The effectiveness of recovery interventions following prolonged multiple sprint team sports matches has rarely been studied despite the potential for exercise-induced muscle damage to adversely affect training in the days following games. The lack of research related to this topic is probably owing to the wide variability that exists in the movement demands of players between matches and the impact that this has on the subsequent rate and magnitude of recovery which makes it difficult to detect meaningful differences when conducting research with small sample sizes. Therefore, the purpose of this thesis was to develop a rugby league-specific match simulation protocol that replicates the movement demands, physiological responses and subsequent recovery from matches in order to study the effectiveness of recovery interventions. Hence, two time-motion analysis studies were conducted using a semi-automated image recognition system to inform the development of the rugby league match simulation protocol (RLMSP). Whilst mean total distance covered over the duration of the match was 8,503 m, ball in play and stoppage work-to-rest ratios were 1:6.9 and 1:87.4, respectively, for all players. Furthermore, a significant decline in high and very high intensity running locomotive rates were observed between the initial and final 20 min periods of the match. Thus a RLMSP was devised to replicate the overall movement demands, intra-match fatigue and recovery from a senior elite rugby league match. Not only was there a low level of variability in the movement demands during the RLMSP over consecutive trials, but with the exception of creatine kinase, the rate and magnitude of recovery following the RLMSP was similar to that that has been published following competitive matches. Therefore, the RLMSP devised in this thesis may be a more appropriate research tool for assessing the effectiveness of recovery interventions following match related exercise than following actual match play.

Muitos equinos participantes de provas de corrida, ao exame endoscópico, apresentam evidências de ocorrência de Hemorragia Pulmonar Induzida pelo Exercício (HPIE). A HPIE trata-se de um sangramento de origem pulmonar que ocorre em equinos durante atividade física intensa e pela alta prevalência, muitas vezes associada aos equinos de corrida. Considerando, baseado nos estudos realizados, que o principal mecanismo descrito no desenvolvimento dos quadros de HPIE envolve o aumento da pressão transmural, resultante do aumento da pressão pulmonar causada pelo exercício físico, a furosemida parece ter papel importante na atenuação destes fatores, o que suporta a sua utilização nestes animais. Foram avaliados 21 equinos da raça Puro Sangue Inglês, atletas de distintas modalidades (corrida e polo), com e sem HPIE em dois momentos, antes (T0) e 4 horas após a administração da furosemida (T1) na dose de 0,5 mg/kg. Os animais foram submetidos a exame ecocardiográfico nos dois momentos, e também a colheita de sangue para avaliação hematológica e bioquímica. Ao exame ecocardiográfico foram consideradas as seguintes variáveis: FC, DC, VEj, FEj, VSFVE, VDFVE, FS, SIV, PLVE, DVE em sístole e diástole, AEs, Ao, AE:Ao, TEVE, E-S, e pico de velocidade do fluxo na artéria pulmonar. Para os exames laboratoriais foram consideradas as seguintes variáveis: He, Hb, Ht, VCM, HCM, CHCM, Leu, Neu, Linf, Mon, Plaq, AST, GGT, Alb, Pt, BT e BD. O uso da furosemida exerceu influência sobre os índices ecocardiográficos estudados de animais sem HPIE alterando a velocidade do fluxo da artéria pulmonar e o TEVE. Os demais parâmetros ecocardiográficos estudados bem como os parâmetros hemáticos não apresentaram alteração significativa, exceção feita aos valores de ureia e creatinina que aumentaram em T1, em função da hemoconcentração, sendo significantemente maiores no grupo sem HPIE. / Many racehorses at endoscopic examination after race present evidence of Exercise Induced Pulmonary Hemorrhage (HPIE). HPIE is a bleeding that occurs from pulmonary origin in horses during intense physical activity, often associated, by the high prevalence, to the racehorses, being able to present itself in many other equines, since undergoing intense physical exercise. Considering, based on previous studies, that the main mechanism involved in the development of HPIE involves the increase of the transmural pressure, resulting from the increase of the pulmonary pressure caused by the physical exercise, furosemide seems to play an important role in the attenuation of these factors, which supports their use in these animals. Twenty-one Thoroughbred horses, athletes, with and without HPIE were evaluated at two moments, before (T0) and 4 hours after furosemide administration (T1) at a dose of 0.5 mg / kg. All equines were submitted to echocardiographic examination at both moments, as well as blood sampling for hematological and biochemical evaluation. Echocardiographic examination showed the following variables: FC, DC, VEj, FEj, VSFVE, VDFVE, FS, SIV, PLVE, DVE, AEs, Ao, AE:Ao, TEVE, E-S, and flow in the pulmonary artery. For the laboratory tests, the following variables were considered: He, Hb, Ht, VCM, HCM, CHCM, Leu, Neu, Linf, Mon, Plaq, AST, GGT, Alb, Pt, BT and BD. Furosemide influenced some echocardiographic indexes of non-HPIE animals, altering the velocity of pulmonary artery flow and TEVE. All others echocardiographic and hematological parameters did not present any influence of furosemide administration, although urea and creatinine values have increased in T1 due to the hemoconcentration in non-HPIE group.

