Made available in DSpace on 2015-07-22T20:50:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-11-24 / Objetivo: O objetivo deste estudo foi avaliar a força dos músculos respiratórios em crianças e adolescentes com asma pela mensuração das pressões respiratórias máximas e compará-las às observadas com indivíduos controles com mesmas características antropométricas. Métodos: Estudo transversal, em que foram realizadas medidas antropométricas (peso, estatura e perímetro braquial), provas de função pulmonar e medida das pressões respiratórias máximas inspiratória (Pimáx) e expiratória (Pemáx) de pacientes com asma e controles saudáveis com idades entre 6 e 16 anos, independentemente do sexo. Resultados: Foram avaliadas as pressões respiratórias máximas de 75 indivíduos asmáticos e 90 saudáveis (controles), de ambos os gêneros, divididos por idade cronológica em crianças e adolescentes. Os grupos apresentaram características antropométricas semelhantes. Não houve diferença estatisticamente significante nos valores de Pimáx e Pemáx (p>0,05) entre asmáticos e saudáveis. Não houve diferença estatisticamente significativa entre as pressões máximas dos asmáticos do gênero masculino e feminino. No grupo controle a Pemáx foi maior no gênero masculino (p=0,004). Nos dois grupos (asmáticos e controles) os adolescentes apresentaram valores de pressões respiratórias máximas maiores que as crianças. Houve fraca correlação entre o VEF1 e a Pimax (r=0,247) e moderada entre o VEF1 e a Pemax (r=0,385) dos indivíduos asmáticos, porém, a Pemáx foi maior nos adolescentes com maior gravidade da doença. As pressões respiratórias máximas não foram afetadas pela condição nutricional dos indivíduos avaliados. Conclusão: A ocorrência de asma não determinou alterações significativas na força dos músculos respiratórios de crianças e adolescentes independente do gênero. Porém, a maior gravidade da doença pode estar associada a um incremento da força dos músculos expiratórios de adolescentes com asma provavelmente pelo recrutamento exacerbado a que as fibras destes músculos são frequentemente submetidas nos períodos de crise sendo maior nos do sexo masculino, o que pode estar associado a maior área muscular frequente nos garotos. / Objective: The objective of this study was to evaluate the strength of respiratory muscles in children and adolescents with asthma by measurement of maximal respiratory pressures and compare them with those observed in control subjects with the same anthropometric characteristics. Methods: Cross-sectional study, which included anthropometric measures (weight, height and arm circumference), pulmonary function tests and measurement of maximal respiratory pressures inspiratory (MIP) and expiratory (MEP) of patients whith asthma and healthy controls aged between 6 and 16 years, regardless of gender. Results: We evaluated the maximal respiratory pressure of 75 asthmatics and 90 healthy individuals (controls) of both sexes, divided by chronological age in children and adolescents. The groups had similar physical characteristics. There was no statistically significant difference in the values of MIP and MEP (p> 0.05) between asthmatics and healthy. There was no statistically significant difference between the maximum pressure of asthmatic males and females. In the control group, MEP was higher in males (p = 0.004). Both groups (asthmatics and controls) adolescents have higher values of maximal respiratory pressures higher than children. There was a weak correlation between FEV1 and MIP (r = 0.247) and moderate between FEV1 and MEP (r = 0.385) of asthma patients, however, the MEP was higher in adolescents with more severe disease. Maximal respiratory pressures were not affected by the nutritional condition of individuals evaluated. Conclusion: The incidence of asthma do not determinate significant alterations in respiratory muscle strength in children and adolescents, regardless of gender. However, the severity of the disease may be associated with an increase in expiratory muscle strength in adolescents with asthma probably by the exacerbated recruitment to the fibers of these muscles are often subjected during periods of crisis is higher in males, which may be associated with greater muscle area common in boys. / TEDE / BV UNIFESP: Teses e dissertações

