Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-07-19T14:58:19Z No. of bitstreams: 1 dianemichelaneryhenrique.pdf: 7655862 bytes, checksum: 28c817a6bfd0f9b2a6f1809cbed1cc96 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-09T12:19:37Z (GMT) No. of bitstreams: 1 dianemichelaneryhenrique.pdf: 7655862 bytes, checksum: 28c817a6bfd0f9b2a6f1809cbed1cc96 (MD5) / Made available in DSpace on 2017-08-09T12:19:37Z (GMT). No. of bitstreams: 1 dianemichelaneryhenrique.pdf: 7655862 bytes, checksum: 28c817a6bfd0f9b2a6f1809cbed1cc96 (MD5) Previous issue date: 2009-03-13 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Na população geral, a prática regular de exercícios físicos se associa à melhora da capacidade funcional e à redução de eventos cardiovasculares. Por outro lado, em portadores de doença renal crônica, uma população que apresenta significativo comprometimento da capacidade funcional, alta prevalência de hipertensão arterial e elevadas taxas de mortalidade cardiovascular, poucos são os estudos que avaliam o efeito da atividade física na capacidade funcional e no controle da hipertensão arterial. Portanto, o objetivo deste estudo foi avaliar o efeito do treinamento aeróbico, realizado durante as sessões de hemodiálise, sobre a capacidade funcional e sobre a pressão arterial de pacientes renais crônicos. Foram avaliados 14 indivíduos portadores de doença renal crônica sob tratamento hemodialítico, antes e depois de 12 semanas de treinamento aeróbico realizado em cicloergômetro de membros inferiores, durante as sessões de hemodiálise. Constatou-se que dentre os pacientes, quatro eram homens e 10 eram mulheres, com média de idade de 47,6 ± 12,79 anos, cinco eram brancos e nove eram negros e que o tempo de hemodiálise variou de 93,7 ± 43,90 meses. Os pacientes foram submetidos à monitorização ambulatorial da pressão arterial de 24 horas, ao teste de caminhada de 6 minutos e ao teste cardiopulmonar de exercício tanto antes como depois do período de treinamento (p < 0,05). Após o período de treinamento aeróbico, observou-se aumento da distância percorrida no teste de caminhada de 6 minutos de 509 ± 91,9 m para 555 ± 105,8 m (p < 0,001), além de redução da pressão arterial sistólica de 151 ± 18,4 mm Hg para 143 ± 14,7 mm Hg (p = 0,08), pressão arterial diastólica de 94 ± 10,5 mm Hg para 91 ± 9,6 mm Hg (p = 0,05), pressão arterial média de 114 ± 13,0 mm Hg para 109 ± 11,4 mm Hg (p = 0,07), pressão arterial sistólica no sono de 150 ± 23,9 mm Hg para 140 ± 19,3 mm Hg (p = 0,02), pressão arterial diastólica no sono de 93 ± 15,3 mm Hg para 88 ± 14,3 mm Hg (p = 0,01), pressão arterial média no sono de 112 ± 18,0 mm Hg para 106 ± 16,1 mm Hg (p = 0,04). O valor de pico de consumo de oxigênio no primeiro e segundo limiar ventilatório aumentou de 20,6 ± 6,92 mUkg.m-1 para 21,2 ± 10,13 milkg.m-1 (p = 0,45) no pré e pós-treinamento aeróbico. Nas variáveis laboratoriais a hemoglobina aumentou de 10,8 ± 1,20 g/dL para 11,6 ± 11,6 g/dL (p = 0,04), o hematócrito aumentou de 32,8 ± 3,57% para 35,2 ± 2,76 (p = 0,03) e os triglicérides aumentou de 96,6 ± 35,17 mg/dL para 127,0 ± 54,56 (p = 0,04) no pré e pós-treinamento aeróbico. Com base nos resultados obtidos pode-se concluir que o treinamento aeróbico realizado durante as sessões de hemodiálise contribuiu para a melhora da capacidade funcional e para o melhor controle da hipertensão arterial de pacientes portadores de doença renal crônica. / In general population, physical fitness has been shown to improve functional capacity and to reduce cardiovascular events. On the other hand, in patients with chronic kidney disease, which have significant reduction of functional capacity, high prevalence of hypertension and high rates of cardiovascular mortality, there are only a few studies evaluating the effects of exercise training on functional capacity and on blood pressure control. Therefore, the objective this study was to evaluate the effect of aerobic training performed during hemodialysis sessions on functional capacity and hypertension control of patients with chronic kidney disease. Fourteen patients with chronic kidney disease on hemodialysis treatment were evaluated before and after 12 weeks of aerobic training cycle held in the lower limbs during the hemodialysis sessions. Patients underwent 24 hours ambulatory blood pressure monitoring, six-minute walking test and exercise cardiopulmonary test before and after the period of 12 weeks of training (p < 0,05). It was found that among the patients, four males and 10 females, mean age 47,6 ± 12,79 years, five were white and nine were black and the time of hemodialysis ranged from 93,7 ± 43,90 months. The patients underwent ambulatory blood pressure monitoring, 24 hours, the test for 6 minutes of walking and exercise cardiopulmonary test both before and after the period of training (p < 0.05). After the period of aerobic training, there is increasing distance in the test of the 6 minute walk 509 m to 555 ± 91.9 ± 105.8 m (p < 0, 001), and reduction of systolic blood pressure of 151 ± 18.4 mm Hg to 143 ± 14,7 mm Hg (p = 0,08), diastolic blood pressure of 94 ± 10,5 mm Hg to 91 ± 9,6 mm Hg (p = 0,05), pressure mean blood of 114 ± 13.0 mm Hg to 109 ± 11.4 mm Hg (p = 0,07), systolic blood pressure in the sleep of 150 ± 23,9 mm Hg to 140 ± 19,3 mm Hg (p = 0,02), diastolic blood pressure in the sleep of 93 ± 15,3 mm Ng to 88 ± 14,3 mm Ng (p = 0,01), mean arterial pressure during sleep was 112 ± 18.0 mm Hg to 106 ± 16.1 mm Hg (p = 0,04). The value of peak oxygen consumption in the first and second ventilatory threshold increased from 20,6 ± 6,92 mL/kg.m-1 to 21,2 ± 10,13 mL/kg.m-1 (p = 0,45) in pre-and post-aerobic training. Laboratory variables in the hemoglobin increased from 10,8 ± 1.20 g/dL to 11,6 ± 11,6 g/dL (p = 0,04), the hematocrit increased from 32,8 ± 3,57% to 35,2 ± 2,76 (p = 0,03) and triglycerides increased from 96,6 ± 35,17 mg/dL to 127,0 ± 54,56 (p = 0,04) in pre-and post-aerobic training. Based on the results we can conclude that aerobic training performed during hemodialysis sessions improved functional capacity and contributed to hypertension control of patients with chronic kidney disease.

