A asma é uma doença pulmonar inflamatória crônica com alta prevalência e que leva a importantes danos funcionais à saúde e à qualidade de vida do paciente. A fisiopatologia da asma é caracterizada por intensa imunorregulação e o exercício físico pode ter um papel importante nesta resposta inflamatória devido a seus efeitos imunorreguladores. Objetivo: Avaliar o efeito de um programa de treinamento físico aeróbio na inflamação sistêmica e pulmonar, no controle clinico e fatores de saúde relacionados à qualidade de vida controle clínico de pacientes adultos com asma persistente moderada ou grave. Métodos: Foram estudados 58 adultos asmáticos divididos aleatoriamente nos grupos controle (GC; n=28) e treinado (GT; n=30) e 16 indivíduos não asmáticos (GNA). Os pacientes do GC foram submetidos a um programa educacional e a um programa de exercícios respiratórios, enquanto os pacientes do GT foram submetidos a todos os procedimentos do grupo controle e a um programa de condicionamento físico aeróbio. A resposta imune foi avaliação pelo perfil plasmático das citocinas Th1 (fator de necrose tumoral, interleucina-6 (IL-6), IL-8), Th2 (IL-4, IL- 5), regulatórias (IL-10) e quimiocinas (MCP-1, IP-10, MIG, RANTES) tanto cronicamente como após uma sessão de exercício. Antes e após a intervenção todos os pacientes realizaram uma prova de função pulmonar, um teste cardiopulmonar de esforço, avaliação do controle clínico, dos fatores de saúde relacionados a qualidade de vida (FSRQV), da fração exalada de óxido nítrico (FeNO), exame de escarro induzido e coleta de amostra sanguínea. Os sujeitos do GNA realizaram apenas um teste cardiopulmonar de esforço e a coleta de sangue. Resultados: Os pacientes com asma persistente moderada ou grave submetidos a um programa de condicionamento físico aeróbio apresentaram redução no plasma das interleucinas (IL) 6, IL-8 e proteína quimiotática de monócito-1 (MCP-1) (p < 0,05). Uma única sessão de exercício eleva os níveis de IL-6, IL-8 e IL-5, para depois retornar ao seu valor basal uma hora após o exercício (p < 0,05). A IL-10 também aumentou, porém manteve-se em níveis mais elevados mesmo uma hora após o exercício (p < 0,05). A inflamação pulmonar reduziu apenas nos pacientes do GT com níveis elevados de eosinófilo e FeNO (p < 0,05). Os FSRQV, controle clínico e capacidade física também melhoraram apenas no GT (p < 0,005). Conclusão: Nossos resultados mostram que a melhora da capacidade física de pacientes asmáticos pode ter um efeito anti-inflamatório e que pode ser relevante para o manejo clínico destes pacientes / Asthma is a chronic inflammatory disorder of the airway with high prevalence that leads functional impairment to health related quality of life (HRQoL). The pathophysiology of asthma is characterized by intense immunoregulation and exercise can play an important role in this inflammatory response due to its immunoregulatory effects. Objective: To evaluate the effect of an aerobic training program on systemic and pulmonary inflammation, clinical control and HRQoL of adult patients with moderate or severe persistent asthma. Methods: Fifty-eight asthmatic adult patients were randomly assigned to either control (CG, n = 28) or training groups (TG, n = 30) and 16 subjects non-asthmatic (NAG). The CG performed an educational program and breathing exercises, while the TG performed all procedures in the CG and an aerobic training program. The immune response was assessed by plasma levels of Th1 cytokines (tumor necrosis factor, interleukin-6 (IL-6), IL-8, Th2 (IL-4, IL-5), regulatory (IL-10) and chemokines (MCP-1, IP-10, MIG, RANTES), either chronically and after a single bout of exercise. Before and after the intervention all patients performed a pulmonary function test, cardiopulmonary exercise testing, clinical control test, HRQoL questionnaire, fractional exhaled nitric oxide (FeNO), induced sputum and blood sample. The NAG performed only the cardiopulmonary exercise test and plasma levels of cytokines. Results: Patients that performed a aerobic training program decreased plasma of interleukin (IL) 6, IL-8 and monocyte chemotactic protein-1 (MCP-1) (p < 0.005). A single bout session of exercise raises the levels of IL-6, IL-8 and IL-5, and then return to baseline one hour after exercise (p < 0.05). IL-10 has also increased immediately after exercise and its levels remained higher even for one hour (p < 0.05). The pulmonary inflammation reduced only GT patients with high levels of eosinophils and FeNO (p < 0.05). The FSRQV, clinical control and physical capacity also improved only in GT (p < 0.05). Conclusion: Our results show that the improvement of the physical capacity of patients with asthma may have an anti-inflammatory effect and may be relevant for the clinical management of these patients

