D.Phil. / Asthma exemplifies a major medical concern and is a considerable cause of morbidity and mortality globally and in South Africa. Biokineticists have in the past primarily prescribed aerobic modes of exercise to asthmatics regardless of other modes of exercise that could be used in the management of asthma, each with their own unique benefits. The aim of this investigation was to develop a management model from a biokinetic perspective for the management of asthma in moderate, persistent asthmatics. The present study utilised a quantitative, comparative, research trial making use of a pre-test, eight-week intervention period and a post-test. Eighty-eight sedentary moderate, persistent asthmatics were matched by age and gender and randomly assigned to either a non-exercising control group (NE) (n = 22), an aerobic exercise group (AE) (n = 22), a diaphragmatic inspiratory resistive breathing group (DR) (n = 22) or an aerobic exercise combined with diaphragmatic resistive breathing group (CE) (n = 22). Dependent t-Tests and rank-ordered analyses revealed that five of the 13 pulmonary function parameters assessed were found to be significantly altered following the AE and CE training, with the CE training having a larger impact than AE training. The DR training resulted in improvements in four of the 13 pulmonary function parameters. The CE and AE training were also found to be equally effective at altering physical work capacity, while the DR training proved ineffective at altering physical work capacity. The CE training proved to be the most effective at improving the abdominal and chest wall excursion parameters. The DR training was found to be the least effective mode of exercise training to impact favourably on abdominal and chest wall excursion parameters. The DR and CE training had a similar significant and favourable change in respiratory muscle flexibility followed by the AE training only impacting on nine of the 11 respiratory muscle flexibility parameters. Regarding the respiratory muscle strength, despite AE and CE training altering 18 of the 20 parameters, CE training was found to be more effective. DR training only altered 16 of the 20 respiratory muscle strength parameters. The DR training was the only modality to alter a postural parameter, albeit unfavourably. Even though the DR and AE training significantly altered four of the six anthropometric parameters, the AE training proved to be superior, while CE training proved least effective as it altered v only three of the measured anthropometric parameters. The overall success of the CE training exemplified the fact that an optimal training regime for the management of asthma may require both an aerobic exercise and diaphragmatic inspiratory resistive breathing component. Exercise training, and specifically CE training is a cost-effective, home-based asthma management programme that may reduce the public health burden of this disease and provide the patient with alternative treatment options. CE training should form the cornerstone in the management of asthma to minimise and prevent asthma exacerbations and thus improve health-related quality of life and may even prove to be life-saving.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2017-07-17T16:55:24Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Comparação entre Corrida em Esteira e Hiperventilação Isocápnica no Diagnóstico do Broncoespasmo Induzido por Exercício e~1.pdf: 3080338 bytes, checksum: f032c38bc2ef2e09e4f9c47bf7556fd5 (MD5) / Made available in DSpace on 2017-07-17T16:55:24Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Comparação entre Corrida em Esteira e Hiperventilação Isocápnica no Diagnóstico do Broncoespasmo Induzido por Exercício e~1.pdf: 3080338 bytes, checksum: f032c38bc2ef2e09e4f9c47bf7556fd5 (MD5) Previous issue date: 2014-08-27 / CNPQ / O broncoespasmo induzido por exercício (BIE) é definido como o estreitamento agudo dos brônquios após exercícios físicos vigorosos. É um evento comum em pacientes asmáticos e ocorre em 50% a 90% deles, especialmente em crianças e adolescentes. As queixas respiratórias durante ou após atividades físicas (AF) também são muito comuns nestes indivíduos, mas nem sempre estão associados ao BIE, sendo necessária a comprovação através de testes objetivos. A corrida em esteira (CE) é o método de desencadeamento mais utilizado. Entretanto, a hiperventilação isocápnica (HIso) é sugerida como alternativa ao exercício, embora a utilidade dela na clínica diária para o diagnóstico de BIE em crianças e adolescentes ainda não esteja bem estabelecida. Assim, o objetivo principal deste estudo foi comparar as duas técnicas de broncoprovocação no diagnóstico do BIE em crianças e