Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. COPD is a slowly progressive, inflammatory disease in the airways and lungs, caused mainly by smoking. The inflammation leads to a narrowing of the small airways (airway obstruction) and a destruction of tissue in the lungs. This gives a decreased expiratory airflow which leads to dyspnea, the primary symptom of the disease. The chronic airflow limitation also is associated with the development of limb muscle dysfunction. Decreases in both limb muscle strength and endurance have been shown which, in turn, is associated with exercise intolerance, one of the key disabling factors of the disease. Pulmonary rehabilitation including exercise training is the cornerstone of treatment and is strongly recommended. However, it is still unclear how to optimize exercise training for this group of patients. Also how to address the increase in dyspnea which limits the exercise stimulus, and how to assess muscular strength, need further study. Partitioning the exercising muscle mass, known as single limb exercises, is a novel exercise strategy aimed at reducing the negative consequences of chronic airflow limitation in patients with COPD. The aim of this thesis was to study the current evidence of single limb approaches in patients with COPD, to examine the feasibility and effects of a high-repetitive single limb exercise (HRSLE) regimen in patients with COPD and to examine whether elastic resistance could be used to evaluate muscular strength. This thesis is based on five papers. In order to study the evidence on single limb exercises, a systematic review of randomized controlled trials was performed. The review showed that single limb exercises, performed as one-legged cycling appeared to be more effective than two-legged cycling with regard to exercise capacity but not dyspnea, and might be included in exercise programs for patients with COPD (Paper I). Thirty healthy older women and men participated in a validation study comparing elastic resistance maximal strength with isokinetic dynamometry measurements. Excellent levels of agreement and no differences between the two pieces of equipment were found which indicates that elastic resistance could be used to evaluate muscular strength (Paper II). A study protocol was created for a randomized controlled trial designed to identify the effects of HRSLE in combination with COPD-specific patient training (experimental group) in comparison to patient information alone (control group) (Paper III). HRSLE was performed as resistance training, using a single limb at a time, elastic bands as resistance and a high number of repetitions (25 repetitions in 2 sets) with the aim of increasing limb muscle endurance. After eight weeks of exercise, the differences between the groups were in favor of the experimental group on lower- and upper-extremity functional capacity, upper-extremity endurance capacity and muscular function. No differences were seen between the groups on endurance-cycle capacity or health-related quality of life (Paper IV). In patients with COPD, the HRSLE regimen was considered feasible with a high attendance rate, excellent compliance and high relative exercise intensity. No severe adverse events occurred. The physiotherapists conducting the HRSLE in the clinical setting also found it to be feasible (Paper V). This thesis shows that single limb exercises performed as one-legged cycling may be useful and effective for patients with COPD. Eight weeks of HRSLE was feasible and effective with regard to exercise capacity but without effect with regard to health-related quality of life. Elastic resistance could be used as exercise equipment to improve limb muscle function in patients with COPD and to evaluate muscular strength in healthy older adults. / Kroniskt obstruktiv lungsjukdom (KOL) är idag ett stort globalt problem.  KOL är en långsamt fortskridande inflammatorisk sjukdom i luftvägar och lungor, i huvudsak orsakad av cigarrettrökning. Inflammationen leder till en förträngning i de små luftvägarna och förstör vävnaden i lungorna. Detta medför en luftvägsobstruktion där flödet av luft vid utandning är minskat, vilket bidrar till varierande grad av andnöd hos patienten. Luftvägsobstruktionen är relaterad till försämrad muskelfunktion hos patientgruppen. Både nedsatt muskulär styrka och uthållighet har påvisats vilket är relaterat till ett av huvudproblemen vid KOL; nedsatt förmåga till fysisk aktivitet och träning.  