Ballet dancers are a unique population of athletes in that, unlike other sports, their success strictly depends on both physical capabilities and aesthetic factors. While the physical demands of the performing sport are strenuous, ballet dancers are often required to exhibit a thin physique, frequently resulting in weights 10-12% below the ideal. These low weights are commonly achieved by low energy intakes which increase dancers' susceptibility to the development of various health conditions. Research investigating the health of dancers, however, is limited and hampered by methodological limitations. To address these issues, we tested the hypothesis that dancers would report a low habitual energy intake and, therefore, be subject to conditions comprising the Female Athlete Triad, including low energy availability, suboptimal bone density and menstrual irregularities. In addition, we hypothesized that elite female dancers would have lower than expected resting metabolic rate (RMR) based upon their fat-free mass, and thus greater energetic efficiency as a result of chronic energy deficiency. As hypothesized, dancers reported a significantly lower energy intake and exhibited a lower RMR as compared to lean, pair-matched controls. Because treatment of these metabolic abnormalities is challenging, prevention of adverse health outcomes among adolescent pre-professional dancers is key in promoting overall health and optimal performance. Through our subsequent 'formative work', we determined that the current availability of nutrition education offered to both professional and pre-professional dancers is minimal and of questionable quality. Thus, we developed, implemented, and evaluated a DVD-based educational program, entitled "Nutrition for Optimal Performance", aimed at improving health knowledge and behaviors of pre-professional adolescent ballet dancers. Our findings indicate that participants increased their knowledge of basic nutrition principles and self-efficacy for adopting healthier dietary habits, as compared to pre-program and control group scores, and that knowledge gains were sustained at a six-week follow-up assessment. Collectively, these studies provide the field of dance medicine with novel findings related to the characteristics and health conditions of professional ballet dancers, and the effectiveness of a low-resource, disseminable nutrition education program which promotes the health and optimal performance of pre-professional adolescent ballet dancers. / Ph. D.

Made available in DSpace on 2016-04-04T18:30:08Z (GMT). No. of bitstreams: 1 Andressa Melina Becker da Silva.pdf: 5234431 bytes, checksum: 3dc76eae125e27cf91d4beacad0f4393 (MD5) Previous issue date: 2016-02-22 / Dancers live with pain due to intense training, which may affect performance and quality of life, there are psychological processes could interfere in the pain coping. This research examined the effects of a psychological intervention focused on coping of pain in dancers, analyzing the psychological processes related to coping (stress, exercise dependence, anxiety and self-efficacy) and its relationship to quality of life and technical performance. Participants included 19 semi-professional dancers (12-17 years) in a dance school in Curitiba-PR., Brasil. A longitudinal design followed the training phases of the dancers, for a year, assessing behavioral and psychophysiological indicators: 1) The Preparatory Phase measured cortisol in saliva and hair and three general scales - the Stress Scale for Teens, the Trait Anxiety Inventory and State and the Pediatric Quality of Life Inventory - and two specific scales - the Exercise Dependence Scale-21 and Self-efficacy scale for Dancers, previously validated in this research in a sample of 442 dancers, using the Item Response Theory and network analysis were applied; 2) The Competition Phase 1, the two specific scales were reapplied, as well as six others - Inventory of Competitive Anxiety State, the List of Symptoms of Stress Pre-Competitive Children and Youth, Stress Questionnaire and Recovery for Athletes, Athletic Coping Skills Inventory-24-BR, the Questionnaire on Athletes' Quality of Life and Pain Coping Inventory for Dancers, also validated, and psychophysiological measures were applied; 3) The Transition Phase, was composed of an pain coping intervention program, with 8 week -45 minutes sessions. Sessions were filmed and were specially tailored using Imagery Training, one Pain Coping Game, Pain Diary and Questionnaire for Imagination in Dance; 4) Competitive Phase 2, instruments were reapplied including a Technical Scouting for dance. A developmental perspective was adopted for analyzing the data, based on the Motivational Theory of Coping. It was