Doctor of Philosophy / Department of Anatomy and Physiology / Thomas J. Barstow / The physiological mechanisms determining the tolerable duration of exercise dictate human physical accomplishments across all spectrums of life. Despite extensive study, these specific mechanisms, and their dependence on oxygen delivery and oxygen utilization, remain, a certain extent, undefined. The purpose of this dissertation was to test the overarching hypothesis that muscle contraction characteristics (i.e., intensity of contraction, muscle contraction-relaxation duty cycle, etc.) alter oxygen delivery and oxygen utilization, which directly influence the power-duration relationship and fatigue development, and therefore, exercise tolerance. To accomplish this, specific interventions of altered muscle contraction-relaxation duty cycle and blood flow occlusion were utilized. In the first investigation (Chapter 2), we utilized low and high muscle contraction-relaxation duty cycles to alter blood flow to the active skeletal muscle, demonstrating that critical power (CP) was reduced with the high muscle contraction-relaxation duty cycle due to a reduction in blood flow, while the curvature constant (W’) was not altered. The second investigation (Chapter 3) utilized blood flow occlusion to show that CP was reduced and W’ increased for blood flow occlusion exercise conditions compared to control blood flow exercise conditions. The final investigation (Chapter 4) utilized periods of blood flow occlusion during and post-exercise to reveal greater magnitudes of peripheral and central fatigue development during blood flow occlusion exercise compared to control blood flow exercise. Moreover, this investigation demonstrated that W’ was significantly related to the magnitude of fatigue development. Collectively, alterations in oxygen delivery and oxygen utilization via muscle contraction characteristics and blood flow occlusion directly influence CP and the magnitude of fatigue development. However, W’ does not appear to be influenced by manipulations in oxygen delivery and oxygen utilization, per se. Rather, W’ may be determined by the magnitude of fatigue accrued during exercise, which is dependent upon oxygen delivery and oxygen utilization. The novel findings of the investigations presented in this dissertation highlight important physiological mechanisms that determine exercise tolerance and demonstrate the need for interventions that improve oxygen delivery and oxygen utilization in specific populations, such as those with chronic heart failure or chronic obstructive pulmonary disease, to improve exercise tolerance.

A qualidade de vida relacionada à saúde tem aparecido, com frequência, entre as metas dos estudos clínicos destinados ao desenvolvimento de novos tratamentos para a hipertensão arterial pulmonar (HAP). Embora os novos tratamentos melhorem o desempenho ao exercício na fase inicial de 12 - 16 semanas, não se sabe se existe associação entre tolerância ao exercício e qualidade de vida (QV), sobretudo em médio e longo prazo. Os objetivos do estudo foram: a) verificar, em pacientes com HAP, a existência ou não de correlação entre a QV e desempenho físico; b) verificar como as possíveis associações entre QV e desempenho ao exercício se comporta ao longo de um ano de observação sob tratamento medicamentoso específico; c) verificar se a aplicação de um protocolo de orientação de enfermagem, especificamente planejado para pacientes com HAP, poderia exercer impacto sobre a QV e o desempenho físico. Foram incluídos 34 pacientes no estudo, adolescentes ou adultos com o diagnóstico de HAP idiopática, hereditária ou associada a cardiopatias congênitas. Para o comprimento do terceiro objetivo, os pacientes foram organizados em pares, seguindo-se randomização para o tipo de seguimento a que seriam submetidos: apenas orientação médica ou orientação médica seguida de consulta de enfermagem. O acompanhamento constou de cinco visitas, a saber, no início, e aos três, seis, nove e 12 meses. Nas visitas, foram avaliados o desempenho físico, através da classe funcional e do teste de caminhada de seis minutos, e a QV mediante aplicação do questionário SF-36. A idade variou entre 14 e 58 anos (mediana de 35,5 anos). Houve dez pacientes com o diagnostico de hipertensão arterial pulmonar idiopática, dois na forma hereditária e 22 indivíduos com a forma associada a cardiopatias congênitas. Com relação à classe funcional, 25 pacientes estavam em classe II e nove em classe III. A distância caminhada inicialmente foi 177 a 564 metros (mediana 399 metros). A saturação periférica de oxigênio em repouso esteve entre 63 e 98% (mediana 94,5%), e ao final do exercício, foi de 38 a 98% (mediana de 84%). Com relação aos escores de QV iniciais (valores de zero a 100, representando respectivamente pior e melhor estado de saúde), somente duas das oito categorias analisadas através do questionário SF-36 mostraram valores medianos abaixo de 50, ambas relacionadas à saúde física. Analisando-se os 31 pacientes que completaram 12 meses de seguimento, observou-se que não houve modificação com significância estatística na classe funcional, distância caminhada aos seis minutos, na saturação periférica de oxigênio e nos escores do questionário SF-36, componentes físico e mental da QV. Analisando-se todas as 40 possíveis correlações entre a distância caminhada e as oito diferentes categorias do questionário, observou-se 12 associações significantes ao longo do seguimento (p< 0,05, relacionado ao coeficiente rS de Spearman). O limite em termos de distância caminhada abaixo do qual os pacientes passariam a expressar maior insatisfação em relação à sua QV (escores 25) situou-se entre 235 e 285 metros