A estratégia de corrida utilizada durante uma prova de média e longa duração é dependente de fatores fisiológicos e psicológicos, sendo esses expressos de maneira integrada e consciente pela percepção subjetiva de esforço (PSE) e pelas sensações afetivas. A economia de corrida (EC) tem sido apontada por ter uma importante participação nos ajustes da estratégia de prova. Nesse sentido, a melhora na EC poderia alterar a PSE e o afeto durante a corrida e consequentemente a estratégia utilizada pelo atleta. Uma vez que o treinamento pliométrico tem sido demonstrado por melhorar a EC em corredores, o presente estudo teve como objetivo verificar se as mudanças na EC induzidas pelo treinamento pliométrico poderiam alterar a estratégia de prova em corrida de 10km contrarrelógio. Concluíram o estudo 28 corredores divididos em dois grupos, controle (C, n = 13) e treinamento pliométrico (TP, n=15). Ambos os grupos mantiveram suas rotinas de treinamento, porém o grupo TP realizou duas sessões semanais de treinamento pliométrico, durante oito semanas. Foram avaliados antes e após o tratamento experimental: o desempenho, a estratégia de prova, a PSE e o afeto durante uma corrida de 10km contrarrelógio; a altura, o tempo de contato com o solo e o índice de força reativa durante o salto em profundidade (SP) e a distância nos cinco saltos horizontais; a economia de corrida a 10km/h (EC10) e 12km/h (EC12) e o VO2 na velocidade média da prova (VM10); o VO2máx, o pico de velocidade na esteira (PV) e a velocidade do VO2max (vVO2máx) em um teste máximo; a força dinâmica máxima no teste de 1RM no leg-press 45º e a contração voluntária isométrica máxima no dinamômetro isocinético; o stiffness do tendão patelar, a espessura dos tendões patelar e calcâneo e a arquitetura muscular do vasto lateral e do gastrocnêmico. Os principais resultados mostram que o treinamento pliométrico melhorou a EC10 em 3,6% (p = 0,05) e a EC12 em 4,9% (p = 0,01). No entanto, não alterou a PSE, o afeto ou o padrão estratégia de prova utilizada durante a corrida. Entretanto, quando apenas os atletas responsivos ao TP (EC >3,5%, n = 11) foram avaliados, observamos maior velocidade média durante a segunda metade da corrida e melhor desempenho (1,6%, p = 0,01). O treinamento pliométrico melhorou a altura do SP (7,2%, p = 0,004), o VO2máx (3,4%, p = 0,03) e o PV (1,6%, p = 0,02). Foi observada maior espessura do tendão patelar na região distal (10,1%, p = 0,05) e menor ângulo de penação no músculo gastrocnêmio (-11,1%, p = 0,04). Em conclusão, a melhora na EC induzida pelo treinamento pliométrico não alterou o padrão de estratégia de prova utilizada durante uma corrida de 10km contrarrelógio. No entanto, permitiu que o atleta mantivesse maiores velocidades durante a segunda metade da prova. Os efeitos do treinamento pliométrico sobre a EC podem ter sido induzidos pela melhora na utilização do ciclo alongamento-encurtamento decorrente da redução no ângulo de penação dos fascículos no músculo gastrocnêmio / During middle and long distance races the pacing strategy is dependent on physiological and psychological factors which are expressed in a conscious way by the RPE and the affective feelings. The running economy (RE) has been suggested to be an important factor in the pacing strategy control. Improvements in RE may change the RPE and affective feeling during running which could change the pattern of the pacing strategy. Since the plyometric training has been shown to be an effective method to improve the RE, the aim of this study was to verify if the improvement of RE after a plyometric training program could change the pacing strategy during 10-km time-trial running. Twenty eight runners were divided into two groups, control (C, n=13) and plyometric training (TP, n=15). All of the athletes maintained their running training routines; however, the PT performed two sessions/week of plyometric training during eight weeks. Performance, pacing strategy, RPE and affective feelings during the 10-km time-trial running; the jump high, time of ground contact and reactive strength index in drop-jump and the distance of horizontal five bounds; RE to 10km/h (RE10) and 12km/h (RE12) and the VO2 to 10-km running average speed (VM10); VO2max, peak of velocity (PV) and velocity of VO2max (vVO2max) in a treadmill progressive maximal test; one repetition maximum strength in a 45º leg-press and the maximum voluntary isometric contraction (CVIM) in a isokinetic dynamometry; patellar tendon stiffness, patellar and calcaneus tendon thickness and muscle architecture of vastus lateralis and gastrocnemius muscles were analyzed pre and post experimental treatment. The main results showed that the plyometric training improved the RE10 (3.6%; p = 0.05) and RE12 (4.9%; p = 0.01). Nevertheless, it did not change the RPE, affective feelings or pacing strategy during the 10-km running. When just the responsive athletes (EC >3.5%, n = 11) were analyzed we observed higher average speed during the second part of the running and better performance (1.6%, p = 0.01). Drop-jump performance (7.2%, p = 0.004), VO2max (3.4%, p=0.03) and PV (1.6%, p=0.02) were also improved. It was observed increased of distal patellar tendon thickness (10.1%, p = 0.05) and a lower pennation angle in the gastrocnemius muscle (-11,1%, p = 0,04). In conclusion, the RE improvement did not change the pacing strategy during a 10-km time-trial running. However, the athletes were able to maintain higher speeds during the second part of the running and improve their performance. The effects of plyometric training on RE seems to be associated to stretch-shortening cycle improvement induced by changes in pennation angle of the gastrocnemius muscle

Esta tese avaliou as respostas fisiológicas à hiperinsulinemia aguda em mulheres na pós-menopausa, verificando os efeitos isolados e associados da terapia hormonal (TH) e do treinamento aeróbico (TF) sobre estas respostas. Assim, 31 mulheres histerectomizadas, saudáveis e na pós-menopausa foram divididas, aleatoriamente e de forma duplo cega, nos grupos: PLA-CO(n=7), TH-CO(n=6), PLA-TF(n=10), TH-TF(n=8). Os grupos TH receberam valerato estradiol (1 mg/dia) e os PLA, placebo. Os grupos TF treinaram em cicloergômetro, 3x/sem em intensidade moderada e os CO permaneceram sedentários. Antes e após 6 meses, foi realizado um clampeamento euglicêmico/hiperinsulinêmico. Em resposta à hiperinsulinemia, houve aumento das catecolaminas plasmáticas, da modulação simpática cardíaca, da pressão arterial sistólica, da frequência cardíaca e do fluxo sanguíneo. Após 6 meses, o TF aumentou a sensibilidade à insulina e reduziu o aumento da noradrenalina durante a hiperinsulinemia. Tanto isoladamente quanto em associação, o TF e a TH impediram a redução do aumento do fluxo sanguíneo durante a hiperinsulinemia, o que foi observado no grupo PLA-CO. Além disso, quando associadas, estas condutas reduziram o aumento da adrenalina durante a hiperinsulinemia. Concluindo: em mulheres pós-menopausadas saudáveis, a hiperinsulinemia aguda aumentou a atividade simpática e promoveu vasodilatação, levando ao aumento da pressão arterial sistólica e da frequência cardíaca, sem alterar a pressão diastólica, respectivamente. O TF aumentou a sensibilidade à insulina, diminuindo a ativação simpática e mantendo a vasodilatação induzida pela hiperinsulinemia, enquanto que a TH teve o mesmo efeito sobre a vasodilatação, sem alterar a sensibilidade à insulina. A associação das duas condutas teve pouco efeito aditivo / This thesis evaluated the physiological responses to acute hyperinsulinemia in post-menopausal women, analyzing the isolated and combines effects of hormone therapy (HT) and aerobic training (AT) on these responses. Thus, 31 healthy, hysterectomized postmenopausal women were randomly divided (in a double-blinded manner) into groups: PLA-CO(n=7), HT-CO(n=6), PLA-AT(n=10), HT-AT(n=8). HT groups received valerato estradiol (1 mg/day) while PLA groups received placebo. AT groups trained on cycle ergometer, 3x/week at moderate intensity, while CO groups stayed sedentary. Before and after 6 months, an euglycemic hyperinsulinemic clamp were performed. Hyperinsulinemia increased plasma catecholamines, sympathetic cardiac modulation, systolic blood pressure, heart rate, and blood flow. After 6 months, AT increased insulin sensitivity and reduced insulin induced increase in norepinephrine. AT and HT, applied alone or together, abolished the decline in insulin induced increase in blood flow that was observed in PLA-CO. Besides, the association of both interventions decreased insulin induced increase in epinephrine. In conclusion: in healthy postmenopausal women, acute hyperinsulinemia increased sympathetic activity but produced vasodilation, which resulted in an increase in systolic blood pressure and heart rate, with no change in diastolic blood pressure, respectively. AT increased insulin sensitivity, decreasing sympathetic activation and maintaining vasodilatory response during hyperinsulinemia, while HT had the same effect on vasodilation without changing insulin sensitivity. The association of both interventions had minor addictive effects