evidenced chronic stress by salivary and hair cortisol. Significant differences between training phases in physical and psychological self-efficacy and dependence of exercises were found. The JT method showed a positive and reliable post-intervention change in confidence indicators (B3); stressors: intrinsic physiological and cognitive/emotional (B6), social extrinsic (B2, B6); levels of general and specific to dance stress (B2); and non promoting components of quality of life (B6). There was reliable negative change in intrinsic physiological and cognitive / emotional stressors (B12); general stress (B7, B11, B12); components and promoters of quality of life (B1). The analysis of verbal reports by IRAMUTEQ and the Pain Diary showed reduction in the frequency and intensity of pain and changes in coping strategies. According to judges, mediation intervention provided more structure than promoted the involvement and empowerment of dancers. This study concludes that this intervention can be replicated in other teenage dancers, considering that there was improvement in psychological conditions of the participants. They reported satisfaction to participate of this study, even the learning about the psychological process, adaptive ways of coping and the relationships of the Psychology with the dance. / Bailarinos convivem com a dor devido ao treinamento intenso, prejudicando o desempenho e a qualidade de vida, havendo processos psicol?gicos que podem interferir no enfrentamento da dor. Esta pesquisa verificou os efeitos de uma interven??o psicol?gica centrada no enfrentamento (coping) da dor em bailarinos, analisando os processos psicol?gicos relacionados ao coping (estresse, depend?ncia de exerc?cio, ansiedade e autoefic?cia), assim como suas rela??es com a qualidade de vida e o desempenho t?cnico. Participaram 19 bailarinas semiprofissionais (12-17 anos), em uma escola de dan?a de Curitiba-PR. O delineamento longitudinal seguiu as etapas de treinamento das bailarinas, por um ano, avaliando-se indicadores comportamentais e psicofisiol?gicos: 1) na Etapa Preparat?ria, mediu-se o cortisol salivar e capilar, e aplicou-se tr?s escalas gerais - a Escala de Stress para Adolescentes, o Invent?rio de Ansiedade Tra?o e Estado e o Pediatric Quality of Life Inventory e duas escalas espec?ficas - o Exercise Dependence Scale-21 e a Escala de Autoefic?cia para Bailarinos, validadas previamente nesta pesquisa em uma amostra de 442 bailarinos, usando a Teoria de Resposta ao Item e an?lise de redes; 2) na Etapa Competitiva 1, reaplicou-se as duas escalas espec?ficas, al?m de outras seis - o Invent?rio de Ansiedade-Estado Competitiva, a Lista de Sintomas de Stress Pr?-Competitivo Infanto-Juvenil, o Question?rio de Estresse e Recupera??o para Atletas, o Athletic Coping Skills Inventory 24-BR, o Question?rio sobre Qualidade de Vida de Atletas e o Invent?rio de Coping da Dor para Bailarinos, tamb?m validados, e as medidas psicofisiol?gicas; 3) na Etapa de Transi??o, aplicou-se um programa de interven??o no enfrentamento da dor, com 8 sess?es semanais de 45 minutos filmadas, especialmente elaborado, usando Imagery Training, um Jogo de Coping da Dor, Di?rio da Dor e o Question?rio para Imagina??o na Dan?a; 4) na Etapa Competitiva 2, reaplicou-se os instrumentos, incluindo um Scouting T?cnico para a Dan?a. Adotou-se uma perspectiva desenvolvimentista na an?lise dos dados, com base na Teoria Motivacional do Coping. Evidenciou-se estresse cr?nico pelo cortisol salivar e capilar. Houve diferen?as significativas entre as etapas de treinamento na autoefic?cia f?sica e psicol?gica, e na depend?ncia de exerc?cios. O M?todo JT mostrou mudan?a p?s-interven??o positiva e confi?vel nos indicadores de autoconfian?a (bailarina 3- B3); estressores: intr?nsecos fisiol?gicos e cognitivos/emocionais (B6), extr?nsecos sociais (B2, B6); n?veis de estresse geral e espec?fico da dan?a (B2); e componentes n?o promotores da qualidade de vida (B6). Houve mudan?a negativa confi?vel nos estressores: intr?nsecos fisiol?gicos e cognitivos/emocionais (B12); estresse geral (B7, B11, B12); e componentes promotores da qualidade de vida (B1). A an?lise dos relatos verbais pelo IRAMUTEQ e do Di?rio da Dor indicou redu??o na frequ?ncia e intensidade da dor e mudan?as nas estrat?gias de enfrentamento. Segundo ju?zes, a media??o da interven??o promoveu mais a estrutura do que o envolvimento e a autonomia das bailarinas. Conclui-se que essa interven??o pode ser replicada em outros bailarinos, j? que houve melhora nas condi??es psicol?gicas das participantes. Estas relataram satisfa??o em participar da pesquisa, bem como a aprendizagem sobre os processos psicol?gicos, estrat?gias de enfrentamento adaptativas e as rela??es da Psicologia com a dan?a.

