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BACKGROUND: The female body changes during pregnancy to create a favorable environment for fetal development which may result in musculoskeletal disorder and painful symptoms in the lumbopelvic region. OBJECTIVE: To analyze the evidence of therapeutic exercise versus other modalities to prevent and treat LBP, LGP, and LPP during pregnancy. METHODS: Full text randomized controlled trials (RCT) evaluating interventions to prevent or treat LBP, PGP, and LPP during pregnancy (any gestational age) that comparing therapeutic exercises with usual care or other modalities to reduce the incidence or severity of LBP or PGP or both during pregnancy will be included. 5 electronic databases will be searched to identify studies. Assess risk of bias in each study using the Cochrane Handbook for Systematic Reviews of Interventions and quality of overall body of evidence for all primary outcomes will be assessed for all comparisons using the approach outlined in GRADE Handbook.

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Some respiratory muscles work in synergy with the pelvic floor (PF). Pelvic organ prolapse (POP) is characterized by weak PF muscles and has been associated with worse pulmonary ventilation function in women. To date no studies have investigated the association between respiratory muscle strength and POP. This study aimed to determine whether symptomatic POP is associated with respiratory muscle strength in middle-aged and older women. In this observational cross-sectional study, 204 community-dwelling women (41-80 years old) from Santa Cruz (Northeastern Brazil) provided information on socioeconomic characteristics, health behavior, reproductive history and symptomatic POP via a structured questionnaire. A digital manometer was used to measure their maximal inspiratory and expiratory pressures (MIP and MEP). Multiple linear regression analyses, adjusted for covariates (age, income, education, body mass index, and smoking), evaluated the association between POP and MIP/MEP. The results show that 14.7% of the sample reported symptomatic POP. These women exhibited lower mean MIP and MEP than those reporting no POP, but the intergroup difference was only significant for MEP (p = .01). The association between POP and MEP remained statistically significant, even after covariates (ß = 11.9, p = .04) were adjusted. Symptomatic POP is associated with expiratory muscle strength in middle-aged and older women. This innovative research provides important information regarding the need to evaluate the integrity of PF muscles when assessing respiratory muscle strength, which may help clinicians devise preventive and treatment strategies to improve women's health during the aging process.

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Abstract Introduction: The emergence of painful pathologies during gestation, such as lumbopelvic pain (LPP), can influence in the achievement of functional activities, such as sit-to-stand, throughout the gestational period. Objective: To compare the variables of static and dynamic postural balance (sit-to-stand activity) among pregnant women with and whitout lumbopelvic pain and the outcome variables between the gestational trimesters. Method: A total of 100 pregnant women participated in this study allocated as follows: 51 in the LPP group and 49 in the group without LPP. All participants were subjected to an evaluation protocol: filling an identification form, Analogic Visual Scale (AVS) and Oswestry Disability Index (ODI). Evaluation of postural balance was subsequently performed using the Balance Master System®. Results: 64.7% of women during the third trimester of pregnancy reported LPP. No statistically significant differences were found between LBP presence or absence in postural balance variables (p>0.05). However, gestational age influenced the VFEC variable (p=0.001). Conclusion: Women during the third gestational trimester presented complaints of lumbopelvic pain. However, the data acquired suggest that women with LPP do not have alterations in postural balance during sit-to-stand movement when compared to pregnant women without pain.

Resumo Introdução: O surgimento de patologias dolorosas na gestação, como a dor lombopélvica (DLP), podem influenciar na realização de atividades funcionais, como o sentar-levantar, ao longo do período gestacional. Objetivo: Comparar as variáveis do equilíbrio postural estático e dinâmico (atividade do sentar-levantar) entre gestantes com e sem dor lombopélvica e as variáveis-desfecho entre os trimestres gestacionais. Método: Participaram desse estudo 100 mulheres grávidas alocadas da seguinte maneira: 51 gestantes no grupo com DLP e 49 gestantes no grupo sem DLP. Todas as participantes foram submetidas ao protocolo de avaliação: preenchimento de ficha de identificação, Escala Visual Analógica (EVA) e Oswestry Disability Índex (OII), seguido da avaliação do equilíbrio postural por meio do Balance Master System ® . Resultados: 64,7% das mulheres no terceiro trimestre gestacional relataram DLP. Não foram encontradas diferenças estatisticamente significativas entre a presença/ausência da DLP nas variáveis do equilíbrio postural (p>0,05). Contudo, observou-se diferença estatística ao analisar a idade gestacional na variável velocidade de oscilação em superfície firme de olhos fechados (VFOF) (p=0,001). Conclusão: Mulheres no terceiro trimestre gestacional apresentam queixas de dor lombopélvica. Entretanto, os dados obtidos sugerem que mulheres com DLP não tem alteração no equilíbrio postural durante o movimento sentar-levantar quando comparadas a gestantes sem dor.

