Objective To compare the acute effects of transcutaneous auricular vagus nerve stimulation (taVNS) on blood pressure (BP) and heart rate variability (HRV) in hypertensive individuals at two auricular sites. Materials and Methods Eighty-four hypertensive adults underwent three taVNS sessions applied to the tragus, cymba conchae, and earlobe (control), with one-week intervals between sessions. Systolic (SBP) and diastolic BP (DBP), heart rate (HR), peripheral oxygen saturation (SpO2), autonomic function, and HRV were assessed before, during, and after stimulation. HRV analysis included time-domain, frequency-domain, and nonlinear indices. Results Participants exhibited baseline sympathetic predominance and reduced HRV. Stimulation at the cymba conchae produced greater reductions in SBP and DBP than the other sites (p < 0.05), without significantly affecting HRV parameters. Conclusion A single taVNS session did not produce clinically meaningful changes in autonomic function. However, stimulation at the cymba conchae showed greater potential for BP reduction. Further studies using longer and more robust protocols are warranted.

INTRODUCTION:Population aging is a significant global challenge, demanding strategies that promote healthy aging. Regular physical activity is crucial for maintaining functional capacity, quality of life, and preventing chronic diseases in older adults. However, sedentary behavior remains high, and evidence on effective, supervised smartphone-based exercise strategies for older adults is limited. OBJECTIVE:To evaluate the effects of smartphone-based exercises with in-person or remote therapeutic supervision on functional capacity. METHODS:Thirty-four older adults were randomized into two training groups with App-based exercises: a Control Group with in-person supervision and an Experimental Group with remote supervision. The exercises were performed three times a week for 8 weeks. The Experimental Group performed exercises at homes with remote supervision, and the Control Group performed exercises in the laboratory. Functional capacity was measured using the Glittre Activities of Daily Living (Glittre ADL) test, postural balance with the Mini Balance Evaluation Systems Test, and lower limb strength with the Five Times Sit-to-Stand test. RESULTS:Both groups demonstrated significant improvement in functional capacity. After 8 weeks, Glittre-ADL test time reduced similarly in both groups (Experimental Group: 217±63 to 188±47 s and Control Group 194±34 to 171±30 s, ES=0.09). Postural balance improved similarly in both groups (ES=0.15), and the lower limb strength improved in the Experimental Group (ES=0.32). CONCLUSION:A smartphone App-based exercise program, with and without in-person supervision, improved functional capacity and postural balance in older adults, whereas lower limb strength improved only with in-person supervision. Brazilian Registry of Clinical Trials: RBR-22ctkjq.

BACKGROUND:and PurposeTranscutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising noninvasive strategy to modulate autonomic function and reduce blood pressure (BP). However, whether the stimulation site influences acute cardiovascular responses remains unclear. OBJECTIVE:To compare the acute effects of taVNS applied to the tragus and cymba conchae on BP and cardiac autonomic modulation in hypertensive and healthy individuals. METHODS:This pilot randomized crossover clinical trial included 14 hypertensive and 14 healthy participants who underwent two taVNS sessions (tragus and cymba conchae) in randomized order, one week apart. Sessions lasted 30 min and delivered a sinusoidal current (30 Hz, 500 ms pulse width), with intensity adjusted to the individual sensory threshold. Systolic BP (SBP), diastolic BP (DBP), and heart rate variability (HRV) parameters were assessed at baseline, during stimulation, and post-stimulation. Generalized estimating equations were used for analysis. RESULTS:A significant group × time × stimulation site interaction was observed for SBP (χ2 = 19.0, p = 0.001) and DBP (χ2 = 10.0, p = 0.038). Cymba conche stimulation reduced BP in healthy individuals, whereas no meaningful BP changes were observed in hypertensive participants. Tragus stimulation reduced diastolic BP only in the hypertensive group. Significant interactions were also detected for normalized spectral HRV components and sample entropy (p < 0.05), though autonomic responses were modest and not consistently indicative of enhanced parasympathetic modulation. DISCUSSION:Acute taVNS induces site- and group-dependent cardiovascular responses, with limited clinical impact after a single session. These findings suggest that short-term stimulation may be insufficient to overcome impaired autonomic regulation in hypertension and highlight the need for repeated or longer stimulation protocols in future clinical trials.