Introdução: A ansiedade pode se manifestar por meio de sintomas físicos e autonômicos. Os transtornos de ansiedade são geralmente descritos por uma interação de sintomas somáticos e sinais subjetivos, o que aumenta a importância de um conhecimento mais amplo sobre como esses fatores estão relacionados e ocorrem em conjunto com distúrbios psiquiátricos e não psiquiátricas. Assim, a ansiedade pode estar associada a diversas condições médicas, entre as quais a hipermobilidade articular. A hipermobilidade articular (JHM) é caracterizada pelo aumento da flexibilidade das articulações. É um sinal de maior elasticidade que pode até ser vantajoso para algumas pessoas em atividades específicas. Por outro lado, a síndrome da hipermobilidade articular (JHS) é mais ampla do que a JHM, sendo acompanhada de sintomas clínicos, especialmente de histórico de lesões, sinais da pele, instabilidade e dor. Objetivos: A associação entre ansiedade e hipermobilidade articular foi investigada em cinco estudos, desenvolvidos com três amostras diferentes e independentes, como descrito a seguir: um grupo de estudantes universitários, uma amostra de famílias com alta agregação genética de ansiedade e hipermobilidade e uma amostra composta por bailarinas. Método: O primeiro estudo foi desenvolvido por meio de uma revisão sistemática da literatura. Utilizando um protocolo, foi realizada uma pesquisa sistemática de artigos nas bases de dados eletrônicas PubMed, LILACS, PsycINFO e SciELO utilizando as palavras-chave \'anxiety\', \'joint\' e \'hipermobility\' e operadores booleanos. O segundo estudo foi desenvolvido como uma avaliação epidemiológica, com 2.300 estudantes universitários de ambos os sexos, com idade entre 17-35 anos, de duas universidades brasileiras. Os participantes responderam a instrumentos de autorrelato de ansiedade (Inventário de Ansiedade de Beck - BAI), Ansiedade Social (Inventário de Fobia Social - SPIN) e um questionário de screening para JHM (questionário de cinco partes para a identificação da hipermobilidade). O terceiro estudo foi desenvolvido com uma amostra de conveniência, extraída deste estudo epidemiológico, formada por 87 estudantes universitários, divididos em dois grupos, de acordo com a presença ou ausência de Transtorno de Ansiedade Social (TAS). Eles responderam aos mesmos instrumentos de autorrelato e também passaram por uma avaliação clínica, em que responderam à entrevista clínica semiestruturada para o DSM-IV (SCID-IV) e foram avaliadas de acordo com o escore de Beighton para JHM. O estudo seguinte foi desenvolvido através de um desenho longitudinal, avaliando uma amostra de famílias espanholas com alta agregação genética de ansiedade e hipermobilidade. No início do estudo, a amostra foi formada por 156 participantes; em oito anos de seguimento, a amostra foi composta por 98 sujeitos. Os participantes preencheram instrumentos de autorrelato (Inventário de Medo [FSS] e Inventário de Ansiedade Estado-Traço [IDATE]), assim como responderam à SCID-IV e foram avaliados de acordo com o escore de Beighton para JHM e critérios de Brighton para a JHS. Por último, o quinto estudo foi realizado com 145 bailarinas, divididas em três grupos: alunas de balé (n=59), professoras de balé (n=37) e bailarinas profissionais (n=49). As participantes responderam a instrumentos de autorrelato para avaliação da JHM (questionário de screening), ansiedade (BAI), ansiedade social (SPIN), pânico (Patient Health Questionnaire - Brief PHQ), sintomatologia depressiva (PHQ-9), abuso de álcool (FAST) e dor (Inventário breve de dor [BPI] e avaliação da incapacidade funcional por causa da dor [SEFIP]). As bailarinas também foram submetidas a uma avaliação clínica de acordo com o escore de Beighton e os critérios Brighton. Resultados: Dos 34 artigos inicialmente encontrados, 17 foram incluídos na revisão sistemática. Em geral, eles ratificaram a associação entre os sintomas de ansiedade (como medos e sintomas psicológicos) e JHM. No que se refere aos transtornos de ansiedade, os dados se mostraram mais heterogêneos, dependendo do tipo de transtorno, parecendo mais associados ao transtorno de pânico. No segundo estudo, desenvolvido com 2.300 estudantes universitários, os resultados indicaram importantes diferenças de gênero. Mulheres hipermóveis (mas não os homens) apresentaram correlação entre a ansiedade e a JHM, com especial atenção para a sintomatologia autonômica e pânico. A terceira amostra (87 universitários brasileiros) não apresentou diferenças no que diz respeito à associação entre TAS e JHM. No quarto estudo, desenvolvido com famílias espanholas, a JHM mostrou-se associada ao transtorno de pânico, pânico e agorafobia na primeira avaliação. A JHS foi associada à ansiedade-traço. Na avaliação de seguimento (follow-up), os dados apresentados indicaram aumento do risco para a incidência de pânico e fobia simples entre os participantes com JHS. No estudo desenvolvido com bailarinas, as participantes com JHM apresentaram maior pontuação na subescala de sintomas neurofisiológicos da BAI, embora com pontuação mais baixa na sintomatologia de ansiedade social. A JHS mostrou correlação com as subescalas de sintomas subjetivos e de pânico da BAI e com a SPIN. Os participantes com JHS também apresentaram escores mais altos em itens específicos da BAI, como tremores, medo de perder o controle e dificuldade em respirar, assim como em itens específicos da SPIN, como rubor e maior esforço para evitar críticas. Entre as bailarinas, também foi possível discutir diferenças e características importantes da JHM, JHS e dor ao longo da carreira de balé. Conclusões: A integração de dados desses diversos estudos chama a atenção para a força de características genéticas na associação entre ansiedade e a hipermobilidade. Ela também reforça a importância de identificar claramente a JHM e a JHS como duas condições clínicas diferentes. Em conjunto, os dados destes estudos sugerem que a JHS tem mais indicadores de associação com a ansiedade do que a hipermobilidade