percorridos, com especificidade superior a 0,90. Entretanto, a baixa sensibilidade (máxima 0,42) sugeriu que diversos pacientes expressariam tal descontentamento mesmo com desempenho físico acima do intervalo mencionado. Com relação ao tipo de consulta, ainda que subjetivamente se tenha observado maior esclarecimento quanto à doença e seu tratamento em alguns pacientes acompanhados com a consulta suplementar de enfermagem, não houve diferenças estatísticas quanto à classe funcional, distância percorrida aos seis minutos ou escores de QV. Os dados observados permitiram concluir que pacientes portadores de HAP, nas subcategorias diagnósticas analisadas, uma vez colocados em tratamento específico, se mantêm estáveis, em médio prazo, sem deterioração significante de seu desempenho físico e QV. Apesar do tratamento em curso, o maior grau de insatisfação está relacionado à percepção da saúde física. Evolutivamente, a associação entre desempenho físico e QV existe em apenas 30% das oportunidades avaliadas. Pacientes caminhando, menos de 235 metros no teste de caminhada, quase certamente expressarão insatisfação marcante em relação à sua QV. Finalmente, com respeito à consulta de enfermagem, embora subjetivamente se tenha tido impressão de seu real papel, não houve impacto demonstrado objetivamente com significância estatística. Assim, desempenho físico e QV se mostram como aspectos complementar a serem avaliados em pacientes com HAP / Health-related quality of life (HRQOL) has been explored as an additional end point in clinical studies for development of new therapies in pulmonary arterial hypertension (PAH). Although treatments have been shown to improve the exercise capacity in 12-16 weeks, little is known of how patients do over the medium and long term on these therapies, in terms of HTQOL. The objectives of the present study were: 1- to observe how PAH patients do on specific therapies over 12 months of follow-up in terms of the exercise capacity and HRQOL; 2- to test for possible associations between the exercise capacity and HRQOL, and determine if such associations persist over the medium term (12 months); 3- to examine if a PAH-specific nursing approach (following conventional visits to the doctor) has a positive impact on patients exercise capacity and quality of life. Thirty-four patients were enrolled, with PAH associated with congenital heart disease (N=22) or idiopathic/hereditary PAH (N=12). Patients were seen at baseline, and three, six, nine and twelve months thereafter. The exercise capacity was assessed by performing the six-minute walk test, and the quality of life using the SF-36 questionnaire. The functional class was recorded according to the World Health Organization classification. The age range was 14 to 58 years (median 35.5 years). Patients were in functional class II (N=25) or III (N=9), and baseline six-minute walked distance was 177 to 564 meters (median 399 meters). Peripheral oxygen saturation was 63% to 98% (median 94.5%) at rest, and 38% to 98% (median 84%) at the end of the exercise. At baseline, in two of the eight domains of the SF-36 questionnaire (physical functioning and physical role), median score were lower than 50 (0-100 scale, 100 indicating best health). In 31 patients who completed the follow-up, there were no statistically significant changes in the functional class, six-minute walked distance, peripheral oxygen saturation and SF-36 scores. All these variables remained stable in the whole patient group. Of 40 possible associations between the exercise capacity and aspects of HRQOL analyzed over 12 months, only 12 were statistically significant (p<0.05, Spearmans coefficient of correlation). Using regression models, it was observed that patients walking less than 235-280 meters during the six-minute test had a severe depression in HRQOL (SF-26 scores 25). Although the specificity was adequate (> 0.90) the low sensitivity of prediction ( 0.42) indicated that many patients would be unsatisfied with their quality of life even above this range. Nursing assistance did not add a significant benefit in terms of the sixminute walked distance or the SF-36 scores in PAH patients on treatment with specific therapies. On the basis of the present data, it is possible to conclude that patients on specific PAH therapies tend to remain stable over 12 months of observation in terms of the exercise capacity and HRQOL. It is noticeable that most patients in the study had PAH associated with congenital heart disease (no patients with systemic sclerosis included). Dissatisfaction in terms of HRQOL is mainly related to the perception of physical health. Over the medium term, associations between HRQOL and the exercise capacity are present in only 30% of instances, suggesting that these are different perspectives of patients health. Anyway, patients walking less than 235 meters in six-minutes are very likely to express severely depressed HRQOL. Finally, further studies possibly using qualitative research methodology are warranted for a better understanding of the role of nursing assistance in this disorder