Resumen Introducción: El surgimento de patologias dolorosas em la gestación, como el dolor lombopélvico (DLP), puede influir em la realización de atividades funcionales, como el sentarse, durante el embarazo. Objetivo: Comparar las variables delequilibrio postural estático y dinâmico (actividad del sentar-levantar) entre gestantes com y sin dolor lombopélvico y las varibles desenlace entre los trimestres gestacionales. Método: Participaron de esse estúdio 100 mujeres embarazadas assignadas de la siguiente manera: 51 gestantes en el grupo com DLP y 49 gestantes en el grupo sin DLP. Todas las participantes fueron sometidas al protocolo de evaluación: llenado de ficha de identificación, Escala Visual Analógica (EVA) y Oswestry Disability Índex (OII),seguido de la evaluación del equilíbrio postural através del Balance Master System ® . Resultados: 64,7% de las mujeres en el tercer trimestre gestacional informaron DLP. No se encontraron diferencias estadísticamente significativas entre la presencia/ausência de la DLP em las variables del equilíbrio postural (p>0,05). Sin embargo, se observo diferencia estadística al analizar la edad gestacional em la variable velocidade de oscilación en superfície firme de ojos cerrados (VFOC) (p=0,001). Conclusión: Las mujeres en el tercer trimestre gestacional presentan quejas de dolor lombopélvico. Sin embargo, los datos obtenidos sugieren que las mujeres com DLP no tienen alteración em el equilíbrio postural durante el movimento sentarse cuando se comparan a las gestantes sin dolor.

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OBJECTIVE: Previous studies show that multiparity and a number of chronic conditions are correlated among women. Also, low respiratory muscle strength has been associated to adverse health outcomes such as chronic lung disease and early mortality. This study aimed to investigate associations between the number of lifetime pregnancies and maximal inspiratory/expiratory pressures. METHODS: In a cross-sectional study, 204 women ages 41-80 years-old, from the rural community of Santa Cruz, Brazil, provided data regarding demographics, socioeconomic characteristics, health behaviors, and number of lifetime pregnancies (≤3, 4-6 or ≥7). Maximal respiratory pressures were measured with a digital manometer. Multiple linear regression analysis was used to examine the association of multiple childbearing on maximal respiratory pressures. RESULTS: Of the participants, 44.1% had ≤3 pregnancies, 30.4% had 4-6 pregnancies and 25.5% had >7 pregnancies. In the unadjusted analyses, maximal inspiratory and expiratory pressures varied significantly according to multiple childbearing categories. After adjustment, the values remained statistically significant only for maximal expiratory pressure. Compared to women with ≤3 lifetime pregnancies, those who had ≥7 pregnancies had significantly lower maximal expiratory pressure values (ß = -18.07, p = 0.01). CONCLUSION: Multiple childbearing appears to be negatively associated with maximal respiratory pressures; women with a higher number of lifetime pregnancies had lower values of maximal respiratory pressures when compared to those with fewer pregnancies. This association may be due to biomechanical changes in the respiratory muscles promoted by multiple lifetime pregnancies. This finding indicates a need to motivate women, from the prenatal to postpartum period, to safely exercise their respiratory muscles, including abdominal muscle exercises as well as respiratory muscle training.