Introduction Hypertensive individuals experience chronic inflammation, higher sympathetic nervous system activity, and decreased functional capacity. While Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) and aerobic training have shown benefits for hypertension, their combined effects have not been explored. Objective To evaluate the effects of taVNS combined with aerobic training on blood pressure, cardiac autonomic modulation, inflammation, oxidative stress, and functional capacity in individuals with hypertension. Methods This protocol outlines a randomized, controlled, single-blind clinical trial involving hypertensive adults. Participants will be randomly assigned to one of three groups: aerobic training with taVNS, aerobic training alone, or taVNS alone. Aerobic training will consist of 50 min of stationary cycling, while taVNS will be applied using a neuromuscular stimulator with an electrode placed on the left ear for 30 min. The intervention will be administered three times per week for 8 weeks, totaling 24 sessions. The primary outcome is blood pressure measurement, while secondary outcomes include heart rate variability, functional capacity, serum inflammatory mediators, and biomarkers of systemic oxidative stress. Assessments will be conducted before the intervention, after 24 sessions, and 30 days of post-treatment. Results The groups will be compared to the outcome measures to determine the taVNS benefits combined with aerobic training for hypertensive individuals. Conclusion This is the first clinical trial to assess the taVNS effects combined with physical exercise in hypertensive individuals. The study will provide data on this approach's efficacy for improving blood pressure, cardiac autonomic modulation, oxidative stress, and functional capacity in hypertensive people.

PURPOSE:To analyze the effect of physical exercise on functional parameters in individuals with long coronavirus disease-2019 (COVID-19). REVIEW METHODS:A search in MEDLINE, EMBASE, Web of Science, Scielo, and EBSCO was carried out in October 2022, and it was updated in June 2024. For inclusion, studies should have involved physical training without pulmonary rehabilitation, have involved individuals who had long COVID-19, and were prospective trials, clinical trials, or controlled trials. Two reviewers independently performed data extraction and assessed the risk of bias. Seven studies were reviewed, three of high methodological quality. Participants with long COVID-19 were hospitalized in two studies. Interventions lasted 2 to 16 weeks, with frequencies of 2 to 7 days per week, often involving resistance exercise. Strength improved in 67% of studies, cardiorespiratory fitness in 50%, and agility/mobility in 60%. Anxiety improved in 25% of studies, while depression improved in 75%. Quality of life improved across all studies, with dyspnea and fatigue improving in 40% and 80%, respectively. SUMMARY:Results suggest potential benefits of exercise training for subjects with long COVID-19 in several outcomes, mainly in functional capacity, depression symptoms, quality of life, and fatigue.

OBJECTIVE:The aim of the study is to identify the predictors of social participation in Down syndrome adults from the biopsychosocial model of the International Classification of Functioning, Disability, and Health. METHODS:An exploratory, analytical, cross-sectional study was conducted with Down syndrome adults. The social participation was assessed using the Life Habits Assessment. The independent variables were determined using the International Classification of Functioning, Disability, and Health biopsychosocial model: body functions were assessed by body mass index, cognition function (Mini-Mental State Examination), and lower limbs muscle strength (Sit-to-Stand Test). Activities were assessed by the 8-Foot Up and Go Test. Environmental factors were assessed by the measure of the quality of the environment, and personal factors were assessed by age, sex, and education level. RESULTS:The total Life Habits Assessment score indicates that individuals show moderate restriction in social participation, with major restriction in the education, employment, and responsibilities domains. The 8-Foot Up and Go Test was the best social participation predictor variable, followed by Mini-Mental State Examination, and the Sit-to-Stand Test. Contextual factors were not predictors of participation. CONCLUSIONS:It was concluded that individuals with Down syndrome present the most restrictions to social participation in activities that involve social roles. The predictors influencing social participation are functional mobility, cognition, and lower limb muscle strength.

