Introdução: A insuficiência cardíaca (IC) é uma síndrome multissistêmica via final comum de diversas doenças cardíacas que cursa com redução da capacidade funcional e sintomas como fadiga muscular, dispneia e piora na qualidade de vida. Para melhorar a capacidade respiratória e funcional desses pacientes, estratégias voltadas ao fortalecimento muscular podem ser utilizadas, tais como o treinamento muscular inspiratório e o fortalecimento muscular periférico. Objetivo: Avaliar os efeitos de um programa de treinamento combinado muscular inspiratório e periférico de baixa intensidade (TBI) e de moderada intensidade (TMI) sobre a força muscular respiratória, a capacidade funcional e a qualidade de vida de pacientes com IC avançada. Métodos: Cinquenta e três pacientes com idade >= 18 anos, New York Heart Association (NYHA) classe funcional II-III e fração de ejeção do ventrículo esquerdo < 40% foram randomizados em grupo Controle (sem intervenção), TBI (15% da pressão inspiratória máxima e 0,5 kg de carga periférica) ou TMI (30% da pressão inspiratória máxima e 50% da 1 repetição máxima). Ambos os programas de treinamento foram aplicados ao longo de 8-semanas e 7 sessões/semana com duração de 45 minutos cada sessão. Nós avaliamos ao longo do estudo: qualidade de vida, força muscular respiratória, função pulmonar, inflamação de vias aéreas, força muscular periférica, distância percorrida e classificação funcional NYHA. Resultados: Após 8-semanas, todos os pacientes dos grupos Controle (n=9), TBI (n=13) e TMI (n=13) relataram melhora de 10% na qualidade de vida. Os programas TBI e TMI resultaram em melhora da força muscular inspiratória (24 e 33%, respectivamente), força muscular periférica de membros superiores (41 e 72%, respectivamente) e de membros inferiores (28 e 47%, respectivamente) além de aumentar a distância percorrida (9 e 16%, respectivamente). O TMI também levou à melhora da força muscular expiratória e a melhora da classe funcional NYHA. Conclusões: O TMI melhorou a força muscular inspiratória, expiratória e periférica, distância caminhada e classe funcional da NYHA em pacientes com IC. No entanto, o TBI também foi benéfico para aumentar a força muscular inspiratória, a força muscular periférica e a distância percorrida. Dessa forma, o TBI é um método eficiente de reabilitação para pacientes com IC debilitados e/ou à espera de transplante cardíaco / Introduction: Heart failure (HF) is a multisystem syndrome and a final common pathway of several cardiovascular diseases that results in reduction of the functional capacity and symptoms such as early fatigue, dyspnea and reduction in quality of life. To improve the respiratory and functional capacity of these patients, strategies such as peripheral muscle strengthening and inspiratory muscle strengthening can be used. Objective: To assess the effects of a combined inspiratory and resistance training at low intensity (LRT) and moderate intensity (MRT) on the respiratory muscle strength, functional capacity and quality of life in patients with HF. Methods: Fifty-three patients aged >= 18 years, New York Heart Association (NYHA) functional class II-III and left ventricular ejection fraction < 40% were randomly assigned to a control group (non-exercise), the LRT group (15% maximal inspiratory workload and 0.5 kg of peripheral muscle workload) or the MRT group (30% maximal inspiratory workload and 50% of 1 maximum repetition peripheral muscle workload). Both training programs were performed along 8-weeks and 7 sections/week with 45 min each exercise section. We assessed quality of life using questionnaires, respiratory muscle strength, pulmonary function, airway inflammation, peripheral muscle strength, walking distance and NYHA functional class along the study period. Results: After 8- weeks, all patients from Control (n=9), LRT (n=13) and MRT (n=13) reported 10% improvement in quality of life. LRT and MRT resulted in respiratory muscle improvement (24 and 33%, respectively) and peripheral muscle strength in upper limbs (41 and 72%, respectively) and in lower limbs (28 and 47%, respectively), besides improvement in walking distance (9 and 16%, respectively). The MRT also improved expiratory muscle strength and NYHA functional class. Conclusions: The MRT improved inspiratory, expiratory and peripheral muscle strength, walking distance and NYHA functional class in HF patients. However, the LRT also was beneficial to improve inspiratory and peripheral muscle strength and walking distance. Therefore, LRT is an efficient rehabilitation method for both debilitated HF patients and/or for patients awaiting cardiac transplantation

