Marcelo Cardoso de Souza

Background and Purpose: To evaluate participants' preferences following acute exposure to three resistance training protocols differing solely in the number of sets performed. Methods: Randomized crossover clinical trial. Thirty‐eight women aged 18–65 years with fibromyalgia diagnosed according to the 2016 American College of Rheumatology criteria completed the study. All participants were naïve to resistance training during the previous 6 months and completed every intervention protocol and assessment. Participants performed three resistance training sessions in randomized order, consisting of one‐, two‐, or three‐set protocols separated by 7‐day washout periods. Exercise selection, intensity, and repetitions were standardized across protocols, with the number of sets representing the only intervention variable. The primary outcome was participant preference for resistance training volume after completion of all three protocols. Secondary outcomes included treatment expectancy, pain intensity assessed before and after exercise and 24 hours later, and exercise execution time. Results: No participant selected the one‐set protocol as the preferred training volume, whereas the two‐ and three‐set protocols were equally preferred, each being selected by 50% of participants ( p < 0.001; Cohen's w = 0.71). Treatment expectancy did not differ significantly among protocols ( p = 0.20). No between‐protocol differences in pain intensity were observed at any assessment time point. A significant within‐protocol reduction in pain over time was identified only for the two‐set protocol ( p = 0.015); however, the magnitude of change did not reach the predefined minimal clinically important difference. Exercise execution time did not differ significantly among training volumes, and no serious adverse events occurred during the study. Discussion: Women with fibromyalgia demonstrated equivalent preference for resistance training protocols involving two and three sets, whereas no participant identified the one‐set protocol as the preferred option. Treatment expectancy was similar across protocols, and no clinically meaningful differences in pain intensity were observed. These findings support the incorporation of patient preference into individualized resistance training prescriptions and warrant further investigation of whether such preferences translate into improved long‐term adherence and clinical outcomes. Trial Registration: ClinicalTrials.gov (Identifier: NCT06424743, 2024‐08‐21)

Objective: To compare the effect of 24 sessions of progressive intensity strength training on the impact of fibromyalgia (primary outcome). Furthermore, we evaluated its effects on sleep, anxiety, depression, wind‐up mechanism, conditioned pain modulation, cutaneous sensory threshold, musculoskeletal performance, walking ability, perceived improvement, and treatment adherence (secondary outcomes). Design: A blinded randomised controlled trial. Setting: After blinded outcome assessments, 66 people were randomised and concealed and allocated to progressive ( n = 22), constant ( n = 22), or walking ( n = 22) strength training groups. Participants: People with fibromyalgia. Interventions: In the progressive group, exercise intensity increased by 20% of maximum strength each month: 50% in the first month, 70% in the second month, and 90% in the third month. In the constant or walking exercise groups, moderate intensity was maintained at the end of the treatment. Each person received 24 individual exercise sessions (2x/week), with three months of exercise and three months of no exercise. Main Outcome Measure: Fibromyalgia impact. Results: Groups were similar at baseline. There were no significant between‐group differences in the primary outcome at any time point. In within‐group comparisons, we observed significant differences indicating that all three types of exercise reduced fibromyalgia symptoms; however, no variable achieved a minimal clinically important difference. In between‐group comparisons for the secondary outcomes, groups reported a positive perception of improvement, but most of each group did not adhere to treatment and/or did not answer about adherence after follow‐up without exercise. Conclusions: Twenty‐four sessions of progressive intensity strength training did not provide a greater reduction in the fibromyalgia impact than constant intensity or walking exercises. Trial Registration: Brazilian Registry of Clinical Trials (ReBEC): RBR‐9pbq9fg, date of registration: October 06, 2022. Protocol Publication: BMC Musculoskeletal Disorders: Doi – 10.1186/s12891‐023‐06952‐3 | Published: Volume 24, article number 816, October 14, 2023.

The aging population is a global phenomenon that represents a significant demographic shift, with life expectancy closely related to individuals’ functional capacity. Background/Objectives: Identify latent dimensions in self-perceived functional variables among Brazilian older adults. Methods: This cross-sectional study used data from module K of the 2019 National Health Survey (NHS) in Brazil. Multivariate statistics were applied using Principal Component Analysis (PCA). Results: The sample consisted of 22,728 older adults from all regions of Brazil, with a predominance of females (56%), an average age of 70 years (CI: 69.68–70.03), 61% engaged in weekly physical exercise, and most living with a spouse or partner (56.3%). The multivariate statistical analysis, conducted through PCA, resulted in two distinct macro-dimensions of functionality: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). When analyzing each macro-dimension separately, we identified internal micro-dimensions. Within ADLs, two subdimensions stood out: ADLs Upper Limb Function and ADLs Lower Limb Function. Within IADLs, the micro-dimensions included IADLs Health Management and IADLs Independent Outdoor Mobility. Close results in the subdimensions of variable K25 did not allow for a clear distinction between the estimated IADLs. However, given the importance of this variable in explaining the cognitive aspect of the functional capacity construct, we suggest maintaining it as a separate subdimension: IADLs Financial Management. Conclusions: The latent dimensions of functional capacity identified in this study may help guide functional assessment in older adults, inform therapeutic decision-making, shape public policy, and support further research on functional capacity in aging populations.