Background: Stroke survivors often experience autonomic nervous system (ANS) dysfunction. While Transcranial Direct Current Stimulation (tDCS) has been shown to modulate the ANS when applied to the left hemisphere, its effects on the right hemisphere remain unexplored. Objective: We aimed to compare the effects of tDCS applied to both the injured and the contralateral hemispheres on heart rate variability (HRV) and functional capacity in individuals post-stroke. Methods: Twenty individuals with cerebral hemisphere lesions (ten with right-hemisphere lesions and ten with left-hemisphere lesions) were randomized into four groups: anodal and sham tDCS on the left temporal cortex (T3) and anodal and sham tDCS on the right temporal cortex (T4). HRV was assessed before the intervention, after the six-minute walk test (6MWT), and following tDCS. HRV data were categorized into frequency ranges: low frequency (LF), high frequency (HF), and sympathovagal balance. The 6MWT (meters) was conducted both pre- and post-tDCS. Results: In individuals with right-hemisphere lesions, a higher global LF value was observed (right side: 71.4 ± 16.8 nu vs. left side: 65.7 ± 17.3 nu; p = 0.008), as well as lower values of the HF component (right side: 29.5 ± 18.9 nu vs. left side: 34.0 ± 17.4 nu; p = 0.047), consequently exhibiting higher global values of the low/high-frequency ratio (right side: 3.9 ± 2.8 vs. left side: 2.9 ± 2.4). Regarding the stimulation site, tDCS over T3 led to a lower overall value of the low/high-frequency ratio (left hemisphere: 3.0 ± 2.2 vs. right hemisphere: 3.7 ± 2.9; p = 0.040) regardless of the lesion location. A significant increase in the distance covered in the 6MWT was observed for individuals with lesions in both hemispheres after tDCS at T3. Conclusions: Participants with right-hemisphere lesions exhibited superior global sympathetic autonomic nervous system activity. When the tDCS was applied on the left hemisphere, it maintained lower sympathovagal balance values and improved functional capacity regardless of the hemisphere affected by the stroke.

RESUMO A espasticidade é uma sequela comum na esclerose múltipla (EM) a qual pode causar dor, deformidades e interferir em movimentos. A estimulação magnética transcraniana (EMT) tem sido investigada para tratamento da espasticidade; no entanto, carece de mais investigações. O objetivo é comparar o efeito da EMT de alta e baixa frequência sobre a espasticidade do quadríceps na EM. Indivíduos adultos com diagnóstico de EM e que apresentem espasticidade em quadríceps bilateral serão submetidos a duas sessões de tratamento com EMT. A primeira sessão é randomizada para receber EMT de alta (≥ 5Hz) ou baixa frequência (≤1Hz) sobre o córtex motor esquerdo; após uma semana, receberá a segunda sessão, oposta à primeira. A espasticidade será avaliada bilateralmente, antes e após cada intervenção, pela escala de Ashworth, pela latência da EMT ao músculo quadríceps, pela amplitude do potencial evocado motor, pelo tempo de condução motora central, pelo tempo de latência do reflexo patelar e pela amplitude do teste do pêndulo do quadríceps. As análises estatísticas serão realizadas pelo programa SPSS Statistic versão 26, com nível de significância de p<0,05. Será utilizado o teste de Shapiro-Wilk para a análise de normalidade das variáveis. Os dados paramétricos são representados em média e desvio-padrão e os não paramétricos em mediana e intervalo interquartílico, e frequência e porcentagem para as variáveis categóricas. Para o desfecho primário, será utilizado o teste de análise de variância (Anova) de duas vias para os dados paramétricos, e o teste de Friedman para os dados não paramétricos.