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ABSTRACT BACKGROUND AND OBJECTIVES: The various gestational adaptations may lead to changes in the gait pattern. Also, the lumbopelvic pain in this period can impact the gait dynamics. The objective of this study was to compare gait variables between pregnant women with and without lumbopelvic pain, according to the gestational trimesters, and to compare the outcome variables between the second and third gestational trimesters. METHODS: Analytical and cross-sectional study with 277 pregnant women. They were divided into two groups, considering the gestational trimester as a grouping factor. Subsequently, the two groups were subdivided considering the absence or presence of lumbopelvic pain. All participants were submitted to the evaluation protocol: identification form, visual analog scale, and gait assessment using the Balance Master System®. RESULTS: The chronological age averages of the second and third-trimester groups were, respectively, 29.9±4.6 and 29.7±3.7 years. When comparing gait variables between pregnant women with and without lumbopelvic pain, a statistically significant difference was observed only for the gait velocity (p=0.04) in the third-trimester group. CONCLUSION: It is suggested that women in the third trimester with complaints of lumbopelvic pain have reduced gait velocity when compared to those without pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: As diversas adaptações decorrentes da gestação podem levar a modificações no padrão da marcha. A queixa de dor lombopélvica nesse período pode repercutir na dinâmica da marcha. Assim, o objetivo deste estudo foi comparar as variáveis da marcha entre gestantes com e sem dor lombopélvica, respeitando os trimestres gestacionais, e comparar as variáveis-desfecho entre o segundo e o terceiro trimestre gestacionais. MÉTODOS: Estudo do tipo analítico e transversal com 277 gestantes alocadas em dois grupos, considerando o trimestre gestacional como fator de agrupamento. Posteriormente, os dois grupos foram subdivididos considerando a ausência ou presença de dor lombopélvica. Todas as participantes foram submetidas ao protocolo de avaliação: preenchimento de ficha de identificação, escala analógica visual e avaliação da marcha por meio do Balance Master System®. RESULTADOS: As médias da idade cronológica para o grupo do segundo e terceiro trimestres foram, respectivamente, entre 29,9±4,6 e 29,7±3,7 anos. Ao comparar as variáveis da marcha entre gestantes com e sem dor lombopélvica foi observada diferença estatisticamente significativa, apenas para a velocidade da marcha (p=0,04), no grupo do terceiro trimestre. CONCLUSÃO: Sugere-se que mulheres no terceiro trimestre com queixas de dor lombopélvica apresentam redução da velocidade da marcha, quando comparadas àquelas sem dor.

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Abstract Introduction: Brazil presents high C-section prevalence rates. Several factors may be associated with such high rates. Objective: To observe and analyze factors associated with the prevalence of cesarean sections in Brazil, according to their occurrence in Brazilian regions. Methods: An ecological study, having C-section as the outcome, from 1990 to 2013, in Brazilian regions, using data from the Brazilian National Health Survey, 2013. Records of women in their reproductive period, aged between 18 and 49 years, were included, totaling a sample of 16,175 women. Descriptive and bivariate analysis was carried out with logistic regression. Results: The prevalence of cesarean sections in Brazil was 53.03%. Vaginal delivery was more prevalent in the North (52.74%) and Northeast (51.06%) regions, while C-section was more prevalent in the Southeast (59.32%), South (56.96%) and Midwest (61.48%) regions. Over the years, an increased probability of cesarean sections was observed, particularly in the following regions: Northeast (2.21 times more, CI95%: 1,42 - 3,46) and South (2.75 times more, CI95%: 1,44 - 5,23). Women with higher levels of education are 2.05 times (CI95%: 1.27 - 3.30) more likely to have a C-section, especially those in the Northern and Southern regions. In the Northeast, this probability increased, regardless of the level of education. Conclusion: The prevalence of cesarean sections in Brazil is high and, over the years, factors such as level of education, maternal age and having health insurance, seem to contribute to the increase in surgical deliveries.