INTRODUÇÃO: A obesidade é uma doença universal de prevalência crescente e vem adquirindo proporções epidêmicas, sendo um dos principais problemas da saúde pública modernos. Constitui consenso que a abordagem clínica geralmente é ineficaz e a cirurgia bariátrica se apresenta como melhor opção de tratamento. A cirurgia bariátrica é atualmente a única modalidade terapêutica a oferecer perda de peso maciça e mantida ao longo do tempo a pacientes obesos mórbidos. OBJETIVO: Determinar se um programa de fisioterapia respiratória pré-operatória melhora a função pulmonar do paciente e verificar a relação entre quadro (clínico apnéia do sono e/ou espirometria) e circunferências do pescoço, tórax e abdominal. MATERIAIS E MÉTODOS: Foram selecionados 34 pacientes portadores de obesidade mórbida e candidatos a cirurgia bariátrica, com sinais clínicos de apnéia do sono (ronco, sono agitado, dor de cabeça matinal e sono diurno excessivo) e/ou espirometria com padrão restritivo, obstrutivo, inespecífico ou misto. Os pacientes foram selecionados de acordo com sua disponibilidade para aderir ao preparo pré-operatório e que aceitaram participar do estudo assinando o termo de consentimento livre e esclarecido. Os pacientes eram de ambos os sexos, idade entre 20 a 75 anos. Todos os pacientes foram submetidos a duas avaliações fisioterapêuticas: 15 dias antes da cirurgia e a outra na véspera, sendo analisadas as seguintes variáveis: circunferências do pescoço, tórax, abdome e quadril, IMC, FR, SpO2, capacidade vital lenta, volume minuto , PImax, PEmax , espirometria, índice de percepção de esforço de Borg e sinais clínicos de apnéia do sono. Foram constituídos dois grupos, grupo controle G1 e grupo experimental G2. A diferenciar os grupos de estudo, um programa de fisioterapia respiratória pré-operatória foi oferecido aos doentes G2, mas não aos doentes G1. RESULTADOS: Dentre as variáveis analisadas, mostraram diferença estatisticamente significante principalmente as relações: VEF1/CVF 1 e VEF1/CVF 2 do G1 e G2 (p-valor =0,030 e 0,005); PImáx (p-valor=0,032) e FR (p-valor=0,001), IPE de Borg (p=0,001), SpO2 (p=0,001) do G2. Os pacientes com sinais clínicos de apnéia têm circunferência de tórax e abdominal maiores em relação aos pacientes sem sinais clínicos de apnéia (p=0,012 e p=0,021). CONCLUSÃO : Um programa de fisioterapia respiratória é capaz de melhorar volumes, capacidades pulmonares e força da musculatura respiratória em pacientes obesos mórbidos em preparo pré-operatório para cirurgia bariátrica. / BACKGROUND: Obesity is an increasingly prevalent universal disease acquiring epidemic proportions and is one of the main problems of modern public healthcare. There is consensus that the clinical approach is usually ineffective in more serious cases of obesity and bariatric surgery constitutes a better treatment option. Bariatric surgery is currently the best therapeutic modality for massive weight loss maintained over time and consequently offers a cure or control of associated diseases, which is its main goal. AIM: The aim of the present study was to determine the effect of an intensive preoperative chest physiotherapy program on morbidly obese patients scheduled to undergo bariatric surgery with the intention of improving lung function and verify the relationship between clinical (sleep apnea and spirometry) and circumferences of the neck, chest and abdominal. MATERIALS AND METHODS: Thirty-four morbidly obese candidates for bariatric surgery with clinical symptoms of sleep apnea (snoring, restless sleep, morning headaches and excessive daytime sleep) and/or a restrictive, obstructive, nonspecific or mixed spirometry pattern were selected. The selection of patients for surgical treatment was supervised by the Department of Obesity Surgery of the University Hospital of the University of São Paulo. Patients were selected based on their availability regarding the preoperative therapy, willingness to participate in the study and having signed a term of informed consent. Male and female participants between 20 and 75 years of age were included. All were submitted to preoperative chest physiotherapy program and two evaluations: 15 days prior to surgery and a second 1 day prior to surgery. The following variables were analyzed: circumference of the neck, chest, abdomen and hip; body mass index (BMI); respiratory rate (RR); arterial oxygen saturation (SpO2); slow vital capacity (SVC); minute volume (Vol-min); maximal inspiratory pressure (MIP); spirometry; Borg Rate of Perceived Exertion (RPE); and clinical signs of sleep apnea. Two groups: control group (G1) and experimental group (G2). The G2 was submitted a program of preoperative respiratory therapy. RESULTS: There were favorable significant differences between evaluations for the following variables: FEV1/FVC 1 and VEF1/CVF 2 of G1 and G2 (p-valor =0.030 and 0.005) MIP (p = 0.032); RR (p = 0.001); Borg RPE (p = 0.001); SpO2 (p = 0.001) of G2. CONCLUSION: A chest physiotherapy program is capable of improving lung volume, lung capacity and respiratory muscle strength in morbidly obese patients in preoperative preparation for bariatric surgery. There is correlation between thorax and abdominal circumference and clinical symptoms of obstructive sleep apnea.