Lungrehabilitering inklusive fysisk träning är centralt i behandlingen och starkt rekommenderat. Det är dock inte fastställt hur patientgruppen skall träna för att optimera effekterna av träningen eller hur träningen bäst kan utvärderas. Det är också oklart hur man skall hantera den successivt ökande andfåddheten vid träning. Träning med en arm eller ett ben i taget, så kallad lokal muskelträning är en strategi som syftar till att minska andnöd under träning hos patienter med KOL Syftet med denna avhandling var att undersöka vilken evidens det finns för lokal muskelträning hos patienter med KOL, utvärdera genomförbarhet och effekter av lokal högrepetitiv muskelträning utfört med elastiska träningsband hos patienter med KOL samt att undersöka ifall elastiska träningsband kan användas för att utvärdera muskelstyrka. Avhandlingen består av fem delstudier. För att undersöka evidens för lokal muskelträning genomfördes en systematisk litteraturgranskning av randomiserade kontrollerade studier. Granskningen visade att lokal muskelträning, i form av cykling med ett ben i taget kan vara effektivt, avseende fysisk förmåga, men utan effekt avseende andfåddhet för patienter med KOL (delstudie 1). Trettio friska kvinnor och män, deltog i en valideringsstudie där jämförelser gjordes mellan maximal kraftutveckling utfört med elastiska träningsband och en isokinetisk dynamometer. Ett högt samband mellan de två metoderna och ingen skillnad i maximal kraft, indikerade att elastiska band kan användas för att utvärdera muskelstyrka (delstudie 2). Ett studieprotokoll skapades för en randomiserad kontrollerad studie, som syftade till att undersöka effekterna av lokal högrepetitiv muskelträning i kombination med KOL-specifik patientutbildning (interventionsgrupp) jämfört med enbart KOL-specifik patientutbildning (kontrollgrupp) (delstudie 3). Lokal högrepetitiv muskelträning utfördes i grupp med elastiska träningsband som redskap. Övningarna genomfördes med en arm eller ett ben i taget med 25 repetitioner i 2 set med syfte att påverka muskulaturens uthållighet. Efter åtta veckors träning hade interventionsgruppen bättre muskelfunktion i både övre och nedre extremitet samt en bättre funktionell förmåga jämfört med kontrollgruppen. Inga skillnader i effekt sågs mellan grupperna avseende uthållighet vid test på ergometercykel eller avseende hälsorelaterade utfallsmått, såsom livskvalitet och tilltro till sin egen förmåga (delstudie 4). För patienter med KOL, visade sig lokal högrepetitiv muskelträning vara en genomförbar metod avseende följsamhet och närvaro i träningen. De fysioterapeuter som ledde träningen i klinisk verksamhet ansåg att den var möjlig att genomföra med hög relativ intensitet och utan allvarliga biverkningar (delstudie 5). Sammanfattningsvis visar denna avhandling att lokal muskelträning kan vara en användbar och effektiv metod för patienter med KOL. Åtta veckor med lokal högrepetitiv muskelträning är genomförbart och effektivt avseende fysisk förmåga hos dessa patienter. Elastiska träningsband kan användas som träningsredskap för att förbättra muskelfunktion hos patienter med KOL samt för att utvärdera muskelstyrka hos friska vuxna.

Na Folha de Rosto da obra, consta o t?tulo: "Efeitos do treinamento de vibra??o de corpo inteiro na funcionalidade, for?a muscular, qualidade de vida e concentra??es plasm?ticas de marcadores inflamat?rios-oxidativos de pacientes com doen?a pulmonar obstrutiva cr?nica". / Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-09-26T17:48:49Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) camila_danielle_cunha_neves.pdf: 2344806 bytes, checksum: 77c976c7c337e030f1b4c85cc1aa033e (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-10-01T18:27:36Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) camila_danielle_cunha_neves.pdf: 2344806 bytes, checksum: 77c976c7c337e030f1b4c85cc1aa033e (MD5) / Made available in DSpace on 2018-10-01T18:27:36Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) camila_danielle_cunha_neves.pdf: 2344806 bytes, checksum: 77c976c7c337e030f1b4c85cc1aa033e (MD5) Previous issue date: 2018 / O treinamento de vibra??o de corpo inteiro (VCI) tem sido identificado com uma interven??o alternativa para a melhora da capacidade de exerc?cio e qualidade de vida de pacientes com Doen?a Pulmonar Obstrutiva Cr?nica (DPOC). Entretanto, o efeito do treinamento de VCI nas concentra??es de biomarcadores inflamat?rios-oxidativos permanece desconhecido. O objetivo deste trabalho foi avaliar os efeitos do treinamento de VCI em par?metros inflamat?rios-oxidativos, na funcionalidade e na qualidade de vida de pacientes com DPOC. Vinte pacientes com DPOC foram igualmente divididos em: 1) grupo interven??o (GI), que realizou o treinamento de VCI; e, 2) grupo controle (GC) que n?o recebeu a interven??o. A interven??o consistiu da realiza??o de agachamento est?tico sobre uma plataforma vibrat?ria, em seis s?ries de 30 segundos, tr?s vezes semanais, durante 12 semanas. Os pacientes foram avaliados quanto ? (as): concentra??es plasm?ticas de IL-6, IL-8, IFN-? e receptores sol?veis de TNF-?; contagem de leuc?citos; concentra??es plasm?ticas de marcadores oxidantes e antioxidantes; dist?ncia caminhada no teste de caminhada de seis minutos (TC6?); consumo pico de oxig?nio (VO2 pico) durante o TC6?; for?a de preens?o manual; qualidade de vida (question?rio Saint George?s); teste de sentar e levantar da cadeira 5 vezes e teste timed get-up and go (TUG). Os dados foram analisados pelo teste-t independente (linha de base) e Anova two-way para medidas repetidas (efeitos do treinamento). Considerou-se significativo p< 0,05. Ap?s o treinamento de VCI, pacientes do GI aumentaram significativamente a dist?ncia caminhada (65 m) no TC6?, o VO2 pico e a for?a de preens?o manual (p< 0,05). Al?m