Resumo Introdução: O Brasil apresenta altos níveis de prevalência de partos cesáreas. Vários fatores podem estar associados a essas taxas elevadas. Objetivo: Observar e analisar fatores associados à prevalência de cesáreas no Brasil, de acordo com a ocorrência nas regiões brasileiras. Métodos: Estudo ecológico, cujo desfecho é o parto cesáreo, na série histórica de 1990 a 2013, no contexto das regiões brasileiras, com dados da Pesquisa Nacional de Saúde, 2013. Foram incluídos registros de mulheres em período reprodutivo, com idade entre 18 e 49 anos, totalizando 16.175 mulheres na amostra. Foi realizada a análise descritiva e bivariada, com a regressão logística. Resultados: A prevalência de partos cesarianos no Brasil foi de 53,03%. O parto vaginal foi mais prevalente nas regiões Norte (52,74%) e Nordeste (51,06%), enquanto o parto cesáreo nas regiões Sudeste (59,32%), Sul (56,96%) e Centro Oeste (61,48%). Com o passar dos anos, foi evidenciado um aumento na probabilidade de ter parto cesárea, principalmente nas regiões Nordeste (2,21 vezes mais, IC95: 1.42 - 3.46) e Sul (2,75 vezes mais, IC95: 1.44 - 5.23). Mulheres com maiores níveis de escolaridade têm 2,05 vezes (IC95%: 1.27 - 3.30) mais chances de ter um parto cesárea, com destaque as das regiões Norte e Sul. No Nordeste, esta probabilidade aumentou, independentemente do nível de escolaridade. Conclusão: A prevalência de cesáreas no Brasil é alta e, com o passar dos anos, fatores como grau de escolaridade, idade materna e ter plano de saúde parecem contribuir para o aumento dos partos cirúrgicos.

Resumen Introducción: Brasil presenta altos niveles de prevalencia de partos cesáreas. Varios factores pueden estar asociados a estas altas tasas. Objetivo: Observar y analizar factores asociados a la prevalencia de cesáreas en Brasil, de acuerdo con la ocurrencia en las regiones brasileñas. Métodos: Estudio ecológico, cuyo desenlace es el parto cesáreo, en la serie histórica de 1990 a 2013, en el contexto de las regiones brasileñas, con datos de la Encuesta Nacional de Salud, 2013. Se incluyeron registros de mujeres en período reproductivo, con edad entre 18 y 49 años, totalizando 16.175 mujeres en la muestra. Se realizó el análisis descriptivo y bivariado, con la regresión logística. Resultados: La prevalencia de partos cesarianos en Brasil fue del 53,03%. El parto vaginal fue más prevalente en las regiones Norte (52,74%) y Nordeste (51,06%), mientras que el parto cesáreo en las regiones Sudeste (59,32%), Sur (56,96%) y Centro Oeste (61, 48%). Con el paso de los años, se evidenció un aumento en la probabilidad de tener parto cesárea, principalmente en las regiones: Nordeste (2,21 veces más, IC95: 1.42 - 3.46) y Sur (2,75 veces más, IC95: 1.44 - 5.23). Las mujeres con mayores niveles de escolaridad tienen 2,05 veces (IC95%: 1.27 - 3.30) más posibilidades de tener un parto cesáreo, con destaque las de las regiones Norte y Sur. En el Nordeste, esta probabilidad aumentó, independientemente del nivel de escolaridad. Conclusión: La prevalencia de cesáreas en Brasil es alta y, con el paso de los años, factores como grado de escolaridad, edad materna y tener plan de salud, parecen contribuir al aumento de los partos quirúrgicos.

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RESUMO Este estudo observacional, quantitativo e transversal teve por objetivo avaliar a função sexual e comparar a qualidade de vida e independência funcional entre indivíduos acometidos por acidente vascular encefálico (AVE) sexualmente ativos e inativos. Estes foram previamente contatados por telefone e tiveram suas avaliações agendadas de acordo com sua conveniência. Realizou-se a aplicação de uma ficha de avaliação contendo dados sociodemográficos, hábitos de vida, saúde referida e função sexual, além do questionário abreviado de avaliação de qualidade de vida WHOQOL e da escala de medida de independência funcional. Ao avaliar 29 indivíduos, observou-se que 48,3% eram sexualmente ativos. Destes, 64,3% eram do sexo masculino e 35,7% do sexo feminino. A maioria da amostra relatou diminuição da atividade sexual após a doença (64,3%); 60% das mulheres apresentou disfunção sexual pelo quociente sexual - versão feminina -, e 77,7% dos homens apresentou disfunção erétil, avaliada pelo Índice Internacional de Função Erétil. Observou-se que os indivíduos ativos sexualmente apresentavam melhor qualidade de vida relativa ao domínio físico (p=0,035) e maior independência funcional motora (p=0,005) e cognitiva (p=0,006) quando comparados aos indivíduos que não praticavam atividade sexual. Concluiu-se que uma parcela significativa dos pacientes continua ativa sexualmente e que a prática de atividade sexual esteve associada à independência cognitiva e motora.

