Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-06-02T22:17:32Z No. of bitstreams: 1 JessicaDinizCavalcanti_DISSERT.pdf: 3709179 bytes, checksum: 1f4133118938481eee1cc6cd7dba2cb8 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-06-08T19:14:48Z (GMT) No. of bitstreams: 1 JessicaDinizCavalcanti_DISSERT.pdf: 3709179 bytes, checksum: 1f4133118938481eee1cc6cd7dba2cb8 (MD5) / Made available in DSpace on 2017-06-08T19:14:48Z (GMT). No. of bitstreams: 1 JessicaDinizCavalcanti_DISSERT.pdf: 3709179 bytes, checksum: 1f4133118938481eee1cc6cd7dba2cb8 (MD5) Previous issue date: 2017-02-24 / Os indiv?duos asm?ticos apresentam preju?zos tanto da fun??o muscular respirat?ria, devido as modifica??es da mec?nica ventilat?ria, quanto perif?rica, ocasionada pela altera??es metab?licas com redu??o da capacidade oxidativa. Tais condi??es resulta em aumento da dispneia e fadiga. Como esses m?sculos s?o ativados durante atividades cotidianas nessa popula??o ? indeterminado. O presente trabalho teve como objetivo analisar o comportamento da atividade el?trica dos m?sculos respirat?rios e perif?ricos e o desempenho nos testes de exerc?cio: Incremental Shuttle Walking Test (ISWT) e o teste Glittre-AVD, em indiv?duos asm?ticos versus indiv?duos n?o-asm?ticos. Participaram indiv?duos com diagn?stico cl?nico de asma, de ambos os sexos, com idade entre 20 e 50 anos, doen?a controlada, ?ndice de massa corporal (IMC) abaixo de 30 kg/m?, n?o-fumantes e indiv?duos n?o asm?ticos pareados por idade, sexo e IMC. Ap?s avalia??o inicial, todos os participantes foram submetidos a dois testes de exerc?cio: ISWT e o teste Glittre-AVD. Durante os testes, foram avaliados os m?sculos esternocleidomast?ide (ECOM), escaleno (ESC), reto abdominal (RA) e reto femoral (RF) para o ISWT e ESC, RA, RF e o m?sculo deltoide m?dio (DM) para Glittre-AVD, atrav?s da eletromiografia de superf?cie (EMGs). A an?lise estat?stica foi feita pelo programa estat?stico GraphPad Prism vers?o 6.0, para p<0,05. Foi utilizado o teste Shapiro-Wilk para normalidade das vari?veis estudadas. O teste Mann-Whitney para an?lise intergrupo das vari?veis cardiovasculares, respirat?rias e Borg (dispneia e fadiga). Para an?lise intergrupo da atividade el?trica dos m?sculos estudados, foi utilizado o teste ?t? n?o ? pareado, para o ISWT, e teste Mann-Whitney para o Glittre-AVD. Dezesseis pacientes asm?ticos compuseram o Grupo Asma (GA) e 10 sujeitos n?o-asm?ticos o Grupo Controle (GC). A amostra do GA vs GC apresentaram: idadeanos: 35,31? 11,31 vs 34,70?15,61, IMCkg/m2: 24,49?4,15 vs 22,34?1,797, VEF1%: 78,74?17,41 vs 90,84?7,74 (p<0,01), VEF1/CVF%predito: 84,46?12,53 vs 100,6?8,43 (p<0,01), respectivamente. N?o houve diferen?a na sintomatologia relatada de dispneia e fadiga em membros inferiores, vari?veis cardiorrespirat?rias e capacidade inspirat?ria, entre os grupos, ao final de cada teste. Em rela??o ao desempenho no ISWT, o GA percorreu uma dist?ncia menor que o GC (p<0,05). Para o teste Glittre-AVD, o GA executou o teste com quase 1 minuto a mais comparada ao GC (p<0,05). A an?lise da EMGs durante o ISWT demonstrou aumento da atividade el?trica dos m?sculos avaliados de maneira coordenada e similar, em ambos os grupos, com diferen?a significativamente maior apenas para ECOM do GC em 100% do teste (p<0,05). No Glittre-AVD n?o houve diferen?a de ativa??o para os m?sculos ESC e DM. Os m?sculos RA e RF exibiram uma maior ativa??o no GC, por?m sem diferen?a significativa. Nossos resultados sugerem que durante os testes de exerc?cio ISWT e Glittre-AVD, os pacientes asm?ticos apresentam atividade eletromiogr?fica coordenada e similar aos indiv?duos saud?veis, entretanto com menor desempenho em ambos os testes. / Asthmatic individuals exhibit impairment both respiratory muscle function, due to changes in ventilatory mechanics, and peripheral, caused by metabolic alterations with reduction of oxidative capacity. Such conditions result in increased dyspnea and fatigue. How these muscles are activated during daily activities in this population is undetermined. Thus, the goal of this study