Obesity is the fifth leading cause of global deaths. The efficacy and safety of obesity treatment is still controversial. The objective of the thesis is to evaluate the efficacy and safety of bariatric surgery, through a systematic review of the current evidence and meta- analysis of important outcomes. Nineteen (19) randomized controlled trials (RCTs) with 1346 participants were included. Bariatric surgery resulted in greater weight loss when compared to non-surgical treatment. Weight loss was also associated with resolution and/or improvement of obesity related comorbidites such as diabetes, hypertension, hyperlipidemia, and sleep apnea. Weight loss and safety varied across the surgical procedures. Biliopancreatic diversion/duodenal switch had the greatest weight loss, followed by sleeve gastrectomy and Roux-en-Y gastric bypass, purely restrictive procedures such as vertical banded gastroplasty and adjustable gastric banding resulted in the least weight loss. Long term, high quality, and adequately powered trials are still needed to support the available evidence

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Προσχεδιασμένη συγκριτική διπλή τυφλή μελέτη της αποτελεσματικότητας της επιμήκους γαστρεκτομής (LSG) και της μερικής γαστρικής παράκαμψης Roux-en-Y (LRYGB) σε ασθενείς με κλινικά σοβαρή παχυσαρκία (BMI 35-49,9) Η λαπαροσκοπική γαστρική παράκαμψη (LRYGB) αποτελεί στις μέρες μας το χρυσό κανόνα για τη χειρουργική αντιμετώπιση της κλινικά σοβαρής παχυσαρκίας. Η λαπαροσκοπική επιμήκης γαστρεκτομή (LSG) είναι μία σχετικώς νέα επέμβαση περιοριστικού τύπου η οποία τελευταία έχει αρχίσει να εφαρμόζεται ως μοναδική επέμβαση για την κλινικά σοβαρή παχυσαρκία. Η παρούσα προοπτική διπλή τυφλή μελέτη έχει σκοπό να διερευνήσει την ασφάλεια των παραπάνω επεμβάσεων καθώς και την αποτελεσματικότητα τους σε χρονικό ορίζοντα τριών χρόνων. Μέθοδος: Εξήντα ασθενείς με δείκτη σωματικής μάζας <50 Kg/m2 μετά από τυχαιοποίηση υπεβλήθησαν τριάντα σε LSG και τριάντα σε LRYGB. Οι ασθενείς παρακολουθήθηκαν μετεγχειρητικά για τρία χρόνια. Στο διάστημα αυτό καταγράφηκε η απώλεια βάρους, η πρώιμη και όψιμη νοσηρότητα και θνητότητα, η ίαση των συνοδών της παχυσαρκίας νόσων και η ανάπτυξη μικροθρεπτικών ανεπαρκειών μετά τους δύο τύπους χειρουργείων. Αποτελέσματα: Η θνητότητα ήταν μηδενική και στους δύο τύπους επεμβάσεων. Δεν καταγράφηκε σημαντική διαφορά στην πρώιμη (10% μετά από LRYGBP και 13.3% μετά από LSG, P>0.05) και όψιμη νοσηρότητα (10% σε κάθε ομάδα) μετά και τους δύο τύπους χειρουργείων. Η απώλεια βάρους ήταν στατιστικώς μεγαλύτερη μετά από LSG καθόλη τη διάρκεια της μελέτης. Τον τρίτο μετεγχειρητικό χρόνο η επί τις εκατό απώλεια του υπερβάλλοντος βάρους κυμαίνονταν στο 62.09% μετά από LRYGBP και στο 68.46% μετά από LSG (p=0.02). Δεν παρατηρήθηκε σημαντική διαφορά ως προς την ίαση των συνοδών της παχυσαρκίας νόσων, εκτός από τη δυσλιπιδαιμία η οποία βελτιώθηκε σε σημαντικότερο βαθμό μετά από LRYGB και την υπέρταση η οποία βελτιώθηκε σε σημαντικότερο βαθμό μετά από LSG. Ανεπάρκεια μικροθρεπτικών συστατικών παρατηρήθηκε σε ανάλογο βαθμό μετά τις δύο επεμβάσεις εκτός από την έλλειψη βιταμίνης Β12 η οποία παρατηρήθηκε σε μεγαλύτερο βαθμό μετά από LRYGB (P<0.001). Συμπεράσματα: Και οι δύο επεμβάσεις είναι ασφαλείς και αποτελεσματικές ως προς την απώλεια βάρους και την ίαση των συνοδών της παχυσαρκίας νόσων. Η LSG συνοδεύεται από λιγότερες μεταβολικές ανεπάρκειες και δεν απαιτεί τη χορήγηση συμπληρωμάτων εφ’ όρου ζωής. Η LSG φαίνεται ότι είναι μία υποσχόμενη επέμβαση για την κλινικά σοβαρή παχυσαρκία η οποία στα τρία χρόνια μετεγχειρητικής παρακολούθησης επιτυγχάνει μεγαλύτερη απώλεια βάρους από την LRYGB. / The efficacy of sleeve gastrectomy (LSG) and Roux en Y gastric bypass (LRYGB) in patients with morbid obesity (BMI 35-49,9). A comparative double-blind randomized trial Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently the gold standard bariatric procedure for the treatment of morbid obesity. Laparoscopic sleeve gastrectomy (LSG) is an innovative restrictive procedure which has been increasingly applied as a sole bariatric procedure. A randomized trial was conducted to evaluate perioperative safety (30-day) and 3-years results. Methods: Sixty patients with body mass index (BMI) ≤ 50 Kg/m2 were randomized to LRYGB or LSG. Patients were monitored for 3 years after operation and throughout the study period weight loss, early and late complications, improvement of obesity related comorbidities and nutritional deficiencies were compared between studied groups. Results: There was no death in either group and no significant difference in early (10% after LRYGBP and 13.3% after LSG, P>0.05) and late morbidity (10% in each group). Weight loss was significantly better after LSG throughout the study period. At 3 years %EWL reached 62.09% after LRYGBP and 68.46% after LSG (p=0.02). There was no significant difference in the overall improvement of comorbidities but dyslipidemia improved more after LRYGB, whereas hypertension resolved more after LSG. Nutritional deficiencies occurred at same rate in the two groups except to vitamin B12 deficiency which was more common after LRYGB (P<0.001). Conclusion: In conclusion, LSG and LRYGBP are equally safe and effective in the amelioration of comorbidities, while LSG is associated with fewer postoperative metabolic deficiencies, without the need of supplementation. Furthermore, LSG is a promising bariatric procedure, since it seems to be superior to LRYGB at 3 years follow up on weight reduction.

Context: The purpose of this research was to examine if the educational approach (the Approach) adopted at Kilnbarn Residential Special School (the School) secured the developmental learning pathways for its pupils. All pupils were diagnosed with Autistic Spectrum Disorder (ASD), Severe Learning Difficulties (SLD) and many had single or multiple comorbid conditions. The research sought to understand how their parents could be substantive partners and co-creators in the design, modification, and implementation of the Approach. It was a unique feature of Kilnbarn’s Approach to fulfil the potential of parents to be co-creators and co-therapists in their child’s progress. Objective: The case study became one of the instruments in which to test the School’s effectiveness in meeting the needs of its pupils. It enabled a review of the School’s methodology, curriculum and organisational practices. The Approach was designed to provide secure developmental learning pathways for its pupils, improving their quality of life and independence. Method: The case study design, was chosen as it was considered the most appropriate research model. A Parents’ Questionnaire, distributed annually over 3 consecutive years (2004-6) was the evidential basis for this study. Interviews and collected data were used to analyse and evaluate the progress of the School through parents’ eyes. Results: The combination of parents working with professionals to maximise the culture of “technical eclecticism” seems to be, in the light of this case study, best suited to the needs of children diagnosed with autism, SLD and comorbid conditions. The child should be immersed in a consistent approach across all areas of their life. Improvements in well-being, communication and joint action routines, sleep balance, a healthy diet, physical exercise, incontinence and behaviours was observed. Conclusion The study identified that parents could be substantive partners and influencers in the design and modification of the Kilnbarn Approach. The Approach secured developmental learning pathways for its pupils and appeared to improve their quality of life. Parents as co-creators and co-therapists had regained ownership of their child’s quality of life, learning outcomes and personal development. From the experience and unique evidence of this case study schools should utilise and profit from the mass resource of their parents. It has been shown that the Kilnbarn Approach was, during the research, an effective and suitable intervention for the many children it served. It is hoped that further studies in this field will explore the concept of a “technical eclectic” approach that further validates and brings together interventions that are conceptually grounded and incorporates evidence-based focused intervention practices.

