Made available in DSpace on 2016-06-02T20:18:20Z (GMT). No. of bitstreams: 1 4970.pdf: 2137632 bytes, checksum: 24df6302ff25ccdf968d2ef39fc8b67f (MD5) Previous issue date: 2013-03-22 / The thesis consisted of two studies described below. The study I, entitled: "The influence of body composition measured by dual-energy absorptiometry functional capacity in patients with chronic obstructive pulmonary disease", aimed to analyze the influence of body composition assessed by dual-energy x-ray absorptiometry on functional capacity in patients with chronic obstructive pulmonary disease (COPD). We Eleven male patients with COPD (COPDG), 7 presenting moderate obstruction and 4 severe, and 11 sedentary male subjects (CG) were evaluated by dual-energy x-ray absorptiometry to assess their body composition, all subjects have also performed the 6 minute walk test (6MWT) and step test (6MST) to assess their functional capacity. No significant differences were found between groups for anthropometric data such as age, weight, height and body mass index (BMI). However, the COPDG presented forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, maximal voluntary ventilation (MVV),walked distance (WD) and number of steps (NS) significantly lower than the CG (p<0,05; Student s t test). The body bone mass (BBM), BBM%, Lean Mass (LM), LM%, and right lower limb (RLL) and left lower limb (LLL) were significantly lower in the COPDG when compared with the CG, presenting statistically significant positive correlations with 6MWT on WD and 6MST on NS (p<0,05, Pearson s test). We conclude that body composition is an important prognostic factor for patients with COPD, which reinforces the importance of assessing body composition by dual-energy absorptiometry since it has demonstrated with satisfactory accuracy in clinical practice. Moreover, it is a parameter useful evaluation and reassessment in pulmonary rehabilitation programs. Following the II study entitled: "Effects of training of high and low intensity in musculature inspiratory in individuals with severe COPD and malnourished," which aimed to verify and analyze the effects of training in high and low intensity inspiratory muscles in patients with severe COPD and malnourished. We evaluated 32 men with severe COPD and malnourished, divided into two groups (G1 and G2). Assessments of the degree of dyspnea, pulmonary function test, MIP, WD, SGRQ and DM were performed at pre-training and after 12 weeks of training. We found that G1 got significant increase in MVV, MIP, WD and DM, and significant decreases in the percentages MRCm and SGRQ at 12 weeks of training, which remained after 12 weeks without training. Group 2 showed the same behavior when compared with the G1 at 12 weeks of training, but values returned to the initial MVV, MRCm, DM and MIP and WD had values below the baseline, and the percentage increased significantly SGRQ after 12 weeks without training. In the intergroup analysis (12-12 weeks) G1 showed higher values in MVV, MIP, WD and DM values and smaller percentages in the SGRQ compared with G2. Comparing the 24-24 weeks, G2 showed lower values in MVV, MIP, WD and DM and significant increases in the percentages MRCm and SGRQ compared with G1. The TMI high and low intensity promoted benefits to individuals with severe COPD and malnourished, which were maintained after 12 weeks of high intensity training. / A tese constou de dois estudos descritos a seguir. O estudo I, intitulado: A influência da composição corporal avaliada pela absorciometria duo-energética na capacidade funcional em portadores de doença pulmonar obstrutiva crônica , teve como objetivo analisar a influência da composição corporal avaliada pela absorciometria duo-energética na capacidade funcional em portadores de DPOC. Foram avaliados 11 indivíduos do sexo masculino portadores de DPOC, sendo 7 com obstrução moderada e 4 grave (Grupo DPOC - GDPOC) e 11 indivíduos sedentários do sexo masculino (Grupo Controle - GC), por meio da absorciometria duo-energética para avaliar a composição corporal, bem como pelo teste de caminhada de seis minutos (TC6) e teste do degrau (TD6) para avaliar a capacidade funcional. Não houve diferenças significantes intergrupos na idade, peso, altura e índice de massa corporal (IMC). No entanto, o GDPOC apresentou Capacidade Vital Forçada (CVF), Volume Expiratório Forçado no primeiro segundo (VEF1), relação VEF1/CVF, Ventilação Voluntária Máxima (VVM), Distância Percorrida (DP) e Número de Degraus (ND) significantemente menores que o GC (p&#61603;0,05, teste t Student). A Massa Óssea Corporal (MOC), % MOC, Massa Magra (MM), % MM e MM do Membro Inferior Direito (MID) e