adolescentes asmáticos. Métodos: Trata-se de um estudo analítico, inferencial, transversal, de comparação de métodos diagnósticos realizado com crianças e adolescentes, entre 08 e 18 anos de idade, com asma intermitente e persistente. Inicialmente, o volume expiratório forçado no primeiro segundo (VEF1) basal dos pacientes foi determinado. Em seguida, as crianças e os adolescentes foram submetidos à CE ou à HIso em dias consecutivos e no mesmo horário, com a definição da ordem do primeiro exame realizada aleatoriamente. A CE foi realizada durante 8 minutos, sendo que nos últimos 6 minutos a velocidade foi o suficiente para manter a frequência cardíaca entre 80% e 90% da FC prevista. Na HIso, os pacientes foram estimulados a hiperventilar de modo a alcançar uma ventilação minuto 21 vezes o VEF1 basal. Novas medidas de VEF1 foram realizadas 3, 5, 7, 10, 15 e 30 minutos após as provocações. O diagnóstico do BIE foi definido como a redução do VEF1 ≥ 10% do basal em, pelo menos, dois momentos consecutivos de avaliação. Resultados: Em nosso estudo participaram 34 crianças e adolescentes com média de idade de 11,9 anos, sendo excluídos 5 deles. Dezenove indivíduos apresentaram BIE após CE (E+) e 17 após HIso (HIso+); em 6 houve redução no VEF1 apenas após o exercício e em 4 apenas após a HIso. Responderam a ambos os estímulos 13 asmáticos (κ = 0,41, p <0.05). Com relação a intensidade da redução do VEF1, não houve diferenças significativas entre as duas técnicas dentro de um mesmo intervalo de tempo. Na análise da taxa de ventilação/minuto, a média calculada durante a CE foi maior do que a medida na HIso (44,0 L.min-1 versus 36.9 L/min-1, p<0,001), mas não entre os pacientes HIso+ e HIso- (35,2L.min-1 Versus 38,6L.min-1, p=0,09). Conclusão: A hiperventilação isocápnica pode ser utilizada como alternativa ao exercício em esteira, entretanto mais estudos necessitam ser realizados, sobretudo para avaliar a repetibilidade da técnica de HIso e comparar com a da corrida em esteira. Crianças e adolescentes com asma e queixas de dispneia aos exercícios com teste negativo devem ser submetidos a um segundo teste. / Exercise induced bronchoconstriction (EIB) is defined as the acute and transient increase in lower airway resistance that follows vigorous exercise. It is a common event in asthmatics with estimated prevalence between 50% and 90%, especially in the young. Respiratory symptoms are frequent complaints during or after physical activities (PA) in these individuals but, as they are highly variable and nonspecific, objective methods for EIB diagnosis are required, usually by serial one second Forced Expiratory Volume (FEV1) after exercise challenge (EC). Treadmill running (TR) is the most adopted EC method. Eucapnic Voluntary Hyperventilation (EVH) is a widely recommended surrogate to TR for EIB diagnosis, especially in athletes, although its clinical utility in young asthmatic is not established. Our objective was to compare both challenge methods for EIB diagnosis in asthmatic children and adolescents. Methods: Were recruited children and adolescents diagnosed with asthma, aged between 8 and 18 years, with basal FEV1 > 60% of predicted, from the Allergy and Immunology Clinic of Hospital das Clínicas/UFPE (Recife, Brazil) between September and December 2013. After basal FEV1 determination patients were randomly assigned to TR or EVH, in consecutive days at the same time. Treadmill running was performed for 8 minutes with the last six minutes at a speed to keep heart rate at 80% of maximum or higher. At EVH patients were instructed and coached to reach 60% of calculated MVV (21 X FEV1) for six minutes. Serial FEV1 measurements were taken at 3, 5, 7, 10, 15 e 30 minutes after both challenges. EIB diagnosis was defined as a fall > 10% from basal FEV1 in at least two consecutive moments. Results: Were recruited 39 individuals, 5 were excluded (3 not willing to participate and 2 due to a FEV1 < 60% of predicted). Completed the evaluations 34 subjects (18 male, mean age 11.8 + 2.3 years). EIB was diagnosed after both challenges in 13, in 6 only after EC and in 4 only after EVH (κ = 0.412, p=0.016). Estimated minute ventilatio during the sixth minute of treadmill running was higher than that measured at EVH (44.0 L.min-1 versus 36.9 L/min-1 , p<0,001) but there was no difference between EVH positive and negative patients (35.2L.min-1 versus 38.6L.min-1, p=0,09). Conclusion: Our results show that EVH can be a surrogate for TR, but highlight the need for studies to compare the repetibility of the methods and appropriate minimum minute ventilation for EVH. Individuals with PA associated respiratory complaints but negative test should have a repeated challenge to exclude EIB.