Abstract Becoming involved in war is an experience that has the potential to shape later-life health. The aim of the present study was to explore Finnish Second World War veterans’ health status and the determinants of self-rated health (SRH) and functional capacity, especially the ability to walk, and to identify risk factors and their combinations that predict late-life mortality among veterans. The study population comprised Finnish Second World War veterans who participated in the Veteran 1992 and Veteran 2004 Project surveys. In 1992, a postal questionnaire was sent to all 242,720 war veterans living in Finland. The follow-up survey, the Veteran 2004 Project, was conducted with a randomized sample of veterans who participated in the Veteran 1992 Project. The total number of participants in the baseline survey was 177,989 men and 48,745 women, and in the follow-up survey, 4,348 men and 651 women. The response rate was high in both surveys: 93% in 1992 and 87% in 2004. All analyses were conducted separately for men without disability, men with disability and women. In a cross-sectional study, SRH and functional capacity was found to be better among 80–84-year-old Finnish war veterans in 2004 compared with 1992, although the prevalence of many diseases increased during the follow-up. Among the 4,999 veterans who participated in both surveys, the majority rated their health as improved or unchanged during the follow-up. Walking difficulties and cardiovascular (CVD), musculoskeletal and neurological diseases were found to be predictors of declined SRH. When exploring functional capacity among veterans, neurological and musculoskeletal diseases, but especially walking difficulties, predicted veterans’ future functional impairment as many as 12 years in advance, and worsening of these conditions was associated with impaired activities of daily living. During an average 9.9-year follow-up, walking difficulties alone or together with multimorbidity and/or with a third risk factor was the most important risk factor for total and for CVD mortality among all veteran groups. In conclusion, the majority of veterans rated their SRH as improved or unchanged during the follow-up. The importance of walking difficulties as a determinant of SRH and functional capacity and as a predictor of mortality was confirmed. / Tiivistelmä Tutkimuksen tarkoituksena oli arvioida suomalaisten toisen maailmansodan veteraanien terveydentilaa ja tutkia, mitkä tekijät vaikuttavat veteraanien itsearvioituun terveyteen ja toimintakykyyn (erityisesti kävelykykyyn) sekä tunnistaa ne riskitekijät ja tekijäyhdistelmät, jotka ennustavat kuolleisuutta. Tutkimuspopulaationa käytettiin Veteraaniprojekti 1992 ja Veteraaniprojekti 2004 -tutkimuksiin osallistuneita veteraaneja. Vuonna 1992 kysely lähetettiin postitse jokaiselle Suomessa tuolloin asuneelle 242 720 veteraanille. Seurantatutkimukseen valittiin 5 750 veteraanin satunnaisotos vuoden 1992 tutkimukseen osallistuneista. Veteraaniprojekti 1992 -tutkimukseen osallistui 177 989 miestä ja 48 745 naista ja seurantatutkimukseen 4 348 miestä ja 651 naista. Osallistumisprosentti oli 93 % (1992) ja 87 % (2004). Analyysit tehtiin erikseen veteraanimiehille joilla ei ollut invaliditeettia, invalidimiehille ja naisille. Poikkileikkaustutkimuksessa tarkasteltiin 80–84-vuotiaiden veteraanien terveyttä ja toimintakykyä vuosina 1992 ja 2004. Vuonna 2004 veteraanit arvioivat terveytensä ja toimintakykynsä paremmiksi kuin samanikäiset veteraanit vuonna 1992, vaikka monet sairaudet yleistyivät seuranta-aikana. Suurin osa molempiin kyselyihin vastanneista 4 999 veteraanista arvioi terveytensä joko parantuneen tai pysyneen ennallaan seuranta-aikana. Veteraanien kokemat kävelyvaikeudet, sydän- ja verisuonisairaudet, tuki-ja liikuntaelinsairaudet sekä neurologiset sairaudet ennustivat itsearvioidun terveyden heikkenemistä. Sydän- ja verisuonisairauksia lukuun ottamatta edellä mainitut tekijät ennustivat myös toimintakyvyn laskua jopa 12 vuotta etukäteen. Myös kävelykyvyn heikkeneminen ja sairauksien paheneminen seuranta-aikana ennustivat toimintakyvyn laskua. Kävelyvaikeudet joko yksin tai yhdessä multimorbiditeetin ja/tai jonkin kolmannen riskitekijän kanssa oli tärkein sekä kokonaiskuolleisuutta että sydän- ja verisuonitautikuolleisuutta ennustava tekijä kaikissa veteraaniryhmissä keskimäärin 9,9 vuoden seuranta-aikana. Yhteenvetona voidaan todeta, että enemmistö tutkimukseen osallistuneista veteraaneista arvioi terveytensä joko parantuneen tai pysyneen ennallaan seuranta-aikana. Koetut kävelyvaikeudet ovat erittäin tärkeä itsearvioitua terveyttä, toimintakykyä ja kuolleisuutta ennustava tekijä.