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Background: The aim of this systematic review and meta-analysis was to evaluate the global postural re-education (GPR) program’s effectiveness compared to other exercise programs in subjects with persistent chronic low back pain. Methods: A systematic review and meta-analysis were carried out using PRISMA2020. An electronic search of scientific databases was performed from their inception to January 2021. Randomized controlled trials that analyzed pain and patient-reported outcomes were included in this review. Four meta-analyses were performed. The outcomes analyzed were disability due to back pain and pain. The risk of bias and quality of evidence were evaluated. The final search was conducted in March. Results: Seven trials were included, totaling 334 patients. The results showed improvement in pain measured by Visual Analogue Scale (VAS) (Standardised Mean Difference (SMD) = −0.69; 95% Confidence Interval (CI), −1.01 to −0.37; p < 0.0001), Numerical Pain Scale (NRS) (SMD = −0.40; 95% CI, −0.87 to 0.06); p = 0.022), VAS + NRS (SMD = −1.32; 95% CI, −1.87 to −0.77; p < 0.0001) and function (Roland Morris Disability Questionnaire (RMDQ)) (SMD = −0.55; 95% CI, −0.83 to −0.27; p < 0.0001) after GPR treatment. Conclusion: This meta-analysis provides reliable evidence that GPR may be an effective method for treating LBP by decreasing pain and improving function, with strong evidence. Yes

Background: The aim of this systematic review and meta-analysis was to evaluate the global postural re-education (GPR) program's effectiveness compared to other exercise programs in subjects with persistent chronic low back pain. Methods: A systematic review and meta-analysis were carried out using PRISMA2020. An electronic search of scientific databases was performed from their inception to January 2021. Randomized controlled trials that analyzed pain and patient-reported outcomes were included in this review. Four meta-analyses were performed. The outcomes analyzed were disability due to back pain and pain. The risk of bias and quality of evidence were evaluated. The final search was conducted in March. Results: Seven trials were included, totaling 334 patients. The results showed improvement in pain measured by Visual Analogue Scale (VAS) (Standardised Mean Difference (SMD) = -0.69; 95% Confidence Interval (CI), -1.01 to -0.37; p < 0.0001), Numerical Pain Scale (NRS) (SMD = -0.40; 95% CI, -0.87 to 0.06); p = 0.022), VAS + NRS (SMD = -1.32; 95% CI, -1.87 to -0.77; p < 0.0001) and function (Roland Morris Disability Questionnaire (RMDQ)) (SMD = -0.55; 95% CI, -0.83 to -0.27; p < 0.0001) after GPR treatment. Conclusion: This meta-analysis provides reliable evidence that GPR may be an effective method for treating LBP by decreasing pain and improving function, with strong evidence., This research was partially financially supported by the Erasmus+ Strategic Partnership for Higher Education Programme (Key Action 203) [Grant number: 2018-1-PL01-KA203-051055].

Background: As the effectiveness on stress urinary incontinence (SUI) prevention of pelvic floor muscle training (PFMT) for pregnant women has been inconclusive, we are planning to conduct a trial to evaluate a video program designed for prevention of SUI developed through combining PFMT with global postural reeducation (GPR). Methods: As a randomized controlled trial, eligible participants will be randomized (1:1) into an exercise group and a control group to perform PFMT regularly following video guidance or with no intervention, respectively. The experimental stage will be from the 16th gestation week (GW) to the 12th month postpartum, with eight appointments at the 16th, 28th, 37th GW, delivery, the 6th week and the 3rd, 6th, and 12th month postpartum. Data will be collected regarding urinary leakage symptoms, the stress test, the modified Oxford Scale, pelvic floor ultrasound, perineal laceration classification at delivery, neonatal Apgar score, and questionnaires (PISQ-12, ICIQ-UI SF, I-QOL, OABSS). The primary outcome is the occurrence of the symptomatic SUI and positive stress test at the 6th week postpartum. Discussion: This protocol is anticipated to evaluate the efficacy of the intervention via video app for the design of a future randomized control trial (RCT). Trial registration: The trial has been registered at Chinese Clinical Trial Registry (registration number: ChiCTR2000029618).

