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Rodrigo Rodrigues Gomes Costa, Rodrigo Luiz Carregaro, and Frederico Ribeiro Neto

Context: There seems to be no consensus on which aspects better distinguish the different levels of spinal cord injury regarding body composition, strength, and functional independence. Objective: The study aimed to determine which variables better differentiate tetraplegia (TP) from paraplegia and high paraplegia (HP) from low paraplegia (LP). Design: Cross-sectional study. Setting: Rehabilitation hospital network. Patients: Forty-five men with spinal cord injury, n = 15 for each level (TP, HP, and LP) causing complete motor impairment (American Spinal Injury Association Impairment Scale: A or B) were enrolled in the study. Main Outcome Measures: The 1-maximum repetition test, functional independence measure, spinal cord independence measure, and body composition (skinfold sum, body fat percentage, and body mass index) were assessed. Discriminant analysis was carried out using the Wilks lambda method to identify which strength and functional variables can significantly discriminate subjects for injury classification (TP, HP, and LP). Results: The discriminant variable for TP versus HP was body mass index and for TP versus LP was 1-maximum repetition (P ≤ .05). There were no variables that discriminated HP versus LP. Conclusions: The discriminant variables for TP versus HP and TP versus LP were body mass index and 1-maximum repetition, respectively. The results showed that HP and LP are similar for strength and functional variables.

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Frederico Ribeiro Neto, Ramires Alsamir Tibana, Jefferson Rodrigues Dorneles, and Rodrigo Rodrigues Gomes Costa

Context: Paracanoeing is one of the adapted sports eligible for different motor impairments. The acute:chronic workload ratio (ACWR) is an index between acute and chronic training workload. However, no studies have analyzed this variable in paracanoeing, relating it with training recovery markers. Objective: This study aimed to quantify the internal (session rating of perceived exertion) and external (distance traveled and total training time) training workloads in 4 experienced paracanoe athletes over 9 months and 5 canoeing events. Design: Cross-sectional study. Setting: Rehabilitation Hospital Network, Paralympic Program. Participants: Four experienced paracanoe athletes participated in 36 weeks of training for 5 events. Main Outcomes Measures: The daily and weekly training workload, monotony, ACWR, distance, and total training time were described for all the training phases. The perceived recovery status scale (PRS) and medicine ball throw (MBT) were used to quantify recovery. Results: The average daily and weekly training workload varied from 213.1 to 239.3 and 767.3 to 1036.8 arbitrary units, respectively. Average ACWR results ranged from 0.96 to 1.10 in the 4 athletes, findings that were outside the safety zone in 38% of the training weeks. All the correlations between MBT and PRS were classified as weak (ρ between .20 and .39, P > .05). ACWR showed a very weak correlation with MBT and moderately and highly significant correlations with PRS in 2 athletes, respectively. Conclusions: The training workloads of 4 paracanoe athletes may serve as a comparison with other periodization models. Pretraining recovery assessments (MBT and PRS) exhibited a low, nonsignificant correlation. However, ACWR correlated significantly with PRS in 2 athletes and might be a suitable tool for daily training adjustments.

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Rodrigo Rodrigues Gomes Costa, Jefferson Rodrigues Dorneles, Guilherme Henrique Lopes, José Irineu Gorla, and Frederico Ribeiro Neto

Context: Monitoring training loads and consequent fatigue responses are usually a result of personal trainers’ experiences and an adaptation of methods used in sports for people without disabilities. Currently, there is little scientific evidence on the relationship between training load and fatigue resulting from training sessions in wheelchair sports. Analogous to the vertical jump, which has been associated with competitive performance and used to assess fatigue in Olympic sports, the medicine ball throw (MBT) is a fast, feasible, and accessible test that might be used to measure performance outcomes in Paralympic athletes. Objective: To test the MBT responsiveness to detect meaningful changes after training sessions in beginner wheelchair basketball players (WBP). Design: Cross-sectional study. Setting: Rehabilitation Hospital Network, Paralympic Program. Participants: Twelve male WBP. Main Outcomes Measures: The participants performed 3 consecutive days of training sessions involving exercises of wheelchair basketball skills, strength, and power. The MBT test was performed pre and post training sessions. Results: The smallest worthwhile change for MBT was 0.10 cm, and the lower and upper limits were 3.54 and 3.75 m, respectively. On the first day, the MBT started below the smallest worthwhile change lower limit and increased above the upper limit (3.53 and 3.78 m, respectively). On the second day, the MBT pretraining and posttraining session results were near the sample mean (3.62 and 3.59 m, respectively). On the third day, the WBP started the MBT test training higher than the upper limit (3.78 m) and decreased to near the mean (3.58 m). Conclusions: During 3 consecutive days of training sessions, the magnitude-based inference model presented meaningful changes in MBT test performance. The accurate association of the magnitude-based inference model with the MBT allows coaches and sports team staff to interpret the correct magnitude of change in WBP performance.