This study determined if insulin resistance (IR), induced by an acute bout of eccentrically-biased contractions that resulted in muscle injury, was attenuated following a repeated bout of contractions. Female subjects (n = 10, age 24.7 ± 3.0 yr, weight 64.9 ± 7.4 kg, height 1.67 ± 0.02 m, body fat 29.1 ± 1.9 %) performed two 30 minute bouts of downhill treadmill running (DTR 1 and DTR 2, -12 % grade, 8.0 mph) separated by 14 days. Oral glucose tolerance tests (OGTT) were administered at baseline and 48 hours following DTR 1 and DTR 2, with IR assessed by calculation of insulin and glucose areas under the curve (AUC). Maximum isometric quadriceps strength (MVC), muscle soreness (SOR), and serum creatine kinase (CK) were assessed pre-, immediately post-, and 48 hours post-DTR 1 and DTR 2 to determine the presence of muscle injury. Compared to baseline OGTT, insulin and glucose AUC (37.6 ± 8.4 and 21.4 ± 4.7 % increase, respectively), and peak insulin (44.1 ± 5.1 vs. 31.6 ± 4.0 uU·mL-1) and glucose (6.5 ± 0.4 vs. 5.5 ± 0.4 mmol·L-1) were elevated following DTR 1. These same insulin and glucose measures showed no increase above baseline 48 hours following DTR 2 (p > 0.05). MVC was reduced to a greater degree immediately following DTR 1 (16.7 ± 2.6 vs. 8.6 ± 1.2 % decline) and, although demonstrating a significant degree of recovery, remained reduced by 9.4 ± 2.7 % 48 hours following exercise. In contrast, MVC made a full recovery back to baseline values 48 hours after DTR 2. SOR was elevated to a greater degree 48 hours following DTR 1 than after DTR 2 (48.08 ± 6.16 vs. 12.70 ± 3.24 mm). There was a tendency for an attenuated serum CK response 48 hours following DTR 2 (812.8 ± 365.1 vs. 162.5 ± 42.5 U·L-1, p = 0.08). In conclusion, a novel bout of eccentrically-biased contractions resulting in a moderate degree of muscle injury confers a protective effect, whereby a subsequent bout of contractions 14 days later results in complete elimination of the IR observed following the initial bout.

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.

Chronic exertional compartment syndrome (CECS) is a common problem within both military and athletic populations that can be difficult to diagnose. Furthermore, it is unclear what causes the development of CECS, particularly in the military population, as personnel undertake a variety of activities that can cause pain with CECS such as fast walking, marching and running. Chronic exertional compartment syndrome has been hypothesised to develop due to excessive muscle activity, foot pronation and abnormal biomechanics predominantly at the ankle. Treatment of CECS through running re-education to correct these abnormalities has been reported to improve symptoms. However no primary research has been carried out to investigate the biomechanical, muscle activation and clinical characteristics of military patients with CECS. The purpose of this thesis was to provide an original contribution to the knowledge through the exploration of these characteristics; and the development of insights into the development of CECS, with implications for prevention and treatment. Study one investigated the clinical characteristics of 93 service personnel with CECS. Plantar pressure variables, related to foot type and anterior compartment muscle activity, and ankle joint mobility were compared during walking between 70 cases and 70 controls in study two. Study three compared three-dimensional whole body kinematics, kinetics and lower limb muscle activity during walking and marching between 20 cases and 20 controls. Study four compared kinematics and lower limb muscle activity during running in a separate case-control cohort (n=40). Differences in electromyography (EMG) intensity during the gait cycle were compared in the frequency and time domain using wavelet analysis. All studies investigated subject anthropometry. Cases typically presented with bilateral, ‘tight’ or ‘burning’ pain in the anterior and lateral compartments of the lower leg that occurred within 10 minutes of exercise. This pain stopped all cases from exercising during marching and/or running. As such subsequent studies investigated the biomechanics of both ambulatory and running gaits. Cases in all case-control studies were 2-10 cm shorter; and were typically overweight resulting in a higher body mass index (BMI) than controls. There was strong evidence from study 3 that cases had greater relative stride lengths than controls during marching gait. This was achieved through an increase in ankle plantarflexion during late stance and a concomitant increase in the gastrocnemius medialis contraction intensity within the medium-high frequency wavelets. Given the differences in height observed, this may reflect ingrained alterations in gait resulting from military training; whereby all personnel are required to move at an even cadence and speed. These differences in stride length were also observed in walking and running gaits although to a lesser extent. There was no evidence from the EMG data that cases had greater tibialis anterior activation than controls during any activity tested, at any point in the gait cycle or in any frequency