BACKGROUND:Pelvic floor muscle training (PFMT) is widely used for pelvic floor muscle (PFM) weakness in women; however, it has no prolonged effects.OBJECTIVE:To evaluate the effect of Transcranial Direct Current Stimulation (tDCS) associated with PFMT on PFM contraction, sexual function and quality of life (QoL) in healthy women.STUDY DESIGN:32 nulliparous women, aged 22.7 ± 0.42 years, were randomized into two groups: G1 (active tDCS combined with PFMT) and G2 (sham tDCS combined with PFMT). The treatment was performed three times a week for 4 weeks, totaling 12 sessions. PFM function was assessed using the PERFECT scheme (P = power, E = endurance, R = repetitions, F = rapid contractions, ECT = each timed contraction) and the perineometer (cmH2O). Sexual function was assessed by The Female Sexual Function Index, and QoL by the SF-36 questionnaire. These assessments were performed before and after the 12nd treatment session and after 30-day follow-up.RESULTS:There was a significant increase (p = 0.037) in the power of G2 compared to G1; repetitions and fast contraction increased in the G1 group, and the resistance increased in both groups, however, without statistical difference between the groups. ECT increased in the G1 group (p = 0.0).CONCLUSION:Active tDCS combined with PFMT did not potentiate the effect of the PFMT to increase the PFM function, QoL, and sexual function in healthy women. However, adjunctive tDCS to PFMT improved the time of contractions, maintaining it during follow-up.

RESUMO A fraqueza muscular do assoalho pélvico pode gerar incontinência urinária, prolapso de órgãos pélvicos e disfunção sexual, e pode ser minimizada pelo treinamento muscular do assoalho pélvico (TMAP). No entanto, este efeito não é duradouro. Assim, terapia combinada parece ser promissora para a melhora deste quadro. Dessa forma, objetiva-se avaliar o efeito da estimulação transcraniana por corrente contínua (ETCC), combinada ao TMAP, sobre a pressão intravaginal, força muscular do assoalho pélvico (FMAP), função sexual (FS) e qualidade de vida (QV) em mulheres saudáveis. Serão 32 mulheres, entre 18 e 45 anos, que realizaram TMAP (contrações e relaxamento do períneo) e Biofeedback associados a ETCC ativa ou ETCC sham por 20 minutos, três vezes por semana, por 4 semanas, totalizando 12 sessões. Durante o protocolo, as participantes também realizarão diariamente, em domicílio, o TMAP. O eletrodo anodal da ETCC será posicionado sobre a área motora suplementar do hemisfério cortical dominante, e o catodal sobre a região supraorbital contralateral, com intensidade de 2mA, por 20 minutos. A pressão intravaginal (manômetro de pressão), FMAP (palpação digital, esquema Perfect), FS (Índice de Função Sexual Feminina) e QV (questionário SF-36) foram avaliadas antes e depois das 12 sessões, bem como após acompanhamento de 30 dias.

ABSTRACT Pelvic floor muscle weakness can lead to urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Although it can be minimized by pelvic floor muscle training (PFMT), its effects are not lasting. Therefore, using combination therapy seems promising. This study aims to evaluate the effect of transcranial direct current stimulation (tDCS) combined with PFMT on intravaginal pressure, pelvic floor muscle strength (PFMS), sexual function (SF), and quality of life (QoL) in healthy women. A total of 32 women, aged from 18 to 45 years, will undergo PFMT (with perineal contractions and relaxation) with the aid of pressure biofeedback associated with active tDCS or sham tDCS. Sessions will last 20 minutes, three times per week, for four weeks, totaling 12 sessions. During the protocol, participants will be instructed to also perform the home-based PFMT daily. The tDCS anodal electrode will be positioned over the supplementary motor area of the dominant cortical hemisphere, whereas the cathodal will be over the contralateral supraorbital region, with a 2mA intensity for 20 minutes. Intravaginal pressure (pressure gauge), PFM strength (measured by digital palpation and the PERFECT scheme), FSFI (Female Sexual Function Index), and QoL (SF-36 questionnaire) will be evaluated before and after the 12 sessions and after a 30-day follow-up.