A estratégia de corrida utilizada durante uma prova de média e longa duração é dependente de fatores fisiológicos e psicológicos, sendo esses expressos de maneira integrada e consciente pela percepção subjetiva de esforço (PSE) e pelas sensações afetivas. A economia de corrida (EC) tem sido apontada por ter uma importante participação nos ajustes da estratégia de prova. Nesse sentido, a melhora na EC poderia alterar a PSE e o afeto durante a corrida e consequentemente a estratégia utilizada pelo atleta. Uma vez que o treinamento pliométrico tem sido demonstrado por melhorar a EC em corredores, o presente estudo teve como objetivo verificar se as mudanças na EC induzidas pelo treinamento pliométrico poderiam alterar a estratégia de prova em corrida de 10km contrarrelógio. Concluíram o estudo 28 corredores divididos em dois grupos, controle (C, n = 13) e treinamento pliométrico (TP, n=15). Ambos os grupos mantiveram suas rotinas de treinamento, porém o grupo TP realizou duas sessões semanais de treinamento pliométrico, durante oito semanas. Foram avaliados antes e após o tratamento experimental: o desempenho, a estratégia de prova, a PSE e o afeto durante uma corrida de 10km contrarrelógio; a altura, o tempo de contato com o solo e o índice de força reativa durante o salto em profundidade (SP) e a distância nos cinco saltos horizontais; a economia de corrida a 10km/h (EC10) e 12km/h (EC12) e o VO2 na velocidade média da prova (VM10); o VO2máx, o pico de velocidade na esteira (PV) e a velocidade do VO2max (vVO2máx) em um teste máximo; a força dinâmica máxima no teste de 1RM no leg-press 45º e a contração voluntária isométrica máxima no dinamômetro isocinético; o stiffness do tendão patelar, a espessura dos tendões patelar e calcâneo e a arquitetura muscular do vasto lateral e do gastrocnêmico. Os principais resultados mostram que o treinamento pliométrico melhorou a EC10 em 3,6% (p = 0,05) e a EC12 em 4,9% (p = 0,01). No entanto, não alterou a PSE, o afeto ou o padrão estratégia de prova utilizada durante a corrida. Entretanto, quando apenas os atletas responsivos ao TP (EC >3,5%, n = 11) foram avaliados, observamos maior velocidade média durante a segunda metade da corrida e melhor desempenho (1,6%, p = 0,01). O treinamento pliométrico melhorou a altura do SP (7,2%, p = 0,004), o VO2máx (3,4%, p = 0,03) e o PV (1,6%, p = 0,02). Foi observada maior espessura do tendão patelar na região distal (10,1%, p = 0,05) e menor ângulo de penação no músculo gastrocnêmio (-11,1%, p = 0,04). Em conclusão, a melhora na EC induzida pelo treinamento pliométrico não alterou o padrão de estratégia de prova utilizada durante uma corrida de 10km contrarrelógio. No entanto, permitiu que o atleta mantivesse maiores velocidades durante a segunda metade da prova. Os efeitos do treinamento pliométrico sobre a EC podem ter sido induzidos pela melhora na utilização do ciclo alongamento-encurtamento decorrente da redução no ângulo de penação dos fascículos no músculo gastrocnêmio / During middle and long distance races the pacing strategy is dependent on physiological and psychological factors which are expressed in a conscious way by the RPE and the affective feelings. The running economy (RE) has been suggested to be an important factor in the pacing strategy control. Improvements in RE may change the RPE and affective feeling during running which could change the pattern of the pacing strategy. Since the plyometric training has been shown to be an effective method to improve the RE, the aim of this study was to verify if the improvement of RE after a plyometric training program could change the pacing strategy during 10-km time-trial running. Twenty eight runners were divided into two groups, control (C, n=13) and plyometric training (TP, n=15). All of the athletes maintained their running training routines; however, the PT performed two sessions/week of plyometric training during eight weeks. Performance, pacing strategy, RPE and affective feelings during the 10-km time-trial running; the jump high, time of ground contact and reactive strength index in drop-jump and the distance of