Background: The Global Postural Re-education (GPR) method seems to be an effective method for the treatment of musculoskeletal disorders. However, no study has examined its effects on a group of musicians with musculoskeletal pain. Additionally, infrared thermography (IRT) has been widely used in the field of medicine as a monitoring a diagnostic tool, which can provide empirical data about the effectiveness of the GPR method. Objective: To examine the effects of GPR using scales and questionnaires and IRT. Methods: This thesis enclosed two articles. In the first, musicians with (N=6) and without (N=6) musculoskeletal pain underwent a thermographic evaluation to examine the skin temperature asymmetry (STA) between both groups as a representation of musculoskeletal pain. The second article was a randomized control trial and examined the effects of the GPR on a group of 13 participants with musculoskeletal pain (7 experimental, 6 controls) after receiving 8 sessions of GPR. Pain, disability and quality of life data was collected using the VAS, MPIIQM, SF-36. A thermographic assessment was also conducted to examine the correlation between pain severity and degree of STA, and changes in contralateral skin asymmetries before and after the intervention. Results: The first article revealed no significant differences in STA between groups. Results from the second article showed statistical significant improvements in pain, disability and quality of life on the group who received the GPR intervention. Results from the IRT analysis were not significant. Conclusion: Results from the self-report questionnaires suggest that GPR is effective in treating musculoskeletal pain in the targeted group of musicians. Pain changes did not correlate with thermal outcomes. Further studies are needed to confirm the results obtained with IRT.

CONTEXTUALIZAÇÃO: O método de Reeducação Postural Global (RPG) tem sido utilizado na clínica com relatos de benefícios para a prevenção e recuperação de disfunções musculoesqueléticas. Após duas décadas de aplicação, estudos têm verificado sua eficácia no tratamento de diferentes condições clínicas e ele tem sido comparado com outros recursos fisioterapêuticos. Entretanto, são poucos os estudos voltados à comprovação dos princípios defendidos pelo autor do método, o que torna frágeis as argumentações em favor dele. OBJETIVO: Realizar, com base na literatura científica, uma análise crítica dos efeitos da intervenção fisioterapêutica utilizando o método RPG. MÉTODOS: Pesquisaram-se as bases de dados Medline, SciELO, LILACS e PeDRO, de 2000 a 2010, considerando os unitermos: RPG, alongamento global e alongamento ativo. RESULTADOS: Foram encontrados 25 estudos, sendo 13 relacionados ao método RPG e oito aos alongamentos global e ativo, além de três livros e uma tese. Após análise, 20 referências foram utilizadas. CONCLUSÕES: Parte dos estudos aponta que o método RPG é mais efetivo, enquanto outros mostram resultados similares a outros métodos de intervenção fisioterapêutica. Estudos indicam benefícios do método na melhora da força muscular respiratória, expansibilidade torácica, mobilidade toracoabdominal e da pressão respiratória máxima, além de reduzir a dor, a perda de urina em mulheres incontinentes, melhorar a flexibilidade, a atividade eletromiográfica nas disfunções temporomandibulares e a estabilidade postural em alterações ortopédicas de membros inferiores. Limitações metodológicas observadas sugerem a necessidade de maior rigor em futuras pesquisas.BACKGROUND: The Global Postural Re-education (GPR) method has been widely used in clinical practice, with reported benefits for prevention and rehabilitation of musculoskeletal dysfunctions. In parallel with almost two decades of clinical implementation, research studies have tested and verified the effectiveness of GPR in treating different clinical conditions and have also compared this method with other physical therapy resources. However, few studies focused on the verification of the principles of mechanisms of action defended by the author of the method making the arguments in favor of the method weak. OBJECTIVE: To perform a critical systematic review of the effects of physical therapy intervention that use the GPR method. METHODS: We searched Medline, SciELO, LILACS and PeDRO, from 2000 to 2010, considering the key words: Global Postural Re-education, global and active stretching. RESULTS: We found 25 studies, 13 about GPR and 8 about global and active stretching in addition to three books and a thesis. After analysis, 20 references were included. CONCLUSIONS: Some of the studies indicated that the GPR method was more effective than other physical therapy interventions, while others demonstrated similar results of GPR when compared to other physical therapy interventions. Studies showed benefits of the GPR in improving the respiratory muscle strength, chest expansion, maximal respiratory pressure and in reducing pain, loss of urine in incontinent women, increasing flexibility, the electromyographic activity in temporomandibular disorders and postural stability in lower limb orthopedic alterations. Methodological limitations observed suggest the need for greater rigor in future research.