Orientador: Maria Rita Marques de Oliveira / Resumo: A obesidade é resultante de uma complexa interação entre fatores genéticos, ambientais e metabólicos, cujo controle dos casos extremos tem se realizado com cirurgia. Embora efetivos, os resultados da cirurgia são variáveis e pouco se sabe sobre os efeitos em longo prazo. Objetivo: avaliar o efeito tardio da cirurgia bariátrica considerando técnica cirúrgica, consumo alimentar e as variações de peso, diante de um desfecho clínico desejável e indesejável. Métodos: Este estudo prospectivo não concorrente envolveu a participação de 74 mulheres (idade 42,2 ± 6,2 anos; IMC 44,7 ± 6,5 kg/m2) submetidas à cirurgia de derivação gástrica em Y-Roux (DGYR). Os pacientes foram categorizados em dois grupos de acordo com a variação de peso pós-cirúrgica: Grupo 1 – variação ≤10% do menor peso alcançado (desfecho desejável); Grupo 2 – reganho de peso >10% do menor peso alcançado (não desejável). Foram avaliados peso corporal, % perda do excesso de peso (%PEP), peso mínimo atingido, presença de comorbidades, consumo de energia e macronutrientes e Baros. Resultados: Após 6 anos da cirurgia, 35/74 pacientes apresentaram reganho de peso >10% do menor peso atingido (Grupo 2). Os grupos eram homogêneos para variáveis pré-cirúrgicas. A mediana do menor peso atingido para os pacientes do Grupo 1 foi de 74 (67,8 - 80) kg e 71,4 (64,6 – 80,8) Kg para os pacientes do Grupo 2, alcançados em 24 (18 – 42) e 18 (12 – 24) meses, respectivamente (p=0,017). O %PEP dos pacientes do Grupo 1 foi de 77% e 66% para... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Incidence of obesity-related diseases is greater in cases of morbid obesity, which leads to higher health risks. Primarily for those patients in whom clinical intervention proved unsuccessful, bariatric surgery has become viable for the treatment of severe obesity. Starting with a review of the medical literature, the discussion herein involves obesity and its magnitude in adults, placing emphasis on diagnostic criteria, epidemiological data, especially in obese women, etiology, comorbidities, and treatment. It also looks into the complexity of the surgical treatment, its techniques, indication and contraindication criteria, benefits, complications, and nutritional deficiencies. Lastly, women who underwent Capella surgery at the Alberto Antunes University Hospital at the Federal University of Alagoas and who were enrolled in its Bariatric Surgery Program had their metabolic and anthropological profiles assessed and discussed afterwards. One hundred and thirty-five women took part in this prospective study and were assessed preoperatively (T1) and between 12 and 24 months postoperatively (T2). They all underwent Fobi-Capella surgery and were divided into three 45-patient groups, according to different preoperative body mass index (BMI) terciles. Age, body mass (BMI), waist circumference, metabolic profile (total cholesterol, HDL-c, LDL-c, triglycerides, fasting glucose), comorbidities, and the use of medication were all taken into account. Patients signed an informed consent form. Statistical tests were employed when evaluating the groups. Mean age was 33.9 ± 9.3 years. Post-operative results showed a respective decrease of 38.1%, 37.9%, and 28.9% in body mass, BMI, and waist circumference. Serum levels of glucose, cholesterol, triglycerides, and LDL-c dropped 21.4%, 19.0%, 48.1%, and 28.1%, respectively. The HDL-c level rose 15.6%. Glycemic levels were brought to normal in all groups. Mean weight loss for the groups was 36.7%, 39.0%, and 38.4%. Patients in groups 1 and 2, preoperatively classified as having class 3 obesity, were deemed overweight at endpoint, whereas those in group 3 came down to class 1 obesity. As to waist circumference, all of them had