horizontal five bounds; RE to 10km/h (RE10) and 12km/h (RE12) and the VO2 to 10-km running average speed (VM10); VO2max, peak of velocity (PV) and velocity of VO2max (vVO2max) in a treadmill progressive maximal test; one repetition maximum strength in a 45º leg-press and the maximum voluntary isometric contraction (CVIM) in a isokinetic dynamometry; patellar tendon stiffness, patellar and calcaneus tendon thickness and muscle architecture of vastus lateralis and gastrocnemius muscles were analyzed pre and post experimental treatment. The main results showed that the plyometric training improved the RE10 (3.6%; p = 0.05) and RE12 (4.9%; p = 0.01). Nevertheless, it did not change the RPE, affective feelings or pacing strategy during the 10-km running. When just the responsive athletes (EC >3.5%, n = 11) were analyzed we observed higher average speed during the second part of the running and better performance (1.6%, p = 0.01). Drop-jump performance (7.2%, p = 0.004), VO2max (3.4%, p=0.03) and PV (1.6%, p=0.02) were also improved. It was observed increased of distal patellar tendon thickness (10.1%, p = 0.05) and a lower pennation angle in the gastrocnemius muscle (-11,1%, p = 0,04). In conclusion, the RE improvement did not change the pacing strategy during a 10-km time-trial running. However, the athletes were able to maintain higher speeds during the second part of the running and improve their performance. The effects of plyometric training on RE seems to be associated to stretch-shortening cycle improvement induced by changes in pennation angle of the gastrocnemius muscle

La Neuréguline 1 (NRG1) est une cytokine appartenant à la famille des facteurs decroissance. Pouvant être libéré par la contraction musculaire, elle fut récemment décritecomme une myokine. Au-delà de son rôle dans les processus de croissance et de maturation,la NRG1 favorise la régulation du métabolisme du glucose in vitro. L’objectif de ce travailétait d’étudier l’influence des pathologies métaboliques et de l’entrainement sur la voie dela NRG1 ainsi que son rôle physiologique dans la régulation du métabolisme énergétique.Nos résultats ont montré que la voie de la NRG1 n’était pas modifiée chez des rats rendusobèses par un régime enrichi lipides et en glucides. A l’inverse, l’entrainement en endurancecouplé à un régime équilibré favorise l’activation de la voie de la NRG1 dans le musclesquelettique de rats obèses. En effet, une période d’entrainement de huit semaines associéà un régime équilibré permet le clivage de la NRG1 et l’activation de son récepteur ErbB4dans le muscle gastrocnémien de rats obèses via l’activation de la métalloprotéase ADAM17.De plus, un traitement en chronique ou en aigu favorise la captation du glucose chez lasouris obèse et diabétique (db/db). Les mécanismes sous-tendant ce phénomèneimpliquerait l’activation du récepteur ErbB3 et l’activation des protéines FOXO1 et Akt dansle foie. Cependant, le traitement à la NRG1 ne modifie la dépense énergétique, la prisealimentaire et la composition alimentaire des souris db/db. Ainsi, il apparait que la NRG1pourrait jouer un rôle important dans la régulation du métabolisme glucidique in vivo chezen condition de pathologies métaboliques et que l’entrainement pourrait activer cette voiedans le muscle squelettique. / Neuregulin 1 (NRG1) is a cytokine that belongs to the epidermal growth factors family. NRG1can be released during exercise and can be define as a myokine. Initially studied for its rolein growth and maturation, NRG1 can also regulate glucose homeostasis in vitro. Thus, theaim of this work was to investigate the effect of training and metabolic disorders on NRG1pathway and its role in energy metabolism. Results showed that NRG1 pathway was notaltered in skeletal muscle of obese rats. Conversely, endurance training combined with awell-balanced diet improved NRG1 pathway activation in skeletal muscle of obese. Indeed, 8weeks of training and diet increased the cleavage of NRG1 and the activation of its receptorErbB4 through the activation of the metalloprotease ADAM17. Moreover, acute and chronictreatment improved glucose tolerance in diabetic mice (db/db). Acute treatment loweredglycemia by activating ErbB3, Akt and FOXO1 in the livre. Thus, NRG1 might play a key role inthe regulation of glucose homeostasis in people who suffers from metabolic disorders.Training might a good tool to activate this pathway in skeletal muscle.