isolada\" (JHM). A correlação entre a ansiedade e a JHS é estatisticamente significativa, mas sua força foi moderada. Parece que ansiedade claramente desempenha um papel nos sintomas extra-articulares da JHS, apesar de não ser o único fator relevante nesta condição clínica. / Introduction: Anxiety manifests through physical and autonomic symptoms. Anxiety disorders are usually described as an interaction between somatic symptoms and subjective signs, and it is thus important to understand how those factors are related and co-occur with both psychiatric and non-psychiatric disorders. Thus, anxiety may be associated with diverse medical conditions, among which joint hypermobility. Joint hypermobility (JHM) is characterized by increased joint flexibility. It is a sign of higher elasticity that can even be advantageous for some people in specific activities. On the other hand, joint hypermobility syndrome (JHS) is a more complex condition that includes other clinical symptoms, especially a history of injuries, skin signs, instability and pain. Objectives: The association between anxiety and joint hypermobility was investigated in five studies, developed with three different and independent samples, as follows: a group of university students, a sample of families with high genetic aggregation of anxiety and hypermobility and a sample consisting of ballet dancers. Methods: The first study was developed as a systematic review of the literature. Using a protocol, we conducted a systematic search of articles in the electronic databases PubMed, LILACS, PsycInfo e SciELO, using the keywords anxiety, joint and hypermobility and Boolean operators. The second study was developed as an epidemiological survey, with 2,300 university students of both genders, aged 17-35 years, from two Brazilian universities. Participants completed self-reporting instruments asessing anxiety (Beck Anxiety Inventory BAI), social anxiety (Social Phobia Inventory SPIN) and a screening questionnaire for JHM (the five-part questionnaire for identifying hypermobility). The third study was developed with a convenience sample of the epidemiological study, consisting of 87 university students, divided into two groups, according to the presence or absence of social anxiety disorder (SAD). The volunteers completed the same self-rating instruments and underwent a clinical evaluation that included the Semi-structured Clinical Interview for DSM-IV (SCID-IV) and the Beighton score for JHM. The fourth study had a longitudinal design and included a sample of Spanish families with high genetic aggregation of anxiety and hypermobility. At baseline, the sample consisted of 156 participants; at eight yearsof follow-up, the sample comprised 98 subjects. The volunteers completed self-reting instruments (Fear Survey Schedule [FSS] and Spielberger Stait-Trait Anxiety Inventory [STAI]) and underwent a clinical evalution including the SCID-IV, the Beighton score for JHM and also the Brighton criteria to assess the JHS. Lastly, the fifth study included 145 dancers, divided into three groups: ballet students (n=59), ballet teachers (n=37) and professional ballerinas (n=49). The participants completed self-rating instruments assessing JHM (five-part questionnaire), anxiety (BAI), social anxiety (SPIN), panic (Patient Health Questionnaire - Brief PHQ), depressive symptomatology (PHQ-9), alcohol abuse (FAST) and pain (Brief Pain Inventory [BPI] and Self-Estimated Functional Inability because of Pain [SEFIP]). Ballet dancers also underwent a clinical evaluation based on the Beighton score and Brighton criteria. Results: From 34 articles initially found, 17 were included in the systematic review. In general, they ratified the association between anxiety symptoms (such as fears and psychological distress) and JHM. In regard to anxiety disorders, data were less homogeneous and varied according to the type of disorder, with stronger association between hypermobility and panic disorder. In the second study, which involved a sample of 2,300 university students, results suggested important gender-related differences. Hypermobile women (but not men) presented a correlation between anxiety and JHM, with special emphasis on autonomic and panic symptomatology. The third sample (87 Brazilian university students) did not present significant differences in regard to the association between SAD and JHM. In the fourth study, developed with Spanish families, JHM was associated with panic disorder and panic with agoraphobia at baseline. JHS was associated with trait anxiety at baseline. At follow-up, the data showed an increased risk for the incidence of panic and simple phobia among participants with JHS. Among ballet dancers, participants with JHM had higher scores in neurophysiological subscale of the BAI, but less social anxiety symptomatology. JHS correlated with the subjective and panic subscales of the BAI and with SPIN. Participants with JHS also presented higher scores in specific items of BAI, such as trembling, fear of losing control and difficulty breathing, as in specific items of SPIN, such as blushing and higher efforts to avoid criticism. In the study developed with ballet dancers, it was also possible to discuss differences between important features of JHM, JHS and pain throughout the ballet career. Conclusions: The integrated data of these five studies draw attention to the strength of genetic features in the association between anxiety and hypermobility. Their results also highlighted the importance of clearly identifying JHM and JHS as two different clinical conditions. Taken together, our data suggest that JHS seems to be more consistently associated with anxiety than the isolated hypermobility (JHM). Nevertheless, although the correlation between anxiety and JHS was statistically significant, its strength was moderate. It seems that anxiety clearly play a role in extra-articular symptoms of the JHS, although not being the only relevant factor in this clinical condition.

