Graduated in Physical Education (Bachelor's and Bachelor's degrees), master's degree in sports science, and currently a doctoral student, both at the Federal University of Minas Gerais.
Association Between Objective Sleep and Clinical Outcomes in Older Adults With Low Back Pain Receiving Physical Therapy Care: A Secondary Analysis of a Responsiveness Study Samuel Silva, Rafael Zambelli Pinto, Gabriel Mendes, Raimundo Lucas Santos, Isadora Grade, et al. Journal of Aging and Physical Activity, 2025 Background/Objectives: Sleep seems to be associated with worse low back pain (LBP) outcomes in older adults; however, studies investigating the association of objective sleep with future changes in LBP outcomes are lacking. The objectives of this study are as follows: (a) to investigate the association between objectively measured sleep with changes in clinical outcomes in older adults with LBP receiving physical therapy care and (b) to examine the cross-sectional association between sleep and pain catastrophizing. Methods: This was a prospective cohort study. We recruited older adults (≥60 years old) with chronic LBP undergoing physical therapy treatment. At baseline, we assessed participants’ sleep (actigraphy for 10–14 days), pain intensity, disability, pain catastrophizing, and covariates. After 8 weeks, we reassessed pain intensity, disability, and self-perceived recovery. We ran linear regression models and Spearman coefficient tests. Results: Fifty-eight participants were included, and 51 completed follow-up assessments (60.8% women; mean age 70.1 ± 5.6 years). We found no associations between sleep quantity and efficiency with changes in pain intensity, disability, and self-perceived recovery after 8 weeks of physical therapy care. We found a correlation between sleep fragmentation and pain catastrophizing (r = .30; 95% confidence interval: [.03, .54]). Conclusion: Objective sleep quantity and efficiency may not be associated with changes in LBP outcomes after physical therapy care in older adults. Among the sleep domains evaluated, sleep fragmentation may be the sleep domain with the strongest association with pain catastrophizing. Significance/Implications: Objectively measured sleep might not be a prognostic factor for LBP improvement in older adults. Future studies should explore the association between sleep fragmentation and pain catastrophizing.
Knowledge About Sleep, Sleep Hygiene, and Sleep Behaviors of Paralympic Athletes Isadora Grade, Andrea M. Esteves, Fábio S. Lira, Camila S. Padilha, Eduardo Stieler, et al. Journal of Sport Rehabilitation, 2025 Context: Understanding Paralympic athletes’ perspectives on the importance of sleep is the first step toward developing effective sleep hygiene (SH) strategies. We aim to describe and compare the knowledge about SH and sleep behaviors practiced by medalists and nonmedalists Paralympic athletes at the Tokyo 2020 Paralympic Games and between sexes (female vs male), identify whether the coaching staff encourages SH, and the perspective of these athletes on the importance of SH. Methods: 98 Paralympic athletes responded to the Sleep Beliefs Scale and the Athlete Sleep Behavior Questionnaire-BR. Results: Medalists (68%) and nonmedalists (78%) Paralympic athletes had low knowledge about SH (60% vs 55%; P = .20), with no difference between groups. The Athlete Sleep Behavior Questionnaire-BR score (48.7 [5.9]) for all Paralympic athletes (n = 98) indicated high practice of maladaptive sleep behaviors. Male athletes had significantly worse sleep behaviors than female athletes (49.1 [6.0] vs 39.5 [7.2]; P < .01) and less knowledge about behaviors that can affect sleep (64% vs 72%; P < .05), 26% of Paralympic athletes considered SH practices necessary, and the frequency of coaching staff encouraging SH was higher among medalists Paralympic athletes compared to nonmedalists athletes (29% vs 13%, P = .04). Conclusions: Most Paralympic athletes have inadequate sleep behaviors and knowledge about SH. There was no difference between knowledge about SH and sleep behaviors between medalists and nonmedalists Paralympic athletes, although medalists athletes were more encouraged to practice SH. Male Paralympic athletes had worse sleep behaviors and worse knowledge about SH than female athletes.
The Sleep Parameters of Olympic Athletes: Characteristics and Assessment Instruments Marco Túlio de Mello, Eduardo Stieler, Isadora Grade, André Fernandes Chaves Filho, Gabriel Mendes, et al. International Journal of Sports Medicine, 2024 This systematic review aims to identify the sleep parameters of Olympic athletes and the instruments used to assess and monitor the sleep of these athletes. The search was conducted until February 2023 and was performed in PubMed, Web of Science, and Scopus databases. This systematic review has included studies that investigated at least one of the following sleep parameters: total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), awakenings after sleep onset (WASO), quality of sleep, daytime sleepiness, and chronotype; the participants were Olympic athletes. The search returned a total of 280 studies. After screening based on exclusion and inclusion criteria, 11 studies were included. The main results demonstrate that Olympic athletes have TST of 06:10 h, SE of 84%, SOL of 28 min, and WASO of 49 min. The most predominant chronotype is indifferent; over half of the athletes have poor sleep quality and complaints. Furthermore, actigraphy was the most used method to assess sleep. It is concluded that Olympic athletes have TST, SE, and WASO poor than the recommended values. In addition, sleep complaints and poor sleep quality were also observed. Among the objective sleep assessment methods, actigraphy was the method most frequently used in this population.