Introdução: A redução da capacidade inspiratória (CI) induzida pelo exercício observada em alguns pacientes com hipertensão arterial pulmonar (HAP) poderia potencialmente ser influenciada por disfunção muscular respiratória. Objetivos: Investigar se há alguma relação entre CI e força muscular respiratória antes e após o exercício máximo e estudar o papel da pressão muscular respiratória e da CI na dispneia e na capacidade de exercício em pacientes com HAP. Métodos: 27 pacientes com HAP e 12 controles saudáveis pareados foram comparados. Todos os participantes foram submetidos a teste de exercício cardiopulmonar (TECP) com determinação seriada da CI. As pressões inspiratória e expiratória máximas (PImáx e PEmáx, respectivamente) foram medidas antes, no pico e após o exercício. Resultados: Os pacientes tiveram menor volume expiratório forçado no primeiro segundo (VEF1), capacidade vital forçada (CVF) (com relação VEF1/CVF semelhante) e capacidade aeróbia máxima e maior dispneia no exercício. A PImáx e a PEmáx foram significativamente menores nos pacientes com HAP que nos controles. Entretanto, a variação pós exercício em relação ao repouso não foi significativamente diferente nos dois grupos. Os pacientes apresentaram redução significativa da CI do repouso ao pico do exercício em comparação aos controles. 17/27 pacientes (63%) apresentaram redução da CI durante o exercício. Considerando-se apenas os pacientes, não houve associação entre CI e PImáx ou PEmáx (pré, pós exercício ou mudança do repouso). Comparando-se os pacientes com e sem redução da CI, não houve diferença na proporção de pacientes que apresentaram redução da PImáx (41 vs 44%) ou da PEmáx (76 vs 89%) após o exercício. Da mesma forma, nenhuma diferença na PImáx ou PEmáx foi observada no exercício comparando estes subgrupos. Conclusões: Em resumo, a força muscular respiratória foi significativamente menor em pacientes com HAP em comparação com controles e uma proporção significativa de pacientes com HAP apresentaram redução da CI durante o exercício. No entanto, não foram observadas associações entre CI e alterações de força muscular respiratória com o exercício, sugerindo que ocorra verdadeira hiperinsuflação dinâmica. Além disso, o único parâmetro relacionado com a dispneia induzida pelo exercício foi a CI no repouso e com capacidade aeróbia no pico foi a magnitude da redução da PEmáx após o exercício. / Rationale: The exercise induced inspiratory capacity (IC) reduction observed in some patients with pulmonary arterial hypertension (PAH) could potentially be influenced by respiratory muscle dysfunction. Aims: To investigate if there is any relationship between IC and respiratory muscle strength before and after maximal exercise and to study the contribution of respiratory muscle pressure and IC in exercise dyspnea and capacity in PAH patients. Methods: 27 patients with PAH and 12 healthy matched controls were compared. All participants underwent cardiopulmonary exercise test (CPET) with serial IC measurements. Inspiratory and expiratory maximal mouth pressure (PImax and PEmax, respectively) were measured before and at peak/post exercise. Results: Patients had lower forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) (with similar FEV1/FVC ratio) and peak aerobic capacity and higher exercise dyspnea. PImax and PEmax were significantly lower in PAH patients compared to controls. However, post exercise variations from rest were not significant different in either group. Patients presented significant rest-to-peak reduction in IC compared to controls. 17/27 patients (63%) exhibited IC reduction during exercise. Considering only patients, there was no association between IC and PImax or PEmax (pre, post exercise or change from rest). Comparing patients with and without IC reduction, there was no difference in the proportion of patients presenting inspiratory (41 vs 44%) or expiratory (76 vs 89%) pressure reduction after exercise, respectively. In the same way, no difference in both inspiratory and expiratory respiratory pressure change with exercise was observed comparing these subgroups. Conclusions: In summary, respiratory muscle strength was significantly lower in PAH patients compared to controls and a significant proportion of PAH presented IC reduction during exercise. Nonetheless, no associations between IC and respiratory muscle strength changes with exercise were observed, suggesting a true dynamic lung hyperinflation. Additionally, the only parameter associated with exercise induced dyspnea was resting IC and with peak aerobic capacity was the magnitude of PEmax reduction after exercise.