Introdução: A ansiedade pode se manifestar por meio de sintomas físicos e autonômicos. Os transtornos de ansiedade são geralmente descritos por uma interação de sintomas somáticos e sinais subjetivos, o que aumenta a importância de um conhecimento mais amplo sobre como esses fatores estão relacionados e ocorrem em conjunto com distúrbios psiquiátricos e não psiquiátricas. Assim, a ansiedade pode estar associada a diversas condições médicas, entre as quais a hipermobilidade articular. A hipermobilidade articular (JHM) é caracterizada pelo aumento da flexibilidade das articulações. É um sinal de maior elasticidade que pode até ser vantajoso para algumas pessoas em atividades específicas. Por outro lado, a síndrome da hipermobilidade articular (JHS) é mais ampla do que a JHM, sendo acompanhada de sintomas clínicos, especialmente de histórico de lesões, sinais da pele, instabilidade e dor. Objetivos: A associação entre ansiedade e hipermobilidade articular foi investigada em cinco estudos, desenvolvidos com três amostras diferentes e independentes, como descrito a seguir: um grupo de estudantes universitários, uma amostra de famílias com alta agregação genética de ansiedade e hipermobilidade e uma amostra composta por bailarinas. Método: O primeiro estudo foi desenvolvido por meio de uma revisão sistemática da literatura. Utilizando um protocolo, foi realizada uma pesquisa sistemática de artigos nas bases de dados eletrônicas PubMed, LILACS, PsycINFO e SciELO utilizando as palavras-chave \'anxiety\', \'joint\' e \'hipermobility\' e operadores booleanos. O segundo estudo foi desenvolvido como uma avaliação epidemiológica, com 2.300 estudantes universitários de ambos os sexos, com idade entre 17-35 anos, de duas universidades brasileiras. Os participantes responderam a instrumentos de autorrelato de ansiedade (Inventário de Ansiedade de Beck - BAI), Ansiedade Social (Inventário de Fobia Social - SPIN) e um questionário de screening para JHM (questionário de cinco partes para a identificação da hipermobilidade). O terceiro estudo foi desenvolvido com uma amostra de conveniência, extraída deste estudo epidemiológico, formada por 87 estudantes universitários, divididos em dois grupos, de acordo com a presença ou ausência de Transtorno de Ansiedade Social (TAS). Eles responderam aos mesmos instrumentos de autorrelato e também passaram por uma avaliação clínica, em que responderam à entrevista clínica semiestruturada para o DSM-IV (SCID-IV) e foram avaliadas de acordo com o escore de Beighton para JHM. O estudo seguinte foi desenvolvido através de um desenho longitudinal, avaliando uma amostra de famílias espanholas com alta agregação genética de ansiedade e hipermobilidade. No início do estudo, a amostra foi formada por 156 participantes; em oito anos de seguimento, a amostra foi composta por 98 sujeitos. Os participantes preencheram instrumentos de autorrelato (Inventário de Medo [FSS] e Inventário de Ansiedade Estado-Traço [IDATE]), assim como responderam à SCID-IV e foram avaliados de acordo com o escore de Beighton para JHM e critérios de Brighton para a JHS. Por último, o quinto estudo foi realizado com 145 bailarinas, divididas em três grupos: alunas de balé (n=59), professoras de balé (n=37) e bailarinas profissionais (n=49). As participantes responderam a instrumentos de autorrelato para avaliação da JHM (questionário de screening), ansiedade (BAI), ansiedade social (SPIN), pânico (Patient Health Questionnaire - Brief PHQ), sintomatologia depressiva (PHQ-9), abuso de álcool (FAST) e dor (Inventário breve de dor [BPI] e avaliação da incapacidade funcional por causa da dor [SEFIP]). As bailarinas também foram submetidas a uma avaliação clínica de acordo com o escore de Beighton e os critérios Brighton. Resultados: Dos 34 artigos inicialmente encontrados, 17 foram incluídos na revisão sistemática. Em geral, eles ratificaram a associação entre os sintomas de ansiedade (como medos e sintomas psicológicos) e JHM. No que se refere aos transtornos de ansiedade, os dados se mostraram mais heterogêneos, dependendo do tipo de transtorno, parecendo mais associados ao transtorno de pânico. No segundo estudo, desenvolvido com 2.300 estudantes universitários, os resultados indicaram importantes diferenças de gênero. Mulheres hipermóveis (mas não os homens) apresentaram correlação entre a ansiedade e a JHM, com especial atenção para a sintomatologia autonômica e pânico. A terceira amostra (87 universitários brasileiros) não apresentou diferenças no que diz respeito à associação entre TAS e JHM. No quarto estudo, desenvolvido com famílias espanholas, a JHM mostrou-se associada ao transtorno de pânico, pânico e agorafobia na primeira avaliação. A JHS foi associada à ansiedade-traço. Na avaliação de seguimento (follow-up), os dados apresentados indicaram aumento do risco para a incidência de pânico e fobia simples entre os participantes com JHS. No estudo desenvolvido com bailarinas, as participantes com JHM apresentaram maior pontuação na subescala de sintomas neurofisiológicos da BAI, embora com pontuação mais baixa na sintomatologia de ansiedade social. A JHS mostrou correlação com as subescalas de sintomas subjetivos e de pânico da BAI e com a SPIN. Os participantes com JHS também apresentaram escores mais altos em itens específicos da BAI, como tremores, medo de perder o controle e dificuldade em respirar, assim como em itens específicos da SPIN, como rubor e maior esforço para evitar críticas. Entre as bailarinas, também foi possível discutir diferenças e características importantes da JHM, JHS e dor ao longo da carreira de balé. Conclusões: A integração de dados desses diversos estudos chama a atenção para a força de características genéticas na associação entre ansiedade e a hipermobilidade. Ela também reforça a importância de identificar claramente a JHM e a JHS como duas condições clínicas diferentes. Em conjunto, os dados destes estudos sugerem que a JHS tem mais indicadores de associação com a ansiedade do que a hipermobilidade