Background: Breathing exercises are widely used after cardiac surgery. The duration of exercises in the immediate postoperative period is not fully evaluated and only limited data regarding the effects of home-based breathing exercises after discharge from hospital have been published. Aim: The overall aim of this thesis was to evaluate the effects of deep breathing exercises with positive expiratory pressure (PEP) and describe lung function and respiratory muscle strength in patients undergoing cardiac surgery. Participants and settings: Adult participants (n=131) were randomised to perform either 30 or 10 deep breaths with PEP per hour during the first postoperative days (Study I): the main outcome was oxygenation, assessed by arterial blood gases, on the second postoperative day. In Study III, 313 adult participants were randomly assigned to perform home-based deep breathing exercises with PEP for two months after surgery or not to perform breathing exercises with PEP after the fourth to fifth postoperative day. The main outcome was lung function, assessed by spirometry, two months after surgery. Studies II and IV were descriptive and correlative and investigated pre and postoperative lung function, assessed by spirometry, and respiratory muscle strength, assessed by maximal inspiratory pressure, and maximal expiratory pressure. Results: On the second postoperative day, arterial oxygen tension (PaO2) and arterial oxygen saturation (SaO2) was higher in the group randomised to 30 deep breaths with PEP hourly. There was no improved recovery of lung function in participants performing home-based deep breathing exercises two months after cardiac surgery, compared to a control group. Subjective experience of breathing or improvement in patient perceived quality of recovery or health-related quality of life did not differ between the groups at two months. Lung function and respiratory muscle strength were in accordance with predicted values before surgery. A 50% reduction in lung function was shown on the second postoperative day. High body mass index, male gender and sternal pain were associated with decreased lung function on the second postoperative day. Two months postoperatively, there was decreased lung function, but respiratory muscle strength had almost recovered to preoperative values. / <p></p><p></p>

Essential voice tremor (EVT) is a voice disorder that results from dyscoordination within the laryngeal musculature, which negatively impacts the symmetrical motion of the vocal folds. Several investigators have shown that individuals with EVT experience difficulty speaking and a reduced quality of life (QOL; Cohen, Dupont, & Courey, 2006; Verdonck-de Leeuw & Mahieu, 2004). While traditional voice therapy has been ineffective in lessening the severity of vocal tremor, a current approach (Barkmeier- Kraemer, Lato, & Wiley, 2011) designed to lessen the perception of vocal tremor has resulted in reported patient satisfaction with little actual change in voice quality. The present study focused on achieving positive voice changes by targeting the physiological aspects of voice production that may be altered through inspiratory breathing techniques, i.e., increased lung volume pressure and laryngeal lowering. The hypothesis was that such changes could result in reductions in vocal tremor and lead to perceived improvements in voice quality and concomitant increases in the participant's QOL. An ABAB (treatment reversal) single subject design was used to assess the effectiveness of inspiratory breathing exercises on reducing the severity of tremor in three women diagnosed with EVT. Pre-treatment measures were administered, and participant progress was determined after one week of treatment (post-treatment #1), a week of no treatment, and another week of treatment (post-treatment #2). The following measures were gathered from each participant to document treatment progress and effectiveness:lung pressure volume levels, Voice Handicap Index (VHI) ratings, acoustic analyses of isolated vowels, and perceptual ratings on the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), as well as untrained listener ratings of vocal steadiness and pleasantness. Physiological, QOL, acoustic, and perceptual data did not triangulate to demonstrate treatment effectiveness. However, individual treatment effects were found in increases in lung pressure volume for participant 1, decreases in CAPE-V scores for participant 3, and decreases in VHI scores for participants 1 and 3. Changes in voice acoustics and untrained listener perceptions were negligible. Thus, the results from this study indicate that inspiratory breathing exercises may show some promise in improving voice and QOL in certain tremor patients and that this technique warrants further research consideration.