disso, pacientes do GI alcan?aram a diferen?a m?nima clinicamente importante em rela??o ? qualidade de vida. N?o foram observadas diferen?as significativas no teste de sentar e levantar da cadeira, TUG, nas concentra??es dos biomarcadores inflamat?rios-oxidativos e na contagem de leuc?citos no GI (p> 0,05). Pacientes do GC n?o apresentaram melhora estatisticamente significante para todas as avalia??es (p> 0,05). Em conjunto, os resultados deste estudo demonstraram que o treinamento de VCI induziu benef?cios clinicamente significantes com rela??o ? capacidade de exerc?cio, a for?a muscular e a qualidade de vida de pacientes com DPOC, que n?o foram relacionados com mudan?as nas concentra??es sist?micas dos biomarcadores inflamat?rios-oxidativos analisados. / Tese (Doutorado) ? Programa Multic?ntrico de P?s-Gradua??o em Ci?ncias Fisiol?gicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2018. / The whole-body vibration training (WBVT) has been identified as an alternative intervention to improve exercise capacity and quality of life of patients with Chronic Obstructive Pulmonary Disease (COPD). However, the effect of WBVT on inflammatory-oxidative biomarkers remains unknown. The aim of this trial was to investigate the effects of WBVT on inflammatory-oxidative, functionality and quality of life parameters in patients with COPD. Twenty patients were equally divided into: 1) intervention group (IG) that performed the WBVT, and 2) control group (CG) that did not receive any intervention. Intervention consisted in performing static squatting on vibrating platform, in six series of 30 seconds, 3 day per week, for 12 weeks. Patients were evaluated for: plasma levels of IL-6, IL-8, IFN-?, soluble receptors of TNF-?; white cells count; plasma levels of oxidant and antioxidant markers; walking distance in six-minute walk test (6MWT); peak oxygen uptake (VO2 peak) during the 6MWT; handgrip strength; quality of life (Saint George?s); timed 5-chair sit-to-stand (5STS) and timed get-up and go test (TUG). The data were analyzed by unpaired t-test (baseline) and Anova two-way (effects of training). The level of significance was p< 0.05. After WBVT, patients from IG showed significant increase in the 6MWD, VO2 peak and handgrip strength (p< 0.05). Furthermore, patients from IG reached minimal clinically important difference regarding quality of life. No significant differences were found in 5STS, TUG, inflammatory-oxidative biomarkers and white cells count in the IG. CG did not show significant improvement in all assessments (p> 0.05). Taking together, our results demonstrated that the WBVT induced clinically significant benefits regarding exercise capacity, muscle strength and quality of life in patients with COPD, that were not related to systemic changes in the inflammatory-oxidative biomarkers analyzed.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-06-19T12:43:50Z No. of bitstreams: 1 felipemartinsdovalle.pdf: 1212367 bytes, checksum: 1eb080fe9bb9c5ae3bdedfa118be339b (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-06-29T12:23:35Z (GMT) No. of bitstreams: 1 felipemartinsdovalle.pdf: 1212367 bytes, checksum: 1eb080fe9bb9c5ae3bdedfa118be339b (MD5) / Made available in DSpace on 2017-06-29T12:23:35Z (GMT). No. of bitstreams: 1 felipemartinsdovalle.pdf: 1212367 bytes, checksum: 1eb080fe9bb9c5ae3bdedfa118be339b (MD5) Previous issue date: 2017-02-22 / Introdução: O sedentarismo é altamente prevalente e aumenta a taxa de mortalidade por todas as causa em pacientes com doença renal crônica (DRC) em hemodiálise (HD). Em contraste, um estilo de vida mais ativo está associado a ganhos para esses pacientes. Assim, investigamos os efeitos do treinamento resistido intradialítico e supervisionado no nível de atividade física diária (NAFD), na capacidade funcional (CF), na qualidade de vida (QV) e na força muscular (FM) de pacientes com DRC em HD. Métodos: Vinte e quatro pacientes com DRC (54,2 ± 13,5 anos) em HD (6,0 ± 5,7 anos) foram randomizados para treinamento resistido de moderada intensidade ou controle. O treinamento resistido foi realizado durante as duas primeiras horas das sessões de HD, três vezes por semana, durante três meses. O NAFD foi avaliado por um acelerômetro pelo tempo gasto em diferentes atividades da vida diária (caminhando, em pé, sentado e deitado) e o número de passos. O acelerômetro foi utilizado por sete dias consecutivos (três dias dialíticos e quatro dias de não dialíticos). A CF, a QV e a FM foram avaliadas pelo teste de caminhada de seis minutos (TC6M), questionário SF-36 e pelo teste de contração isométrica voluntária máxima (CIVM), respectivamente. Os valores foram representados em deltas (pós-tratamento menos pré-tratamento). Resultados: Após três meses de treinamento resistido, não foi encontrada diferença significativa no tempo de caminhada (-1,2 ± 18,3 vs. -9,2 ± 13,1 min/dia), no tempo em pé (-10,2 ± 28,6 vs. ± 20,1 min/dia), no tempo sentado (20,8 ± 58,9 vs. -30,0 ± 53,0 min/dia), no tempo deitado (-9,3 ± 57,9 vs. 34,6 ± 54,0 min/dia) e no número de passos [-147 (1834) vs. -454 (2066)] entre os grupos exercício e