isolada\" (JHM). A correlação entre a ansiedade e a JHS é estatisticamente significativa, mas sua força foi moderada. Parece que ansiedade claramente desempenha um papel nos sintomas extra-articulares da JHS, apesar de não ser o único fator relevante nesta condição clínica. / Introduction: Anxiety manifests through physical and autonomic symptoms. Anxiety disorders are usually described as an interaction between somatic symptoms and subjective signs, and it is thus important to understand how those factors are related and co-occur with both psychiatric and non-psychiatric disorders. Thus, anxiety may be associated with diverse medical conditions, among which joint hypermobility. Joint hypermobility (JHM) is characterized by increased joint flexibility. It is a sign of higher elasticity that can even be advantageous for some people in specific activities. On the other hand, joint hypermobility syndrome (JHS) is a more complex condition that includes other clinical symptoms, especially a history of injuries, skin signs, instability and pain. Objectives: The association between anxiety and joint hypermobility was investigated in five studies, developed with three different and independent samples, as follows: a group of university students, a sample of families with high genetic aggregation of anxiety and hypermobility and a sample consisting of ballet dancers. Methods: The first study was developed as a systematic review of the literature. Using a protocol, we conducted a systematic search of articles in the electronic databases PubMed, LILACS, PsycInfo e SciELO, using the keywords anxiety, joint and hypermobility and Boolean operators. The second study was developed as an epidemiological survey, with 2,300 university students of both genders, aged 17-35 years, from two Brazilian universities. Participants completed self-reporting instruments asessing anxiety (Beck Anxiety Inventory BAI), social anxiety (Social Phobia Inventory SPIN) and a screening questionnaire for JHM (the five-part questionnaire for identifying hypermobility). The third study was developed with a convenience sample of the epidemiological study, consisting of 87 university students, divided into two groups, according to the presence or absence of social anxiety disorder (SAD). The volunteers completed the same self-rating instruments and underwent a clinical evaluation that included the Semi-structured Clinical Interview for DSM-IV (SCID-IV) and the Beighton score for JHM. The fourth study had a longitudinal design and included a sample of Spanish families with high genetic aggregation of anxiety and hypermobility. At baseline, the sample consisted of 156 participants; at eight yearsof follow-up, the sample comprised 98 subjects. The volunteers completed self-reting instruments (Fear Survey Schedule [FSS] and Spielberger Stait-Trait Anxiety Inventory [STAI]) and underwent a clinical evalution including the SCID-IV, the Beighton score for JHM and also the Brighton criteria to assess the JHS. Lastly, the fifth study included 145 dancers, divided into three groups: ballet students (n=59), ballet teachers (n=37) and professional ballerinas (n=49). The participants completed self-rating instruments assessing JHM (five-part questionnaire), anxiety (BAI), social anxiety (SPIN), panic (Patient Health Questionnaire - Brief PHQ), depressive symptomatology (PHQ-9), alcohol abuse (FAST) and pain (Brief Pain Inventory [BPI] and Self-Estimated Functional Inability because of Pain [SEFIP]). Ballet dancers also underwent a clinical evaluation based on the Beighton score and Brighton criteria. Results: From 34 articles initially found, 17 were included in the systematic review. In general, they ratified the association between anxiety symptoms (such as fears and psychological distress) and JHM. In regard to anxiety disorders, data were less homogeneous and varied according to the type of disorder, with stronger association between hypermobility and panic disorder. In the second study, which involved a sample of 2,300 university students, results suggested important gender-related differences. Hypermobile women (but not men) presented a correlation between anxiety and JHM, with special emphasis on autonomic and panic symptomatology. The third sample (87 Brazilian university students) did not present significant differences in regard to the association between SAD and JHM. In the fourth study, developed with Spanish families, JHM was associated with panic disorder and panic with agoraphobia at baseline. JHS was associated with trait anxiety at baseline. At follow-up, the data showed an increased risk for the incidence of panic and simple phobia among participants with JHS. Among ballet dancers, participants with JHM had higher scores in neurophysiological subscale of the BAI, but less social anxiety symptomatology. JHS correlated with the subjective and panic subscales of the BAI and with SPIN. Participants with JHS also presented higher scores in specific items of BAI, such as trembling, fear of losing control and difficulty breathing, as in specific items of SPIN, such as blushing and higher efforts to avoid criticism. In the study developed with ballet dancers, it was also possible to discuss differences between important features of JHM, JHS and pain throughout the ballet career. Conclusions: The integrated data of these five studies draw attention to the strength of genetic features in the association between anxiety and hypermobility. Their results also highlighted the importance of clearly identifying JHM and JHS as two different clinical conditions. Taken together, our data suggest that JHS seems to be more consistently associated with anxiety than the isolated hypermobility (JHM). Nevertheless, although the correlation between anxiety and JHS was statistically significant, its strength was moderate. It seems that anxiety clearly play a role in extra-articular symptoms of the JHS, although not being the only relevant factor in this clinical condition.