The aim of the study was to determine and document evidence of the comparative effect of a 12- week whole body vibration training programme, exercise training programme and sedentary control group on the anthropometric profile, aerobic capacity, lung volumes and hence, the pulmonary capacity in people with asthma. The study used a descriptive, exploratory, quasi-experimental research approach employing randomised pairing to classify participants into either the whole body vibration therapy or exercise training group. Accidental and snowball sampling was used to identify and obtain a base of volunteers. A three-group pre-test/post-test design was employed to gain insight into statistical differences that might be apparent between the whole body vibration therapy group, the exercise group and the control group, and which could potentially be attributed to participation in the whole body vibration exercise programme. Randomised pairing for participant selection was selected because of the potential effects varying pulmonary variables might have had on the reliability of the study. A Physical Activity Selection Criteria Questionnaire was completed by participants to ascertain baseline physical activity readiness and as a means of determining selection criteria for their allocation to the whole body vibration training group, the experimental exercise group or the true control group. The pre-test/post-test assessment made use of a combination evaluation that incorporated an anthropometric profile assessment of height, weight, biceps, triceps, subscapular and suprailliac skinfolds, waist and hip circumference and posture, an aerobic capacity evaluation that incorporated aspects of both the YMCA and Astrand and Rhyming Physical Work Capacity (PWC) evaluation on a cycle ergometer and, lastly, a pulmonary variable assessment that made use of both the Datospir Peak-10 peak flow meter and the Spirovit SP-100AT spirometry unit integrated into the Cardiovit AT-6 model for all spirometry measurements. Participants were required to complete either the whole-body vibration or the exercise training programme a minimum of twice a week and a maximum of four times over the same period. The duration of the intervention programmes was approximately 30 minutes and consisted of three sections including a warm-up comprising flexibility exercises, whole body strength training exercises, and a cool-down which, in turn, consisted of massage exercises or replicated flexibility exercises. The main difference between the whole body vibration and exercise training group thus lay in the exclusion of the use of vibration for those participants assigned to the exercise training programme. Analysis of data was performed using descriptive and inferential statistics with the help of a qualified statistician. The identified variables were tested at a 95 percent level of probability (p<0.05) as recommended by Thomas and Nelson (1996:117). Descriptive data, in the form of a statistical mean, standard deviation, minimum, median and maximum values, obtained during this study were reported in the form of a t-score for selected anthropometric and pulmonary variables. The 12-week intervention programme, on analysis of the results, produced statistically insignificant improvements in the variables of anthropometric profile, aerobic capacity and lung volumes identified as determinants of, and factors influencing, the cardiorespiratory fitness level of participants with asthma and hence, the subsequent severity of this chronic condition. However, slight mean increases for the whole body vibration training group were evident for certain variables identified in this study. Based on the results, the inference could be made that whole body vibration therapy and exercise were both effective modes of training to improve the cardiorespiratory fitness level of people with asthma, but the results of the study did not show sufficient practical or statistical significance to verify the assumption that whole body vibration training was a method superior to conventional exercise training. Hence, the significance of whole body vibration training on the pulmonary variables of people with asthma could not be determined. The researcher recommends that future studies be undertaken to verify whether whole body vibration training incorporating larger participant groups could produce significant improvements in pulmonary variables in people with asthma.