Introdução: A redução da capacidade inspiratória (CI) induzida pelo exercício observada em alguns pacientes com hipertensão arterial pulmonar (HAP) poderia potencialmente ser influenciada por disfunção muscular respiratória. Objetivos: Investigar se há alguma relação entre CI e força muscular respiratória antes e após o exercício máximo e estudar o papel da pressão muscular respiratória e da CI na dispneia e na capacidade de exercício em pacientes com HAP. Métodos: 27 pacientes com HAP e 12 controles saudáveis pareados foram comparados. Todos os participantes foram submetidos a teste de exercício cardiopulmonar (TECP) com determinação seriada da CI. As pressões inspiratória e expiratória máximas (PImáx e PEmáx, respectivamente) foram medidas antes, no pico e após o exercício. Resultados: Os pacientes tiveram menor volume expiratório forçado no primeiro segundo (VEF1), capacidade vital forçada (CVF) (com relação VEF1/CVF semelhante) e capacidade aeróbia máxima e maior dispneia no exercício. A PImáx e a PEmáx foram significativamente menores nos pacientes com HAP que nos controles. Entretanto, a variação pós exercício em relação ao repouso não foi significativamente diferente nos dois grupos. Os pacientes apresentaram redução significativa da CI do repouso ao pico do exercício em comparação aos controles. 17/27 pacientes (63%) apresentaram redução da CI durante o exercício. Considerando-se apenas os pacientes, não houve associação entre CI e PImáx ou PEmáx (pré, pós exercício ou mudança do repouso). Comparando-se os pacientes com e sem redução da CI, não houve diferença na proporção de pacientes que apresentaram redução da PImáx (41 vs 44%) ou da PEmáx (76 vs 89%) após o exercício. Da mesma forma, nenhuma diferença na PImáx ou PEmáx foi observada no exercício comparando estes subgrupos. Conclusões: Em resumo, a força muscular respiratória foi significativamente menor em pacientes com HAP em comparação com controles e uma proporção significativa de pacientes com HAP apresentaram redução da CI durante o exercício. No entanto, não foram observadas associações entre CI e alterações de força muscular respiratória com o exercício, sugerindo que ocorra verdadeira hiperinsuflação dinâmica. Além disso, o único parâmetro relacionado com a dispneia induzida pelo exercício foi a CI no repouso e com capacidade aeróbia no pico foi a magnitude da redução da PEmáx após o exercício. / Rationale: The exercise induced inspiratory capacity (IC) reduction observed in some patients with pulmonary arterial hypertension (PAH) could potentially be influenced by respiratory muscle dysfunction. Aims: To investigate if there is any relationship between IC and respiratory muscle strength before and after maximal exercise and to study the contribution of respiratory muscle pressure and IC in exercise dyspnea and capacity in PAH patients. Methods: 27 patients with PAH and 12 healthy matched controls were compared. All participants underwent cardiopulmonary exercise test (CPET) with serial IC measurements. Inspiratory and expiratory maximal mouth pressure (PImax and PEmax, respectively) were measured before and at peak/post exercise. Results: Patients had lower forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) (with similar FEV1/FVC ratio) and peak aerobic capacity and higher exercise dyspnea. PImax and PEmax were significantly lower in PAH patients compared to controls. However, post exercise variations from rest were not significant different in either group. Patients presented significant rest-to-peak reduction in IC compared to controls. 17/27 patients (63%) exhibited IC reduction during exercise. Considering only patients, there was no association between IC and PImax or PEmax (pre, post exercise or change from rest). Comparing patients with and without IC reduction, there was no difference in the proportion of patients presenting inspiratory (41 vs 44%) or expiratory (76 vs 89%) pressure reduction after exercise, respectively. In the same way, no difference in both inspiratory and expiratory respiratory pressure change with exercise was observed comparing these subgroups. Conclusions: In summary, respiratory muscle strength was significantly lower in PAH patients compared to controls and a significant proportion of PAH presented IC reduction during exercise. Nonetheless, no associations between IC and respiratory muscle strength changes with exercise were observed, suggesting a true dynamic lung hyperinflation. Additionally, the only parameter associated with exercise induced dyspnea was resting IC and with peak aerobic capacity was the magnitude of PEmax reduction after exercise.