Objectives The aim of this study is to evaluate the effects of transcranial direct current stimulation (tDCS) on central and peripheral fatigue in recreational runners. Design This is a clinical randomized, sham-controlled, triple-blind, crossover study. Twenty adult runners will be randomized on the first day of the intervention to receive active or sham tDCS before fatigue protocol. After 1 wk, the participants will receive the opposite therapy to the one that they received on the first day. The tDCS, 2 mA, will be applied for 20 mins over the motor cortex. The fatigue protocol will be performed after tDCS, in which the participant should perform concentric knee flexion/extension contractions until reaching three contractions at only 50% of maximum voluntary contraction. Central fatigue will be evaluated with the motor evoked potential of the quadriceps muscle; peripheral fatigue with the peak torque (N.m) using an isokinetic dynamometer; the electrical activity of the quadriceps muscle using surface electromyography (Hz); blood lactate level (mmol/L); and the subjective perception of effort (Borg scale). All evaluations will be repeated before and after the interventions. Conclusion This study will evaluate the effect of tDCS on fatigue in runners, possibly determining an application protocol for this population.

Initial evidence supports the reliability of the Participation Measurement Scale (PM-Scale) in Brazil, but further exploration of its psychometric properties is needed for Brazilian stroke survivors. The aim of the study is to analyze the reliability, convergent validity, internal consistency, and accuracy of the PM-Scale Brazil. A methodological study involved three assessments over intervals of 7–14 days. Reliability was evaluated through the Intraclass Correlation Coefficient. Convergent validity was assessed using Spearman’s correlation coefficient to evaluate the alignment of the PM-Scale Brazil with the SATIS-Stroke. Internal consistency was assessed through Cronbach’s α. Accuracy was estimated by calculating the area under the receiver operating characteristic curve. The study involved 110 stroke survivors, revealing adequate intra-rater and inter-rater reliability. A significant weak correlation was observed between the PM-Scale and SATIS-Stroke. Internal consistency and accuracy were adequate. The PM-Scale Brazil demonstrates good reliability, internal consistency, and sensitivity. However, its weak correlation with SATIS-Stroke suggests limited convergent validity.

ABSTRACT Spasticity is a common sequela of multiple sclerosis (MS) that can cause pain, deformities, and impair movement. Transcranial magnetic stimulation (TMS) has been investigated for the treatment of spasticity; however, further investigation is needed. This study aimed to compare the effect of high and low frequency TMS on quadriceps spasticity in MS. Adults diagnosed with MS and who present bilateral quadriceps spasticity will undergo two treatment sessions with TMS. The first session will be randomized to receive high (≥5Hz) or low frequency (≤1Hz) TMS over the left motor cortex; after one week they will receive the second session, which will be the opposite. Spasticity will be assessed bilaterally, before and after each intervention, using the Ashworth scale, the latency of TMS to the quadriceps muscles, the amplitude of the motor evoked potential, the central motor conduction time, the latency time of the patellar reflex, and the amplitude of the quadriceps pendulum test. Statistical analyses will be carried out using the SPSS Statistic program, version 26, with a significance level of p<0.05. The Shapiro-Wilk test will be used to analyze the normality of the variables. Parametric data will be represented as mean and standard deviation and non-parametric data will be represented as median and interquartile range, and frequency and percentage for categorical variables. For the primary outcome, the two-way analysis of variance will be used for parametric data, and the Friedman’s test for non-parametric data.

Introduction: The decline in functional capacity (FC) interferes with the functional independence of older adults, so it is important to assess the FC and use appropriate instruments for this. Objective: To investigate the Glittre Activities of Daily Living (ADL) test’s validity and reliability for assessing functional capacity in older adults. Methods: Cross-sectional study with a sample of 100 elderly (68 ± 5.16 years). To assess the convergent validity, the Six-Minute Walk Test (6MWT) and the Timed Up and Go Test (TUG) were performed. The intra-examiner test-retest of the Glittre-ADL test was performed on the same day with a 30-minute interval between repetitions and inter-examiner reliability with an interval of seven days. Results: There was a strong correlation between the Glittre-ADL test and the 6MWT (r= -0.75; p<0.001) and the TUG (r=0.77; p<0.001). The intra-examiner and inter-examiner reliability was excellent (ICC)=0.91 and 95% CI=0.14-0.97; p<0.001 and ICC=0.91; 95% CI: 0.86-0.94; p<0.001, respectively). Conclusion: The Glittre-ADL test demonstrated that it is valid and that its reliability is adequate to assess functional capacity in older adults.