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-23T18:13:52Z No. of bitstreams: 1 Amanda da Conceição Teodósio.pdf: 1530942 bytes, checksum: 16e553986846bcca3d0c579167b8f9bc (MD5) / Made available in DSpace on 2018-07-23T18:13:53Z (GMT). No. of bitstreams: 1 Amanda da Conceição Teodósio.pdf: 1530942 bytes, checksum: 16e553986846bcca3d0c579167b8f9bc (MD5) Previous issue date: 2016-12-13 / The stroke can cause several sequels compromising the neuromuscular, cardiorespiratory system and consequently the performance of the functional activities. For this, an evaluation tool is needed that incorporates the capacity and the functional performance of these individuals. The ADL Glittre test proposes this objective, being already validated in individuals with COPD, but not yet applied in the population with neurological alterations. Objective: To analyze the reproducibility of the ADL Glittre test in hemiparetic individuals due to stroke. METHODS: Patient profiles were plotted for gender, age, anthropometric data, side and site of injury, motor impairment (Fugl Meyer), Mental State (Mini Mental) and Functional Mobility Scale (FMS). The ADL Glittre test was performed with the upper limb not affected, its main outcome being the completion time. For reproducibility, the subject was submitted to four evaluative moments, two intra-rater evaluations and two inter-rater evaluations, adopted randomly. Variables were normalized by the Shapiro-Wilk test, reliability by means of the Intra-Class Correlation Coefficient (ICC), the Intra and Interim Concordance by means of Standard Error of Measure (EPM) and Minimum Changeable Detection (MMD). Results: There was a significant difference in the intra-rater evaluations (1 and 2), but the differences were smaller than the MMD (1.27 and 1.14 seconds). There was no significance in the outcome of the test in the inter-rater evaluations (p = 0.20). Conclusion: The Glittre AVD is reproducible for the hemiparetic population, which I completed in approximately five minutes. Due to the learning effect it is necessary to apply the test and retest. / O AVE pode ocasionar diversas sequelas comprometendo o sistema neuromuscular, cardiorrespiratório e consequentemente o desempenho das atividades funcionais. Para isso, faz-se necessária uma ferramenta de avaliação que incorpore a capacidade e o desempenho funcional desses indivíduos. O teste AVD Glittre propõe esse objetivo, sendo já validado em indivíduos com DPOC, porém ainda não aplicado na população com alterações neurológicas. Objetivo: Analisar a reprodutibilidade do teste de AVD Glittre em indivíduos hemiparéticos decorrente de AVE. Métodos: Os perfis dos pacientes foram traçados avaliando-se sexo, idade, dados antropométricos, lado e local da lesão, comprometimento motor (Fugl Meyer), Estado Mental (Mini mental) e Escala de Mobilidade Funcional (FMS). O teste AVD Glittre foi realizado com o membro superior não acometido, sendo seu desfecho principal o tempo de conclusão. Para a reprodutibilidade o indivíduo foi submetido a quatro momentos avaliativos, duas avaliações intra-avaliadores e duas avaliações inter avaliadores, adotadas de forma aleatorizada. A variáveis foram normalizadas pelo teste Shapiro- Wilk, a confiabilidade por meio do Coeficiente de Correlação Intra classe (CCI), a Concordância Intra e Inter avaliadores por meio do Erro Padrão de Medida (EPM) e pela Mínima Mudança Detectável (MMD). Resultados: Houve diferença significante nas avaliações intra-avaliadores (1 e 2) porém, as diferença foram menores que a MMD (1,27 e 1,14 segundos). Não houve significância no desfecho do teste nas avaliações inter-avaliadores (p=0,20). Conclusão: O AVD Glittre mostra-se reprodutível para a população hemiparética que o concluí aproximadamente em cinco minutos. Devido efeito aprendizado se faz necessário aplicação do teste e reteste.