Fundamentos: Os efeitos benéficos do exercício físico regular, moderado, estão bem estabelecidos. De outra parte, os efeitos do exercício intenso, prolongado e exaustivo são controversos. Alguns efeitos indesejáveis podem ser o estresse oxidativo, a oxidação da LDL nativa e a resposta inflamatória de fase aguda. Objetivo: avaliar essas variáveis em maratonistas. Os efeitos agudos foram avaliados imediatamente e 72 h após a corrida e os efeitos crônicos foram avaliados na comparação com grupo controle. Casuística e métodos: população constituída por vinte e sete maratonistas, homens, 41+- 8 anos de idade, 74% brancos, sadios e 26 controles equiparáveis. Resultados: 1) Em condições basais (maratonistas x controles) no perfil oxidativo evidenciou-se: a) estado antioxidante total do plasma (TAS); 3,76+-0,34 versus 3,45+-0,32, mmol/L, p=0,002; b) peróxidos; 0,41+-0,15 versus 0,65+-0,42, p=0,011; c) LDLox; sem diferença significativa; d) anticorpos anti-Ldlox; não houve diferença significativa. No perfil imunoinflamatório observou-se: a) PCR us; 1,49+-1,11 versus 1,03+-1,39, mg/L, p=0,004; b) IL-15; 42,83+-109,47 versus 34,80+-128,57 pg/ml, p=0,021; c) TNF-alfa 8,07+-13 versus 33,98+-39,63 pg/ml. 2) Maratonistas, condições basais versus imediatamente após a prova: a) LDLox; 88,18+-22,05 versus 148,46+-74,76 U/L, p<0,001; b) Interleucinas: IL-6=30,08+-40,66 versus 113,61+-91,39, pg/ml, p<0,05, IL-8=38,36+-36,57 versus 85,02+-53,91,pg/ml,p<o,05, IL-10=21,08+-36,12 versus 141,82+-124,98,pg/ml,p<0,05, IL-15=42,83+-109,47 versus 169,60 +- 244,84 pg/ml,p<0,05, e TNF-alfa=8,07+-13 versus 32,65+- 42,24, pg/ml,p<0,05; c) leucócitos; 5,581+-1.122 versus 13.807+-5.393,mil/ml, p<0,05; d) Marcadores músculo-esqueléticos: mioglobina; 41+-31 versus 659+-344,ng/ml,p<0,05 ( > 1600%); CPK; 205+-121 versus 403+-134, p<0,05; DHL; 107+-28 versus 302+-44 U/L, p<0,05. e) Marcadores cardíacos: CKMB-Massa; 2,65+-2,43 versus 5,34+-3,01, troponina I; 0,023+-0,032 versus 0,045+-0,044,ng/ml,p<0,05. 3) Maratonistas, condições basais versus 72 h após a prova: a) TAS; 3,76+-0,34 versus 3,39+-0,92 U/L, p=0,05; b) anticorpos anti-LDLox; 439,23+-409,65 versus 225,10+-189,16,U/L, p<0,001; c) peróxidos=0,41+-0,15 versus 0,49+-0,11 U/L, p=0,03. No perfil inflamatório observou-se: a) PCR us 1,49+-1,11 versus 3,15+-2,22, mg/l,p<0,05; b) IL-8;38,36 +- 36,57 versus 45,28+-25,21 pg/ml, p <0,05. Marcadores músculo-esqueléticos a) CPK; 205,93+-121,47 versus 601,30+_567,80 U/L, p<0,001e b)DHL;197,44+-28,99 versus 267,30+-78,21 U/L, p<0,001. Enzimas cardíacas: a) CKMB-Massa;2,65+-2,43 versus 4,88+-5,60 ng/ml, p<0,05. O ecocardiograma mostrou cavidades esquerdas e massa do VE maiores em maratonistas que em controles. Adicionalmente foram submetidos a angiotomografia coronária 22 maratonistas e 20 controles. Em 5 (22,7%) dos maratonistas e em 3 (15%) dos controles, foram encontradas placas ateroscleróticas discretas. Conclusões: após corrida de maratona observa-se agudamente estresse oxidativo, aumento da LDLoxidada, resposta inflamatória de fase aguda e aumento da CKMB-massa. Estas alterações não foram observadas em condições basais. / The beneficial effects of regular, moderate exercise are well estabilished. On the other hand, the effects caused by the heavy and exhaustive exercise for longer periods are controversial. Some of these unpleasant effects. may be oxidative stress, the oxidation of the native LDL and acuse phase inflammatory response. Objective: Assess these variables in marathon runners. The acute effects were assessed immediately and 72 hours after the race, the chronical effects were assessed in basal condition and in comparision with the control group. Methods: A population consisting of 27 marathon runners, male, 41± 8 y old, 74% white, healthy and 26 matchable controls. Results: 1) On basal conditions (marathon runners X control group) regarding oxidative profile, the findings were the following: a) Total Anti-oxidant State of the plasma (TAS); 3.76 ± 0.34 versus 3.45 ± 0.35 mmol/L , p=0.002; b) Peroxides 0.48± 0.15 versus 0.65± 0.42, p=0.011 c) Anti ox LDL antibodies, and oxLDL without a significative difference. In the immunoinflamatory profile the findings are the following observed: a) us CRP; 1.49± 1.11 versus 1.03± 1.36, mg/L, p=0.004; b) IL-15; 42.83± 109.47 versus 4.80± 128.57 pg/ml, p=0.021; c) TNF-alfa 8.07± 13 versus 33.98± 39.63 pg/ml. 2) Marathon runners´ basal conditions versus their condition immediately after the race. a) OxLDL; 88.18± 22.05 versus 148.46± 74.76 U/L, p<0.001; b) Interleukynes: IL-6=30.08± 40.66 versus 113.61± 91.39, pg/ml p<0.05, IL-8=38.63± 36.57 versus 85.02± 53.91,pg/ml, p<0.05, IL-10=21.08± 36.12 versus 141.82± 124.98,pg/ml, p<0.05, IL-15=42.83± 109.47 versus 169.60± 244.84 pg/ml, p<0.05, e TNF-alfa=8.07± 13 versus 32.65± 42.24, ph/ml, p<0.05; c) leucocytes; 5.581± 1.122 versus 13.807± 5.393, mil/ml, p<0.05; d) skeletal muscle markers: myoglobine; 41± 31 versus 659± 344,ng/ml, p<0.05 (>1600%); CPK; 205± 121 versus 403± 134, p<0.05; DHL; 107± 28 versus 302± 44 U/L, p<0.05. e) Myocardial markers: CKMB-mass; 2.65± 2.43 versus troponina I; 0.023± 0.032 versus 0.045± 0.044, ng/ml, p<0.05. 3) Marathon runners´ basal conditions versus their condition 72 hours after the race: a) TAS; 3.76± 0.34 versus 3.39± 0.92 U/L, p=0.05; b) Anti-oxLDL antibodies; 439.23± 409.65 versus 225.10± 489.16, U/L, p<0.001; c) Peroxides= 0.41± 0.15 versus 0.49± 0,11 U/L, p=0.03. Regarding the oxidative profile, the following was found: a) us CRP 1.49± 1.11 versus 3.15± 2.22, mg/l, p<0.05; b) IL-8; 38.36± 36.57 versus 45.28± 25.21pg/ml, p<0.05. Skeletal muscle markers: a) CPK; 205.93± 121.47 versus 601.30± 567.80 U/L, p<0.001 e b) DHL; 197.4± 28.99 versus 267.3± 78.21 U/L, p<0.001. Cardiac enzymes: a) CMKB-mass; 2.65± 2.43 versus 4.88± 5.6 ng/ml, p<0.05. The echocardiogram showed bigger left cavities and increased VE mass in marathon runners than the ones in the control group. In addition, 22 marathon runners and 20 individuals in the control group were submitted to coronary angiotomography. Discreet atherosclerotic plaques were found in five marathon runners and in three individuals of the control group. Conclusion: Accute oxidative stress, inflammatory response acute phase, increased oxLDL as well as a higher level of the CKMB mass were observed after the marathon race.