was to analyze the behavior of the electrical activity of respiratory and peripheral muscles and performance in exercise tests: Incremental Shuttle Walking Test (ISWT) and Glitter-ADL test in asthmatic subjects comparing with non asthmatic subjects. Participated patients with clinical diagnosis of asthma, of both gender, aged between 20 and 50 years, controlled disease, body mass index (BMI) below 30 kg / m?, non smokers and non asthmatic subjects matched by age, sex and BMI. After initial assessment, all participants were submitted to two exercise tests: ISWT and the Glitter-ADL test. During the tests, were evaluated the sternocleidomastoid (ECOM), scalene (ESC), rectus abdominis (RA) and rectus femoris (RF) muscles for the ISWT and ESC, RA, RF and the middle deltoid (DM) muscle for the Glitter-ADL test, through surface electromyography (EMGs). The statistical analysis was done by the statistical program GraphPad Prism version 6.0, for p <0.05. The Shapiro-Wilk test was used for the normality of the studied variables and Mann-Whitney for intergroup analysis of cardiovascular, respiratory and Borg variables (dyspnea and fatigue). For intergroup analysis of the electrical activity of the muscles studied it was used the unpaired T test for the ISWT and Mann-Whitney test for the Glitter-ADL test. Sixteen asthmatic patients composed the Asthma Group (GA) and ten non-asthatic subjects Control Group (CG). The GA vs GC sample showed: age: 35.31 ? 11.31 vs 34.70 ? 15.61, IMC kg / m2: 24.49 ? 4.15 vs 22.34 ? 1.797, FEV1%: 78.74 ? 17.41 vs 90.84 ? 7.74 (p <0.01), FEV 1 / FVC% predicted: 84.46 ? 12.53 vs 100.6 ? 8.43 (p <0.01), respectively . There was no difference in the reported symptomatology of dyspnea and fatigue in lower limbs, cardiorespiratory variables and inspiratory capacity, between the groups, at the end of each test. Regarding the ISWT performance, the GA walked a distance shorter than the GC (p <0.05). For the Glitter-ADL test, GA performed the test with almost 1 minute more compared to GC (p <0.05). The EMG analysis during the ISWT showed an increase in the electrical activity of the muscles evaluated in a coordinated and similar way, in both groups, with a significant difference only for ECOM of GC in 100% of the test (p <0.05). In Glitter-ADL test, there was no difference in activation for the ESC and DM muscles. The RA and RF muscles showed greater activation in the CG, but no significant difference. Our results suggest that during the ISWT and Glitter-ADL exercise tests, asthmatic patients exhibit coordinated electromyographic activity and similar to healthy individuals, however with lower performances in both tests.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-10-04T22:45:45Z No. of bitstreams: 1 DaviFialhoSilvaLima_DISSERT.pdf: 7992805 bytes, checksum: c9ae57ed3d2a37526fb2c44c2d463bfd (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-10-14T00:07:17Z (GMT) No. of bitstreams: 1 DaviFialhoSilvaLima_DISSERT.pdf: 7992805 bytes, checksum: c9ae57ed3d2a37526fb2c44c2d463bfd (MD5) / Made available in DSpace on 2017-10-14T00:07:17Z (GMT). No. of bitstreams: 1 DaviFialhoSilvaLima_DISSERT.pdf: 7992805 bytes, checksum: c9ae57ed3d2a37526fb2c44c2d463bfd (MD5) Previous issue date: 2017-06-19 / Introdu??o: A capacidade funcional ? prejudicada pela obesidade e pode ser avaliada por testes f?sicos que examinam a a??o sincronizada dos sistemas cardiovascular, respirat?rio e musculoesquel?tico. O comportamento cardiovascular e respirat?rio, medido por FC (frequ?ncia card?aca) e cin?tica de oxig?nio, por exemplo, no per?odo de recupera??o do exerc?cio tem mostrado ser um bom indicador de sa?de cardiovascular, reestabelecimento de reservas energ?ticas e equil?brio auton?mico em saud?veis e cardiopatas. Entretanto, n?o se conhece o comportamento da cin?tica de oxig?nio e da FCR (FC de recupera??o) em obesos sem doen?a card?aca diagnosticada. Objetivo: Analisar o comportamento da cin?tica de oxig?nio e FCR e ap?s teste de esfor?o cardiopulmonar em obesas. Materiais e M?todos: Estudo observacional, transversal