Made available in DSpace on 2015-04-14T13:22:08Z (GMT). No. of bitstreams: 1 445314.pdf: 2487058 bytes, checksum: 8400f31d0724c60e094c2ef206204175 (MD5) Previous issue date: 2012-12-12 / This dissertation deals with lifestyle changes in patients with metabolic syndrome (MS), using the Transtheoretical Model (TTM) as the framework of intervention. Initially, we present a contextualization of the current research from both a theoretical and a practical point of view. From a theoretical point of view we discuss (1) the metabolic syndrome and its prevalence in Brazil; (2) constructs from TTM; (3) some studies that used this model for health problems; and (4) factors that may interfere with the motivation of subjects to change their behavior. We approach the practical side from the four dimensions that this dissertation examines: stages of change, processes of change, markers of change and context of change. To answer the four questions in a more detailed way, this dissertation is composed of four articles: a thematic essay about the importance of techniques and therapeutic alliance in the treatment; an empirical study comparing the efficacy of two treatments based on TTM with a control treatment; an empirical study of predictor factors to weight loss; and one article about the development of an intervention based on TTM for patients with MS, with a focus on the adherence to diet and exercise. The thematic essay discusses the treatments with manual versus treatments without a manual to be followed, debating what the more important factor in the treatment is: the techniques or the working alliance. The discussion is based on different authors with diverse opinions, and do not seek a single truth, but provides a platform for discussion about how psychotherapists are formed as well as about their work. The first empirical study tackles the efficacy of two treatments - individual (IT) and group (GT) - both based on TTM for patients with MS. The article presents how each intervention was applied, and shows which variables had significant effect on each group. The results show that participants from IT had significantly improved upon their weight, body mass index (BMI), abdominal circumference, amount of exercise per week, readiness to exercise 3-5 times per week, and their readiness to increase fibers and to decrease salt. Group treatment has no better results than control treatment for any outcome. The second empirical study evaluates the predictor factors of weight loss in these patients, submitted to the treatments tested in the first article. For the total sample, the predictors of weight loss were self-efficacy to keep diet after treatment and self-efficacy to keep exercising after treatment. Perceived problem severity shows to contribute to a very small weight loss or increase in weight. For individual intervention readiness to exercise 3 to 5 times per week was a predictor of weight loss. For group treatment, the predictor factors were: self-efficacy to keep diet after and self-efficacy to keep exercise after the treatment. Pressure to change, familly support, anxiety/depression and intrusive behavior did not significantly contribute to the prediction of changes. Examining the three treatments as independent variables, Individual Treatment increases in 3 times the chance of losing more than 5% of the initial weight / Esta tese aborda a mudan?a do estilo de vida em pacientes com s?ndrome metab?lica (SM), e utilizou como abordagem de interven??o o Modelo Transte?rico de Mudan?a de Comportamento (MTT). Inicialmente apresenta uma contextualiza??o geral, contemplando o contexto da pesquisa do ponto de vista te?rico e do ponto de vista pr?tico. O primeiro deles aborda a s?ndrome metab?lica e sua preval?ncia no Brasil; conceitos do Modelo Transte?rico de Mudan?a; alguns estudos com o modelo e problemas de sa?de; e fatores que podem interferir na motiva??o para mudan?a. O segundo, aborda de forma geral as quatro quest?es de pesquisa que esta tese buscou responder. Para responder ?s quatro quest?es de forma detalhada, a tese ? composta por 4 artigos: um ensaio tem?tico sobre a import?ncia das t?cnicas e da rela??o terap?utica no tratamento; um estudo emp?rico comparando a efic?cia de