Introdução: A prevalência da apneia obstrutiva do sono (AOS) entre pessoas com mais de 70 anos atinge até 95%. As opções de tratamento incluem o uso de pressão positiva nas via aérea, dispositivos intraorais e mudança de estilo de vida. Programa de exercícios aeróbicos ou combinados mostrou reduzir o índice de apneia-hipopneia (IAH) em adultos de meia-idade. No entanto, o efeito do treinamento resistido sobre a gravidade da AOS de pessoas idosas é controverso. O objetivo do presente estudo é avaliar o impacto do treinamento resistido no IAH e identificar possíveis mediadores do efeito do exercício. Métodos: Estudo randomizado, mascarado, controlado, em grupo paralelo. Indivíduos entre 65 e 80 anos, com IAH entre 20 e 50 eventos/hora na poligrafia respiratória foram atribuídos aleatoriamente para 12 semanas de treinamento de força ou grupo controle. IAH foi o principal desfecho. Índice de massa corporal (IMC) e teor de água corporal foram testados como mediadores. Espessura do músculo, força máxima e função física também foram avaliadas. Resultados: A amostra incluiu 23 indivíduos, 57% homens, com média de idade de 71±5 anos, alocados para treinamento (n=12) e grupo controle (n=11). O IAH basal nos grupos de treinamento e controle foi, respectivamente, 30±7/h e 29±9/h. No seguimento, o IAH mostrou significativa interação tempo × grupo. Não foi observada correlação entre Delta IAH e Delta IMC ou Delta teor de água corporal. A interação tempo × grupo permanece significativa após ajustar o modelo GEE para esses possíveis mediadores. Conclusão: Treinamento resistido a curto prazo em pessoas idosas é viável e muda de forma favorável a severidade da AOS e desfechos funcionais. As alterações no IMC e no teor de água corporal não parecem mediar a redução da IAH. Estudos futuros em amostras maiores de pessoas idosas são necessários. / Introduction: Obstructive sleep apnea (OSA) prevalence among persons older than 70 years reaches up to 95%. The treatment options include use of positive airway pressure, intraoral devices, and lifestyle changes. Aerobic or combined exercise program has been shown to reduce the apnea-hypopnea index (AHI) in middle-aged adults. However, the effect of resisted training on OSA severity of older persons is controversial. The aim of the present study is to evaluate the impact of resisted training on the AHI and to identify possible mediators of the effect of exercise. Methods: This was a randomized, masked, controlled, parallel group trial. Subjects between 65 and 80 years, with AHI between 20 and 50 events/hour in the respiratory polygraphy were assigned randomly to 12 weeks of strength training or control groups. AHI was the main outcome. Body mass index (BMI) and bodily water content were tested as mediators. Muscle thickness, maximum strength, and physical function were assessed also. Results: The sample included 23 subjects, 57% men, aged 71±5 years, randomized to training (n=12) and control groups (n=11). The baseline AHI in the training and control groups were, respectively, 30±7/h and 29±9/h. At follow-up, the AHI showed significant time × group interaction. No correlation was observed between Delta AHI and delta BMI or delta bodily water content. The time × group interaction remains significant after adjusting the GEE model for these possible mediators. Conclusion: Short-term resisted training in older persons is feasible and changes favorably OSA severity and functional outcomes. Changes in BMI and in bodily water content do not seem to mediate the reduction in AHI. Future studies in larger samples of older persons are necessary.

L’insuffisance cardiaque est une pathologie provoquant une diminution importante des capacités fonctionnelles des patients ainsi qu’une diminution drastique de la qualité de vie. L’évaluation des capacités fonctionnelles est généralement effectuée par une épreuve d’effort maximal. Cependant pour plusieurs patients, cet effort est difficile à compléter. Les objectifs de l’étude présentée dans ce mémoire sont : (1) valider trois méthodes d’évaluation de la capacité fonctionnelle et aérobie des sujets souffrant d’insuffisance cardiaque avec un complexe QRS élargi; (2) chercher à établir le profil des patients démontrant une meilleure tolérance à l’exercice malgré une consommation maximale d’oxygène identique; et (3) démontrer les conséquences de la présence et de la magnitude de l’asynchronisme cardiaque dans la capacité fonctionnelle et la tolérance à l’exercice. Tous les sujets ont été soumis à un test de marche de six minutes, un test d’endurance à charge constante sur tapis roulant et à une épreuve d’effort maximal avec mesure d’échanges gazeux à la bouche. Les résultats ont montré une association significative entre les épreuves maximale et plus spécifiquement sous-maximale. De plus, une meilleure tolérance à l’exercice serait associée significativement à une plus grande masse du ventricule gauche. Finalement, les résultats de notre étude n’ont pas montré d’effet d’un asynchronisme cardiaque sur la performance à l’effort tel qu’évalué par nos protocoles. / Heart failure is a pathology that significantly decreases functional capacity and life quality. Maximal cardiopulmonary exercise testing is usually used to evaluate the functional capacity. However, the intensity of this test is very high and difficult to complete for some patients. The objectives of the study presented in this master are: (1) to validate three different protocols that evaluate functional and aerobic capacity for patients with congestive heart failure and presenting a large QRS complex; (2) to establish the characteristics of the patients that demonstrate a better exercise tolerance despite an identical aerobic capacity; (3) to identify the consequences of the presence and the magnitude of cardiac asynchrony on the exercise tolerance and the functional capacity. All patients underwent a six minute walk test, an endurance exercise test on treadmill and also a maximal cardiopulmonary test. The results show a significant association between all tests, more importantly between submaximal tests. Also, patients with better exercise tolerance demonstrate a left ventricular mass increased compared to low exercise tolerance patients. Finally, there is no significant effect of cardiac asynchrony on exercise tolerance examined by our protocols.