Ice hockey is a contact sport played in a cold environment which leads to assumptions that players are not exposed to a thermal challenge. The purpose of this study was to test the hypothesis that the wearing of hockey protective equipment during an exercise protocol designed to simulate a hockey game would induce a thermal challenge and lead to decrements in performance. In order to test this hypothesis and qualify the physiological responses, subjects performed a standardized protocol performed on a stationary cycle ergometer in an environmental chamber set at typical (12ºC) ice hockey ambient conditions. The simulation was performed twice; once while wearing cotton undergarments only (NP), and once while wearing cotton undergarments and the typical protective equipment worn during a hockey game (P). Work intensity during each trial was held constant and was evaluated by examining mean power output, which was similar under both P and NP conditions (348.2 W vs 352.08 W, P > 0.05) P vs NP, respectively. Body (37.18 ºC vs 36.58 ºC) and skin temperatures (34.12 ºC vs 28.85 ºC) were elevated in P vs NP, respectively (P<0.05). Core temperatures (37.50 ºC vs 37.41ºC) displayed a trend towards being higher in P vs NP particularly during the third period of simulation (P = 0.053). Sweat loss as a percent of body mass was greater in P vs NP (2.57% vs 1.18%, respectively P<0.05), which led to an increase in plasma osmolality (287 vs 283 mosmol/kg H2O, respectively P<0.05) working heart rate (83.7% vs 78.8% of maximum heart rate), resting heart rate (63.4% and 55.9% of maximum heart rate), and urine specific gravity (1.026 vs 1.017) for P vs NP respectively (each P<0.05). The drop-off in power from pre to post simulated game was examined in both conditions by the use of five repeated maximal six second sprints interspersed with 24 seconds of recovery. The drop-off in both peak (12.0% vs 0.2%) and mean power (14.5% vs 2.7%) was greater in P versus NP (P<0.05). Plasma lactate concentration was higher following the simulated game in P vs NP (9.64 vs 5.96 mmol/L, P<0.05) as was plasma norepinephrine (2274.0 vs 1366.9 pg/ml, P<0.05). Rating of Perceived Exertion increased by 30-53% in the P condition (P<0.05) even though power outputs were equivalent. The elevated body temperature and increased water loss appeared to increase glycolytic flux, which when coupled with the consequences of thermal stress, reduced power output and led to the perception of elevated work intensities during the simulated game.

Excessive exposure to heat stress can cause a host of heat-related illnesses. For laborers, job specific work demands and protective garments greatly increase the risk of succumbing to the effects of heat stress. Microclimate cooling has been used to control heat stress exposure where administrative or engineering controls are not adequate. This study tested the performance of four personal cooling vests for use with insulated protective clothing (gas extraction coveralls) in warm-humid (35 ° C, 50% relative humidity) and hot-dry (40°C, 30% relative humidity) conditions. On 10 separate occasions, 5 male volunteers walked on a treadmill to elicit a target metabolic rate of 300 watts, for 120 minutes, while wearing a (a) water cooled vest, (b) air cooled vest, (c) frozen polymer vest (FP) (d) liquid CO2 cooling (LCO2) vest, or (e) no cooling (NC). A three-way mixed effects ANOVA was used to assess the results and a Tukey's Honestly Significant Difference multiple comparison test was used to identify where significant differences occurred ( < 0.05). The air, water, and FP systems produced significantly lower heat storage rates compared to NC. To the extent that the gas extraction coverall is worn in an environment between 30°C and 45°C and the rate of work is moderate, the FP, air and water vest were shown to manage heat storage well, reducing storage rate by about 48%, 56% and 65% respectively.