Thesis (Ph. D.)--West Virginia University, 2007. / Title from document title page. Document formatted into pages; contains xiv, 155 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-07-15T14:51:13Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE- Marco Valois - Impressao - FINAL.pdf: 1047623 bytes, checksum: fb120dc598daa8bc175ff5ffc50ec873 (MD5) / Made available in DSpace on 2016-07-15T14:51:13Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE- Marco Valois - Impressao - FINAL.pdf: 1047623 bytes, checksum: fb120dc598daa8bc175ff5ffc50ec873 (MD5) Previous issue date: 2016-04-25 / A umidade relativa do ar é descrita como um importante fator associado à asma e ao broncoespasmo induzido por exercício (BIE). Esta tese teve como objetivo avaliar a prevalência, a gravidade e os fatores associados à asma, assim como a ocorrência do broncoespasmo induzido por exercício em uma região de clima quente e seco. Os fatores associados à asma avaliados foram sexo, renda familiar, escolaridade da mãe, fumante na residência, antecedente de asma nos genitores, rinite, dermatite atópica e nível de atividade física. A classificação das doenças alérgicas, assim como sua gravidade foi realizada por meio do questionário International Study of Asthma and Allergies in Childhood (ISAAC). O BIE foi definido por uma redução no volume expiratório forçado no primeiro segundo (VEF1) maior do que 10% e o limite da redução no VEF1 com 95% de confiança (média percentual das quedas no VEF1 - 2 vezes desvio padrão) serviu para avaliar uma resposta normal nos assintomáticos. No que se refere à asma, as razões de prevalência bruta e ajustada foram calculadas para cada variável exploratória utilizando-se a regressão de Poisson. Participaram da pesquisa 1.591 adolescentes, sendo 49,7% do sexo masculino. As prevalências para asma em atividade, asma grave e diagnóstico médico de asma foram de 14,0%, 10,4% e 17,8%, respectivamente. Adolescentes asmáticos faltaram mais as aulas do que seus pares (33 vs 22 aulas/ano; p<0.03). Fatores associados que permaneceram significantes após ajuste foram antecedentes de asma nos genitores (RP = 2,65, p<0,001) e diagnóstico pessoal de rinite (RP = 1,96, p<0,001) e/ou dermatite atópica (RP = 2,18, p<0,001). Dos 1.591 estudantes, 1139 foram classificados como assintomáticos respiratórios, 223 como asmáticos e 229 como riníticos. O teste de broncoprovocação foi realizado em 114 indivíduos (36,8% homens) dos quais 54 eram assintomáticos respiratórios, 30 com asma sem sintomas respiratórias e 30 com rinite sem asma. Os asmáticos tiveram mais BIE em comparação aos riníticos sem asma e aos assintomáticos (46,7% vs 13,3% e 7,4%, p = 0,001). A resposta normal nos assintomáticos não ultrapassou um VEF1 > 8%. Neste ambiente de baixa umidade foram observadas menor prevalência, mas maior gravidade da asma que aquelas relatadas em outras cidades brasileiras. O clima seco talvez possa dificultar o controle adequado da doença e isso pode ter contribuído para o maior absenteísmo escolar observado. A associação com a rinite e a dermatite atópica, bem como com antecedentes de asma nos genitores sugerem que a atopia é importante fator de risco para a asma nesta população. O BIE teve como esperado uma maior prevalência nos asmáticos e a maior queda no VEF1 observada nos assintomáticos estava dentro dos valores recomendados na literatura mundial. / The air relative humidity has been described as an important associated factor both asthma and for exercise-induced bronchoconstriction (EIB). This thesis aimed to assess the prevalence, severity and associated factors with asthma, as well as the occurrence of exercise-induced bronchospasm in a hot and dry climate region. The factors associated with asthma evaluated were gender, family income, mother's education, people smoking in dwelling-place, parental history of asthma, personal history of allergic rhinitis or atopic dermatitis and physical activity level. The classification