La population mondiale est en train de vieillir. Le vieillissement augmente le risque des pertes de la force musculaire (FM), du diabète type II (T2D) et du déclin de la capacité fonctionnelle (CF). Indépendamment de l’âge, les personnes âgées diabétiques ont un risque accru des pertes de la FM et du déclin de la CF comparées aux non-diabétiques. La nutrition est un facteur déterminant d’un vieillissement optimal et joue un rôle primordial dans la prise en charge du diabète, minimise les pertes de FM et peut moduler le déclin de la CF. De plus, l’activité physique (AP) offre des bénéfices semblables à ceux de la nutrition. Ainsi, l’objectif principal de cette thèse est de déterminer le rôle de la qualité alimentaire (QA) dans le maintien de la CF chez les personnes âgées diabétiques vivant dans la communauté, par le biais des analyses secondaires réalisées sur la base de données de la cohorte NuAge. En vue de la réalisation de cet objectif, une caractérisation de plusieurs variables en lien avec la CF était nécessaire. Ainsi, une description globale de l’alimentation des personnes âgées diabétiques fut effectuée. Ensuite, chacun des articles présentés a testé un objectif spécifique chez ces personnes âgées diabétiques, afin de : 1) déterminer si la QA seule, ou combinée à l’AP est associée au maintien des forces musculaires (FM) ; 2) déterminer si la QA seule, ou combinée à l’AP est associée à la prévention du déclin de la CF ; et 3) examiner l’association entre la suffisance en apports énergétique et protéique et le maintien des FM et la CF. De plus, l’association entre la QA, l’AP et la performance physique (PP) a été examinée. Cette thèse de doctorat est la première à examiner le rôle de la QA dans la CF chez la population âgée diabétique. En particulier, les résultats ont montré que la population diabétique de NuAge se caractérise par une bonne alimentation globale et de bonnes habitudes alimentaires, avec des apports en macronutriments conformes aux recommandations nutritionnelles. Néanmoins, ces participants devraient augmenter leurs apports en micronutriments qui étaient inférieurs aux recommandations chez la majorité. En outre, aucune association significative n’a été observée entre la QA seule et le maintien des FM, ni le déclin de la PP et la CF. Cependant, la QA combinée à l’AP a été associée aux FM des membres supérieurs. Spécifiquement, les hommes diabétiques ayant une bonne QA combinée à une stabilité de l’AP pendant les trois ans de suivi ont subi des pertes minimes de la FM comparés aux autres. Toutefois, aucune association n’a été observée pour les FM des membres inférieurs. De plus, la QA combinée à l’AP n’était associée ni à la PP ni à la CF chez ces participants. Finalement, les analyses ont démontré que la suffisance en apports énergétiques et protéiques est associée au maintien de la CF. En effet, un apport en énergie égal ou supérieur à 30 kcal/kg poids corporel a minimisé le déclin de la CF comparativement à un apport inférieur à 30 kcal/kg chez les hommes, alors que les femmes ayant un apport protéique égal ou supérieur à 1g/kg poids corporel ont subi un déclin minime de la CF comparées à celles ayant des apports en protéines inférieurs à 1g/kg. Enfin, il a été démontré qu’un apport suffisant en protéines a minimisé les pertes de FM des membres inférieurs chez les femmes diabétiques de la cohorte NuAge. Collectivement, les résultats de cette thèse fournissent des données probantes indiquant qu’une bonne QA, des apports suffisants en énergie et en protéines et une bonne pratique de l’AP sont nécessaires afin de minimiser les pertes de la FM reliées au vieillissement et accélérées par la présence du diabète et par la suite maintenir la CF des personnes âgées diabétiques. Cependant, d’autres études seront nécessaires pour confirmer ces résultats. / The population is aging, and aging increases the risk of muscle strength (MS) loss, type II diabetes (T2D), and decline in functional capacity (FC). Independent of aging, diabetic older adults (OA) are at increased risk of MS loss and FC decline compared to their non-diabetic counterparts. Nutrition is a determinant of optimal aging, and is important in managing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications; it also minimizes MS losses and finally, modulates decline in FC. In addition, physical activity (PA) offers benefits similar to those conferred by nutrition. Therefore, the main objective of this thesis is to determine the role of diet quality (DQ) in FC maintenance in community-dwelling diabetic OA in secondary analyses of the NuAge cohort database. In order to achieve this objective, characterization of several variables associated with FC was necessary. Thus, a descriptive analysis of the diet of these diabetic older adults was undertaken as our first objective. Then, the three articles are presented, each testing a specific objective in these diabetic OA, to: 1) determine if DQ alone, or combined with PA, is associated with MS maintenance; 2) determine if DQ alone, or combined with PA is associated with prevention of FC decline; and 3) examine the association between adequate protein and energy intakes and MS and FC maintenance. In addition, the association between DQ, PA and physical performance (PP) was studied. This doctoral thesis is the first to study the role of DQ on FC in diabetic OA. The results have demonstrated that diabetic OA in the NuAge cohort have a good diet overall and good dietary habits, and macronutrient intakes that meet nutrition recommendations. Nevertheless, these participants should increase their micronutrient intakes since the majority did not meet recommendations. Moreover, DQ alone was not associated with MS, PP or FC declines over the three year follow-up. However, DQ combined with PA showed associations with upper body MS. Specifically, good DQ combined with maintenance of PA over follow-up was associated with minimal MS losses in diabetic older men compared to others. However, no significant results were found for lower body MS in either males or females. Furthermore, DQ combined with PA was not associated with either PP or FC in these participants. Finally, our results have shown that adequate energy and protein intakes are associated with FC maintenance. In fact, diabetic older men with energy intakes of 30 kcal or greater/kg body weight experienced lesser declines in FC compared to those having inadequate energy intakes, while diabetic older women with protein intakes of 1g or more/kg body weight had minimal declines in FC compared to those with inadequate protein intakes. Finally, we have shown that adequate protein intakes minimized lower body MS losses in diabetic women in the NuAge cohort. Taken together, the results of this thesis provide evidence that good DQ, adequate energy and protein intakes and the practice of PA are all factors that can minimize MS losses related to aging and accelerated by T2D, and hence maintain FC in diabetic OA. Nevertheless, further research is needed to confirm these results.