RESUMEN Este estudio de tipo observacional, cuantitativo, transversal tiene el objetivo de analizar la función sexual y comparar la calidad de vida y la independencia funcional entre los sujetos sexualmente activos e inactivos, acometidos por accidente cerebrovascular. Se contactaron a los sujetos por teléfono y se agendó una cita con ellos según la disponibilidad. Se les aplicó a los participantes una encuesta de evaluación para conocer sus datos sociodemográficos, hábitos de vida, salud y función sexual, además del cuestionario abreviado de la evaluación de la calidad de vida Whoqol-Bref y la escala de la medida de independencia funcional. De los 29 sujetos evaluados un 48,3% eran sexualmente activos. De estos, un 64,3% son hombres y un 35,7% mujeres. La mayoría de los participantes informaron que hubo una disminución de la actividad sexual tras la enfermedad (64,3%), un 60% de las mujeres presentaron disfunción sexual por el coeficiente sexual -versión femenina, y un 77,7% de los hombres presentaron disfunción eréctil, evaluada por el Índice internacional de función eréctil. Los sujetos sexualmente activos presentaron una mejor calidad de vida referente al dominio físico (p=0,035), una mayor independencia funcional motora (p=0,005) y cognitiva (p=0,006) en comparación a los que no tenían actividad sexual. Se concluye que gran parte de estos sujetos mantienen una vida sexual activa y que hay asociación entre la práctica de la actividad sexual a la independencia cognitiva y motora.

ABSTRACT This observational, quantitative and cross-sectional study aimed to assess the sexual function and compare the quality of life and functional independence among individuals, affected by cerebrovascular accident (CVA), sexually active and inactive. Individuals were previously contacted by telephone and scheduled at their convenience. We applied an assessment form containing demographic data, life habits, self-reported health and sexual function, in addition to the WHOQOL questionnaire for the evaluation of quality of life and scale of measure of functional independence. When assessing 29 individuals, we found that 48.3% were sexually active. Among them, 64.3 individuals were male and 35.7 were female. Most of the sample reported decreased sexual activity after the stroke (64.3%), 60% of women have sexual dysfunction through female sexual quotient, and 77.7% of men have erectile dysfunction, evaluated by the International Index of Erectile Function. We observed that sexually active individuals had better quality of life on the physical domain (p=0.035), greater functional (p=0.005) and cognitive (p=0.006) motor independence when compared with individuals who were not sexually active. We concluded that a significant portion of patients remain sexually active and that sexual activity was associated with cognitive and motor independence.

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Abstract Introduction: During pregnancy women undergo several transformations, which promote changes in their gravity center (GC) and can result in postural and balance changes. Objective: To evaluate the influence of Nintendo WiiFit Plus® on postural balance and quality of life of pregnant women in the third trimester. Methods: 250 pregnant women enrolled through a non-probabilistic sampling process. The sample consisted of 32 women selected according to the eligibility criteria (nulliparity; low-risk pregnancy, absence of musculoskeletal disorders or surgical procedures in the spine, pelvis, hip or knee), musculoskeletal disorders, allocated as follows: 17 pregnant women in the control group (CG) and 15 pregnant women in the experimental group (EG). The intervention was performed in 12 sessions of 30 minutes each, three times a week. Sociodemographic and obstetric data were presented as median and interquartile range (25% - 75%). A comparison of the relative values of variables before and after the exercise program was performed using the 2x2 ANOVA test (5% significance level). Results: There were no significant statistical differences in variables related to postural balance (P > 0.06) and quality of life (P > 0.13). Conclusion: The use of Nintendo WiiFit Plus games was not able to promote improvement in postural balance and quality of life of the pregnant women studied.