<p>The overall aims of the studies were to investigate the effects of different training modalities on exercise capacity and health-related quality of life (HRQoL) in patients with moderate or severe COPD and, further, to explore two of the physical tests used in pulmonary rehabilitation.</p><p>In <b>study I</b>, the 12-minute walking distance (12MWD) did not increase on retesting in patients with exercise-induced hypoxemia (EIH) whereas 12MWD increased significantly on retesting in the non-EIH patients. In <b>study II</b>, we found that the incremental shuttle walking test was as good a predictor of peak exercise capacity (W peak) as peak oxygen uptake (VO₂ peak) is. In <b>study III</b>, we investigated the effects of two different combination training programmes when training twice a week for eight weeks. One programme was mainly based on endurance training (group A) and the other on resistance training and callisthenics (group B). W peak and 12MWD increased in group A but not in group B. HRQoL, anxiety and depression were unchanged in both groups. Ratings of perceived exertion at rest were significantly lower in group A than in group B after training and during 12 months of follow-up. Twelve months post-training, 12MWD was back to baseline in group A, but significantly shorter than at baseline in group B. Thus, a short endurance training intervention delayed decline in 12MWD for at least one year. Patients with moderate and severe COPD responded to training in the same way. In <b>study IV</b>, both interval and continuous endurance training increased W peak, VO₂ peak, peak exhaled carbon dioxide (VCO₂ peak) and 12MWD. Likewise, HRQoL, dyspnoea during activities of daily life, anxiety and depression improved similarly in both groups. At a fixed, submaximal workload (isotime), the interval training reduced oxygen cost and ventilatory demand significantly more than the continuous training did.</p>

Chronic obstructive pulmonary disease, COPD, places a substantial burden of disability on the growing number of patients and causes large costs for the society. Tobacco smoke is the most important risk factor. Progressive exertional dyspnea is the major symptom which leads to diminished physical and social activities, reduced physical capacity and decreased health related quality of life, HRQoL. The aim of this thesis was to evaluate different physical training modalities in patients with COPD with regard to physical capacity and HRQoL. Patients with moderate to severe COPD were included in the studies. In the first intervention, 20 patients trained on a treadmill with or without supplemental oxygen, three times per week, during eight weeks. In the second intervention, 30 patients were randomised to high-intensity group training either in water or on land, and 13 patients were included in a control group. The patients in the water and land groups trained three times per week during three months and once a week during the following six months. Oxygen supplementation during physical training did not enlarge the positive effects of the same training with air in patients with exercise-induced hypoxaemia. Both groups improved the distance walked after training. High-intensity group training in water and on land was found to be effective with regard to walking distance and HRQoL compared to the control group. Training in water seemed to be of greater benefit compared to training on land concerning walking distance and experienced physical health when the training was accomplished three times per week. The thigh muscle strength increased after training in both the water and the land group. The muscle endurance in knee extension was low in the majority of the patients and was not improved after the training intervention. An evaluation of the long-term effects of physical group training and the effects of decreased training frequency showed that training with low frequency (once a week) during six months did not seem to be sufficient to maintain the level achieved after a three months period of higher frequency training (three times per week). However, the two periods combined seemed to prevent decline in physical capacity and HRQoL compared to baseline. The conclusion is that physical training is of benefit for patients with COPD with regard to physical capacity and HRQoL. Training can be performed individually or in groups, with high intensity, in water and on land. It is also concluded that the training can, under controlled conditions, be performed without supplemental oxygen even in patients with exercise-induced hypoxaemia.

The overall aims of the studies were to investigate the effects of different training modalities on exercise capacity and health-related quality of life (HRQoL) in patients with moderate or severe COPD and, further, to explore two of the physical tests used in pulmonary rehabilitation. In study I, the 12-minute walking distance (12MWD) did not increase on retesting in patients with exercise-induced hypoxemia (EIH) whereas 12MWD increased significantly on retesting in the non-EIH patients. In study II, we found that the incremental shuttle walking test was as good a predictor of peak exercise capacity (W peak) as peak oxygen uptake (VO2 peak) is. In study III, we investigated the effects of two different combination training programmes when training twice a week for eight weeks. One programme was mainly based on endurance training (group A) and the other on resistance training and callisthenics (group B). W peak and 12MWD increased in group A but not in group B. HRQoL, anxiety and depression were unchanged in both groups. Ratings of perceived exertion at rest were significantly lower in group A than in group B after training and during 12 months of follow-up. Twelve months post-training, 12MWD was back to baseline in group A, but significantly shorter than at baseline in group B. Thus, a short endurance training intervention delayed decline in 12MWD for at least one year. Patients with moderate and severe COPD responded to training in the same way. In study IV, both interval and continuous endurance training increased W peak, VO2 peak, peak exhaled carbon dioxide (VCO2 peak) and 12MWD. Likewise, HRQoL, dyspnoea during activities of daily life, anxiety and depression improved similarly in both groups. At a fixed, submaximal workload (isotime), the interval training reduced oxygen cost and ventilatory demand significantly more than the continuous training did.