CONTEXTUALIZAÇÃO: O método de Reeducação Postural Global (RPG) tem sido utilizado na clínica com relatos de benefícios para a prevenção e recuperação de disfunções musculoesqueléticas. Após duas décadas de aplicação, estudos têm verificado sua eficácia no tratamento de diferentes condições clínicas e ele tem sido comparado com outros recursos fisioterapêuticos. Entretanto, são poucos os estudos voltados à comprovação dos princípios defendidos pelo autor do método, o que torna frágeis as argumentações em favor dele. OBJETIVO: Realizar, com base na literatura científica, uma análise crítica dos efeitos da intervenção fisioterapêutica utilizando o método RPG. MÉTODOS: Pesquisaram-se as bases de dados Medline, SciELO, LILACS e PeDRO, de 2000 a 2010, considerando os unitermos: RPG, alongamento global e alongamento ativo. RESULTADOS: Foram encontrados 25 estudos, sendo 13 relacionados ao método RPG e oito aos alongamentos global e ativo, além de três livros e uma tese. Após análise, 20 referências foram utilizadas. CONCLUSÕES: Parte dos estudos aponta que o método RPG é mais efetivo, enquanto outros mostram resultados similares a outros métodos de intervenção fisioterapêutica. Estudos indicam benefícios do método na melhora da força muscular respiratória, expansibilidade torácica, mobilidade toracoabdominal e da pressão respiratória máxima, além de reduzir a dor, a perda de urina em mulheres incontinentes, melhorar a flexibilidade, a atividade eletromiográfica nas disfunções temporomandibulares e a estabilidade postural em alterações ortopédicas de membros inferiores. Limitações metodológicas observadas sugerem a necessidade de maior rigor em futuras pesquisas. BACKGROUND: The Global Postural Re-education (GPR) method has been widely used in clinical practice, with reported benefits for prevention and rehabilitation of musculoskeletal dysfunctions. In parallel with almost two decades of clinical implementation, research studies have tested and verified the effectiveness of GPR in treating different clinical conditions and have also compared this method with other physical therapy resources. However, few studies focused on the verification of the principles of mechanisms of action defended by the author of the method making the arguments in favor of the method weak. OBJECTIVE: To perform a critical systematic review of the effects of physical therapy intervention that use the GPR method. METHODS: We searched Medline, SciELO, LILACS and PeDRO, from 2000 to 2010, considering the key words: Global Postural Re-education, global and active stretching. RESULTS: We found 25 studies, 13 about GPR and 8 about global and active stretching in addition to three books and a thesis. After analysis, 20 references were included. CONCLUSIONS: Some of the studies indicated that the GPR method was more effective than other physical therapy interventions, while others demonstrated similar results of GPR when compared to other physical therapy interventions. Studies showed benefits of the GPR in improving the respiratory muscle strength, chest expansion, maximal respiratory pressure and in reducing pain, loss of urine in incontinent women, increasing flexibility, the electromyographic activity in temporomandibular disorders and postural stability in lower limb orthopedic alterations. Methodological limitations observed suggest the need for greater rigor in future research.

Stretching by the global postural re-education method (GPR) has been widely used as a physical therapeutic procedure for postural alterations, but its action on the cardio-respiratory system has been little documented. However, scientific evidence is necessary to validate it as an alternative treatment. Within this context, three studies were carried out with the objective of verifying the effect of stretching the respiratory muscle chain in the open-arm, open hip joint angle posture by the GPR method on cardio-respiratory responses. Twenty young (22.7±2.5 years old), healthy, sedentary (VO2max: 30.2±4.3 mL.kg.min-1) men with BMI = 25.3±1.5 kg/m2 were studied, divided at random into two groups of ten: the control group (CG) that did not take part in the stretching and the group submitted to treatment (GPR-G). The intervention consisted of two weekly stretching sessions, each of 30 min, for eight weeks, giving a total of 16 sessions. In the first study, the maximal respiratory pressure and the respiratory coefficient were assessed by way of a manovacuometer and thoracoabdominal cirtometry, respectively. Only the GPR-G presented greater values for inspiratory (IPmax) and expiratory (EPmax) maximal pressures and for axillary, xyphoid and abdominal cirtometry after the intervention period. The results showed that the method caused a beneficial effect on respiratory muscle force and on thoracoabdominal mobility, contributing to an improvement in respiratory mechanics. In the second study, pulmonary function was assessed by spirometry. The manoeuvres of slow vital capacity (SVC), forced vital capacity (FVC) and maximal voluntary ventilation (MVV) were carried out. The results showed there was a significant increase in the values for SVC, inspiratory capacity (IC), FVC, forced expiratory volume in the first second (FEV1) and MVV for the