Resumo Introdução: Durante a gravidez as mulheres passam por várias transformações, que promovem mudanças no seu centro de gravidade (CG) e pode resultar em alterações posturais e de equilíbrio. Objetivo: Avaliar a influência da Nintendo Wii Fit Plus® no equilíbrio postural e qualidade de vida das mulheres grávidas no terceiro trimestre. Métodos: 250 gestantes cadastradas através de um processo de amostragem do tipo não-probabilística. A amostra foi composta por 32 mulheres selecionadas de acordo com os critérios de elegibilidade (nuliparas, gestação de baixo risco, ausência de disfunções musculoesqueléticas ou cirurgia na coluna vertebral, pelve, quadril ou joelho) alocadas da seguinte maneira: 17 gestantes no grupo controle (GC) e 15 gestantes no grupo experimental (GE). A intervenção foi realizada em 12 sessões de 30 minutos cada, três vezes por semana. Os dados sociodemográficos e obstétricos foram apresentados como mediana e interquartil (25% - 75%). Uma comparação entre os valores relativos das variáveis antes e depois do programa de exercícios foi realizada utilizando o teste ANOVA 2x2 (nível de significância de 5%). Resultados: A mediana gestacional e idade cronológica foram, respectivamente, 30,50 (27,2 - 32,0) anos e 28,5 (27,7 - 30,0) semanas. Não houve diferenças estatisticamente significativas nas variáveis relacionadas ao equilíbrio postural (P > 0,06) e qualidade de vida (P > 0,13). Conclusões: O uso de jogos Nintendo Wii Fit Plus não foi capaz de promover a melhora no equilíbrio e qualidade de vida das gestantes estudadas postural.

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AIMS: Changes resulting from the gestational period may lead to changes in the biomechanics of women, which can alter the performance of functional activities such as sit-to-stand. Thus, the objective of this study was to investigate the influence of a virtual reality-based exercise protocol on the kinematic variables of the sit-to-stand movement in women in their second and third gestational trimesters. METHODS: The sample consisted of 44 women selected according to the eligibility criteria, allocated into 4 groups: control group, 2nd trimester (CG2T); experimental group, 2nd trimester (EG2T); control group, 3rd trimester (CG3T); and experimental group, 3rd trimester (EG3T). All the volunteers answered the identification and evaluation form and were sent to the kinematic evaluation through the Qualisys Motion Capture System®. An intervention with game therapy was performed in 12 sessions of 30 minutes each, three times a week. RESULTS: No statistically significant differences were found intra- (P> 0.54) and inter-groups (P> 0.059) for kinematic variables. However, there was a tendency for improvement in the analyzed variables after the proposed protocol. CONCLUSIONS: The data obtained suggest that the use of the Nintendo Wii Fit Plus® was not able to influence sit-to-stand kinematic variables in the analyzed women.(AU)

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Abstract BACKGROUND Physical activity during pregnancy provides countless benefits to pregnant women and results in a smaller number of falls during pregnancy. Thus, this study aims to verify the influence of physical activity and test conditions on the static and dynamic balance of pregnant women. METHODOLOGY The study was an analytical, transversal, and comparative study with a sample of 99 pregnant women divided into two groups, with physical activity as the grouping factor. The evaluation included questions about the type and frequency of physical activity and investigation of postural balance (Balance Master System(r)). For statistical analysis, we used the following tests: Shapiro Wilk, Mann-Whitney, ANOVA One Way and Wilcoxon. RESULTS No relationship was found between physical activity and postural balance (F > 0.40, P > 0.07). However, the test conditions alter the sway velocity (P = 0.001) and directional control movement (P = 0.001). CONCLUSIONS Results suggest that: (1) physical activity does not influence variables related to postural balance in active and sedentary pregnant women; and (2) postural sway velocity and directional control of movement are related to the test conditions used during balance evaluation.

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