Background: Progressive respiratory muscle weakness and ineffective cough contributes to pulmonary morbidity and mortality in children with neuromuscular disease. Inspiratory muscle training aims to preserve or improve respiratory muscle strength, reduce respiratory complications and improve health-related quality of life. Objectives: To describe South African physiotherapists' knowledge and respiratory management strategies and determine the safety, viability, acceptability and efficacy of inspiratory muscle training for children 5-18 years with neuromuscular disease. Methods: Four studies were conducted: i) a quantitative descriptive survey; ii) a systematic review using Cochrane methodology; iii) a prospective, pre-experimental observational study and iv) a prospective, cross-over randomised controlled trial using a standardised 12-week inspiratory muscle training intervention. Results: i) South African physiotherapists (n=64) reported being aware of international clinical practice recommendations, however they favoured manual airway clearance techniques. The use of inspiratory muscle training in chronic management was well supported by South African physiotherapists. ii) Results of the systematic review (seven included studies; n=168) suggested that inspiratory muscle training may be effective in improving inspiratory muscle strength. There was insufficient evidence for an effect on patient morbidity or health-related quality of life. iii) The pre-experimental, pilot study (n=8) suggested that a six-week inspiratory muscle training programme was safe, viable, acceptable and associated with a significant increase in inspiratory muscle strength. iv) The cross-over randomised controlled trial (n=23) did not show evidence of a difference in the primary outcome measures (number of hospitalisations and respiratory tract infections) between intervention and control periods. There were no adverse events related to inspiratory muscle training. Inspiratory muscle strength (Pimax) and peak expiratory cough flow increased by 14.57 (±15.67)cmH2O and 32.27 (±36.60)L/min respectively during the intervention period compared to a change of 3.04 (±11.93)cmH2O (p=0.01) and -16.59 (±48.29)L/min (p=0.0005) during the control period. There was no evidence of change in spirometry, functional ability or total health-related quality of life scores following the intervention. Overall participant satisfaction with inspiratory muscle training was high and adherence was good. Conclusions: Inspiratory muscle training in children with neuromuscular disease is well tolerated, appears to be safe and is associated with significant improvements in inspiratory muscle strength and cough efficacy.

A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfilment of requirements for the degree of Masters of Science. Johannesburg 2012 / Background: The detrimental effects of prolonged mechanical ventilation (MV) on the respiratory muscles, especially the diaphragm, are well documented and it is crucial that MV should be discontinued as soon as possible to prevent added complications and additional risks to patients with critical illness. The spontaneous breathing stage of MV can be managed as a rehabilitation and conditioning phase for the respiratory muscles due to the fact that the respiratory muscles are more active during this stage of MV. Weaning strategies that provide insufficient respiratory work, too high a respiratory muscle load or insufficient respiratory muscle rest may lead to respiratory muscle fatigue and consequently failed weaning and extubation. The aim of this research project was to develop an individualised continuous positive airway pressure (CPAP) weaning programme and test its effects on the outcomes of extubation in the adult ventilated patient. Method: An experimental, prospective, non-randomised, sequential study of two groups of subjects was performed. Forty eight subjects [group one: n =24 (control) and group two: n = 24 (intervention)], who were mechanically ventilated for longer than 48 hours, in an open adult, general intensive care unit were recruited. Subjects in the control group were weaned according to the standard weaning programme of the test setting at the time; and those in the intervention group were weaned according to an individualised CPAP programme. This weaning programme was developed utilising