com 32 volunt?rias, analisadas no teste de esfor?o cardiopulmonar (TECP), alocadas por conveni?ncia nos grupos obesidade (GO, N=16) e n?o obesas (GNOB, N=16). Realizadas avalia??es cl?nica, antropom?trica e de adiposidade e espirom?trica inicial. O TECP cl?nico padr?o foi realizado usando protocolo de rampa individualizado, sendo tomadas as medidas ventilat?rias e metab?licas (breath-?by-?breath), com registro das vari?veis de interesse no repouso (2?) e 5? iniciais de recupera??o (3 minutos-?recupera??o ativa, 2 minutos-?recupera??o passiva). A cin?tica de recupera??o foi calculada por modelo de regress?o linear da curva de decl?nio do VO2 durante o primeiro minuto de recupera??o em fun??o do tempo (T? e VO2/t) e a frequ?ncia FCR obtida pela diferen?a da FC no pico do teste e a FC no primeiro minuto de recupera??o. Resultados: os grupos foram homog?neos quanto ? idade, altura e medidas espirom?tricas. Diferen?as significativas foram encontradas na FCR (p=0,041) e VO2pico (p<0,001) entre os grupos. A cin?tica do VO2 apresentou diferen?a significativa no T? de VO2 (p=0,003) e VO2/t (p=0,041). Observou-?se que o VO2pico (0,59), IMC (-?0,16) e CQ (0,18) justificam a vari?ncia do VO2/t em 72%. Foi atestada uma colinearidade negativa entre as medidas de adiposidade de CQ e IMC. Conclus?o: Obesos jovens t?m respostas lentificadas da cin?tica de recupera??o do VO2 e FC em rela??o a n?o obesas, sugerindo que obesos t?m preju?zo na restaura??o dos estoques energ?ticos ou circulat?rios no m?sculos perif?ricos e disfun??o auton?mica, e que tais altera??es podem contribuir para a instala??o de doen?as cardiovasculares e o aumento da taxa de morbi-?mortalidade nesta popula??o. / Introduction: Functional capacity is impaired by obesity and can be assessed by physical tests that examine a synchronized action of the cardiovascular, respiratory and musculoskeletal systems. Cardiovascular and respiratory behavior, measured by HR (heart rate) and oxygen kinetics, for example, during the period of exercise recovery has been considered as indicator of cardiovascular health, reestablishment of energy reserves and autonomic balance in healthy and patients with heart disease. However, the behavior of oxygen kinetics and HRR (recovery HR) in obese patients without diagnosed heart disease is not known. Aim: To analyze the pattern of oxygen kinetics and HRR after cardiopulmonary exercise test in obese women. Materials and Methods: a cross-?sectional study with 32 volunteer women, analyzed in the cardiopulmonary exercise test (CPX), allocated for convenience into obesity (GO, N=16) and non-?obese (GNO, N=16) group. We performed a clinical, anthropometric and adiposity and spirometry evaluation. The standard clinical CPX was assessed, (individualized ramp protocol), being done as ventilatory and metabolic measures (breath-?by-?breath), with a recording of interest variables at the rest (2?) and 5 initial (3' active recovery, 2'passive recovery). Oxygen kinetic after exercise was calculated by linear regression model of the decline slope of VO2 over time during the first minute of recovery (T?, VO2/t), and the HRR obtained by the difference between HR at the peak of the test and the HR at the first minute of recovery. Results: groups were homogeneous regarding age, height and spirometric measurements. Significant differences were found in the HRR (p=0,041) and VO2peak (p<0,001) between the groups. The oxygen kinetics presented a significant difference in the T? of VO2 (p=0,003) and VO2/t (p=0,041). It was observed that VO2peak (0,59), BMI (-?0,16) and HC (0,18) justified the variance of VO2/t in 72%. A negative colinearity between the HC and BMI adiposity measures was attested. Conclusion: young obese has delayed response of VO2 recovery kinetics and HRR regards no obese it suggests that obese has circulatory or reestablishment of energy reserves impairment on peripheral muscles and autonomic dysfunction, and it?s may contribute to the establishment of cardiovascular diseases, and increased morbidity and mortality rate in this population.

