Submitted by PPG Pediatria e Sa?de da Crian?a (pediatria-pg@pucrs.br) on 2018-05-21T13:54:31Z No. of bitstreams: 1 Tese_Eduardo_Mundstock Versao Final.pdf: 1978473 bytes, checksum: 4be8f1b605788a6e254263a3c448a60f (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-06-06T18:34:35Z (GMT) No. of bitstreams: 1 Tese_Eduardo_Mundstock Versao Final.pdf: 1978473 bytes, checksum: 4be8f1b605788a6e254263a3c448a60f (MD5) / Made available in DSpace on 2018-06-06T18:36:11Z (GMT). No. of bitstreams: 1 Tese_Eduardo_Mundstock Versao Final.pdf: 1978473 bytes, checksum: 4be8f1b605788a6e254263a3c448a60f (MD5) Previous issue date: 2018-03-15 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction: The phase angle is considered an important prognostic marker because it reflects cellular health. Inadequate physical activity and sitting time are associated with a significant number of chronic noncommunicable diseases. Recent studies suggest that these two factors may be associated with phase angle values. Objective: to verify the association of phase angle with physical activity Methodology: the thesis will present two articles: a systematic review with metaanalysis and a cross-section article. Meta-analysis: We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, SciELO, LILACS, SPORTDiscus, Scopus and Web of Science. Two reviewers independently assessed eligibility criteria and bias risks. The results were synthesized using random effects models. The association between physical activity and phase angle was evaluated considering the design of the study. Cross-sectional study: individuals over 11 years of age, of both sexes, who met bioimpedance assessment criteria and without diagnosis of chronic disease, were invited to participate in the study. The phase angle evaluation was performed using Ottoboni's Biospace equipment, model InBodyS10. Physical activity level and sitting time were assessed using the International Physical Activity Questionnaire (IPAQ). The association between the phase angle and the predictor variables was evaluated using a univariate and multivariate generalized linear model (GLM). All variables with a value of p <0.20 were included in the multivariate model. In the final model, only the variables with p <0.05 were included. Results: Systematic Review: Nine studies, totaling 575 participants, were included in the meta-analysis. The results of cross-sectional studies indicate that the active subjects presented a mean value of higher phase angle when compared to controls (DM = 0.70, 95% CI 0.48 to 0.92, P <0.001), with low heterogeneity (I2 = 0%, P = 0.619). In the crosssectional analysis, the differences between health status and type of physical activity evaluation were not significant (P = 0.332, P <0.253). In longitudinal studies (clinical trial and follow-up), mean values of final phase angle increased significantly compared to baseline (DM = 0.30, 95% CI 0.11 to 0.49, P <0.001), with low heterogeneity (I2 = 13%, P = 0.331). The differences were not significant in relation to the state of health and the type of longitudinal study (clinical trials or follow-up studies) (P = 0.900; 0.989). Evidence of publication bias was not observed, and the overall risk of bias was moderate to high. Cross-sectional article: 1228 subjects were included. The multivariate generalized linear model showed that both physical activity (? = 0.164, 95% CI 0.071 to 0.256, P = 0.001) and sitting time (? = 0.152, 95% CI 0.063 to 0, 242, P = 0.001) were determinant for the phase angle. As well as sex, body mass index and age, also remained associated with phase angle (? = -0.890, 95%CI -0.975 to -0.806, P <0.001; ? = 0.037, 95%CI 0.029 to 0,045, p <0.001 e; ? = -0.006, 95%CI -0.008 to -0.003 P<0.001, respectively). Conclusion: The results of the systematic review and the cross-sectional article suggest an association of phase angle with physical activity and sitting time. Among the main factors that may explain the positive