controle, respectivamente. A distância percorrida no TC6M aumentou significativamente no grupo de treinamento em relação ao grupo controle (48,8 ± 35,9 vs. 6,9 ± 45,9 m, p=0,04). Não foi encontrada diferença significativa na FM (3,4 ± 7,2 vs. 0,5 ± 7,3 Kgf) entre os grupos treinamento e controle, respectivamente. Três domínios do SF-36 apresentaram aumento significativo no grupo treinamento em relação ao controle, respectivamente [capacidade funcional = 13,7 ± 9,9 vs. -12,5 ± 16,7, p=0,003; limitação por aspectos físicos = 0,0 (0,0) vs. -50,0 (93,7), p=0,03; estado geral da saúde = 6,6 ± 14,1 vs. -10,4 ± 21,4, p=0,01). O treinamento resistido intradialítico foi realizado com segurança por todos os participantes. Conclusão: O presente estudo demonstrou que o NAFD não foi modificado após três meses de treinamento resistido intradialítico em pacientes com DRC submetidos à HD. No entanto, esse programa de exercícios foi capaz de aumentar a CF e alguns domínios da QV nesses pacientes. / Background: Physical inactivity is highly prevalent and increases all causes of mortality in end-stage renal disease (ESRD) patients on hemodialysis (HD). In contrast, a more active lifestyle is associated with better outcomes in these patients. We therefore investigated the effects of supervised intradialytic resistance training on physical activities in daily life, physical capacity, quality of life and muscle strength in ESRD patients. Methods: Twenty four ESRD patients (54.2 ± 13.5 years) under HD (6.0 ± 5.7 years) were randomly assigned to either 3-month moderate-intensity resistance training or a control period. Resistance training was performed during the first two hours of HD sessions, three times a week, for three months. Physical activities in daily life was evaluated using an accelerometer regarding the time spent in different activities and positions of daily life (walking, standing, sitting and lying down), and the number of steps taken. The accelerometer was used for seven consecutive days (three dialysis days and four nondialysis days). Physical capacity, quality of life and muscle strength were evaluated by six-minute walking test (6MWT), SF-36 questionnaire and maximum voluntary isometric contraction test, respectively. The values were expressed as delta (post-pre treatment). Results: After three months of training, we didn’t find significant difference in walking time (-1.2 ± 18.3 vs. -9.2 ± 13.1 min/day), standing time (-10.2 ± 28.6 vs. 3.2 ± 20.1 min/day), sitting time (20.8 ± 58.9 vs. -30.0 ± 53.0 min/day), lying down time (-9.3 ± 57.9 vs. 34.6 ± 54.0 min/day) and number of steps taken [-147 (1834) vs. -454 (2066)] in training and control groups, respectively. The 6MWT distance increased significantly in training group when compared with control group (48.8 ± 35.9 vs. 6.9 ± 45.9 m, p=0.04). No significant difference was found in muscle strength (3.4 ± 7.2 vs. 0.5 ± 7.3 Kgf) in training and control groups, respectively. Three domains of the SF-36 showed significant increase in training group when compared with control group, respectively (physical functioning = 13.7 ± 9.9 vs. -12.5 ± 16.7, p=0.003; role physical = 0.0 (0.0) vs. -50.0 (93.7), p=0.03; general health = 6.6 ± 14.1 vs. -10.4 ± 21.4, p=0.01). Intradialytic resistance training was safely performed by all participants. Conclusions: The present study showed that daily life activities were not modified after three months of intradialytic resistance training in HD patients. However, the exercise program was able to increase the physical capacity and some domains quality of life in these patients.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-07-05T18:16:40Z No. of bitstreams: 1 cristinamartinscoelho.pdf: 6138721 bytes, checksum: 837fedf307919a77d1cacc742d71aaf4 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-08T14:59:40Z (GMT) No. of bitstreams: 1 cristinamartinscoelho.pdf: 6138721 bytes, checksum: 837fedf307919a77d1cacc742d71aaf4 (MD5) / Made available in DSpace on 2017-08-08T14:59:40Z (GMT). No. of bitstreams: 1 cristinamartinscoelho.pdf: 6138721 bytes, checksum: 837fedf307919a77d1cacc742d71aaf4 (MD5) Previous issue date: 2017-06-07 / Introdução: A atividade física supervisionada tem demonstrado benefícios para adultos com asma. Entretanto, pouco se sabe sobre a efetividade de programas não supervisionados e sobre o nível de atividade física na vida diária (AFVD) nesta população. Objetivo: Investigar os efeitos de 12 semanas de um programa de atividade física não supervisionada baseado em pedômetros em adultos com asma moderada a grave e avaliar o nível de AFVD de mulheres asmáticas em relação a controles saudáveis. Métodos: Foram realizados dois estudos (Estudo 1 e Estudo 2). Os voluntários do Estudo 1 foram selecionados entre os pacientes acompanhados pelo Serviço de Pneumologia do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF). Foram incluídos adultos entre 18 e 65 anos, com asma moderada a grave, clinicamente estáveis e sedentários. Todos participaram de uma sessão individual de educação em asma e foram encorajados a realizar caminhadas diárias de 30 minutos. Em seguida, foram aleatorizados