Le maintien ou le renforcement de la masse et de la fonction musculaire, altérées chez les patients BPCO, est un objectif primordial pour préserver, voire améliorer leur tolérance à l'effort, leur qualité de vie et leur survie. Afin d'optimiser la prise en charge de cette dysfonction musculaire, la réhabilitation est complétée par des interventions nutritionnelles, encore appelées réhabilitations nutritionnelles. Dans ce contexte, l'apport d'acides gras polyinsaturés de la série n-3, et plus particulièrement d'acide docosahexaénoïque (DHA), pourrait s'avérer intéressant en raison de leurs effets bénéfiques démontrés dans plusieurs pathologies chroniques. L'objectif de ce travail était donc de caractériser les effets d'une supplémentation en DHA sur la tolérance à l'effort et sur le métabolisme énergétique des muscles squelettiques de rats adultes exposés à une hypoxie comme modèle de muscle de patient BPCO au stade de l'insuffisance respiratoire chronique. La tolérance à l'effort est améliorée par le DHA, que les rats soient conditionnés en normoxie ou en hypoxie. En normoxie, les mécanismes impliqués seraient liés à un effet du DHA mimétique de celui d'un exercice d'endurance, avec une activation de l'AMPK et une amélioration de la fonction mitochondriale étudiée sur fibres musculaires perméabilisées. En hypoxie, le DHA agirait différemment, réduisant les effets de l'hypoxie sur le muscle, sans que les mécanismes mimétiques de l'exercice d'endurance ne soient clairement retrouvés. La prise de DHA chez des rats entrainés et conditionnés en hypoxie permet également un gain d'endurance mais les mécanismes à l'origine de cet effet ne sont pas élucidés et nécessitent des travaux complémentaires. Au vu des résultats sur le muscle, la supplémentation en DHA pourrait donc être bénéfique dans la prise en charge de la dysfonction musculaire dans les maladies chroniques telles que la BPCO. / The maintenance and reinforcement of skeletal muscle mass and function, impaired in COPD patients, is a crucial aim to preserve, and even improve, their exercise tolerance, quality of life and survival. In order to optimize the management of such a muscular dysfunction, rehabilitation could be completed by nutritional interventions, also called nutritional rehabilitation. In this context, the intake of polyunsaturated fatty acids of the n-3 class, and particularly of docosahexaenoic acid (DHA), could be interesting, due to their benefic effects demonstrated in many chronic pathologies. Therefore, the aim of our work was to characterize the effects of DHA supplementation on exercise tolerance and skeletal muscle metabolism in rats exposed to hypoxia as a model of muscle dysfunction as seen in COPD patients suffering chronic respiratory failure. Results showed that exercise tolerance was improved by DHA in both normoxia and hypoxia conditions. In normoxia, the involved mechanisms may rely on an endurance exercise mimetic effect of DHA, including AMPK activation and improved mitochondrial function studied on permeabilized muscular fibers. In hypoxia, DHA acts differently, probably by minimizing hypoxia effects on muscle. However, the endurance exercise mimetic mechanisms were not clearly found. In hypoxia exposed-endurance trained-rats, DHA improved endurance exercise capacity but the involved mechanisms were not fully characterized and need further work. In conclusion, our results on muscle suggest that DHA supplementation could be beneficial in management of muscular dysfunction induced by chronic diseases such as COPD.

Made available in DSpace on 2014-06-11T19:22:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-06-17Bitstream added on 2014-06-13T20:49:20Z : No. of bitstreams: 1 fujii_nah_me_prud.pdf: 632013 bytes, checksum: e547afd544716bfdacf3188794a7ac08 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Avaliar as características de atividades físicas na vida diária de pacientes brasileiros portadores de DPOC e sua relação com diferentes variáveis fisiológicas. Métodos: Quarenta pacientes brasileiros portadores de DPOC (18 homens; 66±8 anos; VEF1 46±16%pred; IMC 27±6 Kg.m-2) e 30 idosos saudáveis foram avaliados quanto às atividades físicas na vida diária utilizando-se um acelerômetro multiaxial (Dynaport Activity Monitor, Holanda) por 12 h/dia durante 2 dias da semana. Foram ainda avaliados: capacidade máxima e funcional de exercício (teste incremental máximo e teste de caminhada de 6 minutos [TC6], respectivamente), pressões máximas inspiratória e expiratória (PImax e PEmax, respectivamente), força muscular periférica (1 repetição máxima e força de preensão manual), qualidade de vida (Saint George Respiratory Questionnaire [SGRQ]), estado funcional (questionário London Chest Activity of Daily Living [LCADL]) e sensação de dispnéia (escala do Medical Research Council [MRC]). Resultados: Pacientes portadores de DPOC apresentaram menor tempo gasto andando/dia quando comparados aos idosos saudáveis (55±33 versus 80±28 min/dia; p=0,001) e menor intensidade de movimento (1,9±0,4 versus 2,3±0,6 m/s2; p=0,004). Os pacientes com DPOC também tenderam a passar mais tempo sentados (294±114 versus 246±122 min/dia; p=0,08). O tempo andando/dia correlacionou-se com TC6 (r=0,42; p=0,007), carga máxima de trabalho (r=0,41; p=0,009), idade, MRC e domínio atividade do SGRQ (-0,31≤ r ≤-0,43; p≤0,05 para todos). Conclusão: Apesar de serem mais ativos do que pacientes europeus estudados previamente, pacientes brasileiros portadores de DOPC são menos ativos em comparação a idosos saudáveis. O tempo gasto andando/dia é apenas moderadamente relacionado à capacidade máxima e funcional de exercício / To evaluate the characteristics of physical activities in daily life in Brazilian patients with Chronic Obstructive Pulmonary Disease (COPD) and the relationship of these characteristics with different physiologic variables. Methods: Forty Brazilian COPD patients (18 men; 66±8 years; FEV1 46±16%pred; BMI 27±6 Kg.m-2) and 30 healthy age- and sex-matched subjects performed assessment of physical activity in daily life with an accelerometerbased activity monitor (Dynaport Activity Monitor, The Netherlands) for 