three principles of muscle rehabilitation namely; daily stepwise progression, sufficient rest and recovery periods and adapted to the individual needs and progression of each subject. Objective measurements such as the rapid shallow breathing index (RSBI), RSBI rate and the maximum inspiratory pressure (MIP) were used to determine the subjects in group two’s readiness for a spontaneous breathing trial. The primary outcomes assessed were time spent in the different stages of MV, rate of failure to sustain spontaneous breathing in stage 3 of MV, successful extubation and mortality rate. Results and Discussion: The difference in rate of failure to sustain spontaneous breathing between the two groups was statistically significant (p = 0.01) with 10 events of failure in group one and three in group two. The rate of successful extubation from MV between groups one and two was 70.8% and 91.7% iv respectively (p=0.52). The mortality rate was 33.3% for group one and 8.3% for group two (p = 0.02). The difference in the total time spent on MV (days) did not differ significantly (group one = 8.6 (± 0.40) days; group two = 9.3 (±0.32) days; p = 0.75). The results yielded from this study suggest that the use of a multidisciplinary team model and an individualised CPAP programme aids successful extubation from MV as the success rate was much higher in the intervention group than in the control group without adding additional time on MV. Conclusion: Results from this study showed that the implementation of an individualised CPAP programme during the spontaneous breathing stage of MV may improve the outcomes of extubation in adult ventilated patients.

No description available.

Purpose: This study evaluated the effect of lung volume at the catch position to force and power outputs during single maximal effort strokes in rowing. Responses were compared when the participants were ‘fresh’ and following specific inspiratory muscle fatigue (IMF). In addition, a single subject pilot study was performed to characterise the changes in intra-thoracic (ITP), intra-abdominal (IAP) and trans-diaphragmatic (Pdi) pressures during a 30 second maximal effort piece on a rowing ergometer. Methods: Nine male rowers of international standard participated in the research. Static force, as well as the power produced during a single stroke were assessed at residual volume (RV), 25%TLC, 50%TLC, 75%TLC, total lung capacity (TLC), and a self-selected lung volume (S-S). Lung volumes were derived from maximal flow-volume loops (MFVLs) and achieved using online real-time feedback. Inspiratory muscle fatigue (IMF) was induced by breathing against an inspiratory load equivalent to 80% baseline maximal inspiratory pressure (MIP), at a breathing frequency (fB) of 15 breaths per minute, and a duty cycle of 0.6. Expiration was unimpeded. The single subject pilot study was undertaken using balloon catheters to measure ITP, IAP, and Pdi during a 30 second maximal effort free-rating piece on the ergometer. Results: There was no significant effect of lung volume upon either force or power production. The RMF protocol induced a significant reduction in MIP (159.9 ± 70.8 vs. 106.8 ± 58.7 cmH2O; p = 0.000), but not maximal expiratory pressure (MEP; 159.9 ± 79.2 vs. 166.6 ± 53.0 cmH2O; p = 0.376). RMF induced a significant reduction in force output with increasing lung volume, across all lung volumes (mean force 1313.4 ± 31.9 vs. 1209.6 ± 45.0N; p < 0.008), but not power (mean power 598.6 ± 31.9 vs. 592.7 ± 45.0W; p > 0.05). Self-selected lung volumes were consistent across all tests for force and power (mean 38.1 ± 6.9% [Force] vs. 28.2 ± 0.6% [Power]; p > 0.017). The pilot study indicated that internal pressures fluctuate markedly during maximal effort rowing (pressure, [max, min, average] cmH2O; IAP [144.69, 7.46, 73.59], ITP [75, -22.65, 15.34], Pdi [111.84, 7.09, 58.83]), suggesting that the trunk muscles play an active role in power production during rowing. Conclusion: The present study suggests that there is no significant effect of lung volume on force or power when athletes are in a fresh condition. However, a decrement in force production is present with inspiratory muscle fatigue. Combined with evidence of high internal pressures during maximal effort rowing, these data may indicate a role for the inspiratory muscles in force production during rowing.