nos grupos Pedômetro (GP) e Controle. Os voluntários do GP receberam pedômetros e metas incrementais de passos a serem alcançadas diariamente. Os seguintes parâmetros foram avaliados no basal, após 12 semanas de intervenção e 24 a 28 semanas após a aleatorização: passos diários (média dos passos realizados durante seis dias consecutivos mensurados por um pedômetro), teste de caminhada de seis minutos (TC6M), qualidade de vida relacionada à saúde (questionário de qualidade de vida na asma - AQLQ), controle da doença (questionário de controle da asma - ACQ) e níveis de ansiedade e depressão (escala hospitalar de ansiedade e depressão - HADS). No Estudo 2, foram incluídas mulheres entre 18 e 65 anos, com asma moderada a grave, clinicamente estáveis, acompanhadas pelo Serviço de Pneumologia do HU/UFJF (grupo asma - GA) e mulheres saudáveis da mesma faixa etária (grupo controle - GC), atendidas pelo Serviço de Ginecologia do mesmo hospital. Todas realizaram o TC6M e foram avaliadas quanto a AFVD utilizando-se um pedômetro. Além disso, as voluntárias do GA foram avaliadas com relação à qualidade de vida relacionada à saúde (AQLQ), controle da asma (ACQ) e níveis de ansiedade e depressão (HADS) Resultados: No Estudo 1, dos 37 participantes incluídos, 30 completaram o protocolo. Após 12 semanas, houve diferença significativa entre os grupos com relação aos passos diários (diferença média ajustada, 2488 passos; intervalo de confiança [IC] 95%, 803 a 4172; p=0,005) e ao TC6M (diferença média ajustada, 21,9 m; IC 95%, 6,6 a 37,3; p=0,006). Essas diferenças não foram significativas 24 a 28 semanas após a aleatorização. No Estudo 2, foram incluídas 66 voluntárias (36 no GA). Não houve diferença entre GA e GC com relação à AFVD (7490,3 ± 3330,2 vs 6876,4 ± 3242,1 passos respectivamente, p=0,45). No GA, houve correlação significativa entre o domínio limitação às atividades do AQLQ e a AFVD (r=0,43; p<0,01). Conclusão: O programa proposto foi capaz de aumentar os passos diários de adultos com asma moderada a grave. Não foram observadas diferenças entre o nível de AFVD de mulheres com asma e o de mulheres aparentemente saudáveis. / Introduction: Supervised physical activity has shown benefits for asthmatic adults, but little is known about the effectiveness of unsupervised exercise programs on subjects with asthma and the daily life physical activity (DLPA) of this population. Objective: To investigate the effects of a 12-week unsupervised pedometer-based physical activity program on asthmatic adults and to assess the DLPA of asthmatic women in comparison to healthy peers. Methods: Two studies were performed (Study 1 and Study 2). In Study 1, volunteers were recruited from the patients seen at the Pneumology Outpatients Clinic of the University Hospital of the Universidade Federal de Juiz de Fora, Minas Gerais, Brazil (HU-UFJF). Sedentary, clinically stable, moderate to severe asthmatic adults, aged 18 to 65 years, were included. After an individual asthma educational session, all participants were encouraged to take daily 30minute walks. Afterwards, they were randomized to pedometer (PG) and control groups. PG received pedometers and individualized incremental daily step targets. Changes in daily steps (average of steps taken during six consecutive days), six-minute walking test (6MWT), health-related quality of life (asthma quality of life questionnaire - AQLQ), asthma control (asthma control questionnaire - ACQ) and anxiety and depression levels (hospital anxiety and depression scale - HADS) were assessed after 12 weeks of intervention and 24-28 weeks after randomization. In Study 2, clinically stable, moderate to severe asthmatic women, aged 18 to 65 years, seen at the Pneumology Outpatients Clinic of HU-UFJF (asthma group - AG), and apparently healthy volunteers seen at the Gynecology. Outpatients Clinic of the same hospital (control group - CG), were included. All subjects underwent DLPA assessment using a pedometer and performed the 6MWT. Additionally, participants in the AG were assessed regarding asthma control (ACQ), health-related quality of life (AQLQ) and anxiety and depression levels (HADS). Results: In Study 1, 37 participants were included and 30 completed the intervention. At 12 weeks, there were significant differences between groups regarding daily steps (adjusted average difference, 2488 steps; 95% confidence interval [CI], 803 to 4172; p = 0.005) and the 6MWT (adjusted average difference, 21.9 m; 95% CI, 6.6 to 37.3; p = 0.006). These differences were not significant 24-28 weeks after randomization. In Study 2, 66 volunteers were included (33 in AG). There was no difference between the AG and the CG regarding DLPA (7490.3 ± 3330.2 vs 6876.4 ± 3242.1 steps respectively, p = 0.45). DLPA was significantly correlated to the activity limitation domain of the AQLQ among asthmatics (r = 0.43, p < 0.01). Conclusion: The unsupervised pedometer-based physical activity program was effective in increasing daily steps of adults with moderate to severe asthma. There was no difference regarding DLPA between a sample of asthmatic women and apparently healthy controls.