12 h/day in 2 weekdays. Other measurements included maximal and functional exercise capacity (incremental exercise test and six-minute walk test [6MWT], respectively), maximal inspiratory and expiratory pressures, peripheral muscle force (1-repetition maximum and handgrip force), quality of life (Saint George Respiratory Questionnaire, SGRQ), functional status (London Chest Activity of Daily Living questionnaire) and dyspnea sensation (Medical Research Council scale, MRC). Results: COPD patients had lower daily time spent walking in comparison to healthy elderly (55±33 versus 80±28 min/day; p=0.001) as well as reduced movement intensity (1.9±0.4 versus 2.3±0.6 m/s2; p=0.004). In addition, COPD patients also tended to have more daily sitting time (294±114 versus 246±122 min/day, p=0.08). Time spent walking in daily life was correlated with 6MWT (r=0.42; p=0.007), maximal workload (r=0.41; p=0.009), age, MRC scale and SGRQ activity domain (-0.31 ≤ r ≤ -0.43; all p≤0.05). Conclusion: Despite being more active than previous reports of European COPD cohorts, Brazilian patients with COPD are less active in comparison to healthy elderly. Daily time spent walking in real life is only moderately related with maximal and functional exercise capacity

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-02-15T13:45:21Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Adriane Cardim 2015.pdf: 1719203 bytes, checksum: 5820b852957920840a3967619c38ee97 (MD5) / Made available in DSpace on 2017-02-15T13:45:21Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Adriane Cardim 2015.pdf: 1719203 bytes, checksum: 5820b852957920840a3967619c38ee97 (MD5) Previous issue date: 2015-08-20 / CAPES / A doença pulmonar obstrutiva crônica (DPOC) é uma desordem respiratória associada à disfunção muscular esquelética e ao desenvolvimento de hiperinsuflação pulmonar o que contribui para dispneia e redução da tolerância ao exercício. O alongamento dos músculos da caixa torácica e a vibração de corpo inteiro surgem como terapias alternativas para recuperar a função muscular e melhorar a capacidade funcional. Os objetivos desta dissertação foram: 1. Avaliar os efeitos agudos de um programa de alongamentos da musculatura da caixa torácica sobre a mobilidade diafragmática e a cinemática toracoabdominal de pacientes com DPOC durante o exercício; 2. Avaliar a qualidade da evidência da literatura dos efeitos da vibração de corpo inteiro (VCI) sobre a capacidade funcional de pacientes com DPOC. Foi realizado um ensaio clínico composto por 14 pacientes com DPOC, 6 hiperinsufladores severos (HS) e 8 não hiperinsufladores (NH). Os pacientes foram divididos em dois grupos: Alongamento (GA) e Controle (GC) e tiveram avaliadas a mobilidade diafragmática bem como o padrão ventilatório e os volumes da parede torácica antes da intervenção (GA ou GC) e após exercício de carga constante em bicicleta ergométrica. Os resultados mostraram aumentos no volume corrente abdominal (p<0,001), mobilidade diafragmática (p=0,030), além de maiores valores de saturação periférica de oxigênio (p=0,024) no GA em relação ao GC nos pacientes com HS; e redução da frequência respiratória (p=0,023), aumento do volume inspiratório final (p=0,004) e menor sensação de fadiga de membros inferiores (p=0,043) no GA em relação ao GC nos pacientes NH. A sessão de alongamentos não foi capaz de aumentar a tolerância ao exercício. Também foi desenvolvida uma revisão sistemática e metanálise que incluiu quatro artigos envolvendo 185 pacientes, todos os estudos mostraram aumento na distância percorrida no teste de caminhada de seis minutos no grupo com VCI em relação ao controle (57,85 m; IC 95% 16,33-99,33). A qualidade da evidência foi moderada. Concluímos que o alongamento dos músculos da caixa torácica pode trazer benefícios agudos para os pacientes com DPOC, principalmente naqueles que apresentam hiperinsuflação dinâmica severa e que a vibração de corpo inteiro é capaz de melhorar a capacidade funcional de pacientes com DPOC. / Chronic obstructive pulmonary disease (COPD) is a respiratory disorder associated with skeletal muscle dysfunction and the development of lung hyperinflation which contributes to dyspnea and reduced exercise tolerance. Stretching the muscles of the rib cage and the whole body vibration emerge as alternative therapies to restore muscle function and improve functional capacity. The objectives of this study were: 1. To assess the acute effects of a stretching program for the muscles of the rib cage on the diaphragmatic motion and kinematics thoracoabdominal patients with COPD during exercise; 2. To assess the quality of evidence from the literature of the effects of whole body vibration (WBV) on the functional capacity of patients with COPD. It conducted a clinical trial comprising 14 patients with COPD, 6 severe hyperinflators (SH) and 8 non hyperinflators (NH). Patients were divided into two groups: Stretching (SG) and control (CG) and were evaluated diaphragmatic mobility and the ventilatory pattern and volume of the chest wall before the intervention (SG or CG) and after constant load exercise bicycle exercise. The results showed increases in abdominal tidal volume (p <0.001), diaphragmatic mobility (p = 0.030), as well as higher peripheral oxygen saturation values (p = 0.024) in SG than the CG in patients with SH; and reduced respiratory rate (p = 0.023), increased end-inspiratory volume (p = 0.004) and less sense of fatigue of the lower limbs (p = 0.043) in SG than the CG in NH patients. The stretching session was not able to increase exercise tolerance. It was also developed a systematic review and meta-analysis that included four articles involving 185 patients, all studies showed an increase in the distance covered on the six-minute walk test in the group with VCI compared to the control (57.85 m; 95% CI 16.33 to 99.33). The quality of evidence was moderate. We conclude that the stretching of the muscles of the rib cage can bring benefits for acute COPD patients, particularly those with severe dynamic hyperinflation and the whole-body vibration can improve the functional capacity of patients with COPD.