shown much greater risk for metabolic complications, and only those patients in group 1 progressed to increased risk. The others remained unchanged. The most prevalent comorbidity was dyslipidemia, followed by gastric disorders, joint diseases, hepatic steatosis, systemic arterial hypertension, and diabetes mellitus. Hypertension decreased in 91.8% of the patients, and the remission of diabetes and dyslipidemia stood at 95.7% and 41.5% of the cases, respectively. Cardiovascular risk factors were significantly reduced and the use of medication fell 57.1%. Despite the different pre-operative BMI categories, there were no significant differences across the groups regarding the assessed variables. The three groups showed equally positive results in the follow-up period. / A incidência de doenças secundárias à obesidade é maior em obesos mórbidos, o que implica em grandes riscos à saúde. A cirurgia bariátrica constitui-se em opção de tratamento da obesidade severa com índice de sucesso consistente, especialmente para aqueles em que a intervenção clínica não alcançou resultados positivos. Este estudo discute a problemática e a magnitude da obesidade em adultos, com revisão da literatura, enfatizando critérios diagnósticos, dados epidemiológicos - especialmente em mulheres obesas - etiologia, comorbidezes e tratamento. Evidencia a complexidade do tratamento cirúrgico, as técnicas de cirurgia, critérios de indicação e contra-indicação, benefícios, complicações e deficiências nutricionais. Por fim, analisa e discute o impacto sobre o perfil metabólico e antropométrico de mulheres inseridas no Programa de Cirurgia Bariátrica do Hospital Universitário Profº Alberto Antunes da Universidade Federal de Alagoas, submetidas à cirurgia de Capella. Trata-se de um estudo prospectivo com cento e trinta e cinco mulheres em períodos pré-operatório (T1) e entre 12 a 24 meses de pós-operatório (T2), submetidas à cirurgia de Fobi-Capella e alocadas em três grupos de 45 componentes, segundo diferentes tercis de índice de massa corporal (IMC) pré-operatório. Foram avaliados idade, massa corporal (IMC), circunferência da cintura, perfil metabólico (colesterol total, HDL-c, LDL-c, triglicerídios, glicemia de jejum), comorbidades e uso de medicamentos. Os indivíduos selecionados assinaram o termo de consentimento livre e esclarecido. Testes estatísticos foram usados para analisar os grupos. A idade média foi de 33,9 ± 9,3 anos. Após a cirurgia houve diminuição de 38,1% da massa corporal, 37,9% do IMC e de 28,9% da circunferência da cintura, com redução dos níveis séricos de glicose, colesterol, triglicerídios e LDL-c em 21,4%; 19,0%; 48,1% e 28,1%, respectivamente. O HDL-c aumentou 15,6%. Os níveis glicêmicos normalizaram em todos os grupos. A perda ponderal média dos grupos foi de 36,7%; 39,0% e 38,4%. Os grupos 1 e 2, classificados no pré-operatório como obesidade classe 3, evoluíram para sobrepeso e o grupo 3 para obesidade classe 1. Quanto à circunferência da cintura, todos apresentavam risco muito aumentado para complicações metabólicas e apenas o grupo 1 evoluiu para risco aumentado, com os demais permanecendo na classificação anterior. Dentre as comorbidades, a dislipidemia foi prevalente, seguida de doenças gástricas, doenças articulares, esteatose hepática, hipertensão arterial sistêmica e diabetes mellitus. A hipertensão regrediu em 91,8%; houve remissão de 95,7% do diabetes e de 41,5% da dislipidemia. Observou-se evolução satisfatória dos fatores de risco cardiovasculares e redução de 57,1% do uso de medicamentos. Embora apresentassem diferentes categorias de IMC no período pré-operatório, não houve diferenças significantes quanto às variáveis analisadas entre os grupos, os quais se beneficiaram igualmente do acompanhamento e procedimento cirúrgico.