Abstract Coronary artery disease (CAD) and type 2 diabetes (T2D) are associated with cardiovascular autonomic dysfunction, which is widely used as a predictor of mortality in cardiovascular diseases. The determinants of autonomic dysfunction in CAD patients with or without T2D are not well known. The aim of this thesis was to examine the determinants of cardiovascular autonomic function in healthy subjects and CAD patients with and without T2D. A second aim was to study the prognostic value of autonomic function in the patient population. A third aim was to study the effects of exercise prescriptions on physical activity and exercise capacity in the patient groups. The association between heart rate (HR) variability and physical activity was examined by means of 24-hour recordings in 45 healthy adults. The determinants and prognostic value of autonomic function, measured by HR recovery, HR variability, and HR turbulence, were assessed in 1060 CAD patients (50% were patients with T2D). Physical activity was measured before and after a six-month exercise prescription in 44 CAD patients without T2D and 39 CAD patients with T2D. In healthy patients, short-term HR variability indexes and the complexity properties of HR were influenced by physical activity, whereas long-term HR variability indexes remained relatively stable at various activity levels, making them robust indexes for assessment of autonomic function during ambulatory conditions. In CAD patients, exercise capacity was the most important determinant of autonomic function in addition to physical activity, age, presence of T2D, and left ventricular systolic function. During a 2-year follow-up, autonomic dysfunction predicted cardiovascular events only in CAD patients with T2D, but did not provide independent prognostic information after multivariate adjustment when high-sensitivity C-reactive protein, a marker of inflammation, remained as an independent predictor. CAD patients with T2D were physically less active than patients without T2D. Exercise prescription promoted a more active lifestyle and improved exercise capacity in both patient groups. In conclusion, cardiovascular autonomic dysfunction in CAD patients with and without T2D is closely related to low exercise capacity and physical activity, which both can be increased by exercise prescriptions. Autonomic dysfunction predicts short-term cardiovascular events only in CAD patients with T2D, but is not as strong an independent predictor as low-grade inflammation. / Tiivistelmä Autonomisen hermoston toiminnan häiriö on yleinen komplikaatio sepelvaltimotaudissa ja tyypin 2 diabeteksessa (T2D), ja sen tiedetään olevan itsenäinen kuolleisuutta ennustava tekijä. Autonomista säätelyä selittäviä tekijöitä ei kuitenkaan tunneta hyvin. Tässä tutkimuksessa selvitettiin autonomisen hermoston toimintaa selittäviä tekijöitä kolmessa ryhmässä: osa tutkittavista oli terveitä, osalla oli sepelvaltimotauti ja T2D, ja osalla pelkästään sepelvaltimotauti. Lisäksi tutkittiin, miten autonominen säätely vaikuttaa sepelvaltimotautipotilaiden ennusteeseen sekä miten liikuntaohjelma vaikuttaa heidän fyysiseen aktiivisuuteensa ja suorituskykyynsä. Sykevaihtelun ja fyysisen aktiivisuuden välistä yhteyttä selvittävään tutkimukseen osallistui 45 tervettä henkilöä. Autonomisen hermoston toimintaa selittäviä tekijöitä ja sen ennustearvoa tutkittiin 1060 sepelvaltimotautipotilaalta, joista puolet sairasti T2D:ta. Näistä potilaista valittiin satunnaisotannalla kuuden kuukauden liikuntaohjelmaan ja fyysisen aktiivisuuden mittauksiin 44 sepelvaltimotautipotilasta, joilla ei ollut T2D:ta, ja 39 potilasta, jotka sairastivat T2D:ta. Terveillä henkilöillä lyhyen aikavälin sykevaihtelumuuttujat olivat yhteydessä fyysiseen aktiivisuuteen, mutta pitkän aikavälin sykevaihtelumuuttujissa tätä yhteyttä ei havaittu. Sepelvaltimotautipotilailla vahvimmiksi autonomista säätelyä selittäviksi tekijöiksi osoittautuivat maksimaalinen suorituskyky, fyysinen aktiivisuus, ikä, T2D ja vasemman kammion ejektiofraktio. Poikkeava autonominen säätely ennusti sydän- ja verisuonitautitapahtumia kahden vuoden seurannan aikana vain T2D:ta sairastavilla sepelvaltimotautipotilailla, mutta sillä ei ollut itsenäistä ennustearvoa, kun vakioitiin muilla riskitekijöillä. Lopulta ainoa huonon ennusteen merkki oli tulehdustilaa kuvaava herkkä CRP. T2D:ta sairastavat sepelvaltimotautipotilaat olivat fyysisesti passiivisempia kuin pelkästään sepelvaltimotautia sairastavat. Yksilöllinen liikuntaohjelma lisäsi korkean intensiteetin fyysistä aktiivisuutta ja paransi suorituskykyä molemmissa potilasryhmissä. Tämän tutkimuksen tulokset osoittavat, että sepelvaltimotautipotilailla autonomisen hermoston toiminnan häiriö on yhteydessä vähäiseen fyysiseen aktiivisuuteen ja heikkoon fyysiseen kuntoon. Molempiin tekijöihin voidaan vaikuttaa positiivisesti liikuntaohjelmalla. Poikkeava autonominen säätely ennustaa lyhyen aikavälin sydän- ja verisuonitautitapahtumia vain T2D:ta sairastavilla sepelvaltimotautipotilailla. Se ei kuitenkaan ole yhtä vahva itsenäinen ennustaja kuin tulehdusta kuvaava herkkä CRP.