INTRODUÇÃO: Diversos ensaios clínicos randomizados (ECR) foram realizados nos últimos anos sobre a eficácia dos agentes biológicos no tratamento da artrite reumatóide (AR). Porém, as revisões sistemáticas sobre o tema ainda geram dúvidas sobre a real eficácia relacionada à capacidade funcional e qualidade de vida. MÉTODOS: O presente estudo sintetizou as evidências geradas pelas revisões sistemáticas que compararam o tratamento realizado com a utilização dos agentes biológicos e o tratamento convencional com a utilização das drogas anti-reumáticas modificadoras da doença de síntese química (DARMDq), considerando a capacidade funcional e qualidade de vida dos pacientes com AR, além de avaliar a qualidade metodológica das revisões sistemáticas recuperadas. Utilizamos as bases de dados PubMed (Medline), EMBASE e Cochrane para realizar o levantamento de revisões sistemáticas com ou sem meta-análises de ECR. Dois pesquisadores de maneira independente realizaram a seleção das revisões sistemáticas, avaliaram a qualidade metodológica utilizando a ferramenta AMSTAR e classificaram a qualidade das evidências pelo GRADE. RESULTADOS: Esta overview incluiu 10 revisões sistemáticas e meta-análises de ECR que avaliaram a capacidade funcional mensurada pelo HAQ e a qualidade de vida mensurada pelo SF-36 (PCF e PCM) em pacientes com AR que utilizaram a terapia com os agentes biológicos comparada a terapia convencional com a utilização das DARMDq. A maioria da revisões sistemáticas apresentaram alta qualidade metodológica avaliada pela ferramenta AMSTAR e a qualidade da evidência variou entre baixa a alta qualidade pelo GRADE. A melhora da capacidade funcional e qualidade de vida observada no período inicial do tratamento (24 semanas) com a terapia biológica, foi de pequena relevância clínica. Esta diferença entre os tratamentos não foi observada no longo prazo (52 semanas), principalmente com os agentes biológicos na forma de monoterapia. CONCLUSÃO: Evidências que variam entre baixa a alta qualidade mostraram que os agentes biológicos apresentaram melhora de baixa relevância clínica na capacidade funcional e qualidade de vida no período inicial do tratamento em comparação à terapia convencional com as DARMDq. Entretanto, não há diferenças entre a utilização da terapia biológica e da terapia convencional a longo prazo / INTRODUCTION: Several randomized clinical trials (RCTs) have been conducted in recent years on the efficacy of biological agents in the treatment of rheumatoid arthritis (RA). However, systematic reviews on this topic still raise doubts about the real efficacy related to functional capacity and quality of life. METHODS: This study synthesized the evidence generated by systematic reviews comparing the treatment with biological agents and the conventional treatment with disease-modifying antirheumatic drugs (DMARD), considering the functional capacity and quality of life of patients with RA, also evaluating the methodological quality of the systematic reviews retrieved. PubMed (Medline), EMBASE and Cochrane databases were searched for systematic reviews with or without RCT meta-analyzes. Two researchers independently carried out the selection of systematic reviews, assessed the methodological quality using the AMSTAR tool and classified the quality of the evidence by GRADE. RESULTS: This overview included 10 systematic reviews and meta-analyzes of RCTs that assessed functional capacity measured by HAQ and quality of life measured by SF-36 (PCS and MCS) in RA patients who used therapy with biological agents compared to conventional therapy with DMARDq. Most of the systematic reviews presented high methodological quality evaluated by the AMSTAR tool and the quality of the evidence ranged from low to high quality by GRADE. The improvement in functional capacity and quality of life observed in the initial period of treatment (24 weeks) with biological therapy presented low clinical relevance. This difference between the treatments was not observed in the long term (52 weeks), mainly with the biological agents in the form of monotherapy. CONCLUSION: Evidence that varied between low to high quality demonstrated that biological agents presented improvement with low clinical relevance of the functional capacity and quality of life during the initial period of treatment compared to conventional therapy with DMARDq. However, there are no differences in the long term between the use of biological therapy and conventional therapy

Made available in DSpace on 2016-04-27T18:47:27Z (GMT). No. of bitstreams: 1 Vera Lucia Tavares.pdf: 107214831 bytes, checksum: f1016e97b07cb2aa1f4547b4f8e15e3a (MD5) Previous issue date: 2008-04-07 / Aging is a world phenomenon that comprises biological, psychological, and social changes, which many times lead the elder to a total or partial dependence of a caretaker, who are usually the spouses, sons, daughters, daughters-in-law, sonsin- law, nephews, nieces, or grandchildren. Most of these caretakers do not have a healthcare professional background, but are moved by their good will and availability. However, it is noticed that, more and more, these relatives have professional activities out of the house and the Long-Term Stay Institutions (LTSI) many times consist in the only choice for these subjects and their families. The purpose of this study is to identify the will of the residents regarding the LTSI, and what they expect of the place where they live, through a qualitative research. Semi-structured interviews were used as a data collection technique, upon the use of an open-question questionnaire. Reflections regarding the social representations of the residents of this LTSI, which identify their wishes related to the place where they live and what they expect of it, are presented. These reflections also identify the inter-relations among residents and how they relate to the institution managers, contributing for the resident to preserve his/her functional ability and autonomy. There are also suggestions for the elaboration of action plans for the continuous healthcare improvements to these residents, turning the LTSI into a pleasant community, which provides them with quality of life and preserves their identities / O envelhecimento é um fenômeno mundial que pressupõe alterações biológicas, psicológicas e sociais, que muitas