of allergic diseases, as well as its severity was conducted by questionnaire International Study of Asthma and Allergies in Childhood (ISAAC). The EIB was defined by a decrease in forced expiratory volume in one second (FEV1) greater than 10% and the limit of the reduction in FEV1 with 95% confidence (mean value falls in FEV1 - 2 standard deviation) was used to evaluate a normal response in asymptomatic. The reasons of crude and adjusted prevalence ratios were calculated for each exploratory variable using Poisson regression. Participated in the study 1,591 adolescents, 49.7% were male. The prevalence of asthma in activity, severe asthma and physician-diagnosed asthma were 14.0%, 10.4% and 17.8%, respectively. Adolescents with asthma had more school absence than their peers (33 vs 22 class/year; p <0.03). Associated factors that remained significant after adjustment were a parental history of asthma (PR = 2.65, p <0.001) and personal history of rhinitis (PR = 1.96, p <0.001) and / or atopic dermatitis (PR = 2,18, p <0.001). Of the 1,591 students, 1139 were classified as asymptomatic respiratory, 223 in asthma and 229 in rhinitis. The bronchial provocation test was performed in 114 subjects (36.8% men) from which 54 were asymptomatic respiratory, 30 with asthma without respiratory diseases and 30 with rhinitis without asthma. Asthmatics had more BIE as compared with rhinitis without asthma and asymptomatic (46.7% vs 13.3% and 7.4%, p = 0.001). The normal response in asymptomatic did not exceed an FEV1> 8%. In this low-humidity environment were observed lower prevalence, but more severe asthma than those reported in other Brazilian cities. The dry climate may perhaps hamper the adequate control of the disease and that could have contributed to the higher school absenteeism observed. The association with rhinitis and atopic dermatitis, as well as a parental history of asthma suggest that atopy is an important risk factor for asthma in this population. The EIB prevalence was as expected, higher in asthmatics and the biggest drop in FEV1 observed in asymptomatic patients was within the recommended in the world literature

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-02-13T16:12:48Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Avaliação da Repetibilidade do Teste de Broncoprovocação com hiperventilação eucápnica em Crianças e Adolescentes asmáticos.pdf: 1655734 bytes, checksum: 6cb6ad69a95791cc9cc4facd609b4dcd (MD5) / Made available in DSpace on 2017-02-13T16:12:48Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Avaliação da Repetibilidade do Teste de Broncoprovocação com hiperventilação eucápnica em Crianças e Adolescentes asmáticos.pdf: 1655734 bytes, checksum: 6cb6ad69a95791cc9cc4facd609b4dcd (MD5) Previous issue date: 2015-08-27 / O broncoespasmo induzido por exercício (BIE) ocorre entre 40 a 90% das crianças e adolescentes asmáticos. É definido como o estreitamento agudo dos brônquios após exercícios físicos vigorosos e sua presença é um marcador de controle inadequado da doença. Queixas respiratórias durante ou após atividades físicas são comuns nestes indivíduos, mas nem sempre estão associados ao BIE, sendo necessária a comprovação através de testes objetivos, podendo ser realizada por testes de exercício ou testes alternativos como a hiperventilação eucápnica voluntária (HEV). A HEV vem sendo descrita em vários estudos como substituta ao teste de exercício, embora a sua utilidade clínica diária para o diagnóstico de BIE em crianças e adolescentes ainda não esteja bem estabelecida. Testes diagnósticos estão sujeitos a variações mesmo quando são realizados de forma repetida, nos mesmos indivíduos, sob as mesmas condições e com os mesmos instrumentos. O desconhecimento destas variações ou sua não consideração pode interferir na confiabilidade do diagnóstico e das avaliações evolutivas. A avaliação de repetibilidade da resposta das vias aéreas ao teste de HEV sob condições