Orientadores: Maria Cecília Bueno Jayme Gallani, Cláudio Alexandre Gobatto / Dissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T07:45:37Z (GMT). No. of bitstreams: 1 Domingues_GabrieladeBarrosLeite_M.pdf: 2449497 bytes, checksum: c73325ac9dcba344fe88939add648631 (MD5) Previous issue date: 2010 / Resumo: A capacidade física é considerada um importante fator prognóstico para pacientes com doença cardiovascular (DCV). Questionários têm sido desenvolvidos para avaliar a capacidade física, dentre os quais se destaca o Veterans Specific Activity Questionnaire (VSAQ), que estima a capacidade física em METs (equivalente metabólico de repouso). Objetivos: Este estudo teve como objetivo realizar a adaptação cultural do instrumento VSAQ para a língua portuguesa do Brasil, analisar sua validade de conteúdo, bem como avaliar sua confiabilidade e validade convergente pela correlação com consumo de oxigênio pico (VO2pico), com o limiar de anaerobiose (Lan) de lactato e com o nível de atividade física. Metodologia: O processo de adaptação cultural seguiu metodologia recomendada internacionalmente, com as etapas de tradução-retrotradução, análise por comitê de juízes especialistas para avaliação da equivalência semântico-idiomática e cultural, identificação das atividades culturalmente não relevantes e levantamento das atividades mais freqüentes no cotidiano (recordatório de 24h) junto à amostra da população de interesse (n=20 e 24 respectivamente); análise por um segundo comitê, da equivalência metabólica das atividades incluídas em substituição àquelas culturalmente não compatíveis e dois pré-testes (n=30). A confiabilidade foi avaliada segundo o critério da estabilidade (teste re-teste), junto a outros 50 pacientes, com intervalo de 7-15 dias. Para análise da validade foi testada com uma amostra diferente da primeira etapa a correlação dos METs obtidos com a versão brasileira do VSAQ e corrigidos pelo nomograma (Myers et al, 1994) com as medidas diretas e indiretas de capacidade física: VO2 pico e capacidade física em METs mensurada pelo teste de exercício cardiopulmonar (TCP), escore de atividade física habitual Baecke e limiar anaeróbio, estimado pela curva de lactato sanguíneo durante TCP. Esta etapa foi realizada junto a 140 pacientes com sintomatologia de DCV, encaminhados ao teste de esforço por razões clínicas. Análise de dados: Para análise concordância da avaliação dos juízes quanto às equivalências semântico-idiomática e cultural entre as versões original e traduzida do VSAQ, foi empregado o índice de validade de conteúdo (CVI); para análise da validade de concordância do teste re-teste foi utilizado o coeficiente Kappa; para análise da correlação entre o VSAQ e as medidas objetivas de capacidade física e de freqüência de atividade física foi empregado coeficiente de correlação de Pearson. Foi adotado p< 0,05 como nível de significância. Resultados: A avaliação da equivalência metabólica entre as atividades originais e as substituídas apontou 54% de concordância entre os juízes. Os itens com CVI menor que 1,0 foram revistos até obtenção de consenso entre os membros do comitê. A análise do teste re-teste apontou coeficiente de concordância (Kappa) k=0,86 (p<0,001), sugerindo evidências de estabilidade temporal do instrumento. Os dados da versão brasileira do VSAQ com e sem correção pelo Nomograma apresentaram moderada e forte correlação com as medidas de VO2 pico e METs mensurados diretamente (r =0,54, 0,63, 0,52, 0,60, p < 0,001). O escore de atividade física habitual Baecke foi significativamente correlacionado com o METs corrigido pelo Nomograma (r =0,28, P < 0,001). Foi encontrada significativa correlação parcial (corrigida pelo protocolo do teste de esforço) entre o Lan de lactato e o METs corrigido pelo Nomograma e VO2 pico mensurado diretamente (r =0,25, 0,52, p<0,05, p<0,001) Conclusão: A versão brasileira do VSAQ, após extenso e rigoroso processo de adaptação cultural apresentou evidências de confiabilidade segundo critério de estabilidade temporal, bem como foram confirmadas as hipóteses de correlação entre a versão brasileira do VSAQ e outras medidas diretas e indiretas de capacidade física e de prática habitual de atividade física, reforçando as evidências de validade convergente. / Abstract: Exercise capacity is considered an important prognostic factor in patients with cardiovascular disease (CVD). Questionnaires have been developed to evaluate the exercise capacity, among which stands out the Veterans Specific Activity Questionnaire (VSAQ). Objectives: The aim of this study is to present the process of crosscultural adaptation of the VSAQ to the Brazilian culture, and to investigate its content validity, and assess its reliability and convergent validity by correlation with peak oxygen consumption (VO2 peak), with the lactate anaerobic threshold and with the level of physical activity. Methodology: The process of cultural adaptation followed internationally recommended methodology included the steps of translation, back translation, review by an experts committee to assess the semantic, idiomatic and cultural equivalences identity is not culturally relevant activities and lifting of the most frequent activities in daily (24-hour recall) with the sample of the population of interest (n = 20:24, respectively); analysis by a second committee, the equivalence of metabolic activities included to replace those not culturally compatible and two pretests (n = 30). The proportion of agreement of the first committee of experts was quantified using the Content Validity Index (CVI). Reliability was assessed using the criterion of stability (test-retest), with the remaining 50 patients, with an interval of 7-15 days. For the validity analysis was tested with a different sample of the first stage the correlation of the Brazilian version of METs VSAQ and nomogram with the direct and indirect measures of physical capacity: METs and VO2 peak (measured by cardiopulmonary exercise test), score Baecke habitual physical activity and lactate anaerobic threshold. This step was performed in 140 patients with symptoms of CVD, were referred to exercise testing for clinical reasons. Data analysis: For analysis of the evaluation agreement of the judges as to semantic, idiomatic and cultural equivalence was used content validity index (CVI); for analysis of the validity of agreement was used Kappa coefficient; for analysis of the correlation between VSAQ and objective measures of physical capacity and frequency of physical activity was used Pearson correlation coefficient. Adopted was p < 0.05 significance level. Results: The assessment of equivalence between metabolic activities and the original replaced showed 54% agreement among judges. Then, the activities with lower levels of agreement were replaced by others to achieve consensus among the committee members. Analysis of testretest showed concordance coefficient (Kappa) k = 0.86 (p < 0.001), suggesting evidence of temporal stability of the instrument. The Brazilian version VSAQ and nomogram showed moderate to strong correlation with measures of peak measured VO2 and peak measured METs (r =. 