A habilidade do indivíduo em sustentar-se na posição ereta, ajustando de maneira eficaz os movimentos do corpo e reagindo a estímulos externos, representam estratégias de controle postural essenciais para as atividades de vida diária. O Diabetes Mellitus tipo 2 (DM-2) é considerado um grande problema de Saúde Pública tendo como complicações o déficit no desempenho funcional dos membros inferiores e as quedas, que podem interferir na manutenção do equilíbrio, além de ser um forte preditor de limitações funcionais auto referidas. O presente estudo, tem como objetivo analisar o equilíbrio postural em pacientes com Diabetes Mellitus tipo 2, após o treinamento sensório-motor supervisionado e não supervisionado, considerando a posição ortostática, a marcha e testes funcionais. Foram recrutados 80 voluntários com faixa etária entre 45 a 64 anos portadores de DM-2, de ambos os sexos, divididos em três grupos: GC - Grupo Controle (n=27), GT-D - Grupo Treinamento Domiciliar (n=27) e GT-S - Grupo Treinamento Supervisionado (n=26). Foram coletados dados de equilíbrio postural na plataforma Neurocom Balance Master Sistem® e avaliação clínica BESTest. A intervenção foi realizada duas vezes por semana, durante 45 minutos, por 12 semanas, sendo dividido em três fases: aquecimento, treinamento sensório-motor e desaquecimento, com monitoramento da pressão arterial e glicemia. Após a análise da distribuição dos dados, foi aplicado o teste de Wilcoxon para as comparações entre os tempos pré e pós-intervenção e Kruskal-Wallis, seguido de post hoc Dunn, para as comparações intergrupos, ambos com nível de significância de 5%. Os resultados da avaliação incial, referentes a sensibilidade tátil e vibratória, demonstraram ausência de neuropatia periférica nos pacientes diabéticos. Nas comparações entre os tempos, houve aumento significativo da classificação sem sintomas de polineuropatia distal diabética nos grupos GT-D e GT-S (p<0,05). Apresentaram melhor desempenho para respostas posturais reativas, estabilidade na marcha e escore total do BESTest no grupo GT-S (p<0,05); redução significativa da velocidade de oscilação do centro de gravidade do corpo, na superfície firme olhos abertos no GT-S (p<0,05); melhor controle direcional do corpo, no deslocamento lateral direito no GT-S e deslocamento lateral esquerdo no GT-D (p<0,05), além do aumento da velocidade do passo no GT-D (p<0,05). Nas comparações intergrupos não foram encontradas alterações importantes após intervenção. Assim, conclui-se que o treinamento sensório-motor apresentou melhora no desempenho dinâmico do equilíbrio postural somente para as avaliações intragrupos de diabéticos tipo 2. / The individual\'s capacity to maintain an upright position, while adjusting efficiently the body movements and responding to external stimuli, represents essential postural control strategies for the daily-life activities. Type- 2 diabetes mellitus (DM-2) is considered an important public health care problem because of complications, such as functional performance deficit of the lower limbs and consequent falls, which can interfere with maintenance of the balance in addition to being a strong predictor of self-reported functional limitations. The objective of the present study is to assess the postural balance in type-2 diabetic patients after supervised and non-supervised sensory-motor training considering the orthostatic position, gait and functional tests. Eighty type-2 diabetic male and female volunteers aged 45 to 64 years old were distributed into three groups: GC - control group (n=27); GTD - At-home training group (n=27); and GTS - Supervised training group (n=26). Data on postural balance were obtained with the volunteers training on the platform (Neurocom Balance Master System®) and by using BESTest for clinical evaluation. The intervention was performed twice a week during 45 minutes for 12 weeks, divided into three phases: warm-up, sensory-motor training and cool-down, including monitoring of blood pressure and glycemia. After analysis of data distribution, Wilcoxon\'s test was applied to compare the times before and after the intervention, whereas Kruskal-Wallis\' test, followed by Dunn\'s post-hoc test, were used for inter-group comparisons, both whit significance level of 5%. The initial results regarding tactile and vibratory sensitivity showed an absence of peripheral neuropathy in the diabetic