Membro Inferior Esquerdo (MIE) no GDPOC foram significantemente menores que no GC obtendo correlações positivas estatisticamente significantes com a DP no TC6 e ND no TD6 (p&#61603;0,05; correlação de Pearson). Concluímos que a composição corporal é um importante fator de prognóstico para pacientes com DPOC, o que reforça a importância da avaliação da composição corporal pela absorciometria duo-energética uma vez que tem demonstrado precisão satisfatória na prática clínica. Além disso, é um parâmetro de avaliação e reavaliação útil em programas de reabilitação pulmonar. Na sequência, o estudo II intitulado Efeitos do treinamento de alta e baixa intensidade na musculatura inspiratória em indivíduos com DPOC grave e desnutridos , que objetivou verificar e analisar os efeitos do treinamento de alta e baixa intensidade na musculatura inspiratória em indivíduos com DPOC grave e desnutridos. Foram avaliados 32 homens com DPOC grave e desnutridos, divididos em dois grupos (G1 e G2). As avaliações do grau de dispneia, prova de função pulmonar, PImáx, DP, SGRQ e MD foram realizadas no pré-treinamento e após 12 semanas de treinamento. Observou-se que o G1 obteve aumento significante da VVM, PImáx, DP e MD, e diminuições significantes na MRCm e das porcentagens do SGRQ em 12 semanas de treinamento, os quais se mantiveram após 12 semanas sem treinamento. O G2 apresentou o mesmo comportamento quando comparado com o G1 em 12 semanas de treinamento, porém os valores voltaram aos iniciais na VVM, MRCm, MD e as variáveis PImáx e DP apresentaram valores abaixo da avaliação inicial, e as porcentagens do SGRQ aumentaram significantemente após 12 semanas sem treinamento. Na análise intergrupo (12-12 semanas) o G1 apresentou valores maiores na VVM, PImáx, DP e MD e valores menores nas porcentagens do SGRQ quando comparado com o G2. Na comparação das 24-24 semanas, o G2 apresentou valores menores na VVM, PImáx, DP e MD e aumentos significantes na MRCm e nas porcentagens do SGRQ quando comparados com G1. O TMI de alta e baixa intensidade proporcionou efeitos benéficos aos indivíduos com DPOC grave e desnutridos, os quais se mantiveram após 12 semanas do treinamento de alta intensidade.

Critical care has undergone several developments in the recent years leading to improved survival. However, acquired muscle weakness in the intensive care unit (ICU) is an important complication that affects severely ill patients and can prolong their ICU stay. Critical illness myopathy (CIM) is the progressive decline in the function and mass of the limb muscles in response to exposure to the ICU condition, while ventilator-induced diaphragm dysfunction (VIDD) is the time dependent decrease in the diaphragm function after the initiation of mechanical ventilation. Since the complete underlying mechanisms for CIM and VIDD are not completely understood, there is a compelling need for research on the mechanisms of CIM and VIDD to develop intervention strategies targeting these mechanisms. The aim of this thesis was to investigate the effects of several intervention strategies and rehabilitation programs on muscle wasting associated with ICU condition. Moreover, muscle specific differences in response to exposure to the ICU condition and different interventions was investigated. Hence, a rodent ICU model was used to address the mechanistic and therapeutic aspects of CIM and VIDD. The effects of heat shock protein 72 co-inducer (HSP72), BGP-15, on diaphragm and soleus for rats exposed to different durations of ICU condition was investigated. We showed that 5 and 10 days treatment with BGP-15 improved diaphragm fiber and myosin function, protected myosin from posttranslational modification, induced HSP72 and improved mitochondrial function. Moreover, BGP-15 treatment for 5 days improved soleus muscle fibers function, improved mitochondrial structure and reduced the levels of some ubiquitin ligases. In addition to BGP-15 treatment, passive mechanical loading of the limb muscles was investigated during exposure to the ICU condition. We showed that mitochondrial dynamics and mitophagy gene expression was affected by Mechanical silencing while mechanical loading counteracted these effects. Our investigation for other pathways that can be involved in muscle wasting associated with ICU condition showed that the Janus kinase 2/ Signal transducer and activator of transcription 3 (JAK2/STAT3) pathway is differentially activated in plantaris, intercostals and diaphragm. However, further studies are required with JAK2/STAT3 inhibitors to fully examine the role of this pathway in the pathogenesis of CIM and VIDD prior to translation to clinical research.