Introdução: Pacientes infectados com COVID-19 parecem manifestar evolução mais grave quando apresentam comorbidades, como a Diabetes Mellitus (DM). No entanto, dados da população brasileira ainda são pouco disponíveis. Objetivo: Analisar a associação entre DM e evolução para intubação e óbito em indivíduos internados com COVID-19. Metodologia: Estudo transversal, observacional, quantitativo com dados dos prontuários de 74 participantes adultos internados no Hospital Professora Lydia Storópoli, com diagnóstico de COVID-19. O Comitê de Ética em Pesquisa Humana aprovou este estudo e os participantes assinaram o termo de consentimento do estudo. Resultados: Dos 74 pacientes, 18 apresentavam DM, dos quais seis evoluíram para intubação e cinco evoluíram para óbito. Não houve associação significativa (p>0,05) entre DM e intubação e óbito. Conclusão: Na presente amostra a DM não foi associada com a evolução clínica para intubação e óbito.

Introdução: A pandemia da COVID-19 contribuiu para a diminuição das atividades habituais dos idosos, o que pode interferir na capacidade funcional (CF) dos mesmos. Objetivo: Verificar o impacto da inatividade física durante a pandemia da COVID-19 na CF de idosos e associar o nível de atividade física com a CF dos mesmos. Métodos: Participaram do estudo 20 idosos que frequentavam um programa de atividade física antes da pandemia da COVID-19. Foi avaliada a capacidade funcional pelo teste AVD-Glittre, teste de caminhada de 6 minutos (TC6) e Time Up and Go (TUG); os resultados foram comparados com os resultados dos testes obtidos em 2019 (antes da pandemia da COVID-19). Para verificar o nível de atividade física, foi aplicado o Questionário Internacional de Nível de Atividade Física (IPAQ). Os dados foram analisados pelo teste t pareado de Wilcoxon e teste de correlação de Pearson. Resultados: Houve um aumento do tempo da execução do teste de AVD-Glittre de 171.90 ± 35.56 para 272.00 ± 344.77 segundos, no TUG teste de 6.27 ± 119 para 6.92 ± 1.53 segundos, e no TC6 houve uma diminuição de 564.97 ± 85.22 para 464.65 ± 105.95 metros, com p<0.001 em todas as análises. A correlação entre IPAQ e o teste de AVD-Glittre foi fraca (r=0.11, p<0.63), fraca com TC6 (r= -0.10, p>0.001) e moderada com TUG (r=0.59, p>0.001). Conclusão: Houve diminuição da CF dos idosos durante a pandemia da COVID-19, o nível de atividade física influenciou no TUG.

Aging is associated with physiological changes, such as decreased muscle strength, balance, motor coordination, and flexibility. These alterations generate functional limitations, reduction of autonomy, and reduction of the quality of life of this population; however, they can be minimized with physical training. On the other hand, short-term detraining causes a loss of this improvement in functional performance, especially in older adults. Research shows that transcranial direct current stimulation (tDCS) when associated with other therapies improves the results of specific therapy and that adding tDCS to functional training is better than training without it. Long-term effects of tDCS have also been observed To evaluate the additive effect of Transcranial Direct Current Stimulation (tDCS) associated with multi-component training (MT) on the functional capacity (FC) of older adults and to assess whether these effects remain after the end of training. The secondary objectives were to evaluate the locomotion capacity, balance, functional independence, and quality of life and correlate them with functional capacity Twenty-eight older adults were randomized into two groups: experimental (MT associated with active tDCS – a-tDCS) and control (MT associated with sham tDCS – s-tDCS). The tDCS intervention was administered over the left dorsolateral prefrontal cortex at 2 mA for 20 minutes at the beginning of the multicomponent training. The MT was based on exercise and physical activity for the older adults' guidelines according to the American College of Sports Medicine which recommends physical activities involving muscle strength; aerobic activity; flexibility; balance; and agility. It consisted of two weekly sessions for 12 weeks, totaling 24 sessions. The Functional capacity was measured by the Glittre-ADL test, locomotion capacity by the 6-minute walk test, balance by the BESTest, functional independence by the Functional Independence Measure (FIM), and quality of life by the WHQOL. The assessments were performed pre-, post-intervention, and 30-day follow-up There was a significant decrease in the time to the Glittre-ADL test when comparing the a-tDCS and s-tDCS groups after the interventions (139.77 ± 21.62, 205.10 ± 43.02, p <.001) and at the 30-day follow-up (142.74 ± 17.12, 219.55 ± 54.05, p <.001), respectively. There was a moderate correlation between functional capacity and locomotion capacity and balance The addition of tDCS potentiated the results of multicomponent training to impact functional capacity, maintaining the positive results longer. Locomotion and balance influenced the improvement of functional capacity