Submitted by Sara Ribeiro (sara.ribeiro@ucb.br) on 2017-04-17T20:22:06Z No. of bitstreams: 1 CaioVictordeSousaSilvaDissertacao2016.pdf: 5579388 bytes, checksum: d00ac932cc6cb4518d5d39415db47d6f (MD5) / Approved for entry into archive by Sara Ribeiro (sara.ribeiro@ucb.br) on 2017-04-17T20:22:14Z (GMT) No. of bitstreams: 1 CaioVictordeSousaSilvaDissertacao2016.pdf: 5579388 bytes, checksum: d00ac932cc6cb4518d5d39415db47d6f (MD5) / Made available in DSpace on 2017-04-17T20:22:14Z (GMT). No. of bitstreams: 1 CaioVictordeSousaSilvaDissertacao2016.pdf: 5579388 bytes, checksum: d00ac932cc6cb4518d5d39415db47d6f (MD5) Previous issue date: 2016-02-29 / The validity of the double product (DP) response to estimate the anaerobic threshold (AT), an alternative and less costly method has not been tested in patients with type 2 diabetes (T2D). Therefore, the objective of this study is test the reliability of AT identification by the double product breakpoint (DPBP) in T2D. Nine subjects with type 2 diabetes (T2D = 9) and ten non-diabetic (ND = 10) underwent an incremental test on a cycle ergometer. Heart rate (HR), blood pressure (BP) and exhaled gases were measured at the end of each stage. The ventilatory threshold (VT), lactate threshold (LT) and DPBP were considered an exercise intensity below which a disproportional increase of ventilation, [LAC] and DP, respectively, was observed in relation to linear increase in workload. No differences were identified between the workload, HR, and oxygen consumption (VO2) corresponding to the AT identified by VT, LT and DPBP. Further, for the T2D group was identified a high and significant level of reliability between DPBP and VT for workload (ICC = 0.84), FC (ICC = 0.71) and VO2 (ICC = 0.83) and between DPBP and LT for workload (ICC = 0.79) and FC (ICC = 0.82). Similar reliability was identified for the ND group between DPBP and VT for workload (ICC = 0.92), HR (ICC = 0.88) and VO2 (ICC = 0.84) and between DPBP and LT for workload (ICC = 0.70). It concludes that the DPBP is reliable to estimate the AT and it is highly associated with VT and LT in T2D and ND individuals. / A validade da resposta do duplo produto (DP) para estimar o limiar anaer??bio (LAn), um m??todo alternativo e menos oneroso, ainda n??o foi testado em indiv??duos com diabetes tipo 2 (DM2). Portanto, o objetivo deste estudo ?? verificar se ?? poss??vel identificar o LAn pelo ponto de inflex??o do duplo produto (DPBP) em indiv??duos DM2. Nove sujeitos com DM2 (DM2 = 9) e dez n??o diab??ticos (ND = 10) foram submetidos a um teste incremental em cicloerg??metro. Frequ??ncia card??aca (FC), press??o arterial (PA) e gases expirados foram mensurados ao final de cada est??gio. O limiar ventilat??rio (LV), limiar de lactato (LL) e o DPBP foram considerados a intensidade do exerc??cio abaixo a um aumento desproporcional da ventila????o, [LAC] e DP, respectivamente, s??o observados em rela????o ao aumento linear da carga de trabalho. N??o foram identificadas diferen??as entre a carga de trabalho, FC, e consumo de oxig??nio (VO2) correspondente ao LAn identificado pelo LV, LL e DPBP. Al??m disso, para o grupo DM2 foi identificado um alto e significante n??vel de confiabilidade entre DPBP e LV para carga de trabalho (ICC = 0,84), FC (ICC = 0,71) e VO2 (ICC = 0,83) e entre o DPBP e LL para carga de trabalho (ICC = 0,79) e FC (ICC = 0,82). Confiabilidade semelhante foi identificado para o grupo ND entre DPBP e LV para carga de trabalho (ICC = 0,92), FC (ICC = 0,88) e VO2 (ICC = 0,84) e entre o DPBP e LL para carga de trabalho (ICC = 0,70). Conclui-se que o DPBP permitiu a predi????o do LAn, devido ao alto n??vel de confiabilidade com os m??todos tradicionais, LV e LL.