Background: Breathing exercises are widely used after cardiac surgery. The duration of exercises in the immediate postoperative period is not fully evaluated and only limited data regarding the effects of home-based breathing exercises after discharge from hospital have been published. Aim: The overall aim of this thesis was to evaluate the effects of deep breathing exercises with positive expiratory pressure (PEP) and describe lung function and respiratory muscle strength in patients undergoing cardiac surgery. Participants and settings: Adult participants (n=131) were randomised to perform either 30 or 10 deep breaths with PEP per hour during the first postoperative days (Study I): the main outcome was oxygenation, assessed by arterial blood gases, on the second postoperative day. In Study III, 313 adult participants were randomly assigned to perform home-based deep breathing exercises with PEP for two months after surgery or not to perform breathing exercises with PEP after the fourth to fifth postoperative day. The main outcome was lung function, assessed by spirometry, two months after surgery. Studies II and IV were descriptive and correlative and investigated pre and postoperative lung function, assessed by spirometry, and respiratory muscle strength, assessed by maximal inspiratory pressure, and maximal expiratory pressure. Results: On the second postoperative day, arterial oxygen tension (PaO2) and arterial oxygen saturation (SaO2) was higher in the group randomised to 30 deep breaths with PEP hourly. There was no improved recovery of lung function in participants performing home-based deep breathing exercises two months after cardiac surgery, compared to a control group. Subjective experience of breathing or improvement in patient perceived quality of recovery or health-related quality of life did not differ between the groups at two months. Lung function and respiratory muscle strength were in accordance with predicted values before surgery. A 50% reduction in lung function was shown on the second postoperative day. High body mass index, male gender and sternal pain were associated with decreased lung function on the second postoperative day. Two months postoperatively, there was decreased lung function, but respiratory muscle strength had almost recovered to preoperative values. / <p></p><p></p>

Made available in DSpace on 2016-06-02T20:19:28Z (GMT). No. of bitstreams: 1 DissLNK.pdf: 1171474 bytes, checksum: f524111b3f383bbcfc7e0b8acef1f078 (MD5) Previous issue date: 2006-02-17 / Universidade Federal de Sao Carlos / The aim of the present study was to evaluate the effects of three respiratory physiotherapy programs constituted by physical training (PT) on a treadmill and/or respiratory muscle training (RMT) on pulmonary function, respiratory muscle strength (RMS), quality of life (QL), exercise capacity, ventilatory and metabolic variables and dyspnea at rest and during exercise, in patients with COPD, as well as to compare them to subjects of the same age and who have no respiratory disease. Twenty-five patients (68.8±8.3 years old) of both sexes, with moderate-to-severe COPD (FEV1<60% predicted), and ten volunteers who have no respiratory disease of both sexes (67.2±7.4 years old) participated of this study. The patients with COPD were randomized into three groups: the first group (RMTG) underwent 20 minutes sessions of RMT at a resistive load corresponding to 30% of the MIP obtained each week; the second group (PTG) underwent 30 minutes sessions of PT at a work rate corresponding to 70% of the highest heart rate achieved in the symptom-limited cardiorespiratory exercise testing (CRET); and the third group (RMT+PTG) associated 10 minutes of RMT to 15 minutes of PT with the same intensities previously mentioned. All of the programs were constituted by three sessions per week during six consecutive weeks. After treatment, it was observed significant increase of MIP and MEP in RMTG; significant increase of walk distance (WD) in the CRET, decreases of HR and minute ventilation at the same velocity in the CRET after treatment and improvement in the physical capacity domain in the QL questionnaire Short Form 36 (QLQ-SF36) in PTG; and significant increase of MIP, WD in the CRET, decrease of systolic arterial pressure and of blood lactate and improvement