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Frederico Ribeiro Neto, Rodrigo Rodrigues Gomes Costa, Ricardo Tanhoffer, Martim Bottaro, and Rodrigo Luiz Carregaro

Context: Strength training is one of the most common interventions employed to increase functional independence during rehabilitation of individuals with spinal cord injury (SCI). However, in the literature, different results have been reported in terms of strength modifications after a SCI compared with a control group (CG). Objective: This study aimed to verify whether discriminant analysis using relative and absolute strength is able to discriminate individuals with different levels of SCI from a CG and to compare strength values of men with different levels of SCI with a CG. Design: Cross-sectional study. Setting: Rehabilitation hospital setting. Participants: A total of 36 individuals with SCI stratified in tetraplegia (TP; C6–C8), high paraplegia (HP; T1–T6), and low paraplegia (LP; T7–L2), and 12 matched control subjects were enrolled in the study. Main Outcome Measures: The subjects performed a maximum strength test of elbow extension/flexion and also shoulder abduction/adduction and flexion/extension in an isokinetic dynamometer. Discriminant analysis was carried out to identify which strength variables would be able to discriminate the TP, HP, or LP groups from the CG. A 1-way analysis of variance was performed to compare peak torque and agonist/antagonist ratio means. Results: Shoulder adduction, followed by elbow extension peak torque, was the best variable for discriminating the TP group from the CG (function coefficients: −0.056 and 0.051, respectively, Wilks Λ = 0.41, P ≤ .05). There were no significant differences between the HP group, LP group, and CG. Conclusions: The strength similarity of the paraplegic groups and the CG should not be extrapolated for activities of daily living or sports. The TP group demonstrated lower peak torque for all movements than the CG.

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Frederico Ribeiro Neto, Irineu Loturco, Guilherme Henrique Lopes, Jefferson Rodrigues Dorneles, José Irineu Gorla, and Rodrigo Rodrigues Gomes Costa

Context: A detailed analysis of wheelchair basketball skills in beginner wheelchair basketball players (WBP) can provide practitioners with important indications regarding the selection and prospective development of potential sports talents. A comprehensive WBP evaluation can be very time consuming, mainly during the initial phases of the training processes, which could be a barrier in clinical and practical settings. Moreover, the large number and the turnover of beginner WBP attending rehabilitation centers make the applicability of field and strength tests unfeasible. Objective: To verify the relationships between the medicine ball throw (MBT) and wheelchair basketball mobility performance field tests and the shoulder and trunk peak torque in male and female beginner WBP. Design: Cross-sectional study. Setting: Rehabilitation Hospital Network, Paralympic Program. Participants: Thirty-seven female and male beginner WBP. Main Outcomes Measures: Participants performed wheelchair basketball field tests (speed, agility, strength, and power tests) and the maximum strength test in the isokinetic dynamometer. The outcomes were correlated with the MBT results. Results: The MBT presented significantly very high and perfect correlations with all wheelchair basketball field tests assessed (5-m sprint, 20-m sprint, and zig-zag agility test with and without a ball), and peak torque (R 2 ranging from .810 to .995; P ≤ .05) for male and female athletes. Conclusions: The MBT, a simple and feasible test, can be used for estimating and determining the wheelchair mobility performance of female and male beginner WBP. It is suggested to measure the distance of a 5-kg medicine ball thrown by athletes during training and testing routines to follow the players’ progression.

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Talita Molinari, Tainara Steffens, Cristian Roncada, Rodrigo Rodrigues, and Caroline P. Dias

Eccentric-focused training promotes greater gains in muscle strength compared with other types of training in adults. However, for older adults, these findings are still not well understood. A systematic review and meta-analysis were performed using manuscripts that performed eccentric-focused and conventional resistance training for at least 4 weeks and evaluated maximum muscle strength through tests of maximum repetitions in weight machine exercises (knee extension and leg press exercises). Five studies were included (n = 138). Increases in muscle strength were found in both resistance training groups, without a difference between them through meta-analysis. However, a large effect size has been observed only in eccentric-focused training. The findings suggest that resistance training protocols are similar for improving maximal strength in older adults, despite larger effect sizes for eccentric-focused training.

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Bruno Manfredini Baroni, Jeam Marcel Geremia, Rodrigo Rodrigues, Marcelo Krás Borges, Azim Jinha, Walter Herzog, and Marco Aurélio Vaz

It is not known if a physically active lifestyle, without systematic training, is sufficient to combat age-related muscle and strength loss. Therefore, the purpose of this study was to evaluate if the maintenance of a physically active lifestyle prevents muscle impairments due to aging. To address this issue, we evaluated 33 healthy men with similar physical activity levels (IPAQ = 2) across a large range of ages. Functional (torque-angle and torque-velocity relations) and morphological (vastus lateralis muscle architecture) properties of the knee extensor muscles were assessed and compared between three age groups: young adults (30 ± 6 y), middle-aged subjects (50 ± 7 y) and elderly subjects (69 ± 5 y). Isometric peak torques were significantly lower (30% to 36%) in elderly group subjects compared with the young adults. Concentric peak torques were significantly lower in the middle aged (18% to 32%) and elderly group (40% to 53%) compared with the young adults. Vastus lateralis thickness and fascicles lengths were significantly smaller in the elderly group subjects (15.8 ± 3.9 mm; 99.1 ± 25.8 mm) compared with the young adults (19.8 ± 3.6 mm; 152.1 ± 42.0 mm). These findings suggest that a physically active lifestyle, without systematic training, is not sufficient to avoid loss of strength and muscle mass with aging.