The purpose of this investigation was to examine the effects of vitamin E supplementation on lipid peroxidation, muscle damage, muscle soreness and physical performance following repeated bouts of whole body resistance exercise. Eighteen active males were randomly assigned to receive either vitamin E (1200 IU per day) or placebo for 31 days. Following 21 days of supplementation, subjects engaged in 3 resistance exercise sessions, separated by 3 days rest (EX-1, EX-2 and EX-3 on days 22, 25 and 28, respectively). Plasma malondialdehyde concentrations did not peak until the morning prior to EX-3 in the vitamin E (VE) group (10.0 ± 0.6 µmol/L) and the day following EX3 in the placebo (P) group (9.6 ± 0.9 µmol/L), with no significant differences between groups. Creatine kinase activity was significantly elevated the day following EX-1 in both groups. The VE group had a near 2-fold greater CK peak as compared to the P group the day following EX-1 (404 ± 49 and 214 ± 60 U/L, respectively), but the two groups had similar CK values by day 31 (113 ± 35 and 107 ± 36 U/L, respectively). Muscle soreness was significantly increased for each group the day after EX-1 with no significant differences between groups.Furthermore, there were no significant differences between groups in muscle strength, power or endurance. The results of the present study do not indicate any positive effect of vitamin E supplementation against lipid peroxidation, muscle damage or muscle soreness as a result of repeated days of resistance exercise. In addition, vitamin E did not have an effect on muscular performance. / Fisher Institute for Wellness and Gerontology

Introdução: A doença cardiovascular é a principal causa de morbidade e mortalidade em pacientes com síndrome metabólica ou diabetes mellitus tipo 2. Como a disfunção endotelial precede o desenvolvimento da doença cardiovascular, seria desejável identificar e tratar a disfunção endotelial antes que a aterosclerose se desenvolva. Hoje, existe evidência clara para sustentar o efeito protetor do exercício físico regular em pacientes com síndrome metabólica ou diabetes mellitus. O que está menos claro é a relação da intensidade de treinamento e melhora na função endotelial. Objetivo: Avaliar o efeito de um programa de exercício físico, de alta e baixa intensidade, na função endotelial de pacientes com Síndrome Metabólica ou Diabetes Mellitus Tipo 2. Métodos: Foram estudados 31 pacientes com diabetes melittus tipo 2 ou síndrome metabólica, de idade média (±DP) de 58±6 anos, randomizados para treinamento aeróbio de alta intensidade (AI: 75 a 85% freqüência cardíaca máxima, n = 10), treinamento aeróbio de baixa intensidade (BI: 50 a 60% freqüência cardíaca máxima, n = 10) e controle (n = 11). O treinamento foi realizado por 50 minutos, 4 vezes por semana. Antes e após 6 semanas de treinamento, os sujeitos realizaram teste de esforço e estudo da função endotelial, por ultra-som de alta resolução da artéria braquial, avaliados após hiperemia reativa (dependente do endotélio) e após administração de nitrato (independente do endotélio). Resultados: O programa de treinamento aeróbio de alta intensidade resultou em um maior aumento da capacidade funcional, avaliado pelo tempo máximo tolerado no teste de esforço (AI antes 9,39±1,22 minutos e depois 12,12±1,24 minutos; BI antes 8,84s±1,82 minutos e depois 10,41±1,99 minutos; Controle antes 9,36±.1,21minutos e depois 8,96±.1,35minutos; p < 0,05). A diferença no diâmetro do vaso após hiperemia foi significativamente