Background: Do fibromyalgia patients have a preferred resistance training volume? Purpose: This protocol will support a trial evaluating the preference for volume in three different resistance training protocols for women with fibromyalgia. Methods: Protocol for a randomized crossover clinical trial. Women aged 18–65 years with a diagnosis of fibromyalgia will be included. Patients who have undergone resistance training in the last 6 months, who have another associated rheumatic disease, who have travel or scheduling commitments that will require them to be absent for the next 4 (four) weeks from the start of the study, who have upper and/or lower extremity musculoskeletal injuries, or who have cardiac problems that prevent maximal and submaximal exercise will not be included. The primary outcome will be preference. Secondary outcomes will be expectation, pain intensity, affect, and perceived effort, training volume, and cadence. For the primary outcome, the number of choices of the 3 types of training will be recorded as a percentage. For the analysis of the primary outcome, we will summarize the patient's preference in a contingency table, compare the proportions using the chi‐squared test, and finally verify the effect size of the observed differences. For the secondary outcomes, statistical analyses will be performed by a blind statistician. The independent variables of group and time will be considered for each dependent variable. Results: This will be the first study to examine the preference of women with fibromyalgia for different volumes of resistance training. Discussion: We will show whether exercise volume preference is related to subjective perception of exertion and pain intensity in women with fibromyalgia. Trial Registration: ClinicalTrials.gov (Identifier: NCT06424743)

Although exercise is a first-line approach to treating chronic low back pain (CLBP) in clinical practice, passive techniques such as dry cupping therapy are considered complementary to this condition. However, knowledge about the effects of combining dry cupping therapy with active exercises in people with non-specific CLBP is shallow. To evaluate the effects of dry cupping therapy with the McKenzie method (MDT) on disability and functional outcomes in people with non-specific CLBP. Eighty-eight people with non-specific CLBP aging 18 to 59 years will be recruited and evaluated for inclusion and exclusion criteria. Participants will be randomized into intervention (MDT and dry cupping therapy) or sham group (MDT and sham dry cupping therapy). Dry cupping therapy will be applied bilaterally to the vertebrae (L1 to L5). Interventions will be performed twice a week for eight weeks, and participants will be assessed before treatment (T0), immediately after the first intervention (T1), and at four (T4) and eight weeks of intervention (T8). Primary outcomes will be disability (Oswestry Disability Index). Secondary outcomes will be functionality (Timed Up and Go Test), pain (Numeric Pain Rating Scale), trunk range of motion (Toe-touch Test) and participant expectation and perception (Global Perceived Effect Scale). Despite recent research, there is no consensus in the literature regarding the effectiveness of dry cupping therapy in the treatment of people with non-specific CLBP. Also, no study with high methodological rigor has evaluated the combination of dry cupping therapy with active exercise in this population and whether this combination potentiates any clinical effect. Thus, this protocol may guide further research to support the prescription of exercise combined with dry cupping therapy in people with non-specific CLBP. The results of the study will be disseminated to participants through social networks and will be submitted to a peer-reviewed journal and scientific meetings. ClinicalTrials.gov, October, 2023 (report number: NCT05459376). • Study will evaluate the clinical effects of dry cupping therapy with exercise in people with CLBP compared with a sham group. • Study will evaluate short-term and medium-term effects of dry cupping therapy with exercise in people with CLBP. • Blinding physiotherapists is difficult due to the nature of the interventions.

In Brief Chikungunya fever compromises the functionality and quality of life in the affected individuals, even one year after the acute phase of the disease. Chronically affected people experience direct impairment in performing daily activities, along with a risk of developing other morbidities. Highlights Even after a year, chikungunya fever-affected people experience damage to their physical and mental health. Positive screening for depression risk was 13.5 times more likely in chronically affected. Patients with chronic chikungunya fever had a

Introduction Hallux valgus (HV) is one of the most prevalent forefoot deformities, and its frequency increases with age, reaching nearly 23% in adulthood (females are usually more affected). Studies on customised insoles and orthoses for HV showed inconclusive results. There is no consensus in literature regarding the ideal insole or length of use for pain relief or functional improvement in individuals with HV. This study will assess the effects of a customised insole with retrocapital bar associated with an infracapital bar of the first metatarsal on pain and function of individuals with symptomatic HV. Methods This is the protocol for a blinded, sham-controlled randomised clinical trial. Eighty participants with symptomatic HV will be randomised into two groups (40 per group): customised insole or sham insole. Assessments will be performed at baseline (T0), six (T6) and 12 weeks (T12) of intervention. A follow-up will occur after 4 weeks of intervention (T16). The primary and secondary outcomes will be pain (Numerical Pain Scale) and function (Foot Function Index), respectively. Statistical analysis Analysis of variance with a mixed design or Friedman’s test will be considered according to data distribution; post-hoc analyses will be performed using Bonferroni test. Time × group interaction and within-group and between-group differences will also be assessed. The intent-to-treat analysis will be used. A significance level of 5% and 95% s will be adopted for all statistical analyses. Ethics and dissemination This protocol was approved by the research ethics committee of the Faculty of Health Sciences of Trairi/Federal University of Rio Grande do Norte (UFRN/FACISA; opinion number 5411306). The study results will be disseminated to participants, submitted to a peer-reviewed journal and presented in scientific meetings. Trial registrations number NCT05408156.