Background: Positive expiratory pressure (PEP) and continuous positive airway pressure (CPAP) are two forms of resistance breathing used in spontaneously breathing patients. With a threshold resistor or a flow resistor, both PEP and CPAP provide a positive (elevated) pressure level during the expiratory phase. With PEP, inspiratory pressure is negative, i.e. lower than ambient air pressure, as during a normal inspiration, but with CPAP, the inspiratory pressure is positive, i.e. higher than ambient air pressure. Methods: This thesis is based on four separate studies in which four different breathing devices, a PEP-bottle (threshold resistor device), a PEP-mask (flow resistor device), a threshold resistor CPAP and a flow resistor device were investigated. Paper I, II and III are based on studies in healthy volunteers. Paper IV is a bench study performed in a hypobaric chamber. Paper I examined differences between two PEP devices, the PEP-bottle and the PEP-mask. Paper II evaluated the performance of a flow resistor CPAP device, (Boussignac CPAP). Paper III investigated the effect of two PEP-devices, a PEP-bottle and a PEP-mask and two CPAP devices, a threshold resistor CPAP and a flow resistor CPAP, on inspiratory capacity (IC). In paper IV, the effect of changes in ambient pressure on preset CPAP levels in two different CPAP devices was compared. Results: With the PEP bottle, both expiration and inspiration began with a zero-flow period during which airway pressure changed rapidly. With the PEP-mask, the zero-flow period was very short and the change in airway pressure almost non-existent (paper I). During normal breathing with the Boussignac CPAP, changes in airway pressure were never large enough to reduce airway pressure below zero. During forced breathing, as airflow increased, both the drop in inspiratory airway pressure and the increase in expiratory airway pressure were potentiated (paper II). IC decreased significantly with three of the breathing devices, the PEP-mask and the two CPAP devices (paper III). With the threshold resistor CPAP, measured pressure levels were close to the preset CPAP level. With the flow resistor CPAP, as the altitude increased CPAP produced pressure levels increased (paper IV). Conclusion: The effect on airway pressure, airflow, IC and the effect of changes in ambient air pressure differ between different kinds of resistance breathing devices. These differences in device performance should be taken into consideration when choosing the optimal resistance breathing device for each patient.

Orientador: Alfredo Pereira Junior / Resumo: INTRODUÇÃO: O aprendizado de habilidades de autorregulação contribui para um adequado desenvolvimento neurobiológico e psicossocial na infância. Neste estudo, investigamos a respiração como ferramenta para promover a autorregulação em crianças em idade pré-escolar. A modulação respiratória tem sido utilizada como técnica na promoção da regulação psicofisiológica, devido à sua ação benéfica sobre o funcionamento do sistema nervoso autônomo (SNA), ao seu importante papel na regulação do metabolismo e por promover o alinhamento de sistemas oscilatórios do corpo. O estudo teve como objetivos avaliar a capacidade de aprendizagem de uma técnica de respiração em crianças pré-escolares, contribuir para o entendimento de como a modulação respiratória atua sobre suas fisiologias e apoiar o desenvolvimento de estratégias educacionais e programas de intervenção em saúde que adotem a respiração como um método para promover a autorregulação psicofisiológica em crianças. MÉTODOS: Participaram do estudo 42 crianças na faixa etária entre cinco e seis anos. Todas receberam um treinamento diário, com duração de oito semanas, para a prática de uma técnica respiratória (respiração lenta, profunda, com tempos iguais de inspiração e expiração). Para a avaliação dos efeitos da respiração sobre o SNA, foram feitas análises da variabilidade da frequência cardíaca (VFC) nos domínios da coerência cardiorrespiratória, do tempo, da geometria, da frequência e do caos (não-linearidade). Dados da VFC (inter... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

The main task of this thesis was an examination of breathing stereotypes on selected students of Pedagogical faculty aged from 19 to 25. The other objective was to develop an intervention programme according to which the selected students participated in six weeks lasting workouts that were focused on breath training with consecutive heightening of their physical efficiency. A method of content analysis was used for analysing literature and a method of content synthesis was used for application of gathered information and for creating the intervention programme. For the examination of breathing stereotypes a muscle dynamometer was used which is able to record a movement dynamics and simultaneously to record a breathing activity dynamics. The vital capacity was measured through a forced expiratory vital capacity (FVC) when also a value of one second exhale was recorded (FEV1). This test was performed in standing upright position on the machine Spirometr Otthon, evaluation was processed in the Thorsoft programme. The study was participated by six students who at first passed out an entrance examination where the main values were defined, then the intervention programme and after the end of it the participants underwent a checking (output) examination. During processing of the thesis it was confirmed that the developed intervention programme, which is based on aerobic exercises and completed with resistance training, has a factual and statistical significant effect on strengthening the respiratory muscles which are activated by the diaphragmatic breathing within resting breathing and deepened breathing. For the determination of the substantive significance the Cohen's d was used, then the paired Student´s t test for dependent samples.