This diploma thesis takes interest in the issue of physical activities of children with cystic fibrosis, in possible impacts of such activities on clinical condition, in options of prescription of physical activities based on the actual clinical state of a person with cystic fibrosis, and in options of objectification of changes induced by an exercise programme. The theoretic part of this thesis summarizes the current findings about cystic fibrosis, therapy and physical activities in the context of prognosis of patients with cystic fibrosis. In experimental part, we performed examinations on few participants, who were willing to perform a home-based exercise programme. Also, we made a short exploratory questionnaire focused on the attitude of children with cystic fibrosis towards physical exercises. Methodology: We observed the evolution of maximal oxygen uptake VO2max, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and of the scores of 1- minute sit-to-stand test (1-MSTST). All the measurements were performed before and after 12- weeks long exercise intervention. The inclusion criteria were diagnosis of cystic fibrosis, age over 10 years, FEV1 over 60 % predicted and no present signs of an acute exacerbation. Participants were assessed by spirometry examination,...

Dans le monde, une naissance sur 10 est prématurée, se produisant avant 37 semaines de gestation, et environ 1% sont très prématurées (<30 semaines de gestation). La prématurité est associée à des altérations de la structure et fonction cardiovasculaire qui persistent à l’âge adulte et sont liées aux maladies cardiovasculaires. Il n’y a cependant pas de recommandations cliniques pour le suivi de la santé cardiovasculaire chez les jeunes adultes nés très prématurément. Cette thèse porte sur la prévention des maladies cardiovasculaires dans cette nouvelle population à risque. Ses objectifs principaux sont de décrire les effets à long terme de la prématurité sur la santé adulte et de présenter les avenues de prévention et d’intervention permettant de mitiger ces effets. Son premier chapitre présente une revue de la littérature pertinente alors que son second détaille les méthodes employées pour obtenir les résultats présentés dans les chapitres suivants. Brièvement, la cohorte HAPI (Health of Adults born Preterm Investigation) est constituée de jeunes adultes nés entre 1986 et 1996 au Québec soit prématurément (<30 semaines de gestation) ou à terme (>37 semaines de gestation). C’est la population étudiée dans les chapitres 3 à 5. Le chapitre 3 présente une diminution de la capacité aérobie à l’effort chez les sujets nés prématurément et explore les facteurs y contribuant, incluant des paramètres hémodynamiques cardiaques. Le chapitre 4 examine la perception de la santé et l’utilisation des services de santé dans cette cohorte et comment ceux-ci sont influencés ou non par les paramètres de santé objectifs identifiés précédemment dans le cadre de l’étude HAPI. Le chapitre 5 présente un plaidoyer en faveur d’un suivi médical à long terme des individus nés très prématurément dont les arguments proviennent de témoignages des participants de l’étude HAPI. Enfin, le chapitre 6 présente les résultats de l’étude HAPI Fit qui avait pour but d’évaluer les effets chez de jeunes adultes nés très prématurément d’une intervention de 14 semaines en activité physique principalement sur la capacité aérobie maximale et secondairement sur les paramètres de santé cardiovasculaire. L’ensemble de ces résultats permet de brosser un portrait des conséquences cardiovasculaires à long terme de la prématurité et des moyens disponibles pour les mitiger. La dissémination de ces résultats à la population ciblée et à ses soignants constitue la base sur laquelle pourront se bâtir de futurs programmes de prévention dans cette population à risque. / Worldwide, one in ten births is preterm, occurring before the 37th week of gestation, and approximately 1% are very preterm (<30 weeks of gestation). Preterm birth is associated with alterations of cardiovascular structure and function that persist into adulthood and are linked to cardiovascular disease. There are, however, no clinical guidelines regarding long term cardiovascular monitoring for adults who are born very preterm. This thesis’s focus is the prevention of cardiovascular disease in this new