of total score of QLQ-SF36 in RMT+PTG. Those findings suggest that the PT associated with RMT seems to be the best alternative among the programs investigated in the present study because as well as providing an evident improvement of exercise capacity and of QL in the patients, it provided an additional effect in the physiological adaptation with better effectiveness in the clearance and/or less production of blood lactate during exercise. / Este estudo teve o objetivo de avaliar os efeitos de três programas de fisioterapia respiratória constituídos por treinamento físico (TF) em esteira e/ou treinamento muscular respiratório (TMR) sobre a função pulmonar, força muscular respiratória (FMR), qualidade de vida (QV), tolerância ao esforço e variáveis ventilatórias, metabólicas e dispnéia no repouso e durante o esforço, em pacientes com DPOC, bem como compará-los com indivíduos da mesma faixa etária e sem patologia respiratória. Participaram deste estudo, 25 pacientes, de ambos os sexos (68,8±8,3 anos), com diagnóstico clínico e espirométrico de DPOC moderada-grave (VEF1<60% do previsto) e 10 indivíduos sem patologia respiratória e na mesma faixa etária dos pacientes (67,2±7,4 anos). Os pacientes foram divididos aleatoriamente em 3 grupos, sendo o primeiro grupo (GTMR) submetido a sessões de 20 minutos de TMR com 30% da PImax obtida a cada semana, o segundo grupo (GTF) submetido a 30 minutos de TF com 70% da freqüência cardíaca máxima atingida no teste de exercício cardiorrespiratório (TECR) sintoma-limitado e o terceiro grupo (GTMR+TF) associava 10 minutos de TMR e 15 minutos de TF com as mesmas intensidades citadas anteriormente. Todos os programas constituíram-se de 3 sessões semanais por 6 semanas consecutivas. Após tratamento, foram observados aumentos significativos da PImax e PEmax no GTMR; aumentos significativos da distância percorrida (DP) no TECR, redução da FC e da ventilação isovelocidade e melhora no domínio capacidade física do questionário de qualidade de vida Short Form 36 (QQV-SF36) no GTF e; aumento significativo da PImax, da DP no TECR, redução da pressão arterial sistólica e concentração sangüínea de lactato tanto isovelocidade quanto no pico do esforço e melhora na pontuação total do QQV-SF36 no GTMR+TF. Os resultados sugerem que o TF associado ao TMR, parece ser a melhor alternativa terapêutica dentre as investigadas no presente estudo, pois, além de proporcionar uma evidente melhora na capacidade funcional e na QV dos pacientes, promoveu um efeito adicional nas adaptações fisiológicas com uma maior eficácia na remoção e/ou menor produção de lactato sangüíneo durante o esforço. Palavras-chave: Treinamento físico, treinamento muscular respiratório, DPOC.

Submitted by Izabel Franco (izabel-franco@ufscar.br) on 2016-09-27T20:19:19Z No. of bitstreams: 1 DissMF.pdf: 1690143 bytes, checksum: 926071d3df13b9586913717047c129c9 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-10T19:00:59Z (GMT) No. of bitstreams: 1 DissMF.pdf: 1690143 bytes, checksum: 926071d3df13b9586913717047c129c9 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-10T19:01:11Z (GMT) No. of bitstreams: 1 DissMF.pdf: 1690143 bytes, checksum: 926071d3df13b9586913717047c129c9 (MD5) / Made available in DSpace on 2016-10-10T19:01:21Z (GMT). No. of bitstreams: 1 DissMF.pdf: 1690143 bytes, checksum: 926071d3df13b9586913717047c129c9 (MD5) Previous issue date: 2015-05-29 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / The fibromyalgia syndrome (FMS) is a rheumatologic condition characterized by non-inflammatory widespread chronic pain and tender points in specific anatomic locations. In addition to the pain symptoms, FMS is also associated with the presence of a variety of symptoms such as fatigue and dyspnea, which has called attention to the review of the respiratory system in women with FMS. Thus, this work consisted of two studies aiming to elucidate the unknown aspects related to the respiratory system of women with FMS. The Study I, entitled "Pulmonary function, respiratory muscle strength and thoracoabdominal mobility in women with fibromyalgia syndrome: association with clinical manifestations", aimed to evaluate lung function, respiratory muscle strength and thoracoabdominal mobility as well as to assess possible associations of respiratory variables with clinical