Made available in DSpace on 2014-06-11T19:22:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-12-17Bitstream added on 2014-06-13T19:49:08Z : No. of bitstreams: 1 mizuno_j_me_rcla.pdf: 1272357 bytes, checksum: 1cd5b2fb9250513c2c65f7d1e2e82154 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A prática de exercícios de Yoga pode proporcionar inúmeros benefícios à saúde, atuando como terapia complementar em patologias como a hipertensão arterial. O objetivo deste estudo foi descrever os efeitos de uma combinação de seqüências de práticas de yoga realizadas durante quatro meses sobre os parâmetros hemodinâmicos (frequência cardíaca e pressão arterial), bioquímicos (concentração plasmática de colesterol e suas frações, triglicerídeos e glicemia) e a percepção da qualidade de vida em pacientes portadores de hipertensão arterial. Trinta e três voluntários (64±9 anos) participaram do estudo. Três homens e 14 mulheres (68±7 anos) realizaram aulas de yoga durante quatro meses (GY), enquanto dois homens e 14 mulheres (58±8 anos) constituíram o grupo controle (GC), sem intervenção. Os alunos do GY compareceram nas aulas três vezes por semana e realizaram exercícios de yoga em uma seqüência composta por alongamentos, exercícios de respiração, posturas do yoga, relaxamento e meditação. Durante o experimento foram observadas a pressão arterial sistólica e diastólica, frequência cardíaca e respiratória, perfil bioquímico (glicemia de jejum, colesterol total, LDL-colesterol, HDL-colesterol e triglicerídeos) e qualidade de vida (SF-36). Os dados foram submetidos a análise estatística para verificar a normalidade (Shapiro Wilk), a diferença entre os grupos (Mann-Whitney) e entre momentos pré e pós intervenção (Wilcoxon); a variação ao longo dos meses (ANOVA para medidas repetidas) e correlação entre valores iniciais e diferenças finais (Sperman). Foi adotado nível de significância de p<0,05. Os resultados apontaram melhora significativa no valor médio de pressão arterial sistólica final do GY comparado com o valor inicial (113,8±7,7 versus 120,7±7,9; p<0,05), enquanto a pressão arterial diastólica não apresentou diferenças... / The practice of Yoga exercises can provide numerous health benefits, acting as a complementary therapy in diseases like hypertension. The aim of this study was to describe the effects of a combination of yoga sequences carried out during four months, on the hemodynamic parameters (heart rate and blood pressure), biochemical (plasma cholesterol concentrations and its fractions, triglycerides and glucose) and the perception of quality of life in hypertension patients. Thirty-three volunteers (64 ± 9 years) participated in the study. Three men and 14 women (68 ± 7 years) conducted yoga classes for four months (YG), while two men and 14 women (58 ± 8 years) constituted the control group (CG) without intervention. The yoga goers attended the YG classes three times a week and did yoga exercises in a sequence consisting of stretching, breathing exercises, yoga postures, relaxation and meditation. During the experiment it was measured systolic and diastolic blood pressure, heart rate and respiratory rate, biochemical profile (fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides) and quality of life (SF-36). Data were subjected to statistical analysis to ensure normality (Shapiro Wilk), the difference between the groups (Mann-Whitney test) and between pre and post intervention (Wilcoxon), the variation over the months (repeated measures ANOVA) and correlation differences between initial and final values (Spearman). The significance level was p <0.05. The results showed significant improvement in the average of final systolic blood pressure compared with the initial value (113.8 ± 7.7 versus 120.7 ± 7.9, p <0.05) in the YG, while diastolic blood pressure did not showed differences between times. In the CG the initial and final mean of systolic and diastolic blood pressure showed no difference statistically significant. Regarding the biochemical profile, we found... (Complete abstract click electronic access below