patients. In the comparisons between times, there was a significant increase in the asymptomatic classification of diabetic distal polyneuropathy in the Groups GTD and GTS (P<0,05). Type-2 diabetic patients in the Group GTS (P<0,05) had better performance for reactive postural response, gait stability and total BESTest score, also achieving a significant reduction in the oscillation speed of the centre of gravity on stable surface with open eyes (P<0,05) and better directional control of the body during right-lateral displacement, whereas those in the Group GTD (P<0,05) showed increased gait speed and better directional control of the body during left-lateral displacement (P<0,05). In the inter-group comparisons, there was found no substantial change after the intervention. Therefore, one can conclude that sensory-motor training improves the dynamic postural balance performance only for intra-group evaluations of type-2 diabetic patients.

<p>Syftet med denna studie var att kartlägga alternativa behandlingsmetoder för behandling av tidiga klimakteriebesvär, kring menopaus. Studien genomfördes som en litteraturstudie med beskrivande design, där tjugo vetenskapliga artiklar granskades. Resultatet visar fem alternativa behandlingsmetoder: akupunktur, yoga, fysisk aktivitet, naturläkemedel och fytoöstrogener. Både akupunktur och yoga gav en signifikant förbättring vad det gäller värmevallningar, nattliga svettningar, sömnkvalitet och livskvalitet. Med ökad fysisk aktivitet upplevde kvinnorna färre fysiska och psykiska besvär kopplade till klimakteriet och förbättring av allmänna välbefinnandet, ingen skillnad sågs vad det gäller vasomotorbesvär. När naturläkemedel och fytoöstrogener jämförts med placebo, ses möjligen en minskning av värmevallningar och nattliga svettningar, samt ökning av livskvaliteten med dessa olika preparat men samma förbättring ses i dessa studier även med placebopreparat. Ingen av de alternativa behandlingsmetoderna hade effekt på vaginalslemhinnan och förbättrade därmed inte de urogenitala besvären. Slutsats av denna litteraturgenomgång av alternativa behandlingsmetoder är att vissa behandlingsmetoder innebär en förbättring vad det gäller tidiga klimakteriebesvär och livskvalitet, men att flera behandlingsmetoder inte är mer effektfulla än placebo. Ytterligare forskning, med fler stora randomiserade kontrollerade studier är nödvändig för att se effekten av och utvärdera de för närvarande tillängliga alternativa behandlingsmetoderna. Ännu ett forskningsområde är att studera kvinnornas upplevelser av alternativa behandlingsmetoder.</p> / <p>The aim of this study was to describe complementary therapies for treating early climacteric complaints, around menopause. The study was conducted as a literature review with a descriptive design, where the author examined twenty scientific articles. The result shows five complementary therapies, acupuncture, yoga, physical activity, herbal medicines and phytoestrogens. Both acupuncture and yoga significantly reduced hot flushes and night sweats, they also improved subjective sleep quality and quality of life. Increased physical activity made women report fewer physical and psychological symptoms attributed to menopause and improved general well-being, but it had no effect on vasomotor symptoms. When herbal medicines and phytoestrogens have been compared with placebo, they all showed a similar small relief of hot flushes and night sweats and improvement in quality of life. None of the complementary therapies showed effect on vaginal tracts and did not improve urogenital symptoms. The conclusion from this literature review is that some complementary therapies show improvement in the early menopausal symptoms and quality of life, but some treatments are not more powerful than placebo. Further research, with larger randomized controlled studies are necessary, both to see the effect of the currently accessible alternative treatments, but also to examine how women perceive the impact.</p>

Graduation date: 2005