manifestations in women with FMS. The results show that the FMS group in this study has lower respiratory muscle endurance, inspiratory muscle strength and thoracic mobility compared to healthy participants. In addition, the study demonstrated that the lower inspiratory muscle strength, the greater the number of tender points and fatigue and lower axillary mobility. The Study II, entitled "Influence aerobic hydrotherapy program on lung function, respiratory muscle strength and thoracoabdominal mobility in women with fibromyalgia syndrome: a randomized controlled trial", aimed to evaluate the influence of an aerobic hydrotherapy program on respiratory variables and clinical manifestations in women with FMS and assess the association between respiratory variables and clinical manifestations. The results show that a 16-week aerobic hydrotherapy program increased the slow vital capacity, the forced vital capacity, the inspiratory muscle strength, the thoracic mobility, the pressure pain threshold, well-being, and decreased pain, and limitations caused by physical aspects. Clinical improvement was not associated with the respiratory variables. Conclusion: The subjects with FMS had lower respiratory muscle endurance, inspiratory muscle strength and thoracic mobility compared to healthy subjects. In addition, a 16-week aerobic hydrotherapy program showed to be effective in ameliorating lung function, inspiratory muscle strength, thoracic mobility, pressure pain threshold, well-being, pain and limitations caused by physical aspects. However, clinical improvement of FMS symptoms was not associated with the improvement of respiratory variables. / A síndrome fibromiálgica (SFM) é uma condição reumatológica, caracterizada por dor crônica difusa não inflamatória e tender points em locais anatômicos específicos. Além do quadro doloroso, a SFM também está associada à presença de uma variedade de sintomas como a fadiga e a dispneia, os quais têm chamado a atenção para a avaliação do sistema respiratório em mulheres com SFM. Assim, essa dissertação foi composta por dois estudos com o intuito de elucidar os aspectos desconhecidos relacionados ao sistema respiratório de mulheres com SFM. O Estudo I, intitulado “Função pulmonar, força muscular respiratória e mobilidade tóracoabdominal em mulheres com síndrome fibromiálgica: associação com as manifestações clínicas”, teve como objetivo avaliar a função pulmonar, a força muscular respiratória e a mobilidade tóracoabdominal, bem como avaliar as possíveis associações das variáveis respiratórias com as manifestações clinicas em mulheres com SFM. Os resultados mostram que as voluntárias do grupo SFM estudadas apresentam menor endurance muscular respiratória, força muscular inspiratória e mobilidade torácica em relação às voluntárias saudáveis. Além disso, o estudo revelou que quanto menor a força muscular inspiratória, maior o número de tender points ativos e fadiga e menor a mobilidade axilar. O Estudo II, intitulado “Influência de um programa de hidroterapia aeróbio sobre a função pulmonar, força muscular respiratória e mobilidade tóracoabdominal em mulheres com síndrome fibromiálgica: ensaio clínico randomizado controlado”, teve como objetivo avaliar a influência de um programa de hidroterapia aeróbio sobre variáveis respiratórias e manifestações clínicas em mulheres com SFM, bem como avaliar a associação entre as variáveis respiratórias com as manifestações clínicas. Os resultados mostram que o programa de hidroterapia aeróbio de 16 semanas aumentou a capacidade vital lenta, a capacidade vital forçada, a força muscular inspiratória, a mobilidade torácica, o limiar de dor à pressão e o bem-estar, e reduziu a dor e a limitação por aspectos físicos. A melhora clínica não apresentou associação com as variáveis respiratórias. Conclusão: As voluntárias com SFM apresentam menor endurance muscular respiratória, força muscular inspiratória e mobilidade torácica em relação às voluntárias saudáveis. Além disso, um programa de hidroterapia aeróbio de 16 semanas promoveu melhora da função pulmonar, da força muscular inspiratória, da mobilidade torácica, do limiar de dor à pressão, do bem-estar, da dor e da limitação por aspectos físicos. No entanto, a melhora clínica da SFM não apresentou associação com a melhora das variáveis respiratórias.