Made available in DSpace on 2014-12-17T14:13:19Z (GMT). No. of bitstreams: 1 FernandoPB.pdf: 4835339 bytes, checksum: 31251ef256da75068c94b80cfee05d1f (MD5) Previous issue date: 2007-12-03 / The relation between metabolic demand and maximal oxygen consumption during exercise have been investigated in different areas of knowledge. In the health field, the determination of maximal oxygen consumption (VO2max) is considered a method to classify the level of physical fitness or the risk of cardiocirculatory diseases. The accuracy to obtain data provides a better evaluation of functional responses and allows a reduction in the error margin at the moment of risk classification, as well as, at the moment of determination of aerobic exercise work load. In Brasil, the use of respirometry associated to ergometric test became an opition in the cardiorespiratory evaluation. This equipment allows predictions concerning the oxyredutase process, making it possible to identify physiological responses to physical effort as the respiratory threshold. This thesis focused in the development of mathematical models developed by multiple regression validated by the stepwise method, aiming to predict the VO2max based on respiratory responses to physical effort. The sample was composed of a ramdom sample of 181 healthy individuals, men and women, that were randomized to two groups: regression group and cross validation group (GV). The voluntiars were submitted to a incremental treadmill test; objetiving to determinate of the second respiratory threshold (LVII) and the Peak VO2max. Using the m?todo forward addition method 11 models of VO2max prediction in trendmill were developded. No significative differences were found between the VO2max meansured and the predicted by models when they were compared using ANOVA One-Way and the Post Hoc test of Turkey. We concluded that the developed mathematical models allow a prediction of the VO2max of healthy young individuals based on the LVII / A rela??o entre a demanda metab?lica e o consumo de oxig?nio durante a pr?tica de exerc?cios f?sicos ? alvo de investiga??o em distintas ?reas do conhecimento. No campo da sa?de, a determina??o do consumo m?ximo de oxig?nio (VO2m?x) ? considerada um m?todo para classificar o n?vel de aptid?o f?sica ou risco de doen?as cardiocirculat?rias. A obten??o de dados de forma acurada possibilita uma melhor avalia??o das respostas funcionais, o que permite reduzir a margem de erros tanto no momento da classifica??o dos riscos, como tamb?m no momento da determina??o das cargas de treinamento aer?bico. No Brasil a utiliza??o da ventilometria conjugado ao teste de ergom?trico passou a ser uma op??o na avalia??o cardiorrespirat?ria. O emprego deste equipamento possibilita inferir sobre o processo de oxidorredutase, permitindo identificar respostas fisiol?gicas ao esfor?o como o limiar ventilat?rio. A presente tese centrou-se no desenvolvimento de modelos matem?ticos desenvolvidos por meio de regress?o m?ltipla com valida??o pelo m?todo stepwise com o objetivo de predi??o do VO2m?x tomando como base, as respostas ventilat?rias ao esfor?o. Para tanto, o estudo contou com uma amostra aleat?ria de 181 indiv?duos saud?veis, de ambos os sexos, que foram randomizados em dois grupos: grupo de regress?o e o grupo de valida??o cruzada (GV). Os volunt?rios foram submetidos a teste cardiopulmonar em esteira rolante em protocolo incremental; onde se visou a determina??o do limiar ventilat?rio II (LVII) e o VO2m?x de pico. Atrav?s da aplica??o do m?todo adi??o forward foram desenvolvidos 11 modelos de predi??o do VO2m?x em esteira rolante. N?o foram encontradas diferen?as significativa entre o VO2m?x mensurado com os preditos pelos modelos quando comparados pelo teste t pareado. Os resultados possibilitam-nos concluir que os modelos matem?ticos desenvolvidos permitem estimar o VO2m?x de indiv?duos jovens e h?gidos, tendo como ponto de refer?ncia o LVII