at-risk population. Its main objectives are to describe the long-term effects of prematurity on adult health and to present prevention and intervention avenues for mitigating those effects. Its first chapter presents a review of the pertinent literature while its second describes the methods that were employed to obtain results that are presented in subsequent chapters. Briefly, the HAPI (Health of Adults born Preterm Investigation) cohort recruited young adults born between 1986 and 1996 in the province of Quebec either prematurely (<30 weeks of gestation) or at term (>37 weeks of gestation). This is the population studied in chapters 3 to 5. Chapter 3 presents a diminished maximal aerobic capacity in subjects born preterm and explores contributing factors, including cardiac hemodynamic parameters. Chapter 4 examines health perception and healthcare use in the cohort and how these are influenced or not by objective health measurements previously performed in the HAPI study. Chapter 5 advocates for long-term medical follow-up in young adults born preterm, using testimonials from participants in the HAPI cohort. Finally, chapter 6 presents results from the HAPI Fit study which aimed to evaluate the effects in young adults born very preterm of a 14-week exercise intervention on their maximal aerobic capacity and cardiovascular health parameters. Overall, these results allow us to paint a global picture of long-term cardiovascular consequences of prematurity and of possible ways to mitigate them. Dissemination of these results to the target population and their healthcare providers constitute the basis of future prevention programs in this new at-risk population.

The aim was to investigate associations of fitness and types and levels of physical activity with subsequent risk of cardiovascular disease. Four large-scale longitudinal cohort studies were used. The exposures were different measures related to physical activity and the outcomes were obtained through linkage to the Swedish In-Patient Register. In a cohort of 466 elderly men without pre-existing cardiovascular disease, we found that skeletal muscle morphology was associated with risk of cardiovascular events. A high amount of type I (slow-twitch, oxidative) skeletal muscle fibres was associated with lower risk of cardiovascular events and high amount of type IIx was associated with higher risk of cardiovascular events. This association was only seen among physically active men. Among 39,805 participants in a fundraising event, higher levels of both total and leisure time physical activity were associated with lower risk of heart failure. The associations were strongest for leisure time physical activity. In a cohort of 53,755 participants in the 90 km skiing event Vasaloppet, a higher number of completed races was associated with higher risk of atrial fibrillation and a higher risk of bradyarrhythmias. Further, better relative performance was associated with a higher risk of bradyarrhythmias. Among 1,26 million Swedish 18-year-old men, exercise capacity and muscle strength were independently associated with lower risk of vascular disease. The associations were seen across a range of major vascular disease events (ischemic heart disease, heart failure, stroke and cardiovascular death). Further, high exercise capacity was associated with higher risk of atrial fibrillation and a U-shaped association with bradyarrhythmias was found. Higher muscle strength was associated with lower risk of bradyarrhythmias and lower risk of ventricular arrhythmias. These findings suggest a higher rate of atrial fibrillation with higher levels of physical activity. The higher risk of atrial fibrillation does not appear to lead to a higher risk of stroke. In contrast, we found a strong inverse association of higher exercise capacity and muscle strength with vascular disease. Further, high exercise capacity and muscle strength are related to lower risk of cardiovascular death, including arrhythmia deaths. From a population perspective, the total impact of physical activity on cardiovascular disease is positive.

La décompensation cardiaque se manifeste par une symptomatologie de dyspnée et de fatigue, et par une diminution de l’aptitude aérobie. La décompensation cardiaque peut être globale ou gauche (DCG), ou droite comme dans le cas de l’hypertension artérielle pulmonaire (HTAP). Les mesures fonctionnelles de repos (fonction ventriculaire gauche ou pression artérielle pulmonaire moyenne) sont peu corrélées à l’aptitude aérobie, qui est cependant un élément important de la mise au point et du suivi clinique des patients atteints de DCG ou d’HTAP. <p>\ / Doctorat en Sciences de la motricité / info:eu-repo/semantics/nonPublished