Submitted by Marina Zuanazzi Cruz null (marinazc@hotmail.com) on 2016-09-21T14:18:58Z No. of bitstreams: 1 Tese - Marina Z. Cruz - final.pdf: 1398751 bytes, checksum: c4afab40b411c2d5066794106ac0d9a5 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-09-26T19:08:39Z (GMT) No. of bitstreams: 1 cruz_mz_dr_bot.pdf: 1398751 bytes, checksum: c4afab40b411c2d5066794106ac0d9a5 (MD5) / Made available in DSpace on 2016-09-26T19:08:39Z (GMT). No. of bitstreams: 1 cruz_mz_dr_bot.pdf: 1398751 bytes, checksum: c4afab40b411c2d5066794106ac0d9a5 (MD5) Previous issue date: 2016-08-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / INTRODUÇÃO: O aprendizado de habilidades de autorregulação contribui para um adequado desenvolvimento neurobiológico e psicossocial na infância. Neste estudo, investigamos a respiração como ferramenta para promover a autorregulação em crianças em idade pré-escolar. A modulação respiratória tem sido utilizada como técnica na promoção da regulação psicofisiológica, devido à sua ação benéfica sobre o funcionamento do sistema nervoso autônomo (SNA), ao seu importante papel na regulação do metabolismo e por promover o alinhamento de sistemas oscilatórios do corpo. O estudo teve como objetivos avaliar a capacidade de aprendizagem de uma técnica de respiração em crianças pré-escolares, contribuir para o entendimento de como a modulação respiratória atua sobre suas fisiologias e apoiar o desenvolvimento de estratégias educacionais e programas de intervenção em saúde que adotem a respiração como um método para promover a autorregulação psicofisiológica em crianças. MÉTODOS: Participaram do estudo 42 crianças na faixa etária entre cinco e seis anos. Todas receberam um treinamento diário, com duração de oito semanas, para a prática de uma técnica respiratória (respiração lenta, profunda, com tempos iguais de inspiração e expiração). Para a avaliação dos efeitos da respiração sobre o SNA, foram feitas análises da variabilidade da frequência cardíaca (VFC) nos domínios da coerência cardiorrespiratória, do tempo, da geometria, da frequência e do caos (não-linearidade). Dados da VFC (intervalos de tempo de batimento a batimento) foram coletados em dois momentos, com duração de cinco minutos cada: primeiro com as crianças em repouso e com respiração espontânea, depois durante a prática da técnica respiratória. Dados foram coletados ao final da primeira, da quarta e da oitava semana do treinamento. RESULTADOS: Houve um aumento significativo e progressivo da coerência cardiorrespiratória, com elevação expressiva na porcentagem de alta coerência (p < 0,0001), o que indica maior sincronização da função autonômica. Índices do domínio do tempo (Mean RR, SDNN, RMSSD, pNN50) e geométrico (SD1) apontaram para uma significante redução da VFC e da atividade parassimpática. Não foram observadas alterações significantes no domínio da frequência. No domínio da não-linearidade, houve alterações significantes em alguns índices específicos (ApEn, MSE área 1_5, DFAαl, ShanEnt e Lmean) indicando ganho de complexidade, otimização da fractabilidade e afastamento da linearidade, tudo isso representativo de melhora da saúde cardíaca. O grupo controle não apresentou diferenças significantes entre os dois momentos, exceto para um aumento da frequência cardíaca no segundo momento. CONCLUSÃO: A melhora progressiva da coerência cardiorrespiratória gerada por meio de autoaplicação da técnica de respiração, mostra que houve aprendizado, o que indica que crianças em idade pré-escolar são capazes de se autorregularem através de exercícios respiratórios. Isso torna a respiração uma estratégia promissora na promoção da autorregulação psicofisiológica em crianças. A respiração lenta e ritmada também mostrou efeitos fisiológicos bastante contundentes