Background When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values. Objective To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance. Method The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests. Results All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. Conclusion HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.

Supplemental Digital Content is Available in the Text.Treatment with cognitive functional therapy reduced disability compared with core training exercise and manual therapy in patients with chronic low back pain postintervention, but the difference was not clinically important. There was no difference in pain intensity.

ObjetivoInvestigar se um curto programa de treinamento aeróbio poderia causar modifi cação na frequência cardíaca de repouso e alterações na modulação autonômica cardíaca de pré-adolescentes obesos.MétodosEstudo longitudinal que envolveu quinze crianças obesas sedentárias com idades entre 9 e 12 anos que foram submetidas a 12 sessões de treinamento aeróbio de 40 minutos, com intensidade equivalente a 65% da frequência cardíaca submáxima. Para a coleta dos dados de frequência cardíaca e da modulação autonômica cardíaca foram utilizados o monitor Polar S810i e o software Polar Precision Performance que analisa a variabilidade da frequência cardíaca. A análise estatística empregou-se o teste Anova, com nível de significância de p<0,05, para analisar os dados nos momentos pré, durante após o treinamento aeróbio. ResultadosOs valores medianos de frequência cardíaca de repouso foram: pré treinamento aeróbio = 89bpm, após 6 sessões = 95bpm e após 12 sessões = 87,5bpm; e do índice pNN50 da variabilidade da frequência cardíaca estudado para avaliar a modulação autonômica cardíaca, mostrou: pré treinamento aeróbio = 4,95%; após 6 sessões = 3,45%, e após 12 sessões = 11,5%. O índice razão Baixa Frequência/Alta Frequência da Variabilidade da Frequência Cardíaca no domínio da frequência mostrou os seguintes valores: pré Treinamento Aeróbio = 1,28, após seis sessões = 1,22, e após 12 sessões = 0,87. Todos os valores dos índices analisados no estudo não se modificaram significativamente com o treinamento aeróbio.ConclusãoO treinamento aeróbio de curta duração (12 sessões), na intensidade em que foi aplicado, não foi suficiente para promover significativa redução da frequência cardíaca de repouso e alterações no padrão da modulação autonômica cardíaca.

Background: Chronic non-specific low back pain (CNSLBP) is a public health issue associated with a complex interaction of biopsychosocial factors. Cognitive Functional Therapy is a multidimensional approach for CNSLBP which targets negative cognitions and maladaptive functional behaviors (via body relaxation, control and extinction of protective and safety behaviors). Since the evidence about the efficacy of CFT is still limited, it is important to perform clinical trials with the aim of comparing CFT with other interventions commonly used in clinical practice of physiotherapy. The current study will investigate the efficacy of Cognitive Functional Therapy (CFT) compared to combined Core Training exercise and manual therapy (CORE-MT) on pain and disability in patients with CNSLBP. Methods: Two-group, randomized controlled trial with blinded assessors. We will recruit 148 patients with CNSLBP in a private clinic in the city of Campinas, Brazil. The experimental group will receive five one-hour individualized sessions of CFT within a period of two months. The control group will receive five one-hour individualized sessions of CORE-MT within a period of two months. Patients will be assessed pre-intervention, post-intervention and after six and twelve months. The primary outcomes will be pain intensity and disability two months after first intervention session; secondary outcomes will be pain intensity and disability at six and twelve months, as well as global perceived effect and patient satisfaction at two, six and twelve months after the first intervention session. Non-specific predictors, moderators and mediators of outcomes will also be analyzed. Discussion: The result of a high-quality randomized controlled clinical trial involving CFT will assist physiotherapists in the clinical decision-making process. The present study will have a sample size capable of detecting relevant clinical effects of treatment with a low risk of bias. Trial registration: The protocol has been written according to the SPIRIT statement to enhance transparency of content and completeness, has been approved by the Augusto Motta University Center Ethics Committee (research protocol number 2.219.742) and the findings of the trial will be reported following the CONSORT statement and the TIDieR checklist. Trial registration number: NCT03273114

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