Syftet med denna studie var att kartlägga alternativa behandlingsmetoder för behandling av tidiga klimakteriebesvär, kring menopaus. Studien genomfördes som en litteraturstudie med beskrivande design, där tjugo vetenskapliga artiklar granskades. Resultatet visar fem alternativa behandlingsmetoder: akupunktur, yoga, fysisk aktivitet, naturläkemedel och fytoöstrogener. Både akupunktur och yoga gav en signifikant förbättring vad det gäller värmevallningar, nattliga svettningar, sömnkvalitet och livskvalitet. Med ökad fysisk aktivitet upplevde kvinnorna färre fysiska och psykiska besvär kopplade till klimakteriet och förbättring av allmänna välbefinnandet, ingen skillnad sågs vad det gäller vasomotorbesvär. När naturläkemedel och fytoöstrogener jämförts med placebo, ses möjligen en minskning av värmevallningar och nattliga svettningar, samt ökning av livskvaliteten med dessa olika preparat men samma förbättring ses i dessa studier även med placebopreparat. Ingen av de alternativa behandlingsmetoderna hade effekt på vaginalslemhinnan och förbättrade därmed inte de urogenitala besvären. Slutsats av denna litteraturgenomgång av alternativa behandlingsmetoder är att vissa behandlingsmetoder innebär en förbättring vad det gäller tidiga klimakteriebesvär och livskvalitet, men att flera behandlingsmetoder inte är mer effektfulla än placebo. Ytterligare forskning, med fler stora randomiserade kontrollerade studier är nödvändig för att se effekten av och utvärdera de för närvarande tillängliga alternativa behandlingsmetoderna. Ännu ett forskningsområde är att studera kvinnornas upplevelser av alternativa behandlingsmetoder. / The aim of this study was to describe complementary therapies for treating early climacteric complaints, around menopause. The study was conducted as a literature review with a descriptive design, where the author examined twenty scientific articles. The result shows five complementary therapies, acupuncture, yoga, physical activity, herbal medicines and phytoestrogens. Both acupuncture and yoga significantly reduced hot flushes and night sweats, they also improved subjective sleep quality and quality of life. Increased physical activity made women report fewer physical and psychological symptoms attributed to menopause and improved general well-being, but it had no effect on vasomotor symptoms. When herbal medicines and phytoestrogens have been compared with placebo, they all showed a similar small relief of hot flushes and night sweats and improvement in quality of life. None of the complementary therapies showed effect on vaginal tracts and did not improve urogenital symptoms. The conclusion from this literature review is that some complementary therapies show improvement in the early menopausal symptoms and quality of life, but some treatments are not more powerful than placebo. Further research, with larger randomized controlled studies are necessary, both to see the effect of the currently accessible alternative treatments, but also to examine how women perceive the impact.

Thesis (Ph. D.)--University of Missouri--Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 152-178). Also available on the Internet.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 5 uppsatser. Även tryckt utgåva.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / It has been noted that in many recent research studies mechanical neck pain is a serious problem in the world today. There are epidemiological and statistical studies documenting the high incidence and prevalence of mechanical neck pain, which effects people’s daily living (Drew, 1995; Ferrari and Russell, 2003; Cote et al., 2000, Venketsamy, 2007 and Haldeman et al., 2008). Background: Treatments for chronic neck pain, which are non-surgical, appear to be the most beneficial for patients (Haldeman, 2008). In brief, the presentation of chronic mechanical neck pain is defined as localised, asymmetrical neck pain with restricted range of motion and dysfunctional musculature (Grieve, 1988). The muscular dysfunction known as the upper cross syndrome is defined as tightness of the upper trapezius, pectoralis major and levator scapulae and weakness of rhomboids, serratus anterior, middle and lower trapezius and deep neck flexors. These muscles are responsible for stabilizing the scapula and the patient may present with rounded, elevated shoulders and anterior head carriage when diagnosed with this syndrome (Liebenson, 1996). Clinical trials conducted by Cassidy et al., (1992 a, b) concluded that spinal manipulative therapy (SMT) was highly effective in treating mechanical dysfunctions within the cervical spine. However, due to multi systemic involvement of the muscular, neural and passive systems in mechanical neck pain, the treatment may need to target all three of the subsystems of spinal stability to be most effective (Panjabi, 1992 a, b; Lee et al., 1998; Lee 2004 and Richardson et al., 2002). No research has been conducted on the effects and benefits of treatment directed on the cervical spine and upper cross syndromes. This research will compare scapula stabilization training and SMT to SMT in isolation, as a treatment for chronic mechanical