Made available in DSpace on 2014-12-17T15:16:20Z (GMT). No. of bitstreams: 1 NicoleSOC_DISSERT.pdf: 1342792 bytes, checksum: c040154e5911aeafa634f51d3ef0bb57 (MD5) Previous issue date: 2013-11-29 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / obesity affects rightly functional capacity diminishing the cardiovascular system efficiency and oxygen uptake (VO2). Field tests, such as, Incremental Shuttle Walking Test (ISWT) and Six Minute Walk Test (6MWT) has been employed as alternative of Cardiopulmonary Exercise Test (CPX), to functional assessing for conditions which transport of oxygen to peripheral is diminished. Nevertheless, the knowing about metabolic variables response in real time and it comparing among different maximal and submaximal tests in obese is absent. Aim: to compare cardiopulmonary, metabolic response during CPX, ISWT and 6MWT and to analyse it influence of adiposity markers in obese. Material e Method: crosssectional, prospective study. Obese included if: (BMI>30Kg/m2; FVC>80%), were assessed as clinical, anthropometric (BMI, body adiposity index-BAI, waist-WC, hip- HC and neck-NC circumferences) and spirometry (forced vital capacity-FVC, Forced expiratory volume-1?second-FEV1, maximal voluntary ventilation-MVV) variables. Obese performed the sequence of tests: CPX, ISWT and 6MWT. Throughout tests was assessed breath-by-breath by telemetry system (Cortex-Biophysik-Metamax3B) variables; oxygen uptake on peak of activity (VO2peak); carbon dioxide production (VCO2); Volume Expiratory (VE); ventilatory equivalents for VO2 (VE/VO2) and CO2 (VE/VCO2); respiratory exchange rate (RER) and perceived effort-Borg6-20). Results: 15 obese (10women) 39.4+10.1years, normal spirometry (%CVF=93.7+9.7) finished all test. They have BMI (43.5+6.6kg/m2) and different as %adiposity (BAI=50.0+10.5% and 48.8+16.9% respectively women and men). Difference of VO2ml/kg/min and %VO2 were finding between CPX (18.6+4.0) and 6MWT (13.2+2.5) but not between ISWT (15.4+2.9). Agreement was found for ISWT and CPX on VO2Peak (3.2ml/kg/min; 95%; IC-3.0 9.4) and %VO2 (16.4%). VCO2(l/min) confirms similarity in production for CPX (2.3+1.0) and ISWT (1.7+0.7) and difference for 6MWT (1.4+0.6). WC explains more the response of CPX and ISWT than other adiposity markers. Adiposity diminishes 3.2% duration of CPX. Conclusion: ISWT promotes similar metabolic and cardiovascular response than CPX in obese. It suggesting that ISWT could be useful and reliable to assess oxygen uptake and functional capacity in obese / a obesidade afeta diretamente a capacidade funcional diminuindo a efici?ncia do sistema cardiovascular e o consumo de oxig?nio (VO2). Testes de campo, tais como, Incremental Shuttle Walking Test (ISWT) e Teste de Caminhada de 6 minutos (TC6M) tem sido empregados como alternativa ao Teste de Esfor?o Cardiopulmonar (TECP), para avalia??o funcional de patologias que levam a diminui??o da transfer?ncia de oxig?nio ? periferia, entretanto, pouco ? conhecido da respostas fisiol?gicas de vari?veis metab?licas e ventilat?rias em obesos durante teste incremental de exerc?cio. Objetivo: analisar e comparar as respostas cardiopulmonares, metab?licas (VO2pico-consumo de oxig?nio-pico e VCO2-produ??o de di?xido de carbono) e de esfor?o percebido nos testes subm?ximos de esfor?o (ISWT e TC6M) com o TECP. Materiais e M?todo: estudo transversal, prospectivo, onde foi avaliada a concord?ncia de dois diferentes testes de campo (TC6M e ISWT) com o TECP. Crit?rios de Inclus?o (IMC > 30Kg/m2; CVF > 80%). Os