OBJECTIVE:To investigate the effect of osteopathic visceral manipulation (OVM) on disability and pain intensity in individuals with functional constipation and chronic nonspecific low back pain. METHODS:This study is a randomized controlled trial with a blinded assessor. Seventy-six volunteers with functional constipation and chronic nonspecific low back pain were randomized to two groups: OVM and sham OVM. The primary clinical outcome was pain intensity measured using a numeric rating scale (NRS) and disability measured using the Oswestry Disability Index (ODI). The secondary outcomes were electromyographic signals measured during the flexion-extension cycle, the finger-to-floor distance during complete flexion of the trunk and the Fear-Avoidance Beliefs Questionnaire (FABQ). All outcomes were determined after six weeks of treatment as well as three months after randomization. RESULTS:The OVM group reported a reduction in pain intensity after six weeks of treatment and at the three-month evaluation (p < .0002) and the sham group reported a reduction in pain intensity after three-month evaluation (p < .007). For the ODI was also found in the OVM group six weeks after the end of treatment (treatment effect = -6.59, 95% CI: -12.01 to -1.17, p = .01) and at the three-month evaluation (treatment effect = -6.02, 95% CI: -11.55 to -0.49, p = .03). Significant differences were also found for paravertebral muscle activity during the dynamic phases (flexion and extension) six-week evaluations. CONCLUSIONS:The OVM group demonstrated a reduction in pain intensity and improvement in disability after six-weeks and three-month follow-up while the sham group reduction in pain three-month follow-up.

BACKGROUND:Falls are frequent in older adults and can cause trauma, injury, and death. Fall prevention with virtual reality presents good results in improving postural control. Transcranial Direct Current Stimulation (tDCS) has been used with the same aim; however, the combination of the two techniques has still been little studied.PURPOSE:To assess whether tDCS can enhance the effect of video game training (VGT) on improving the postural balance of healthy older women.METHOD:A blinded, randomized, controlled clinical trial was conducted with 57 older women who were randomized to three balance training groups: Control Group (VGT), Anodal Group (VGT combined with anodic tDCS-atDCS), and Sham Group (VGT combined with sham tDCS-stDCS). Balance training was performed twice a week for four weeks, totalizing eight 20-min sessions using VGT associated with tDCS. Postural balance was assessed pre-and post-training and 30 days after the end of the eight sessions using the Mini-Balance Evaluation Systems Test.RESULTS:Compared to pre-intervention the Mini BEST test increased similarly in the three groups in post-intervention (control: pre 23.7 ± 2.8 to post 27.0 ± 2.2; anodal: pre 24.4 ± 1 to post 27.7 ± 0.8 and sham: pre 24.2 ± 1.9 to post 26.5 ± 1.6; p < 0.001) and follow-up (control: pre 23.7 ± 2.8 to follow-up 26.8 ± 2.3; anodal: pre 24.4 ± 1 to follow-up 27.3 ± 1.4 and sham: pre 24.2 ± 1.9 to follow-up 26.8 ± 1.5; p < 0.001).CONCLUSION:There was an improvement in the postural balance of the three training groups that were independent of tDCS.DISCUSSION:Some studies have shown the positive tDCS effects associated with other tasks to improve balance. However, these results convey the effects of only anodic-tDCS compared to sham-tDCS. Possibly, the effect of VGT surpassed the tDCS effects, promoting a ceiling effect from the combination of these two therapies. However, studies with other therapies combined with tDCS for older adults deserve to be investigated, as well as in frail older people.