maior para o grupo de alta intensidade (AI antes 4,28±.0,73mm e depois 5,62±.0,95mm; BI antes 4,24±.0,49mm e depois 5,01±.0,56mm; Controle antes 4,31±.0,37mm e depois 4,23±.0,23mm; p < 0,05). Após nitrato, não houve diferença significativa para nenhum dos grupos (AI antes 5,13±.1,17mm e depois 5,20±.1,10mm; BI antes 4,93±.0,88mm e depois 5,07±.0,70mm; Controle antes 4,96±.0,36mm e depois 4,62±.0,36mm; p = 0,565). Conclusões: Quando comparado ao treinamento aeróbio de baixa intensidade e controle, o treinamento aeróbio de alta intensidade melhorou a capacidade funcional e resposta vasodilatadora dependente do endotélio, em pacientes com síndrome metabólica ou diabetes mellitus tipo 2. Estes achados sugerem que o treinamento físico de alta intensidade possa ser considerado como alternativa preventiva nestes pacientes. / Introduction: Cardiovascular disease is the major cause of morbidity and mortality in patients with the metabolic syndrome or diabetes mellitus type 2. As the endothelial dysfunction precedes the development of cardiovascular disease, it would be desirable to identify and treat the endothelial dysfunction before the development of atherosclerosis. There is currently clear evidence to support the protective effect of regular physical exercise on patients with metabolic syndrome or diabetes mellitus. What is less clear is the relationship between training intensity and improvement in endothelial function. Objective: Evaluate effect of a physical exercise program, of high and low intensity, on endothelial function of patients with Metabolic Syndrome or Diabetes Mellitus Type 2. Methods: Thirty one patients with Diabetes Mellitus type 2 or metabolic syndrome were studied, with mean age (±SD) of 58±6 years, randomized for high intensity aerobic training (AI: 75-85% of maximum heart rate, n = 10), low intensity aerobic training (BI: 50-60% maximum heart rate, n = 10) and control (n = 11). The training was performed for 50 minutes, four times a week. Before and after 6 weeks of training, subjects performed the exercise testing and had been studied for endothelial function, by high resolution ultrasound of the brachial artery, assessed after reactive hyperemia (endothelium dependent) and after nitrate administration (endothelium independent). Results: The high intensity aerobic training resulted in a higher increase of the functional capacity, assessed by maximum tolerated time on the exercise testing (AI before 9.39±1.22 minutes and after 12.12±1.24 minutes; BI before 8.84s±1.82 minutes and after 10.41±1.99 minutes; Controls before 9.36±.1.21minutes and after 8.96±.1.35minutes; p < 0.05). The diameter difference of the vessel after hyperemia was significantly higher for the high intensity group (AI before 4.28±0.73mm and after 5.62±0.95mm; BI before 4.24±0.49mm and after 5.01±0.56mm; Controls before 4.31±0.37mm and after 4.23±.0.23mm; p < 0.05). After nitrate, there was no significant difference for none of the groups (AI before 5.13±.1.17mm and after 5.20±.1.10mm; BI before 4.93±.0.88mm and after 5.07±.0.70mm; Controls before 4.96±.0.36mm and after 4.62±.0.36mm; p = 0.565). Conclusions: When compared to the low intensity aerobic training and controls, the high intensity aerobic training improved the functional capacity and vasodilator response endothelium-dependent in patients with metabolic syndrome and diabetes mellitus type 2. These findings suggest that physical training of high intensity might be considered as a preventive alternative in those patients.