The study aimed to examine whether an experimental imagery intervention, which elicited ecological representations of self, was more effective in enhancing vividness of movement imagery, action control and performance ability than a conventional imagery intervention and/or that of a standard, instruction intervention. In order to test this hypothesis, a sample of 36 young ballet dancers (11-13 years) were secured from five reputable ballet schools and randomly assigned to three groups (n = 12) for the purposes of conducting a true experiment: a standard control group, an imagery control group and an experimental imagery group. Descriptive statistics and frequencies were conducted for all instruments used to describe and represent single variables of interest. Parametric and nonparametric statistical procedures were used to determine whether significant differences existed between the three groups for measures of vividness of movement imagery, action control and performance ability. Additional emerging relationships and trends were explored through bivariate correlational analyses, multiple stepwise regression procedures, a factor analysis as well as MANOVA and ANOVA statistical procedures. The results of the study were varied and some interesting trends were observed. Contrary to what was expected, the results revealed significant differences across the three groups for mean difference scores of performance ability, in favour of the standard control group. In particular, the standard control group revealed positive benefits in performance ability while the imagery control and experimental imagery groups revealed deteriorations in performance ability. The experimental imagery group was found to be significantly different from the imagery control group for mean difference measures of internal vividness ofmovement imagery. However, the study failed to reveal significant variations in mean difference scores for action control across the three groups. Furthermore, the results indicated that external and internal vividness of movement imagery were found to be significantly correlated with performance ability for the entire sample (N = 36) and across the two imagery groups (N = 24) respectively. Finally, numerous significant and near-significant relationships were observed between measures of vividness of movement imagery, action control and performance ability. The results were discussed in relation to the literature on mental imagery, ecological self, action control and development. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

Background: Modern culture has stereotyped the divine female body as one that is continually getting leaner, with the internalization of the “thin” ideal possibly resulting in body dissatisfaction, disturbances in body image and exploitation of extreme weight control measures. These shoddy eating behaviours/attitudes may involve body mass and figure anxiety, sub-optimal nutrition or insufficient energy intake (possibly even a combination of both) and use of pathogenic weight control measures (PWCM). Furthermore, low energy availability can be a consequence of disordered eating (DE) behaviour, but can also inadvertently emerge in the absence of clinical eating disorders, DE behaviours and/or restricted dietary intake. Various researchers have concluded that dancers are overly-concerned about dieting and their body mass, and tend to be discontented with their bodies. Every organ system in the body may potentially be negatively affected as a result of the ensuing undernourishment and/or weight loss related to poor nutritional behaviour. The aim of the study was to investigate the DE behaviour, PWCM use, body image and energy status of a group of University female dancers Methods: Fifty two volunteer (18-30 years) dancers (n=26) matched by controls (n=26) of the same race, and comparable age and body mass index were recruited. DE behaviour was assessed with the Eating disorder inventory-3 (EDI3), Cognitive dietary restraint (CDR) subscale of the Three-factor eating questionnaire (TFEQ) and EDI3 referral form (EDI3-RF) behavioural questions. Body image was assessed using the Body Silhouette Assessment Scale. Energy status was assessed using a 5-day weighed food record to measure energy intake and Actiheart® monitor to measure energy expenditure. Results: Dancers presented with significantly higher EDI3-Drive for thinness, EDI3-Body dissatisfaction and TFEQ-CDR raw subscale scores when compared to controls. Furthermore, the majority of dancers scored above the designated cut-off scores for the EDI3-Drive for thinness (46.2%), EDI3-Body dissatisfaction (61.5%), EDI-Bulimia (53.9%) and TFEQ-CDR (52.0%) subscales. Bingeing was the most common PWCM used by both dancers and controls (19.2% vs. 23.1%), followed by weight loss ≥ 9kg within the preceding 6 months (11.5% vs. 15.4%). Vomiting (7.7%), laxatives (11.5%) and excessive exercise (19.2%) for weight loss were used only by the dancers. Current body weight was significantly different to desired body weight for the dancers only (p=0.0004). The discrepancy between current and ideal body image, also termed Feel Minus Ideal Discrepancy (FID), was significantly different between dancers and