duas interven??es baseadas no MTT com uma interven??o padr?o; um estudo emp?rico dos fatores preditivos de redu??o de peso; e um artigo sobre o desenvolvimento de uma interven??o baseada no MTT para pacientes com s?ndrome metab?lica (SM) com objetivo de enfocar a ades?o ? dieta e ao exerc?cio f?sico. O ensaio tem?tico discute os tratamentos manualizados versus os n?o manualizados, enfocando o que ? mais importante no tratamento, as t?cnicas aplicadas ou a rela??o terap?utica. A discuss?o ? fundamentada em diversos autores com posicionamentos distintos, e n?o busca uma verdade ?nica, mas sim uma reflex?o sobre como os psicoterapeutas s?o formados e o sobre o seu trabalho. O artigo emp?rico aborda a efic?cia das interven??es individual (II) e grupal (IG), baseadas no MTT para pacientes com SM. Este artigo apresenta como cada uma das interven??es aconteceu, e mostra quais vari?veis de interesse tiveram mudan?as significativas em cada grupo de tratamento. Os resultados demonstraram que os participantes da II tiveram melhora significativa no peso, ?ndice de massa corporal, circunfer?ncia abdominal, quantidade de exerc?cio por semana, prontid?o para realizar exerc?cio aer?bico de 3-5 vezes por semana, para aumentar consumo de fibras e para reduzir o de sal. A interven??o grupal n?o obteve resultados estatisticamente significativos quando comparados aos da Interven??o Padr?o em nenhuma vari?vel. O segundo artigo emp?rico avaliou os fatores preditivos de redu??o de peso nestes pacientes submetidos aos tratamentos testados no primeiro artigo emp?rico. Para a amostra como um todo, foram preditores de redu??o de peso: a auto-efic?cia para se manter em dieta ap?s o tratamento e a auto-efic?cia para de manter em exerc?cio ap?s o tratamento. A percep??o de gravidade da SM mostrou ter contribu?do apenas para uma pequena redu??o de peso ou at? mesmo para um aumento de peso. Na interven??o individual a prontid?o para realizar exerc?cio aer?bico de 3 a 5 vezes por semana foi preditora de redu??o de peso. Na interven??o grupal os fatores preditores de sucesso foram: auto-efic?cia para se manter em dieta e auto-efic?cia para se manter em exerc?cio ap?s o tratamento, ao passo que a percep??o sobre a gravidade da SM e a prontid?o para realizar exerc?cio f?sico de 3 a 5 vezes por semana contribu?ram para uma perda m?nima de peso ou at? mesmo ganho de peso. Press?o para mudar, apoio familiar, ansiedade/depress?o e comportamento intrusivo n?o predisseram mudan?as. Avaliando-se os 3 grupos de interven??o como vari?veis independentes, fazer parte da Interven??o Individual mostrou maiores chances de perder mais de 5% do peso inicial. A tese buscou contemplar 4 dimens?es do MTT (est?gios de mudan?a, processos de mudan?a, marcadores e contexto)

Made available in DSpace on 2015-04-14T13:22:12Z (GMT). No. of bitstreams: 1 447811.pdf: 146207 bytes, checksum: 610a9cb5a91a87e979f9474d2a351138 (MD5) Previous issue date: 2013-03-19 / The first choice of treatment for patients with Metabolic Syndrome (MS) is the lifestyle changing, which includes the practice of physical exercise and healthy eating, being the Transtheoretical Model of Change (TTM) one of the most used approaches to intervene in relation to these behaviors. However, the literature points out, despite the paucity of studies, that patients have difficulty in adhere to the proposed orientations and keep the changes achieved after the end of treatment. This dissertation sought to address these two subjects and was composed of two sections. The first compared the baseline characteristics between subjects with MS who completed and did not complete a randomized clinical trial, based on TTM, in order to modify the lifestyle and cardiovascular risk (MERC), and identified factors associated with treatment completion. Were assessed, 127 subjects with a mean age of 49.58 years (SD = 7.77) and diagnosis of MS, enrolled at MERC between the years 2010 and 2012. Most of the sample completed the intervention (p <0.01), whereas those individuals older than 50 years (OR: 7.5, 95% CI 1.2 to 46.7, p <0.05 ), who exercise (OR: 1.9, 95% CI: 1.0 - 7.0, p <0.05), have religion (OR: 4.6, 95% CI 1.1 to 13.2; p <0.05), high self-efficacy for regular eating habits (OR: 