Introdução: A doença cardiovascular é a principal causa de morbidade e mortalidade em pacientes com síndrome metabólica ou diabetes mellitus tipo 2. Como a disfunção endotelial precede o desenvolvimento da doença cardiovascular, seria desejável identificar e tratar a disfunção endotelial antes que a aterosclerose se desenvolva. Hoje, existe evidência clara para sustentar o efeito protetor do exercício físico regular em pacientes com síndrome metabólica ou diabetes mellitus. O que está menos claro é a relação da intensidade de treinamento e melhora na função endotelial. Objetivo: Avaliar o efeito de um programa de exercício físico, de alta e baixa intensidade, na função endotelial de pacientes com Síndrome Metabólica ou Diabetes Mellitus Tipo 2. Métodos: Foram estudados 31 pacientes com diabetes melittus tipo 2 ou síndrome metabólica, de idade média (±DP) de 58±6 anos, randomizados para treinamento aeróbio de alta intensidade (AI: 75 a 85% freqüência cardíaca máxima, n = 10), treinamento aeróbio de baixa intensidade (BI: 50 a 60% freqüência cardíaca máxima, n = 10) e controle (n = 11). O treinamento foi realizado por 50 minutos, 4 vezes por semana. Antes e após 6 semanas de treinamento, os sujeitos realizaram teste de esforço e estudo da função endotelial, por ultra-som de alta resolução da artéria braquial, avaliados após hiperemia reativa (dependente do endotélio) e após administração de nitrato (independente do endotélio). Resultados: O programa de treinamento aeróbio de alta intensidade resultou em um maior aumento da capacidade funcional, avaliado pelo tempo máximo tolerado no teste de esforço (AI antes 9,39±1,22 minutos e depois 12,12±1,24 minutos; BI antes 8,84s±1,82 minutos e depois 10,41±1,99 minutos; Controle antes 9,36±.1,21minutos e depois 8,96±.1,35minutos; p < 0,05). A diferença no diâmetro do vaso após hiperemia foi significativamente maior para o grupo de alta intensidade (AI antes 4,28±.0,73mm e depois 5,62±.0,95mm; BI antes 4,24±.0,49mm e depois 5,01±.0,56mm; Controle antes 4,31±.0,37mm e depois 4,23±.0,23mm; p < 0,05). Após nitrato, não houve diferença significativa para nenhum dos grupos (AI antes 5,13±.1,17mm e depois 5,20±.1,10mm; BI antes 4,93±.0,88mm e depois 5,07±.0,70mm; Controle antes 4,96±.0,36mm e depois 4,62±.0,36mm; p = 0,565). Conclusões: Quando comparado ao treinamento aeróbio de baixa intensidade e controle, o treinamento aeróbio de alta intensidade melhorou a capacidade funcional e resposta vasodilatadora dependente do endotélio, em pacientes com síndrome metabólica ou diabetes mellitus tipo 2. Estes achados sugerem que o treinamento físico de alta intensidade possa ser considerado como alternativa preventiva nestes pacientes. / Introduction: Cardiovascular disease is the major cause of morbidity and mortality in patients with the metabolic syndrome or diabetes mellitus type 2. As the endothelial dysfunction precedes the development of cardiovascular disease, it would be desirable to identify and treat the endothelial dysfunction before the development of atherosclerosis. There is currently clear evidence to support the protective effect of regular physical exercise on patients with metabolic syndrome or diabetes mellitus. What is less clear is the relationship between training intensity and improvement in endothelial function. Objective: Evaluate effect of a physical exercise program, of high and low intensity, on endothelial function of patients with Metabolic Syndrome or Diabetes Mellitus Type 2. Methods: Thirty one patients with Diabetes Mellitus type 2 or metabolic syndrome were studied, with mean age (±SD) of 58±6 years, randomized for high intensity aerobic training (AI: 75-85% of maximum heart rate, n = 10), low intensity aerobic training (BI: 50-60% maximum heart rate, n = 10) and control (n = 11). The training was performed for 50 minutes, four times a week. Before and after 6 weeks of training, subjects performed the exercise testing and had been studied for endothelial function, by high resolution ultrasound of the brachial artery, assessed after reactive hyperemia (endothelium dependent) and after nitrate administration (endothelium independent). Results: The high intensity aerobic training resulted in a higher increase of the functional capacity, assessed by maximum tolerated time on the exercise testing (AI before 9.39±1.22 minutes and after 12.12±1.24 minutes; BI before 8.84s±1.82 minutes and after 10.41±1.99 minutes; Controls before 9.36±.1.21minutes and after 8.96±.1.35minutes; p < 0.05). The diameter difference of the vessel after hyperemia was significantly higher for the high intensity group (AI before 4.28±0.73mm and after 5.62±0.95mm; BI before 4.24±0.49mm and after 5.01±0.56mm; Controls before 4.31±0.37mm and after 4.23±.0.23mm; p < 0.05). After nitrate, there was no significant difference for none of the groups (AI before 5.13±.1.17mm and after 5.20±.1.10mm; BI before 4.93±.0.88mm and after 5.07±.0.70mm; Controls before 4.96±.0.36mm and after 4.62±.0.36mm; p = 0.565). Conclusions: When compared to the low intensity aerobic training and controls, the high intensity aerobic training improved the functional capacity and vasodilator response endothelium-dependent in patients with metabolic syndrome and diabetes mellitus type 2. These findings suggest that physical training of high intensity might be considered as a preventive alternative in those patients.