GPR-G after the training period, providing evidence that the proposed stretching was efficient in promoting an increase in pulmonary capacity and volume. In the third study, the effect of stretching on the autonomic modulation of the heart rate (HR) and on the ventilatory and metabolic variables was assessed at rest and during the cardio-pulmonary exercise test respectively. The ventilatory and metabolic variables were captured using an automatic metabolic system and the HR using a one-channel heart monitor. The exercise test was carried out using a cycle ergometer, with 20 to 25 W/min increments up to physical exhaustion. Intervention did not change the variables studied either at rest or during the cardio-pulmonary exercise test, for either of the groups. These results showed that the respiratory muscle chain stretching exercise did not promote any adaptations with respect to HR neither at rest and the ventilatory and metabolic variables during the exercise, which could be attributed to the noninvolvement of the major muscle groups in the type of protocol used. Finally, the results obtained in the three studies gave evidence that stretching the respiratory muscle chain by the GPR method was efficient in promoting an increase in respiratory muscle strength, thoracoabdominal mobility and pulmonary function, reflecting in an increase in respiratory mechanics, this fact being attributable to the specificity of the training. In this way, the findings of the present study, reinforce the importance of the GPR method in the maintenance of the functional capacity of the respiratory chain muscles, suggesting that it could be used as an alternative treatment for dysfunctions of the respiratory mechanics. O alongamento pelo método de reeducação postural global (RPG) tem sido muito utilizado como conduta fisioterapêutica em alterações posturais, porém, sua ação sobre o sistema cardiorrespiratório é pouco documentada. No entanto, as evidências científicas são necessárias para sua validação como alternativa de tratamento. Dentro desse contexto, foram realizados três estudos com o objetivo de verificar o efeito do alongamento da cadeia muscular respiratória na postura rã no chão com os braços abertos do método de RPG sobre as respostas cardiorrespiratórias. Foram estudados 20 homens jovens (22,7±2,5 anos), saudáveis, sedentários (VO2max: 30,2±4,3 mL.kg.min-1) e com IMC = 25,3±1,5 kg/m2, divididos aleatoriamente em dois grupos de dez: grupo controle (G-C) que não participou do alongamento e grupo submetido ao treinamento (G-RPG). A intervenção consistiu em duas sessões semanais de alongamento de 30 min cada, durante oito semanas, totalizando 16 sessões. No primeiro estudo, foram avaliadas as pressões respiratórias máximas e o coeficiente respiratório, por intermédio da monovacuometria e da cirtometria toracoabdominal, respectivamente. Somente o G-RPG apresentou maiores valores das pressões inspiratórias (PImáx) e expiratórias (PEmáx) máximas e da cirtometria axilar, xifoideana e abdominal após o período de intervenção. Os resultados mostraram que o método teve um efeito benéfico na força muscular respiratória e na mobilidade toracoabdominal, contribuindo para a melhora da mecânica respiratória. No segundo estudo, foi avaliada a função pulmonar por intermédio da espirometria. Foram realizadas as manobras de capacidade vital lenta (CVL), capacidade vital forçada (CVF) e ventilação voluntária máxima (VVM). Os resultados mostraram que houve aumento significativo dos valores da CVL, capacidade inspiratória (CI), CVF, volume expiratório forçado no primeiro segundo (VEF1) e VVM do G-RPG após o período de treinamento, evidenciando que o alongamento proposto foi eficiente para promover aumento dos volumes e capacidades pulmonares. No terceiro estudo, foi avaliado o efeito do alongamento nas variáveis ventilatórias e metabólicas durante o teste de exercício cardiopulmonar e na modulação autonômica da freqüência cardíaca (FC) em repouso. As variáveis ventilatórias e metabólicas foram captadas a partir de um sistema metabólico automático, e a FC a partir de um monitor cardíaco de um canal. O teste de exercício foi realizado em cicloergômetro, com incrementos de 20 a 25 W/min até a exaustão física. A intervenção não modificou as variáveis estudadas em nenhum dos grupos. Esses resultados mostram que o exercício de alongamento da cadeia muscular respiratória não promoveu adaptações na FC e em sua variabilidade em repouso e nas variáveis ventilatórias e metabólicas durante o exercício, o que pode ser atribuído ao não envolvimento de grandes grupos musculares no tipo de protocolo utilizado. Finalizando, os resultados obtidos nos três estudos evidenciaram que o alongamento da cadeia muscular respiratória pelo método de RPG mostrou-se eficiente para promover aumento da força muscular respiratória, mobilidade toracoabdominal e função pulmonar, refletindo na melhora da mecânica respiratória, sendo que tal fato pode ser atribuído à especificidade do treinamento. Desse modo, nossos achados reforçam a importância do método de RPG para manutenção da capacidade funcional dos músculos da cadeia respiratória, sugerindo que a postura utilizada pode ser coadjuvante no tratamento das disfunções da mecânica respiratória.