band. In agreement, there was also no evidence of differences between groups in plantar pressure derived measures of foot type, which modulate TA activity. Toe extensor - related plantar pressure variables also did not differ between groups. In summary, contrary to earlier theories, increased muscle activity of the anterior compartment musculature does not appear to be associated with CECS. The kinematic differences observed during running only partially matched the clinical observations previously described in the literature. Cases displayed less anterior trunk lean and less anterior pelvic tilt throughout the whole gait cycle and a more upright shank inclination angle during late swing (peak mean difference 3.5°, 4.1° and 7.3° respectively). However, no consistent differences were found at the ankle joint suggesting that running is unlikely to be the cause of CECS in the military; and that the reported success of biomechanical interventions may be due to reasons other than modifying pathological aspects of gait. In summary, the data presented in the thesis suggest that CECS is more likely to develop in subjects of shorter stature and that this is associated with marching at a constant speed and cadence. Biomechanical interventions for CECS, such as a change in foot strike or the use of foot orthotics, are unlikely to be efficacious for the military as personnel will continue to be required to march at prescribed speeds to satisfy occupational requirements. Preventative strategies that allow marching with a natural gait and/or at slower speeds may help reduce the incidence of CECS. The lack of association with foot type or muscle activity suggests that foot orthoses would not be a useful prevention strategy or treatment option for this condition.

It was long believed within the scientific community that the adult brain was unable to generate new neurons. In the end of the 1990s the consensus changed and it is since believed that the adult brain can and does generate new neurons after birth, a process referred to as adult neurogenesis. Adult neurogenesis takes place in two places in the adult brain: the subventricular zone (SVZ) in close proximity to the olfactory bulb and the subgranular zone (SGZ) in the hippocampus. The level of adult hippocampal neurogenesis (AHN) can be upregulated and one part of the aim was to examine the effect of voluntary chronic aerobic exercise (VCAE) on AHN. It is clear that voluntary chronic aerobic exercise reliably increases AHN. Still, the function of these new brain cells is under debate. Spatial learning and memory are among the main abilities that have been focused on. The other part of the aim was to examine the effect of VCAE and AHN on spatial learning and memory. The reviewed literature suggests that both AHN and spatial learning and memory increase together from VCAE, although it does not show causation, that an increase of AHN from VCAE causally effects spatial learning and memory. More studies are needed to investigate if a causal relationship exists.

Submitted by LEONARDO COELHO RABELLO DE LIMA null (leonardocrlima@gmail.com) on 2017-10-04T00:12:09Z No. of bitstreams: 1 Tese Leonardo Lima.pdf: 5043553 bytes, checksum: bb0d2f3885d5719b2bd99d08ef4a0617 (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-10-04T17:00:41Z (GMT) No. of bitstreams: 1 Tese Leonardo Lima.pdf: 5043553 bytes, checksum: bb0d2f3885d5719b2bd99d08ef4a0617 (MD5) / Made available in DSpace on 2017-10-04T17:00:41Z (GMT). No. of bitstreams: 1 Tese Leonardo Lima.pdf: 5043553 bytes, checksum: bb0d2f3885d5719b2bd99d08ef4a0617 (MD5) Previous issue date: 2017-08-07 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução: Alguns estudos longitudinais têm mostrado que a força pode influenciar a economia de corrida (EC). Entretanto, outros modelos [p.ex., dano muscular (DM) induzido por corridas em declive (CrED)] mostram que a magnitude e a cinética de recuperação da EC e da força máxima medida em exercícios de cadeia cinética aberta [pico de torque isométrico de extensão do joelho (PTI)] podem ser diferentes. Fatores como o tipo de exercício usado para medir a força e a forma pela qual a força se manifesta (máxima e explosiva), podem explicar, pelo menos em parte, estes dados antagônicos. O objetivo geral deste estudo foi utilizar o modelo de DM induzido pela CrED para analisar a relação entre força máxima e explosiva e a EC. Método: Para isso, foram empregadas três intervenções para modular o DM induzido pela CrED e verificar seus efeitos sobre a força e a EC. Participaram do estudo 85 sujeitos ativos (22,3 ± 2,4 anos, 78 ± 9,4 kg, 176,9 ± 5 cm) que foram aleatoriamente separados em grupo controle (CON), placebo (PLA), suplementação (SUP), isométrico (ISO) e combinado (COMB). CON foi dividido em indivíduos com presença e ausência da α-actinina-3, resultante de polimorfismo do gene ACTN3. Todos os grupos realizaram uma CrED (-15%) por 30 min a 70% VO2max. SUP ingeriu um suplemento rico em compostos flavonoides antes e após a CrED, PLA ingeriu um placebo nos mesmos períodos, ISO realizou 10 contrações isométricas máximas (CIM) dois dias antes da CrED e COMB ingeriu o suplemento e realizou 10 CIM antes da