neuromuscular control of trunk muscles in CLBP treatment.

Objective: To investigate the effects that wearing unstable shoes has on disability, trunk muscle activity, and lumbar spine range of motion (ROM) in patients with chronic lower back pain (CLBP). Design: Randomized controlled trial. Setting: Orthopedic Surgery Service. Participants: We randomized 40 adults with nonspecific CLBP either to an unstable shoes group (n = 20) or to the control group (n = 20). Intervention: The participants in the unstable shoes group were advised to wear these shoes for a minimum of six hours a day for four weeks. Control group participants were asked to continue wearing their regular shoes. Outcome measures: Our primary outcome was measurement of back-related dysfunction, assessed using the Roland-Morris Disability Questionnaire. Secondary outcomes included changes in electromyographic (EMG) activity of erector spinae (ES), rectus abdominis (RA), internus obliquus (IO), and externus obliquus (EO) muscles, and changes in lumbar spine ROM. Results: Between-group analysis highlighted a significant decrease in disability in the unstable shoes group compared to the control (−5, 95% confidence interval (CI) = −8.4 to −1.6). Our results revealed a significant increase in the percentage of RA, ES, IO, and EO EMG activity and in lumbar spine ROM in the unstable shoes group compared to the control group. Moreover, our results showed a significant negative correlation between disability and the percentage of ES, RA, and IO muscle activity at the end of the intervention.