participantes realizaram avalia??o cl?nica, antropom?trica (IMC, IAC-?ndice de adiposidade corporal, RCQ-rela??o cintura-quadril, CQ-circunfer?ncia quadril, CC-circunfer?ncia cintura, CP-circunfer?ncia pesco?o) e espirom?trica (CVF-capacidade vital for?ada, VEF1-volume expirat?rio for?ado no 1? segundo, VVM-ventila??o volunt?ria m?xima). Obesos realizaram em momentos distintos a sequ?ncia de testes (TECP, TC6M e ISWT). Medidas ventilat?rias (VE-ventila??o por minuto, VE/VO2-equivalente ventilat?rio de oxig?nio, VE/VCO2-equivalente ventilat?rio de di?xido de carbono, RER-raz?o de troca gasosa) e metab?licas (VO2 e VCO2) dos gases expirados (breath-by-breath) com sistema de telemetria (Cortex-Biophysik-Metamax3B), al?m das vari?veis de percep??o de esfor?o (fadiga e dispneia-Borg6-20) foram tomadas. Resultados: os participantes eram adultos jovens (39.4+10.1 anos), com altos percentuais de adiposidade corporal (IAC=50.0+10.5%-mulheres; IAC=48.8+16.9%- homens) e IMC=43.5+6.6. Observou-se que IMC e CC justificaram isoladamente 56% e 48% da vari?ncia da dura??o do TECP. Diferen?as de VO2ml/kg/min e %VO2 nos obesos foram encontradas apenas entre TECP e TC6M (%VO2 p=0.008 em mulheres e p=0.01 nos homens), sendo os valores de VO2PICO de 18.6+4.0ml/kg/min no TECP; 15.4+2.9 no ISWT e 13.2+2.5 no TC6M. O Bland-Altman evidenciou concord?ncia entre TECP e o ISWT no VO2PICO (3.2ml/kg/min; 95%; IC -3.0 9.4) e no %VO2 (16.4%; 95%; -23.6 56.4). A an?lise da produ??o de CO2(l/min) xiv confirmou uma maior produ??o ao final do TECP (2.3+1.0), seguido do ISWT (1.7+0.7) e TC6M (1.4+0.6), por?m com diferen?as apenas entre o TECP e TC6M (p<0.01). Conclus?o: apesar de considerado um teste de esfor?o subm?ximo, o ISWT promove respostas metab?licas e cardiovasculares semelhantes ao TECP na popula??o obesa, sugerindo que o ISWT pode ser uma boa op??o para avaliar a capacidade funcional de obesos

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-03-20T22:55:35Z No. of bitstreams: 1 FlavioEmanoelSouzaDeMelo_DISSERT.pdf: 1457088 bytes, checksum: fb912780ad29be5caa6d4575b8e51b3e (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-24T19:35:50Z (GMT) No. of bitstreams: 1 FlavioEmanoelSouzaDeMelo_DISSERT.pdf: 1457088 bytes, checksum: fb912780ad29be5caa6d4575b8e51b3e (MD5) / Made available in DSpace on 2017-03-24T19:35:50Z (GMT). No. of bitstreams: 1 FlavioEmanoelSouzaDeMelo_DISSERT.pdf: 1457088 bytes, checksum: fb912780ad29be5caa6d4575b8e51b3e (MD5) Previous issue date: 2016-06-30 / Introdu??o: Sabe-se que ventila??o n?o invasiva (VNI) ? capaz de aumentar capacidade funcional em pacientes com insufici?ncia card?aca (IC) cr?nica. Contudo, ainda h? diverg?ncias quanto ao modo ventilat?rio mais ben?fico para essa popula??o. Al?m disso, ? poss?vel que haja influencia entre os n?veis press?ricos ajustados na VNI e a magnitude dos seus efeitos. Objetivo: 1) testar se h? diferen?a entre os efeitos agudos da VNI na toler?ncia ao exerc?cio de indiv?duos com IC, quando aplicada modo CPAP ou modo Bi-n?vel; e 2) verificar se h? discrep?ncias nos efeitos agudos do modo Bi-n?vel sobre o desempenho f?sico desses indiv?duos, quando aplicado em n?veis press?ricos distintos. Metodologia: Ensaio cl?nico controlado, randomizado, duplo-cego e cross-over, composto por 14 volunt?rios, portadores de IC cr?nica, com classe funcional II e III (New York Heart Association), em situa??o de estabilidade cl?nica. O experimento ocorreu em quatro visitas distintas, com intervalo m?nimo de 48 horas entre elas. Na primeira visita, houve a triagem dos volunt?rios, em seguida a aplica??o de um SWT sem interven??o pr?via. Em cada uma das 3 visitas seguintes, obedecendo sequ?ncia randomizada, os volunt?rios utilizaram um modo diferente de VNI por 30 