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Rodrigo Siqueira Reis, Adriano Akira Ferreira Hino, Alex Antonio Florindo, Ciro Romélio Rodriguez Añez, and Marlos Rodrigues Domingues


The purpose of this study was to analyze the relationship between adolescents’ physical activity practice and their perception about the environment of urban parks.


A school-based representative sample (n = 1,718; boys = 40.4%) of teenagers of Curitiba, Southern region of Brazil. A questionnaire was employed to identify perceived parks environmental features as well as physical activity practice in the parks (PAP), habitual physical activity (HPA) and demographics. The relationship between PAP and parks environments was analyzed through multivariate logistic regression controlling for age and socioeconomic status, HPA and parks distance.


After controlling for confounders PAP was associated with lack of space to be physically active, activities to choose from and equipments for both boys and girls, (odds ratio (OR)—ranging from 1.5 to 1.8). Among boys, having people of same age (OR = 1.5) and accessibility (OR = 2.0) showed association with PAP only in crude analysis. However, among girls, to be bulled or teased (OR = 1.4) and accessibility (OR = 1.7) were associated with PAP after confounding control.


The results showed that specific attributes in parks may be considered and offered to increase the likelihood of physical activity practice among adolescents in such locations.

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Gabriel dos Santos Oliveira, João Breno de Araujo Ribeiro-Alvares, Felipe Xavier de Lima-e-Silva, Rodrigo Rodrigues, Marco Aurélio Vaz, and Bruno Manfredini Baroni

Context: Eccentric knee flexor strength assessments have a key role in both prevention and rehabilitation of hamstring strain injuries. Objective: To verify the reliability of a clinical test for measuring eccentric knee flexor strength during the Nordic hamstring exercise using a commercially available handheld dynamometer. Design: Reliability study. Setting: Physical Therapy Laboratory, Federal University of Health Sciences of Porto Alegre (Brazil). Participants: Fifty male amateur athletes (soccer or rugby players; 24 [3] y). Main Outcome Measures: Eccentric knee flexor strength. Results: When compared with a load cell–based device, the clinical test using a handheld dynamometer provided smaller force values (P < .05) with large effect sizes (.92–1.21), moderate intraclass correlation (.60–.62), typical error of 30 to 31 N, and coefficient of variation of 10% to 11%. Regarding the test–retest reproducibility (2 sessions separated by 1 week), the clinical test provided similar force values (P > .05) with only small effect sizes (.20–.27), moderate to good correlation (.67–.76), typical error of 23 to 24 N, and coefficient of variation of 9% to 10%. Conclusion: The clinical test with handheld dynamometer proposed by this study can be considered an affordable and relatively reliable tool for eccentric knee flexor strength assessment in the clinical setting, but results should not be directly compared with those provided by load cell–based devices.

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Renato Sobral Monteiro-Junior, Paulo de Tarso Maciel-Pinheiro, Eduardo da Matta Mello Portugal, Luiz Felipe da Silva Figueiredo, Rodrigo Terra, Lara S. F. Carneiro, Vinícius Dias Rodrigues, Osvaldo J. M. Nascimento, Andrea Camaz Deslandes, and Jerson Laks

Background: Inflammatory cytokines and acute phase proteins increase with aging, promoting a chronic low-grade inflammation. Studies have shown a positive effect of exercise on inflammatory markers in older persons. Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) are the main biomarkers investigated. However, it is unclear if exercise could decrease all these biomarkers. Purpose: The aim was to analyze the effect of chronic exercise on IL-6, TNF-α, and CRP levels in older persons. Methods: Preferred Reporting Items in Systematic Reviews and Meta-analyses guidelines were adopted. Original articles that investigated the effect of chronic exercise on inflammatory profile of the elderly persons were eligible for this review. The databases PubMed, PEDro, EBSCO, and BioMed Central were searched. Three reviewers evaluated each publication for reducing bias. Data about IL-6, TNF-α, and CRP were collected and analyzed. A standardized mean difference based on estimated pooled effect size was calculated considering heterogeneity index (I2) and random effect. Results: Seventy-six studies were retrieved from databases, and 8 of them were analyzed. IL-6 and CRP levels decreased after chronic exercise (overall effect P < .05). Conclusion: Regular exercise decreases IL-6 and CRP levels in older persons. The effect of exercise on TNF-α remains unclear.