Efeitos de um programa de exercícios baseado no método Pilates sobre a dor lombar em pilotos de helicóptero da Força Aérea Brasileira

Abstract

Introduction: Helicopter pilots often experience chronic low back pain and muscle performance alterations due to exposure to the vibration produced by the aircraft, as well as the asymmetric posture adopted during flight. Supervised exercise is considered one of the most effective treatment options for improving disability associated with nonspecific chronic low back pain. However, few studies have used the Pilates Method as a training program in this population. Objectives: Study I = To analyze the effects of a Pilates-based exercise program on low back pain among helicopter instructors of the Brazilian Air Force at Natal Air Base. Study II: To observe electromyographic behavior related to fatigue among trained and untrained helicopter pilot instructors, before and after flight. Methods: Study I: This is a single-blinded randomized controlled trial. Fifteen helicopter pilots of the Brazilian Air Force were assessed for pain intensity (Numerical Pain Rating Scale - NPRS), disability associated with low back pain, and spinal muscle endurance in three positions: trunk extension (Ito test) and right and left side bridge. Individuals were randomly allocated to the regular exercise group (REG, n = 7), instructed to maintain their normal exercise routine, or to the Pilates group (PG, n = 8), which followed a Pilates-based exercise program twice a week for 12 weeks. Reassessments occurred after six and 12 weeks. Assessments and reassessments were conducted by a blinded researcher. Data analysis was performed using SPSS 20.0 software, with a significance level of 5%. Study II: This is a cross-sectional analytical observational study conducted with 14 pilots, helicopter instructors from the FAB. The resistance to fatigue of the multifidus muscles was observed bilaterally in trained pilots (training protocol by Bulhões et al., 2024) and untrained pilots. The assessment was conducted before and immediately after the flight, through the median frequency recorded during the Ito test. Results: Study I: The PG showed a significant reduction in low back pain after 12 weeks of training (mean difference of 3.5 points on the NPRS) when compared to the REG (p < 0.0001). We also observed an increase in trunk extensor endurance (p = 0.002) and in the right (p = 0.001) and left (p = 0.001) lateral muscles in the PG compared to the REG. However, disability scores did not change between the groups. Study II: Significant differences were observed for the variable median frequency (Fmed) between the trained and untrained groups before the flight. After the flight, this condition varied between the groups. In the analysis of the percentage drop in median frequency during the Ito test, no significant difference was observed between the groups at any of the evaluated times. Conclusions: Study I: Pain intensity was significantly reduced, while spinal muscle endurance increased in the PG compared to the REG, after the intervention. Thus, Pilates-based exercises should be included in physical conditioning programs for helicopter pilots. Study II = Trained individuals exhibited a higher median frequency in the multifidus muscles than the untrained ones, as revealed by electromyography, before the flight, and a lesser variation of this variable after the flight. However, no difference was observed in the percentage drop of this variable during the Ito test when the groups were compared.