Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-17T23:18:24Z No. of bitstreams: 1 PalommaRussellySaldanhaDeAraujoOliveira_TESE.pdf: 10724965 bytes, checksum: fb9786f1f1478cf8fcd17d5aeb59d620 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-20T23:10:05Z (GMT) No. of bitstreams: 1 PalommaRussellySaldanhaDeAraujoOliveira_TESE.pdf: 10724965 bytes, checksum: fb9786f1f1478cf8fcd17d5aeb59d620 (MD5) / Made available in DSpace on 2017-04-20T23:10:05Z (GMT). No. of bitstreams: 1 PalommaRussellySaldanhaDeAraujoOliveira_TESE.pdf: 10724965 bytes, checksum: fb9786f1f1478cf8fcd17d5aeb59d620 (MD5) Previous issue date: 2016-12-12 / Os m?sculos respirat?rios constituem um dos pilares essenciais da ventila??o. Altera??es na sua estrutura e morfologia em sujeitos com Doen?a Pulmonar Obstrutiva Cr?nica (DPOC) podem influenciar sintomas e sinais cl?nicos como dispneia, tosse ineficaz, intoler?ncia ao exerc?cio e insufici?ncia respirat?ria. O Treinamento Muscular Respirat?rio (TMR), especialmente dos m?sculos inspirat?rios na modalidade limiar de carga press?rica, tem sido utilizado h? mais de 30 anos como terapia coadjuvante em indiv?duos saud?veis e pacientes com DPOC. Ampla variedade de dispositivos para TMR est?o dispon?veis comercialmente, por?m s?o importados, possuem custo elevado e suas caracter?sticas s?o destinadas ao treino individual de grupos musculares ou possuem ajustes de cargas inadequados para pacientes com DPOC. Embora, diversas revis?es sistem?ticas tenham sido realizadas desde 1992 acerca do Treinamento Muscular Inspirat?rio (TMI) em sujeitos com DPOC e postuladas algumas evid?ncias sobre o TMI, falhas metodol?gicas na estrat?gia de busca das revis?es pr?vias e a baixa qualidade metodol?gica dos estudos inclu?dos contribu?ram para o estabelecimento de uma evid?ncia vol?til sobre os benef?cios do TMI. Objetivos: desenvolver um dispositivo de Treinamento do Ciclo Respirat?rio (TCR), integrado para m?sculos inspirat?rios e expirat?rios; verificar os efeitos agudos de diferentes combina??es de cargas inspirat?rias e/ou expirat?rias sobre a atividade muscular respirat?ria, cinem?tica da caixa tor?cica e din?mica dos volumes pulmonares em sujeitos saud?veis com dispositivo semelhante ao desenvolvido; bem como verificar as evid?ncias do TMI sobre a dispneia e capacidade do exerc?cio em sujeitos com DPOC. Metodologia: envolveu tr?s modalidades de pesquisa: i) o desenvolvimento tecnol?gico do dispositivo de TCR, ii) estudo transversal e iii) revis?o sistem?tica associada ? metan?lise. Resultados: i) cria??o de um produto de inova??o tecnol?gica aplicado ? sa?de, denominado ?Equipamento de Treinamento do Ciclo Respirat?rio (TCR) com resist?ncia tipo limiar de carga press?rica?, com dep?sito de patente de inven??o no INPI (BR 1020160253047); ii) mediante estudo transversal, o equipamento comercialmente dispon?vel para treinamento de m?sculos inspirat?rios e/ou expirat?rios n?o ? capaz de deflagrar adequadamente aumento na atividade el?trica dos m?sculos respirat?rios, embora provoque altera??es nos volumes correntes da parede tor?cica e seus compartimentos; e iii) artigo cient?fico intitulado ?Inspiratory muscle training for Chronic Obstructive Pulmonary Disease? evidenciando que, embora o TMI combinado ao cuidado padronizado sozinho versus cuidado padronizado sozinho proporcione melhora na qualidade de vida e que TMI combinado ? Reabilita??o Pulmonar versus Reabilita??o Pulmonar induza ? redu??o na dispneia em sujeitos com DPOC, n?o h? evid?ncia conclusiva para suportar ou refutar o TMI em pacientes com DPOC. Conclus?o: A presente pesquisa substancia a necessidade de constru??o de um novo equipamento de TMR para m?sculos inspirat?rios e expirat?rios, bem como fornece subs?dios para o desenvolvimento de estudos futuros para investiga??o de uma nova modalidade de TMR, denominada TCR, com produ??o de conhecimento na ?rea de biotecnologia. Adicionalmente, contribui para tomada de decis?o cl?nica, pol?tica e financeira sobre a inclus?o ou n?o do TMI como modalidade terap?utica para sujeitos com DPOC. / Respiratory muscles are one of the essential cornerstone of ventilation. Alterations in its structure and morphology in subjects with Chronic Obstructive Pulmonary Disease (COPD) could influence symptoms and signs such as dyspnea, ineffective coughing, exercise intolerance and respiratory failure. Respiratory Muscular Training (RMT), especially inspiratory muscles training, as a threshold modality, has been used for more than 30 years as adjuvant therapy in healthy individuals and patients with COPD. A wide variety of RMT devices are available commercially, but they are imported, have a high cost and their characteristics are intended for the individual training of muscle groups or have inadequate loads adjustments for COPD patients. Although several systematic reviews have been carried out since 1992 on the effects of IMT in subjects with COPD and some evidence has been proposed, some considerations should be made about these revisions.The methodological failures in the search strategy for previous reviews and the low methodological quality of the included studies contributed to the establishment of weak evidence on the benefits of the IMT. Aim: to develop a Respiratory Cycle Training (RCT) device, integrated for inspiratory and expiratory muscles, to verify the acute effects of different combinations of inspiratory and/or expiratory loads in the respiratory muscle activity, kinematics of the chest wall and dynamics of pulmonary volumes in healthy subjects with a device similar to that developed, as well as to analyze the evidence of the effects of IMT on dyspnea and exercise capacity in subjects with COPD. Methodology: involved three research modalities: i) the technological development of the RCT device, ii) cross-sectional study, and iii) systematic review associated with the meta-analysis. Results: i) creation of a technological innovation product applied to health, called "Respiratory Cycle Training equipment (RCT) with threshold load", with patent filing at INPI (BR 1020160253047); ii) through a cross-sectional study, commercially available equipment for inspiratory and / or expiratory muscle training is not capable of adequately triggering an increase in the electrical activity of respiratory muscles, although it causes changes in the current volumes of the chest wall and its compartments; and (iii) a scientific paper entitled "Inspiratory muscle training for Chronic Obstructive Pulmonary Disease", showing that although IMT combined with standardized care alone versus standardized care alone provides improved quality of life and that IMT combined with Pulmonary Rehabilitation versus Pulmonary Rehabilitation induces reduction in dyspnea in individuals with COPD, but there is not conclusive evidence to support or refute IMT in patients with COPD. Conclusion: The present study substantiates the need to construct a new RMT equipment for inspiratory and expiratory muscles, as well as provides subsidies for the development of future studies to investigate a new type of RMT, called TCR, with knowledge production in the area of biotechnology. In addition, it contributes to clinical, political and financial decision making regarding the inclusion or not of IMT as a therapeutic modality for subjects with COPD. / 2018-03-02