Cross-cultural adaptation of the Brazilian version of the Athlete Sleep Behavior Questionnaire Lucas Alves Facundo, Maicon Rodrigues Albuquerque, Andrea Maculano Esteves, Matthew W Driller, Isadora Grade, et al. Sleep Science, 2023 Introduction: Considering the specificity of the sporting context and the influence of sleep on athletic performance, the “athlete sleep behavior questionnare” (ASBQ) was developed to evaluate sleep behavior in English-speaking athletes. Objective: The aim of this study was to perform a cross-cultural adaptation and validation of the ASBQ in Brazilian athletes. Methods: The cross-cultural adaptation was processed by procedures of translation and back-translation. Content validity was performed by 9 experts, calculating the coefficient of content validity for the equivalence of the individual items (Cvci) and the total global score (Cvct), in addition we conducted a pilot study using the translated version of the questionnaire. The next phase of the study included 52 athletes completing the translated ASBQ. The reliability of the questionnaire was assessed by the intraclass correlation coefficient (ICC), standard error of measurement (SEM) and by Cronbach’s alpha (α). Results: The ASBQ passed the process of cross-cultural adaptation, obtaining the Brazilian Version of the ASBQ (ASBQ-BR), and with acceptable values of Cvci (0.89-1.00) and Cvct (0.96). Additionally, the ASBQ-BR showed acceptable values of reliability (ICC=0.857; Cronbach’s α=0.78) and a SEM of 3.05 AU. Conclusion: The ASBQ was translated to a newly developed ASBQ-BR, resulting in acceptable values for content validity and reliability. The ASBQ-BR provides a valuable tool for monitoring sleep behaviors in Brazilian athletes.
The Sleep Parameters of Paralympic Athletes: Characteristics and Assessment Instruments Isadora Grade, Henrique Andrade, Renato Guerreiro, Eduardo Stieler, Flavia R. da Silva, et al. Journal of Sport Rehabilitation, 2023 Context: Sleep serves many important functions for athletes, particularly in the processes of learning, memory, recovery, and cognition. Objectives: Define the sleep parameters of Paralympic athletes and identify the instruments used to assess and monitor sleep Paralympic athletes. Evidence Acquisition: This systematic review was carried out based on the PRISMA guidelines. The survey was conducted in April 2020, the searches were carried out again in September 2021 to check whether there were new scientific publications in the area of sleep and Paralympic sport, searches were performed in the following databases: PubMed, Web of Science, Scopus, SPORTDiscus, Virtual Health Library (BIREME), and SciELO. This systematic review has included studies that investigated at least one of the following sleep parameters: total sleep time, sleep latency, sleep efficiency, number of awakenings, quality of sleep, daytime sleepiness, and chronotype; the participants were comprised of athletes with disabilities. Studies published at any time in English, Portuguese, and Spanish, were included. Evidence Synthesis: Data extraction and study selection were performed by 2 researchers independently, and a third author was consulted as necessary. The search returned a total of 407 studies. Following the screening based on exclusion and inclusion criteria, a total of 13 studies were considered. Paralympic athletes have a low amount (7.06 h) of sleep with poor quality and sleep latency (28.05 min), and 57.2% have daytime sleepiness, with the majority belonging to the indifferent chronotype (53, 5%). Moreover, 11 studies assess sleep using subjective instruments (questionnaires), and 2 studies used an objective instrument (actigraphy). Conclusions: Sleep disorders are common among Paralympic athletes, poor sleep quality and quantity, and high rates of daytime sleepiness. Subjective methods are most commonly used to assess sleep.
Effect of Paralympic powerlifting training on sleep and its relationship with training load Eduardo Stieler, Flávia R. Silva, Isadora Grade, Henrique A. Andrade, Renato C. Guerreiro, et al. Motriz Revista De Educacao Fisica, 2022 - Aim: This study aims to compare the sleep parameters in Paralympic powerlifting athletes during days with and without training, and to analyze the relationship between the training load and sleep on the same day and the relationship between the previous night's sleep and the training load of the following day. Methods: Actigraphy was used to analyze the sleep parameters of 11 Paralympic powerlifting athletes for 14 days (7 days without and with train-ing), whereas Ratings of Perceived Exertion (RPE) analysis was used to assess training load. In addition, the Horne and Östberg chronotype questionnaire and the Epworth Sleepiness Scale were applied. Results: Athletes show morning and indifferent chronotype and low daytime sleepiness. We found that on training days, sleep onset latency (SOL) was lower (average 5.3 min faster), whereas total sleep time (TST) and sleep efficiency (SE) were higher (TST averaged 169 min and SE 7% higher) compared to non-training days. In addition, the TST of the night before the training days correlated positively with the RPE of the following day, and the training volume correlated negatively with the SE of the same day. Conclusion: Our findings show that Paralympic powerlifting training had positive effects in increasing TST and SE and decreasing SOL on training days. These results show the positive effects of this type of training in improving sleep in athletes with physical disabilities. In addition, a good night's sleep the day before training can make it possible to put more effort into the next day's training. Therefore, guiding athletes to sleep more before training with more intense loads is recommended.