effect of physical activity on the phase angle are the increase in cell membrane integrity and the change in intracellular content, these factors reflecting the cellular health and, consequently, the health of the individual. / Introdu??o: O ?ngulo de fase est? sendo considerado um importante marcador progn?stico, pois reflete a sa?de celular. A atividade f?sica inadequada e o tempo sentado est?o associados a um n?mero importante de doen?as cr?nicas n?o transmiss?veis. Estudos recentes sugerem que esses dois fatores podem estar associados com os valores do ?ngulo de fase. Objetivo: verificar a associa??o do ?ngulo de fase com a atividade f?sica. Metodologia: a tese ir? apresentar dois artigos: uma revis?o sistem?tica com metan?lise e um artigo transversal. Metan?lise: foram realizadas buscas nas seguintes bases de dados: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, SciELO, LILACS, SPORTDiscus, Scopus e Web of Science. Dois revisores avaliaram independentemente os crit?rios de elegibilidade e o risco de vi?s. Os resultados foram sintetizados mediante modelos de efeitos aleat?rios. A associa??o entre atividade f?sica e ?ngulo de fase foi avaliada considerando o desenho do estudo. Artigo transversal: os indiv?duos com mais de 11 anos de idade, de ambos os sexos, que atendiam aos crit?rios de avalia??o da bioimped?ncia e sem diagn?stico de doen?a cr?nica, foram convidados a participar do estudo. A avalia??o do ?ngulo de fase foi realizada usando o equipamento Biospace, modelo InBodyS10, da Ottoboni. O n?vel de atividade f?sica e o tempo sentado foram avaliados com o question?rio internacional de atividade f?sica (IPAQ). A associa??o entre o ?ngulo de fase e as vari?veis preditoras foram avaliadas utilizando um modelo linear generalizado univari?vel e multivari?vel (MLG). Todas as vari?veis com um valor de p <0,20 foram inclu?das no modelo multivari?vel. No modelo final, apenas as vari?veis com p <0,05 foram inclu?das. Resultados: Revis?o Sistem?tica: Nove estudos, totalizando 575 participantes, foram inclu?dos na metan?lise. Os resultados dos estudos transversais indicam que os sujeitos ativos apresentaram um valor m?dio de ?ngulo de fase superior quando comparado aos controles (DM = 0,70; IC 95%: 0,48 a 0,92, P <0,001), com baixa heterogeneidade (I2 = 0%; P = 0,619). Na an?lise transversal, as diferen?as entre o estado de sa?de e o tipo de avalia??o da atividade f?sica n?o foram significativas (P = 0,332; P <0,253). Nos estudos longitudinais (ensaio cl?nico e acompanhamento), os valores m?dios do ?ngulo de fase finais aumentaram significativamente comparando com os valores iniciais (DM = 0,30; IC 95%: 0,11 a 0,49, P <0,001), com heterogeneidade baixa (I2 = 13%, P = 0,3314). As diferen?as n?o foram significativas, em rela??o ao estado de sa?de e ao tipo de estudo longitudinal (ensaios cl?nicos ou estudos de seguimento) (P = 0,900; 0,989). N?o encontramos evid?ncia de vi?s de publica??o e o risco geral de vieses foi de moderado a alto. Artigo transversal: foram inclu?dos 1228 indiv?duos. O modelo linear generalizado multivari?vel mostrou que tanto a atividade f?sica (? = 0,164, IC95% 0,071 a 0,256, P= 0,001) como o tempo sentado (? = 0,152, IC95% 0,063 a 0,242, P= 0,001) foram determinantes para o ?ngulo de fase. Assim como o sexo, o ?ndice de massa corporal e a idade tamb?m permaneceram associados com o ?ngulo de fase (? = -0,890, IC95% -0,975 a -0,806, P <0,001; ? = 0,037, IC95% 0,029 a 0,045, p <0,001 e; ? = -0,006, IC95% - 0,008 a -0,003 P<0,001, respectivamente). Conclus?o: Os resultados da revis?o sistem?tica e do artigo transversal sugerem uma associa??o do ?ngulo de fase com a atividade f?sica e com o tempo sentado. Entre os principais fatores que podem explicar o efeito positivo da atividade f?sica sobre o ?ngulo de fase est?o o aumento da integridade da membrana celular e a mudan?a no conte?do intracelular, fatores estes que refletem a sa?de celular e, consequentemente, a sa?de do indiv?duo.