Made available in DSpace on 2015-07-22T20:49:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-10-26 / Objetivo: Avaliar em pacientes obesos mórbidos submetidos à derivação gástrica em Y de Roux com anel de contenção há mais de cinco anos: 1) o efeito a longo prazo da cirurgia nas comorbidades; 2) a relação deste efeito com o reganho de massa. Métodos: Foram estudados 140 pacientes (122 mulheres, média de idade de 41,4±10,6 (variação 19 a 62) anos, média de massa de 138,7±23,1 (variação 98 a 220) kg e média de IMC de 52,3±7,9 (variação 37 a 82) kg/m2 submetidos à derivação gástrica em Y de Roux com anel de contenção há cinco anos ou mais. Foram analisadas as seguintes comorbidades: diabetes tipo 2, hipertensão arterial, doença cardiovascular, dislipidemia, apnéia do sono, artropatia e infertilidade, e classificadas em Resolvida, Melhorada, Inalterada ou Piorada no momento de menor massa e no último seguimento. Resultados: Houve diferença significativa na variação da massa nos três momentos do estudo (inicial x mínimo, p<0.001; inicial x final, p<0.001; mínimo x final, p<0.001). Não houve variação do status obtido no momento de menor massa para diabetes tipo 2, doença cardiovascular e infertilidade. Hipertensão arterial mostrou discreta piora dos resultados, porém, sem significância estatística (p=0,8). Houve piora dos resultados para dislipidemia (p=0,012), apnéia do sono (p=0,046) e artropatia (p=0,007). Não há relação entre a variação do IMC e a evolução da comorbidade para infertilidade (p=0,71, massa mínima e p=0,42, massa final). Há relação direta entre a variação do IMC e a evolução das comorbidades para diabetes tipo 2 (p=0,013, massa mínima e p=0,014, massa final), hipertensão arterial (p=0,015, massa mínima e p=0,001, massa final) e doença cardiovascular (p=0,015, massa mínima e p=0,043, massa final). Há relação direta entre a variação do IMC e a evolução das comorbidades apenas no último seguimento para artropatia (p=0,096, massa mínima e p=0,0012, massa final), dislipidemia (p=0,054, massa mínima e p=0,015, massa final) e apnéia do sono (p=0,11, massa mínima e p=0,011, massa final). Conclusões: Em pacientes obesos mórbidos submetidos à derivação gástrica em Y de Roux com anel de contenção há mais de cinco anos: (1) Há manutenção do status obtido para o momento de menor massa para as comorbidades diabetes tipo 2, hipertensão arterial, doença cardiovascular e infertilidade, mas não para dislipidemia, apnéia do sono e artropatia; (2) A melhoria de todas as comorbidades avaliadas, com exceção da infertilidade, associou-se diretamente ao percentual de perda de massa corpórea. / BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered an effective therapy for weight loss although weight regain may be observed in a long-term follow-up. Obesity-related comorbidities are also well treated by RYGB due to weight loss and intestinal hormone changes. Few studies reported long-term status of comorbidities especially if weight regain is present. This study aims to analyze: (1) the resolution of obesity-related comorbidities after RYGB in a long-term follow-up and (2) its relationship to weight regain. METHODS: 140 patients (mean age 41, 18 male, mean body mass index (BMI) before operation 52 (range 39-82) kg/m2, mean BMI at nadir weight 29 (range 18-46) kg/m2, mean BMI at last follow-up 33 (range 19-49) kg/m2 were followed-up after RYGB for morbid obesity for at least 5 years (mean follow-up 90, range 60-155 months). Diabetes, cardiovascular disease, arterial hypertension, dyslipidemia, sleep apnea, arthropathy, and infertility were present when submitted to surgery in 26 (18%), 14 (10%), 88 (62%), 18 (13%), 83 (59%), 90 (64%), 9 (16%) patients; and in 6 (4%), 8 (5%), 38 (27%), 6 (4%), 45 (32%), 75 (53%), 7 (12%) patients at the Nadir weight, respectively. RESULTS: BMI was significantly different in the 3 periods. Comorbidities resolution was sustained in a long-term follow-up for diabetes, hypertension, cardiopathy and infertility. Comorbidities status was direct related to the % of weight loss for all comorbidities except infertility. CONCLUSION: Our results show that comorbidities remission after RYGB is sustained in the majority of patients in a long-term follow-up. Weight regain is linked to worse results for all comorbidities except infertility. / TEDE / BV UNIFESP: Teses e dissertações

This is a study with the purpose of looking over the pattern of consumption of people visiting tourist attractions associated with war, death and suffering; dark tourism. The demarcation of the work has been to look into attractions inside the Stockholm area which do commercial business with the three aspects of dark tourism. With the help of qualitative and quantitative methods, the authors have collected the material needed for the purpose of the study. These qualitative methods have been interviews with visitors of dark tourism and the commercial business themselves, and with observations on three different attractions in Stockholm. The quantitative method, together with some qualitative aspects, has been a poll, with in-depth questions, to get an understanding of the subject at hand. The places for the observations was Stockholm Ghost Walk, the Vasa museum, and the Army museum. As a result of the study, the authors learned that most visitors didn’t know about dark tourism and that they were, in fact, visiting attractions that was called dark. The phenomena itself was unknown to most of them even though they all had visited at least one place under the dark tourism phenomena. / Detta är en undersökning vars syfte är att se över människors konsumtionsmönster på platser associerade med krig, död och lidande; mörk turism. Avgränsningen för arbetet har varit till de attraktioner i Stockholmsområdet som gör kommersiellt nöje av dessa tre aspekter. Med hjälp av kvalitativa och kvantitativa metoder har författarna samlat in det material de behöver för arbetets syfte. Dessa har varit kvalitativa intervjuer med besökare och aktörer på den mörka turism-marknaden i Sverige och observationer på tre attraktioner, samt en kvalitativ och kvantitativ enkät som förarbete för att få en förståelse kring ämnet. De platser som observerades var Stockholm Ghost Walk i Gamla Stan, Vasamuseet samt Armémuseet. Resultatet visar att mörk turism inte alltid är uppenbart som fenomen för besökaren, även om det är ett fenomen som ofta besöks.