CrED. Foram avaliados marcadores indiretos de DM (força, dor, amplitude de movimento e circunferência da coxa, e atividade sérica de CK) e EC antes e imediatamente, 24, 48, 72 e 96 horas após a CrED. Alterações ao longo do tempo e entre grupos foram analisadas por meio de ANOVA de dois caminhos com post-hoc de Bonferroni. Resultados: Os resultados obtidos demonstraram comprometimento significante da EC após a CrED, assim como alterações significantes em marcadores de DM. Foi identificado um efeito de aceleração da recuperação nas alterações no DM e EC para os grupos SUP e COMB (que apresentaram retorno do VO2 e PTI a níveis basais no dia seguinte e dois dias após a CrED, respectivamente) em relação ao grupo CON. Os grupos que consumiram o suco antioxidante também apresentaram atenuação significante da dor muscular após a CrED. Entretanto, a diferença de cinética de recuperação entre força e EC se manteve mesmo frente aos tratamentos. O grupo ISO apresentou aceleração da recuperação do PTI, mas não da EC, assim como atenuação da dor muscular em relação ao grupo CON. Alterações na altura de saltos foram significantes, sendo que os valores retornaram a níveis basais antes dos valores de PTI. Em relação aos polimorfismos do gene ACTN3, não houve influência do genótipo nas alterações na EC. Entretanto, como esperado, houve maior perda de força para indivíduos RR (que sintetizam a α-actinina-3). Conclusão: Em conjunto, os resultados obtidos sugerem que há, sim, uma relação entre aspectos neuromusculares e a EC. Entretanto, outros fatores, que não a capacidade de produção de força isoladamente, parecem contribuir para essa relação. Ademais, as estratégias de atenuação do DM investigadas no presente estudo parecem ser eficazes na aceleração da recuperação da EC e da força muscular e o polimorfismo do gene ACTN3 parece ser um dos fatores que explicam a susceptibilidade ao DM. / Introduction: Longitudinal studies have been showing that strength production capacity might influence running economy (RE). However, other study models [e.g., downhill running (DhR) induced muscle damage (MD)] show different magnitudes of change and recovery kinetics between strength measured with open kinetic chain exercises [knee extension isometric peak torque (IPT)] and RE might differ. Factors such as the type of exercised used to measures strength and its form of manifestation (maximal or explosive) might, at least in part, explain these differences. The aim of the present study was to analyze the association between strength production capacity and RE using an DhR induced MD model. Methods: To do so, three different prophylactic strategies were adopted to modulate MD induced by DhR and also analyze their effects on strength production capacity and RE. Eighty five active subjects (22.3 ± 2.4 years, 78 ± 9.4 kg, 176.9 ± 5 cm) participated in the study and were randomly allocated to control (CON), placebo (PLA), supplementation (SUP), isometric (ISO), and combined (COMB) groups. Participants in CON were separated based on their ACTN3 polymorphisms. All groups ran downhill (-15%) for 30 min at 70%VO2max. SUP ingested a flavonoid-rich supplement before and following DhR, PLA ingested an isocaloric placebo at the same time points, ISO performed 10 maximal isometric contractinons (MIC) two days prior to the DhR, and COMB ingested the supplement and performed the MIC before DhR. MD symptoms (strength, soreness, knee joint range of motion, thigh circumference, and serum CK activity) and RE were assessed before, immediately after, and 1-4 days following DhR. Changes over time and between groups were analyzed with two-way ANOVA followed by Bonferroni’s post hoc tests. Results: Results showed that RE was significantly compromised following DhR and MD markers were also affected. Faster recovery of RE and MD markers was identified for the SUP and COMB groups (which reached full recovery of VO2 and IPT 1 and 3 days following the DhR, respectively), as compared to CON. Both groups that consumed the antioxidant supplement also presented significant attenuation of muscle soreness following DhR. However, the difference in the recovery kinetics of strength and RE was maintained with this treatment. ISO presented faster recovery of IPT, but not RE, and attenuation and faster recovery of soreness, as compared to CON. Significant changes in jump height were found for all groups, with faster recovery when compared to IPT. No influence of the ACTN3 gene polymorphism was found for changes in RE. However, as expected, RR individuals presented significantly greater strength loss following DhR. Conclusion: When put together, our results suggest that there is, indeed, an association between neuromuscular aspects and RE. However, factors other than strength production per se seem to contribute to this association. Moreover, the prevention/recovery strategies investigated in the present study seem to be effective to promote faster recovery of RE and strength following DhR. Also, ACTN3 gene polymorphism seems to be one of the factors contributing to susceptibility to MD, but not changes in RE. / FAPESP: 2013/23585-4

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.