vezes leva o idoso a uma dependência total ou parcial de um cuidador que geralmente são os cônjuges, filhos, noras, genros, sobrinhos ou netos. Esses cuidadores em sua maioria não dispõem de uma formação profissional de saúde, mas são movidos por sua boa vontade e pela disponibilidade. Porém, percebe-se que cada vez mais, esses familiares exercem atividades profissionais fora do lar e as Instituições de Longa Permanência para Idosos (ILPIs) constituem-se muitas vezes, na única opção para esses indivíduos e suas famílias. O objetivo deste estudo é identificar os desejos dos moradores com relação a ILPI, e o que eles esperam do lugar onde moram, através de uma pesquisa qualitativa. Foi utilizada como técnica de coleta de dados, entrevistas semi estruturadas, mediante a utilização de um questionário com questões abertas. Apresento reflexões que se referem às representações sociais dos moradores que vivem nesta ILPI, identificando seus desejos com relação ao local onde residem e o que esperam deste local. Identificando ainda as relações dos moradores entre si e como se relacionam com os dirigentes da instituição, contribuindo para que o idoso morador preserve sua capacidade funcional e autonomia e também através de sugestões para a elaboração de planos de ação para melhorias contínuas de assistência a esses moradores, tornando a ILPI uma comunidade aprazível, proporcionado-lhes qualidade de vida e preservando sua identidade

Submitted by Anelise Milech (anelisemilech@gmail.com) on 2017-11-08T15:02:55Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Mariana Ribeiro Silva.pdf: 1861046 bytes, checksum: 6fc494bc3a100f6457bd70405caed82e (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-01-02T13:43:54Z (GMT) No. of bitstreams: 2 Mariana Ribeiro Silva.pdf: 1861046 bytes, checksum: 6fc494bc3a100f6457bd70405caed82e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-01-02T13:44:29Z (GMT) No. of bitstreams: 2 Mariana Ribeiro Silva.pdf: 1861046 bytes, checksum: 6fc494bc3a100f6457bd70405caed82e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-01-02T13:44:37Z (GMT). No. of bitstreams: 2 Mariana Ribeiro Silva.pdf: 1861046 bytes, checksum: 6fc494bc3a100f6457bd70405caed82e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-07-07 / Objetivo: Investigar as respostas neuromusculares, cardiorrespiratórias, funcionais e de qualidade de vida de dois programas de treinamento no meio aquático (aeróbio e combinado) e de um programa de atividades físicas não periodizadas em mulheres idosas. Materiais e métodos: Quarenta e uma mulheres idosas voluntárias foram divididas em três grupos: grupo de treinamento aeróbio (TA; n=16; 66 ± 4 anos), grupo de treinamento combinado (ordem força/aeróbio; TC; n=16; 66 ± 4 anos) e grupo controle de atividades terrestres não periodizadas (GC; n=9; 64 ± 3 anos). Os sujeitos realizaram treinamentos no meio aquático duas vezes na semana com as duas primeiras semanas de adaptação ao ambiente e aos exercícios e as 12 semanas posteriores de treinamentos específicos. O grupo controle realizou 14 semanas de programas não periodizado, com atividades de dança e ginástica. O treinamento de força foi realizado com séries em máxima velocidade e o treinamento aeróbio foi realizado em percentuais da frequência cardíaca do limiar anaeróbio (85-110%) determinado em teste progressivo no meio aquático. Foram realizadas avaliações pré e pós-treinamento da força muscular dinâmica máxima dos extensores de joelhos e no supino sentado (avaliada durante o teste de 1RM), do consumo de oxigênio de pico e nos limiares ventilatórios (avaliada em esteira terrestre com protocolo de Bruce), da ativação neuromuscular isométrica máxima dos músculos reto femoral, vasto lateral e deltoide (eletromiografia - EMG), da percepção de qualidade de vida (WHOQOL-BREF) e da capacidade funcional nos testes de levantar e sentar da cadeira, caminhar 6 minutos e levantar, ir e voltar. Analisou-se os dados por protocolo e por intenção de tratar utilizando o teste Generalized Estimating Equations (GEE), e teste post-hoc de Bonferroni (α=0,05). Resultados: Em ambas formas de análise os resultados demonstraram um aumento significativo em 1RM na extensão de joelhos somente para os grupos de treinamento no meio aquático (TA: 16 ± 12%; TC: 15 ± 16%), por outro lado,8 no supino sentado somente pela análise por intenção de tratar foram demonstrados aumentos apenas para os grupos de treinamento aquático (TA: 9 ± 17%; TC: 6 ± 18%). Foi observado melhoras significativas para consumo de oxigênio de pico após o período de treinamento (TA: 23 ± 21%; TC: 18 ± 9%; GC: 7 ± 16%), para o consumo de oxigênio no primeiro limiar (TA: 27 ± 37%; TC: 23 ± 24%; GC: 22 ± 23 %) e para os testes funcionais de sentar e levantar (TA: 32 ± 11%; TC: 24 ± 14%; GC: 20 ± 9), caminhar 6 min (TA: 10 ± 7%; TC: 7 ± 6%; GC: 7 ± 5%) e levantar ir e voltar (TA: 11 ± 5%; TC: 10 ± 9%; GC: 10 ± 6%), nas duas formas de análise sem diferenças entre os grupos. Por outro lado, para consumo de oxigênio no segundo limiar somente os grupos de treinamento aquático melhoraram após o treinamento (TA: 20 ± 24%; TC: 23 ± 13%). Nenhuma diferença foi encontrada para a ativação EMG dos músculos vasto lateral e deltoide, enquanto o reto femoral teve uma diminuição da ativação EMG de 21 ± 24% somente para GC, quando analisado por intenção de tratar. As duas formas de análise geraram resultados similares de percepção de qualidade de vida demonstrando que o GC diminuiu a percepção de qualidade de vida no domínio físico (12 ± 10%) e não alterou nos demais domínios. Nos grupos de treinamento aquático melhoras foram observadas nos domínios físico (TC: 13 ± 16%), psicológico (TA: 9 ± 16%; TC: 10 ± 11%), social (TA: 19 ± 42%; TC: 16 ± 21%), ambiental (TA: 10 ± 17%; TC: 16 ± 28%) e geral (TA: 17 ± 22%; TC: 14 ± 27% somente por intenção de tratar), nenhuma diferença significativa foi observada no domínio físico para TA. Conclusão: Treinamento aeróbio e treinamento combinado no meio aquático são eficazes para uma melhora da condição ardiorrespiratória, da força muscular dinâmica máxima de membros superiores e inferiores, da percepção de qualidade de vida e da capacidade funcional, assim como uma possível manutenção da ativação neuromuscular máxima dos músculos analisados. Ainda, atividades físicas não periodizadas são eficazes para o aumento