Made available in DSpace on 2016-12-06T17:07:20Z (GMT). No. of bitstreams: 1 Winston Souza.pdf: 1071470 bytes, checksum: e97b93b110804dd83532ca09f881f45e (MD5) Previous issue date: 2008-07-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Previous studies have shown that obese individuals with syndrome of obstructive sleep apnea (OSA) present attenuated skeletal muscle metaborreflex. Muscle blood flow (MBF) evaluated by venous occlusion plethysmography has been used as marker of neurovascular control. In the present study, exercise capacity was measured by the distance performed in the six-minute walk test (6mWT), and heart rate (HR) was measured during this procedure. Paired t test, analysis of variance (ANOVA) for repeated measures, and Pearson correlation test were used to statistical analyses, and P<0.05 was assumed as statistically significant. We studied 13 obese individuals aged 26.4 ± 5.8 years (Mean ± standard error), including 9 men and 4 women, with body mass index of 56 ± 6.4 kg/m2. Mean apnea during the sleep was 34.11 ± 8.3 AH / h without drug treatment. There was no correlation between muscle metaborreflex and 6mWT. Compared to baseline, there were significant changes in MBF and forearm vascular resistance during metaborreflex induction (by vascular occlusion 3 minutes after handgrip exercise), but not during the control condition (no occlusion after handgrip exercise). Forearm vascular resistance was increased during metaborreflex induction. There was no correlation between muscle metaborreflex and performed distance in 6MWT. In conclusion, obese subjects with OSA. / Estudos prévios demonstraram que indivíduos obesos portadores da síndrome da apnéia obstrutiva do sono (SAOS) apresentam uma atenuada ativação do metaborreflexo muscular periférico. Analisa-se os efeitos sobre o controle neurovascular, na musculatura esquelética, por meio da avaliação do fluxo sangüíneo muscular (FSM). O FSM foi avaliado por meio das técnicas de pletismografia de oclusão venosa. A capacidade física foi mensurada através da distância percorrida no teste de caminhada de seis minutos (TC6), a freqüência cardíaca (FC) deste teste foi associada às variáveis do metaborreflexo muscular do antebraço pós-exercício. Utiliza-se, para análise estatística, o teste t de Student para amostras pareadas, análise de variância (ANOVA) para amostras repetidas, seguido do teste de Scheffé para detectar as diferenças entre as células e o teste de correlação de Pearson. Os dados foram expressos em valores médios ± erro padrão com P<0,05 sendo considerado significante. Foram estudados 13 indivíduos obesos (9 masculinos e 4 femininos) com média de Índice de Massa Corporal (IMC) de 56,5+6,4kg/m2, idade média de 26,4±5,8 anos, média de apnéia durante o sono de 34,11±8,3AH/h sem tratamento farmacológico. Não obtivemos uma associação entre o metaboreflexo e o teste de caminhada de seis minutos (TC6). Observa-se alterações do FSM, resistência vascular (RV) e PAM nos protocolos com oclusão (OCVPE+) em comparação com os protocolos sem oclusão (OCVPE-), avaliadas por meio da média absoluta, em relação aos valores basais que foram estatisticamente diferentes P<0,05. O metaborreflexo muscular, previamente regular, com respostas do FS atenuado e RV aumentada durante OCVPE+. Não há correlação (r= -0,06, P= 0,42) entre o metaboreflexo do músculo periférico e a distância percorrida no TC6. Conclui-se que este estudo precisa ser ampliado, pois será necessário realizar comparações com sujeitos saudáveis. Ainda devem ser feitos mais estudos para se elucidar o não comprometimento do metaboreflexo muscular nestes pacientes.