nas crianças. As análises mostraram redução da VFC e do tônus parassimpático associada a uma maior coerência cardiorrespiratória e ao aumento da complexidade do sistema cardíaco. Os resultados encontrados neste estudo contribuíram para o levantamento de uma nova hipótese: a de que a respiração lenta age seletivamente na regulação do SNA, aumentando ou reduzindo o tônus vagal, a depender do estado fisiológico inicial. Estudos futuros são necessários para testar e validar esta hipótese. / INTRODUCTION: Learning self-regulation skills contributes for proper neurobiological and psychosocial development in childhood. In this study, we investigated the role of breathing as a tool to promote self-regulation in preschool-aged children. Respiratory modulation has been used as a technique in promoting psychophysiological regulation, due to its beneficial effect on the functioning of the autonomic nervous system (ANS), to its important role in the regulation of metabolism, and for promoting the entrainment of all the oscillatory systems in the body. The study aimed to evaluate the capacity of preschool children to learn a breathing technique for self-regulation, to contribute to the understanding of how the respiratory modulation acts on their physiology, and to support the development of educational strategies and health intervention programs that adopt breathing as a method to promote psychophysiological self-regulation in children. METHODS: The study included 42 children aged between five and six years. All received a daily training, with eight weeks duration, for practicing a breathing technique (slow breathing with equal times of inhalation and exhalation). For the assessment of the effects of breathing on the ANS, analyses of heart rate variability (HRV) were made in cardiorespiratory coherence and in the time, geometry, frequency, and chaos (nonlinearity) domains. HRV data (the beat-to-beat intervals) were collected in two phases, lasting five minutes each: first with the children at rest with spontaneous breathing, then during the practice of the breathing technique. Data were collected at the end of the first, fourth, and eighth weeks of training. RESULTS: There was a significant and progressive increase in the cardiorespiratory coherence, with a remarkable increase in the percentage of high coherence (p < 0.0001), indicating greater synchronization of the autonomic function. Time domain (Mean RR, SDNN, RMSSD, pNN50), and geometric domain (SD1) indices pointed to a reduction in HRV and parasympathetic activity. There were no significant changes in the frequency domain. In the area of nonlinearity, there were significant changes in some specific indices (ApEn, MSE area 1_5, DFAαl, ShanEnt and Lmean) indicating gain in complexity, optimized fractability, and departure from linearity, all representative of improved heart health. The control group showed no significant differences between the two moments, except for an increase in heart rate in the second moment. CONCLUSION: The progressive improvement in the levels of heart rate coherence, generated by self-application of the breathing technique, shows that there was learning, which indicates that pre-school aged children are able to self-regulate through breathing exercises. This makes breathing a promising strategy in promoting psychophysiological self-regulation in children. The slow and paced breathing also showed quite compelling physiological effects in the children. The analyses showed reductions in the HRV and in the parasympathetic tone associated with a higher cardiorespiratory coherence and an increased complexity of the cardiac system. The results of this study contributed to the rise of a new hypothesis: that slow breathing acts selectively in the regulation of ANS, increasing or reducing the vagal tone, depending on the initial physiological state. Future studies are needed to test and validate this hypothesis.