Muitos equinos participantes de provas de corrida, ao exame endoscópico, apresentam evidências de ocorrência de Hemorragia Pulmonar Induzida pelo Exercício (HPIE). A HPIE trata-se de um sangramento de origem pulmonar que ocorre em equinos durante atividade física intensa e pela alta prevalência, muitas vezes associada aos equinos de corrida. Considerando, baseado nos estudos realizados, que o principal mecanismo descrito no desenvolvimento dos quadros de HPIE envolve o aumento da pressão transmural, resultante do aumento da pressão pulmonar causada pelo exercício físico, a furosemida parece ter papel importante na atenuação destes fatores, o que suporta a sua utilização nestes animais. Foram avaliados 21 equinos da raça Puro Sangue Inglês, atletas de distintas modalidades (corrida e polo), com e sem HPIE em dois momentos, antes (T0) e 4 horas após a administração da furosemida (T1) na dose de 0,5 mg/kg. Os animais foram submetidos a exame ecocardiográfico nos dois momentos, e também a colheita de sangue para avaliação hematológica e bioquímica. Ao exame ecocardiográfico foram consideradas as seguintes variáveis: FC, DC, VEj, FEj, VSFVE, VDFVE, FS, SIV, PLVE, DVE em sístole e diástole, AEs, Ao, AE:Ao, TEVE, E-S, e pico de velocidade do fluxo na artéria pulmonar. Para os exames laboratoriais foram consideradas as seguintes variáveis: He, Hb, Ht, VCM, HCM, CHCM, Leu, Neu, Linf, Mon, Plaq, AST, GGT, Alb, Pt, BT e BD. O uso da furosemida exerceu influência sobre os índices ecocardiográficos estudados de animais sem HPIE alterando a velocidade do fluxo da artéria pulmonar e o TEVE. Os demais parâmetros ecocardiográficos estudados bem como os parâmetros hemáticos não apresentaram alteração significativa, exceção feita aos valores de ureia e creatinina que aumentaram em T1, em função da hemoconcentração, sendo significantemente maiores no grupo sem HPIE. / Many racehorses at endoscopic examination after race present evidence of Exercise Induced Pulmonary Hemorrhage (HPIE). HPIE is a bleeding that occurs from pulmonary origin in horses during intense physical activity, often associated, by the high prevalence, to the racehorses, being able to present itself in many other equines, since undergoing intense physical exercise. Considering, based on previous studies, that the main mechanism involved in the development of HPIE involves the increase of the transmural pressure, resulting from the increase of the pulmonary pressure caused by the physical exercise, furosemide seems to play an important role in the attenuation of these factors, which supports their use in these animals. Twenty-one Thoroughbred horses, athletes, with and without HPIE were evaluated at two moments, before (T0) and 4 hours after furosemide administration (T1) at a dose of 0.5 mg / kg. All equines were submitted to echocardiographic examination at both moments, as well as blood sampling for hematological and biochemical evaluation. Echocardiographic examination showed the following variables: FC, DC, VEj, FEj, VSFVE, VDFVE, FS, SIV, PLVE, DVE, AEs, Ao, AE:Ao, TEVE, E-S, and flow in the pulmonary artery. For the laboratory tests, the following variables were considered: He, Hb, Ht, VCM, HCM, CHCM, Leu, Neu, Linf, Mon, Plaq, AST, GGT, Alb, Pt, BT and BD. Furosemide influenced some echocardiographic indexes of non-HPIE animals, altering the velocity of pulmonary artery flow and TEVE. All others echocardiographic and hematological parameters did not present any influence of furosemide administration, although urea and creatinine values have increased in T1 due to the hemoconcentration in non-HPIE group.