1.2, 95% CI: 1.0 - 2.3, p <0.05), don t have binge eating (OR: 6.1 95% CI: 2.1 to 23.8, p <0.05) and don t have depression (OR: 4.9, 95% CI: 1.4 to 19.4, p <0.05), are more likely to complete the treatment. The second section conducted the follow-up (T3) of the MERC program participants, on average, one year after the initial assessment (T1). The sample consisted of 55 individuals with MS and an average age of 51.9 years (SD = 6.5), divided into 3 groups: Group Intervention - GI (n = 19); Individual Intervention - II (n = 20); Standard Intervention - SI (n = 16). Time effect was significant (<0.001), with a decrease in weight, body mass index, waist circumference, diastolic and systolic blood pressure (SBP) means. There were differences between groups only regarding weight, wherein just the individuals of GI and II maintained treatment outcomes and still showed a significant reduction when compared T3 and T1, and SBP, with II standing out in relation to others. At T3, most individuals were motivated, but with selfefficacy on average for regulating eating habit and medium/low to perform physical exercise, which reinforces the need for monitoring continuously these patients. The results show that an interdisciplinary program, aimed at lifestyle changing, based on MTT, is effective in the management of patients with MS, not only in relation to adherence promotion, but also in maintenance of treatment outcomes. / A primeira escolha de tratamento para pacientes com S?ndrome Metab?lica ? a mudan?a do estilo de vida, que contempla a pr?tica de exerc?cio f?sico e alimenta??o saud?vel, sendo o Modelo Transte?rico de Mudan?a (MTT) uma das abordagens mais utilizadas para intervir em rela??o a estes comportamentos. No entanto, a literatura aponta, apesar da escassez de estudos, que os pacientes t?m dificuldade de aderir ?s orienta??es propostas e manter as mudan?as alcan?adas ap?s o t?rmino do tratamento. Esta disserta??o buscou contemplar estas duas quest?es e foi composta por duas se??es. A primeira comparou as caracter?sticas da linha de base entre indiv?duos com SM que conclu?ram e n?o conclu?ram um ensaio cl?nico randomizado, visando ? modifica??o do estilo de vida e risco cardiovascular (MERC), baseado no MTT, e identificou os fatores associados ? conclus?o do tratamento. Foram avaliados 127 sujeitos com m?dia de idade de 49,58 anos (DP=7,77) e diagn?stico de SM, que participaram do programa MERC entre os anos de 2010 e 2012. A maior parte da amostra concluiu a interven??o (p<0,01), sendo que, aqueles indiv?duos com idade acima de 50 anos (OR: 7,5; IC95%: 1,2 46,7; p<0,05), que fazem exerc?cio (OR: 1,9; IC95%: 1,0 - 7,0; p<0,05), t?m religi?o (OR: 4,6; IC95%: 1,1-13,2; p<0,05), auto-efic?cia alta para regular h?bito alimentar (OR: 1,2; IC95%: 1,0 2,3; p<0,05), n?o apresentam compuls?o alimentar (OR: 6,1; IC95%: 2,1 23,8; p<0,05) e n?o possuem depress?o (OR: 4,9; IC95%: 1,4 19,4; p<0,05), t?m mais chance de concluir o tratamento. A segunda se??o realizou o seguimento (T3) dos participantes do programa MERC, em m?dia, um ano ap?s a avalia??o inicial (T1). A amostra foi composta por 55 indiv?duos, com SM e idade m?dia de 51,9 anos (DP= 6,5), divididos em 3 grupos: Interven??o Grupal IG (n=19); Interven??o Individual - II (n=20); Interven??o Padr?o - IP (n=16). O efeito do tempo foi significativo (<0,001), com uma diminui??o das m?dias do peso, ?ndice de massa corporal, circunfer?ncia abdominal, press?o arterial sist?lica (PAS) e diast?lica. Houve diferen?a entre os grupos apenas em rela??o ao peso, em que somente os indiv?duos da II e da IG mantiveram os resultados do tratamento e ainda apresentaram uma redu??o significativa quando comparados T3 e T1, e ? PAS, com a II sobressaindo-se em rela??o ?s demais. No T3, grande parte dos indiv?duos ainda estava motivada, mas com auto-efic?cia m?dia para regular h?bito alimentar e m?dia/baixa para realizar exerc?cio f?sico, o que refor?a a necessidade de realizar o acompanhamento cont?nuo destes pacientes. Os resultados apontam que um programa interdisciplinar, visando ? mudan?a de estilo de vida, baseado no MTT, ? efetivo no manejo de pacientes com SM, n?o s? em rela??o ? promo??o da ades?o, como ? manuten??o dos resultados do tratamento.