54, .63, .52, .60, p < .001). The score Baecke's habitual physical activity was significantly correlated with METs nomogram corrected by (r =. 28, p < .001). It was found a significant partial correlation (corrected by the protocol of exercise testing) between the anaerobic threshold and lactate METs nomogram and corrected by the measured peak VO2 (r =. 25, .52, p < .05, p < .001). Conclusion: The Brazilian version of VSAQ after extensive and rigorous process of cultural adaptation presented evidence of temporal stability and evidence of convergent validity for measuring exercise tolerance in people with cardiovascular symptoms. / Mestrado / Enfermagem e Trabalho / Mestre em Ciências da Saúde

Orientadores: Lair Zambon, Ivete Alonso Bredda Saad / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T19:41:43Z (GMT). No. of bitstreams: 1 Machado_Luciana_M.pdf: 1226085 bytes, checksum: 957e229ddb877def1e539e3bd17e99d5 (MD5) Previous issue date: 2010 / Resumo: O câncer de pulmão (CP) é um grave problema de saúde pública por ser um dos tipos de câncer mais frequentes e o responsável por uma maior mortalidade. A maioria dos pacientes está em estágio avançado da doença no momento da apresentação. A quimioterapia é o tratamento mais indicado para esse perfil de paciente. Entretanto, o tratamento pode vir acompanhado de efeitos colaterais que podem interferir diretamente nas capacidades funcionais bem como na qualidade de vida (QV) do paciente. O objetivo desse estudo foi avaliar o efeito da quimioterapia sobre a condição física e QV de pacientes com CP avançado. Foram avaliados 50 pacientes com câncer de pulmão não pequenas células (CPNPC) nos estágios IIIB e IV e com performance status PS-ECOG entre zero e dois. Todos receberam quimioterapia com as drogas paclitaxel e derivados da platina e foram avaliados em três momentos: pré-quimioterapia, pós-quimioterapia e seis após o início do tratamento. Avaliou-se o PS pelo índice ECOG, índice de massa corpórea (IMC) e teste de caminhada de seis minutos (TC6) e a QV pelos questionários SF-36, EORTC QLQ C-30 juntamente com seu módulo LC13 e escala hospitalar de ansiedade e depressão (HAD). Trinta e um pacientes concluíram o estudo após seis meses. Na evolução, 19 foram a óbito ou pioraram o PS-ECOG. O SF-36 não mostrou significância estatística em nenhum dos domínios, o EORTC-C30 mostrou melhora no domínio social e no sintoma insônia e piora para o sintoma náusea; pelo LC13, houve melhora dos sintomas dispnéia, tosse, hemoptise, alopécia e dor torácica, porém piora da neuropatia periférica. Pela aplicação da HAD, os pacientes não apresentaram ansiedade e depressão. Não houve diferença estatisticamente significante entre as avaliações para o IMC e o TC6 não apresentou diferença estaticamente significante em nenhum dos tempos avaliados. Em relação ao PS-EGOG, houve benefício da quimioterapia, principalmente no aumento de pacientes assintomáticos após seis meses de acompanhamento. Conclui-se que houve benefício do uso da quimioterapia em relação à melhoria do PS. A avaliação do IMC e do TC6 não apresentou alteração durante o estudo, o que pode sugerir uma manutenção da condição física. A QV também não apresentou evidências de piora nem de melhora / Abstract: Lung cancer (LC), one of the most common types of cancer, is a serious public health problem and responsible for a higher number of mortality. Most of the patients are in advanced stage of disease at presentation. Chemotherapy is the most appropriate treatment for this patient profile. However treatment is often accompanied by side effects that may directly interfere in functional capabilities and the quality of life (QoL) of patients. The aim of this study was to evaluate the effect of chemotherapy on the physical condition and QoL of patients with advanced LC. We evaluated 50 patients with non-small cell lung cancer (NSCLC) in stage IIIB and IV and performance status ECOG-PS between zero and two. All received chemotherapy drugs paclitaxel and platinum derivatives, and were evaluated in three stages: pre-chemotherapy, after-chemotherapy and six after six treatment initiation. We evaluated the ECOG-PS and the index, body mass index (BMI) and six minutes walk test (6MWT) and QoL by SF-36, EORTC QLQ C-30 along with your module LC13 and hospital anxiety and depression scale (HAD). Thirty one patients completed the study after six months. At progression, 19 died or deteriorated ECOG-PS. The SF-36 showed no statistical significance in any of the fields, the EORTC-C30 showed improvement in social and insomnia, and worsening for the symptom nausea, the LC13, his symptoms improved dyspnea, cough, hemoptysis, pain and alopecia chest, but worsening of peripheral neuropathy and by the application of HAD patients did not have anxiety and depression. There was no statistically significant difference between assessments for BMI, the 6MWT did not show statistically significant difference in any of the evaluated time. Regarding EGOG, there was a benefit of chemotherapy, mainly in the increase of asymptomatic patients after six months of follow up (p = 0.031). It is concluded that there was benefit from the use of chemotherapy in relation to the improvement of PS. The assessment of BMI and 6MWT did not change during the study, which may suggest maintenance of physical condition. QoL also showed no evidence of worsening or improvement / Mestrado / Ciencias Basicas / Mestre em Clinica Medica