neck pain. Objectives: The purpose of this study was to determine the effect that scapula stabilization had on chronic mechanical neck pain. Pilates exercises were used to strengthen and stabilize the scapula muscles (this included stretching out the hypertonic musculature of the upper cross syndrome). The aim was to improve posture as well as to decrease the mechanical stress on the neck. SMT was also concomitantly used to correct any cervical restrictions that were present. These results were then compared to the results of a group that only received spinal manipulative therapy. The null hypothesis was that the intervention group would not respond differently to the treatment protocol in terms of the subjective and objectives measurements. iv Method: This clinical trial was conducted on a sample population of 30 patients with chronic mechanical neck pain. Each patient was assigned to one of two groups (n=15) according to convenience sampling. Both groups received SMT to the cervical spine, while group B (intervention group) also received pilates classes twice weekly for four weeks, which retrained the scapula stabilization muscles to function optimally. The patients each underwent six spinal manipulative treatments over four weeks and a seventh consultation in the fifth week for data collection. Both groups were evaluated in terms of subjective and objective clinical findings. Subjectively the assessment included 2 questionnaires (Numerical Pain Rating Scale and Canadian Memorial Chiropractic College [CMCC] neck disability index). Objective assessment included cervical motion palpation, Cervical Range Of Motion goniometer (CROM) measurements, scapula stabilization tests and a postural analysis with the use of digital photography. The statistics were completed under the guidance of a biostatistician, from the College of Health Science, University of KwaZulu – Natal, (Esterhuizen, 2008) who analyzed the captured data with the use of SPSS version 15. All outcome measures were quantitative. Repeated measures ANOVA testing was used to assess the presence of a different effect for each outcome measure over time between the two treatment groups. A statistically significant time by group effect would indicate a significant treatment effect. The minimum significance level was 0.05. The trends and direction of the effect were assessed via profile plots. Result: According to the statistical analysis, both groups showed improvements - subjectively and objectively - with regards to chronic mechanical neck pain, which is in keeping with the literature. In terms of the inter-group comparison the SMT group (Group A) showed a more constant improvement in range of motion, pain and disability indexes with the SMT only group while the SMT and pilates group (Group B) showed a greater effect in stabilizing the scapula and increasing the functionality of the surrounding musculature. Conclusions and Recommendations: The intervention treatment (Group B) did not have a greater effect on the short-term treatment of chronic mechanical neck pain than the reference group (Group A). It was also evident that the intervention group (Group B) often continued to improve when the SMT (Group A) only group often regressed at the follow up sessions. This improvement was either not significant enough or v the follow up session did not allow for enough time for a true reflection to be noted. It is recommended that more research be carried out to gain conclusive results indicating whether there is a more beneficial long term result to this treatment protocol.

This study determined whether a pre-operative cardiac “pre-habilitation” (Prehab) program improves the health of elective coronary artery bypass graft (CABG) surgery patients to a greater extent than standard care (StanC). Seventeen elective CABG patients were randomized to StanC (n= 9) or Prehab (n= 8) at Baseline and were followed at 1-2 weeks pre-operatively (Preop) and Three months post-operatively. Functional walking ability was assessed using the 6-Minute Walk Test (6MWT) and 5-meter Gait Speed Test. Baseline data was not different between groups. Patients in StanC did not improve 6MWT scores; whereas Prehab patients improved 6MWT distance by 35% and 39% at Preop and Three months post-operatively, respectively (p<0.05). Gait speed scores were 25% and 27% lower in Prehab patients at Preop and Three months post-operatively, respectively, as compared to StanC (p<0.05). These data suggest that Prehab is an attractive intervention for enhancing functional walking ability before and after elective CABG surgery.