controls, and indicated that controls were content with their body silhouette while dancers were inclined to want to lose weight. A negative energy balance was found in 80.8% of both dancers and controls. The energy availability of 48.0% of dancers and 52.0% of controls was between 30 and 45 kcal/kg fat-free mass/day. A total of 65.4% of dancers and 38.5% of controls reported to be currently trying to lose weight. Conclusion: Irrespective of the limitations of this study, noteworthy observations were made pertaining to the DE behaviour, body image, and energy status of a group of South African student women dancers. This group of South African university women dancers were vulnerable to DE behaviour, had a propensity to be greatly displeased with their body image, and possessed a low energy status possibly because they were trying to lose weight. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Background: Modern culture has stereotyped the divine female body as one that is continually getting leaner, with the internalization of the “thin” ideal possibly resulting in body dissatisfaction, disturbances in body image and exploitation of extreme weight control measures. These shoddy eating behaviours/attitudes may involve body mass and figure anxiety, sub-optimal nutrition or insufficient energy intake (possibly even a combination of both) and use of pathogenic weight control measures (PWCM). Furthermore, low energy availability can be a consequence of disordered eating (DE) behaviour, but can also inadvertently emerge in the absence of clinical eating disorders, DE behaviours and/or restricted dietary intake. Various researchers have concluded that dancers are overly-concerned about dieting and their body mass, and tend to be discontented with their bodies. Every organ system in the body may potentially be negatively affected as a result of the ensuing undernourishment and/or weight loss related to poor nutritional behaviour. The aim of the study was to investigate the DE behaviour, PWCM use, body image and energy status of a group of University female dancers Methods: Fifty two volunteer (18-30 years) dancers (n=26) matched by controls (n=26) of the same race, and comparable age and body mass index were recruited. DE behaviour was assessed with the Eating disorder inventory-3 (EDI3), Cognitive dietary restraint (CDR) subscale of the Three-factor eating questionnaire (TFEQ) and EDI3 referral form (EDI3-RF) behavioural questions. Body image was assessed using the Body Silhouette Assessment Scale. Energy status was assessed using a 5-day weighed food record to measure energy intake and Actiheart® monitor to measure energy expenditure. Results: Dancers presented with significantly higher EDI3-Drive for thinness, EDI3-Body dissatisfaction and TFEQ-CDR raw subscale scores when compared to controls. Furthermore, the majority of dancers scored above the designated cut-off scores for the EDI3-Drive for thinness (46.2%), EDI3-Body dissatisfaction (61.5%), EDI-Bulimia (53.9%) and TFEQ-CDR (52.0%) subscales. Bingeing was the most common PWCM used by both dancers and controls (19.2% vs. 23.1%), followed by weight loss ≥ 9kg within the preceding 6 months (11.5% vs. 15.4%). Vomiting (7.7%), laxatives (11.5%) and excessive exercise (19.2%) for weight loss were used only by the dancers. Current body weight was significantly different to desired body weight for the dancers only (p=0.0004). The discrepancy between current and ideal body image, also termed Feel Minus Ideal Discrepancy (FID), was significantly different between dancers and controls, and indicated that controls were content with their body silhouette while dancers were inclined to want to lose weight. A negative energy balance was found in 80.8% of both dancers and controls. The energy availability of 48.0% of dancers and 52.0% of controls was between 30 and 45 kcal/kg fat-free mass/day. A total of 65.4% of dancers and 38.5% of controls reported to be currently trying to lose weight. Conclusion: Irrespective of the limitations of this study, noteworthy observations were made pertaining to the DE behaviour, body image, and energy status of a group of South African student women dancers. This group of South African university women dancers were vulnerable to DE behaviour, had a propensity to be greatly displeased with their body image, and possessed a low energy status possibly because they were trying to lose weight. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Based on the author's Thesis (M. Phil.)--University of the West Indies, Mona, Jamaica, 2001. / Includes bibliographical references, discography, videography (p. 146-159) and index.

Thesis (Ph.D.)--Tufts University, 2001. / Adviser: Laurence Senelick. Submitted to the Dept. of Drama. Includes bibliographical references (leaves 177-188). Access restricted to members of the Tufts University community. Also available via the World Wide Web;

Thesis (M.A.)--Florida State University, 2005. / Advisor: Dr. John O. Perpener III, Florida State University, School of Visual Arts and Dance, Dept. of Dance. Title and description from dissertation home page (viewed June 8, 2005). Document formatted into pages; contains vi, 87 pages. Includes bibliographical references.