minutos, imediatamente antes do SWT. Foram utilizados os seguintes modos: Bi-n?vel com par?metros m?nimos (EPAP = 6 cmH2O e IPAP = 12 cmH2O), Bi-n?vel com par?metros m?ximos (EPAP = 8 cmH2O e IPAP = 14 cmH2O) e CPAP (6 cmH2O). Durante os testes foram analisados a dist?ncia caminhada, n?veis percebidos de fadiga e dispneia, resposta afetiva, bem como outras vari?veis fisiol?gicas. Para a an?lise estat?stica foi utilizado o teste ANOVA para medidas repetidas, seguido do p?s-teste de Bonferroni, considerando-se o p-valor menor ou igual a 0,05 como estatisticamente significante. Resultados: N?o foi encontrada diferen?a entre a DSP obtida no SWT ap?s CPAP (440,4+72,4m) e ap?s o Bi-n?vel m?nimo (441,6+79,4m). Contudo, a DSP foi maior ap?s o uso da VNI em rela??o ?quela observada no SWT sem interven??o pr?via (381,2+79,8m). Conclus?o: O uso de um suporte ventilat?rio n?o invasivo, independentemente do modo, promove melhora na toler?ncia ao exerc?cio em pessoas com IC, o que pode permitir que essa popula??o alcance, mais amplamente, os benef?cios oriundos do exerc?cio f?sico sobre a sua funcionalidade e qualidade de vida. / Introduction: Dyspnea and fatigue are the main clinical symptoms of heart failure and primarily responsible for exercise intolerance found in this syndrome. Now, It is known that the use of NIV in CPAP mode applied before exercise increases exercise tolerance in people with heart failure; however, it's not yet known if the bi-level mode is able to generate similar or even better results, due to pressure increase of the ventilatory support in this modality. Moreover, it is possible that there is influence between the pressure levels set in the NIV and the magnitude of its effect on the exercise in this population Objective:1) test for differences between the acute effects of NIV on exercise tolerance in patients with HF, when applied CPAP or bi-level mode; and 2) check for discrepancies in the acute effects of Bi-level mode on the physical performance of these individuals, when applied at different pressure levels. Methodology: This is a controlled, randomized, double-blind and cross-over clinical trial, composed of 14 volunteers (age 63 ? 9 years), with chronic heart failure, functional class II and III (New York Heart Association) in clinical stability. The experiment took place in four different visits, with an minimum interval of 48 hours between them. At the first visit, the volunteers were screened and performed a SWT without prior intervention. Following a randomized sequence, In each of the 3 subsequent visits, the volunteers received a different mode of NIV for 30 minutes immediately before the SWT. The following modes were used: Bi-level with minimal parameters (EPAP = 6 cm H2O and IPAP = 12 cm H2O), Bi-level with maximum parameters (EPAP = 8 cm H2O and IPAP = 14 cm H2O) and CPAP (6 cm H2O). In the tests were observed walking distance (WD), perceived levels of fatigue and dyspnea, affective response and other physiological variables. Statistical analysis was performed using ANOVA for repeated measures followed by Bonferroni post-test, considering p-value less than or equal to 0.05 as statistically significant. Results: No difference was found between the WD obtained in T-CP (440.4 + 72,4m) and T-Bi (441.6 + 79,4m) (p = 1.00). However, the WD was higher after the use of NIV in both the T-CP, as in T-Bi compared to that observed in T-Co (381.2 + 79,8m) (p = 0.004 and p = 0.007, respectively). Conclusion: The use of a non-invasive ventilatory support, regardless of mode, promotes improvement in exercise tolerance in people with heart failure, which can allow this population range, more broadly, the benefits from the exercise of its functionality and quality of life.