INTRODUÇÃO: A obesidade é uma doença universal de prevalência crescente e vem adquirindo proporções epidêmicas, sendo um dos principais problemas da saúde pública modernos. Constitui consenso que a abordagem clínica geralmente é ineficaz e a cirurgia bariátrica se apresenta como melhor opção de tratamento. A cirurgia bariátrica é atualmente a única modalidade terapêutica a oferecer perda de peso maciça e mantida ao longo do tempo a pacientes obesos mórbidos. OBJETIVO: Determinar se um programa de fisioterapia respiratória pré-operatória melhora a função pulmonar do paciente e verificar a relação entre quadro (clínico apnéia do sono e/ou espirometria) e circunferências do pescoço, tórax e abdominal. MATERIAIS E MÉTODOS: Foram selecionados 34 pacientes portadores de obesidade mórbida e candidatos a cirurgia bariátrica, com sinais clínicos de apnéia do sono (ronco, sono agitado, dor de cabeça matinal e sono diurno excessivo) e/ou espirometria com padrão restritivo, obstrutivo, inespecífico ou misto. Os pacientes foram selecionados de acordo com sua disponibilidade para aderir ao preparo pré-operatório e que aceitaram participar do estudo assinando o termo de consentimento livre e esclarecido. Os pacientes eram de ambos os sexos, idade entre 20 a 75 anos. Todos os pacientes foram submetidos a duas avaliações fisioterapêuticas: 15 dias antes da cirurgia e a outra na véspera, sendo analisadas as seguintes variáveis: circunferências do pescoço, tórax, abdome e quadril, IMC, FR, SpO2, capacidade vital lenta, volume minuto , PImax, PEmax , espirometria, índice de percepção de esforço de Borg e sinais clínicos de apnéia do sono. Foram constituídos dois grupos, grupo controle G1 e grupo experimental G2. A diferenciar os grupos de estudo, um programa de fisioterapia respiratória pré-operatória foi oferecido aos doentes G2, mas não aos doentes G1. RESULTADOS: Dentre as variáveis analisadas, mostraram diferença estatisticamente significante principalmente as relações: VEF1/CVF 1 e VEF1/CVF 2 do G1 e G2 (p-valor =0,030 e 0,005); PImáx (p-valor=0,032) e FR (p-valor=0,001), IPE de Borg (p=0,001), SpO2 (p=0,001) do G2. Os pacientes com sinais clínicos de apnéia têm circunferência de tórax e abdominal maiores em relação aos pacientes sem sinais clínicos de apnéia (p=0,012 e p=0,021). CONCLUSÃO : Um programa de fisioterapia respiratória é capaz de melhorar volumes, capacidades pulmonares e força da musculatura respiratória em pacientes obesos mórbidos em preparo pré-operatório para cirurgia bariátrica. / BACKGROUND: Obesity is an increasingly prevalent universal disease acquiring epidemic proportions and is one of the main problems of modern public healthcare. There is consensus that the clinical approach is usually ineffective in more serious cases of obesity and bariatric surgery constitutes a better treatment option. Bariatric surgery is currently the best therapeutic modality for massive weight loss maintained over time and consequently offers a cure or control of associated diseases, which is its main goal. AIM: The aim of the present study was to determine the effect of an intensive preoperative chest physiotherapy program on morbidly obese patients scheduled to undergo bariatric surgery with the intention of improving lung function and verify the relationship between clinical (sleep apnea and spirometry) and circumferences of the neck, chest and abdominal. MATERIALS AND METHODS: Thirty-four morbidly obese candidates for bariatric surgery with clinical symptoms of sleep apnea (snoring, restless sleep, morning headaches and excessive daytime sleep) and/or a restrictive, obstructive, nonspecific or mixed spirometry pattern were selected. The selection of patients for surgical treatment was supervised by the Department of Obesity Surgery of the University Hospital of the University of São Paulo. Patients were selected based on their availability regarding the preoperative therapy, willingness to participate in the study and having signed a term of informed consent. Male and female participants between 20 and 75 years of age were included. All were submitted to preoperative chest physiotherapy program and two evaluations: 15 days prior to surgery and a second 1 day prior to surgery. The following variables were analyzed: circumference of the neck, chest, abdomen and hip; body mass index (BMI); respiratory rate (RR); arterial oxygen saturation (SpO2); slow vital capacity (SVC); minute volume (Vol-min); maximal inspiratory pressure (MIP); spirometry; Borg Rate of Perceived Exertion (RPE); and clinical signs of sleep apnea. Two groups: control group (G1) and experimental group (G2). The G2 was submitted a program of preoperative respiratory therapy. RESULTS: There were favorable significant differences between evaluations for the following variables: FEV1/FVC 1 and VEF1/CVF 2 of G1 and G2 (p-valor =0.030 and 0.005) MIP (p = 0.032); RR (p = 0.001); Borg RPE (p = 0.001); SpO2 (p = 0.001) of G2. CONCLUSION: A chest physiotherapy program is capable of improving lung volume, lung capacity and respiratory muscle strength in morbidly obese patients in preoperative preparation for bariatric surgery. There is correlation between thorax and abdominal circumference and clinical symptoms of obstructive sleep apnea.