padronizadas não foi reportada na população pediátrica de asmáticos. Assim o objetivo principal deste estudo foi avaliar a repetibilidade da resposta ao teste e concordância dos resultados realizando-se dois testes de HEV com intervalo de até 96 horas, empregando a mesma intensidade, duração do exercício e condições de ar. A HEV foi realizada em 30 crianças e adolescentes com asma, em dois momentos, atendidos no ambulatório de alergia do hospital das Clínicas (Recife, Brasil), seguidos de provas seriadas de função pulmonar (espirometria) aos 3,5,7,10,15 e 30 minutos para determinação da queda VEF1. Foi medida concordância entre os resultados obtidos e estabelecido o limite de confiança a 95% da diferença na variação do VEF1 como percentual do basal entre os dois dias de testes, com nível de significância de 5%. Resultados: Dos 30 indivíduos testados, 21 (70%) apresentaram redução de VEF1 > 10% em um dos dois dias de exame,5 apenas no 1º dia (17%), 6 (20%) no 2o dia e 10 em ambos os dias. Em 9 (30%) o teste foi negativo em ambos os dias. Os resultados foram concordantes em 19(63%). A média das diferenças e os limites de concordância foi 0,3% e -16,8% e 17,4%). Concluímos que houve concordância dos resultados em 63 % dos pacientes, entretanto, a presença de um segundo teste positivo em 20% dos casos estudados, demonstra a necessidade de realização de um segundo teste antes que um diagnóstico de BIE seja excluído ou tratamento profilático seja prescrito. / The exercise-induced bronchospasm (EIB) occurs in 40-90% of children and adolescents with asthma. It is defined as the sharp narrowing of the bronchi after vigorous exercise and its presence is inadequate control of the disease marker. Respiratory complaints during or after physical activity are common in these individuals, but are not always associated with the EIB, the confirmation is necessary by objective tests, this can be accomplished by alternative exercise tests, or tests as eucapnic voluntary hyperventilation (EVH). The EVH has been described in several studies as a substitute for exercise testing, although its daily clinical utility for the diagnosis of EIB in children and adolescents is not well established. Tests diagnoses are subject to changes even when they are performed repeatedly, in the same individuals, under the same conditions and with the same instruments. Ignorance of these variations or your account may interfere with the reliability of diagnostic and developmental assessments. The response repeatability airway evaluation to EHV test under standardized conditions has not been reported in children of asthmatic. So the aim of this study was to evaluate the repeatability of the response to the test results and agreement of carrying out two HEV tests with an interval of 96 hours, using the same intensity, exercise duration and conditions of the air. The EHV was performed in 30 children and adolescents with asthma treated at the Allergy Clinic Hospital (Recife, Brazil), followed by serial pulmonary function tests to 3,5,7,10,15 and 30 minutes to determine the FEV1 decline. It was measured agreement between the results obtained and established the confidence limit of 95% of the difference in change in expiratory forced volum(EFV1) as a percentage of baseline between the two days of testing, with 5% significance level. Results: Of the 30 individuals tested, 21 (70%) had a reduction in FEV1> 10% in one of two days of examination on day 1 only 5 (17%) 6 (20%) at Day 2 and 10 in both days. In 9 (30%) the test was negative on both days. The results were in agreement in 19 cases (63%). The average of the differences and the limits of agreement was 0.3% and -16,8% e 17,4% . It was concluded that there was agreement on the results in 63% of patients, the presence of a second positive test on 20% of the cases studied, it demonstrates the need to conduct a second test before a diagnosis of EIB is excluded or prophylactic treatment is prescribed.