da condição cardiorrespiratória (com exceção do consumo de oxigênio no segundo limiar) e da capacidade funcional, entretanto não são positivas no aumento da percepção de qualidade de vida e da força muscular dinâmica máxima de membros superiores e inferiores. / Purpose: Investigate neuromuscular, cardiorespiratory, functional and quality of life responses of two training programs in the aquatic environment (aerobic and combined) and a physical activity program not periodized in elderly women. Materials and methods: Fourty-one elderly women volunteer were divided into three groups: aerobic training group (AT; n=16; 66 ± 4 years), combined training group (sequence resistance/aerobic CT; n=16; 66 ± 4 years) and control group (CG; n=9; 64 ± 3 years). The subjects performed the water-based trainings for 14 weeks, twice a week with two weeks of adaptation to the water and exercises and after that 12 weeks of specific training. The control group performed 14 weeks of programs not periodized with dance and gymnastics activities. The resistance training was performed with sets in maximal effort and the aerobic training was performed in percentage of heart rate corresponding to the second ventilator threshold (85-110%) determined during a maximal progressive test in the water environment. Before and after the training period, the subjects were evaluated during maximal dynamic strength in the knee extensors and during the bench press (assessed using 1RM test), peak oxygen uptake and ventilatory thresholds (assessed on treadmill on land by Bruce protocol), the maximal isometric neuromuscular activity of the rectus femoris, vastus lateralis and deltoid (electromyography - EMG), perception of quality of life (WHOQOLBREF) and functional capacity in the tests 30-Second Chair Stand, 6-Minute Walk and 8-Foot Up-and-Go. Data were analyzed by protocol and by intention to treat using Generalized Estimating Equations test (GEE), and post-hoc Bonferroni (α = 0.05). Results: In both forms of analysis the results showed a significant increase in 1RM in the knee extension only for the water-based training (AT: 16 ± 12%; CT: 15 ± 16%), on the other hand, in bench press only by intention to treat analysis was demonstrated increases just for water training groups (AT: 9 ± 17%; CT: 6 ± 18%). It was observed significant improvements in peak oxygen uptake after the training period (AT: 23 ± 21%; CT: 18 ± 9%;11 CG: 7 ± 16%), for the consumption of oxygen in the first threshold (AT: 27 ± 37%; CT: 23 ± 24%; CG: 22 ± 23%) and functional tests 30-Second Chair Stand (AT: 32 ± 11%; CT: 24 ± 14%; CG: 20 ± 9), 6-Minute Walk (AT: 10 ± 7%; CT: 7 ± 6%; CG: 7 ± 5%) and 8-Foot Up-and-Go (AT: 11 ± 5%; CT: 10 ± 9%; CG: 10 ± 6%), in both forms of analysis without differences between groups. On the other hand, for onsumption of oxygen in the second threshold only waterbased training groups improved after training (AT: 20 ± 24%; CT: 23 ± 13%). No difference was found for the EMG activation of vastus lateralis and deltoid, as the rectus femoris had a decrease in EMG activation of 21 ± 24% only for CG, when analyzed by intention to treat. The two forms of analysis generated similar results of perceived quality of life showing that CG decreased perception of quality of life in the physical domain (12 ± 10%) and did not change in other domains. In groups of aquatic training improvements were observed in the physical (CT: 13 ± 16%), psychological (AT: 9 ± 16%; CT: 10 ± 11%), social (AT: 19 ± 42%; TC: 16 ± 21%), environmental (AT: 10 ± 17%; CT: 16 ± 28%) and overall (AT: 17 ± 22%; CT: 14 ± 27% only by intention to treat), no significant difference was observed in the domain physical to AT. Conclusion: Aerobic training and combined training in the aquatic environment are effective for improving cardiorespiratory fitness, maximal dynamic muscle strength of upper and lower limbs, the perception of quality of life and functional capacity, as well as a possible maintenance of maximum neuromuscular activation of muscles analyzed. Also, physical activities not periodized are effective for increasing cardiorespiratory fitness (with the exception of oxygen consumption in the second threshold) and functional capacity, but are not positive to increase the perception of quality of li e and maximal dynamic muscle strength in upper and lower limbs.

Made available in DSpace on 2014-06-11T19:30:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-10-27Bitstream added on 2014-06-13T20:00:59Z : No. of bitstreams: 1 lopes_ag_dr_rcla.pdf: 2903807 bytes, checksum: 228b34baf835343d3246b38b7c81d87c (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O envelhecimento, associado ao sedentarismo vem acompanhado de muitas alterações estruturais, funcionais e comportamentais. O controle postural depende da integridade dos sistemas sensoriais e motor e, portanto, as deteriorações que ocorrem nestes sistemas com a ausência de um estilo de vida saudável, podem influenciar o desempenho de controle postural. Entretanto, ainda não estão claras quais alterações funcionais nos sistemas sensoriais e motor podem ser promovidas pela pratica de exercícios físicos, bem como a relação entre estas alterações e as mudanças no desempenho de controle postural de adultos idosos. Assim, o objetivo deste estudo foi examinar os efeitos de um programa de atividade física no controle postural e componentes de capacidade funcional de idosos, abordando aspectos sensoriais, motores e o relacionamento entre ambos. Treze adultos idosos com idade entre 60 e 70 anos foram submetidos a avaliações sensoriais, motoras, de controle postural e capacidade funcional antes e após a participação em um programa de exercícios físicos generalizado. As avaliações sensoriais foram compostas por avaliação visual (acuidade e sensibilidade ao contraste) e somatossensorial (sensibilidade cutânea e sensibilidade ao movimento passivo). As avaliações motoras consistiram de medidas de torque articular e de latência de ativação muscular após perturbação da superfície de suporte. As avaliações de controle postural consistiram de medidas de oscilação corporal durante manutenção da postura ereta (em semitandem stance) e para capacidade funcional foi aplicada a bateria da AAHPERD, Os resultados indicaram que o programa de exercícios proposto influenciou positivamente as capacidades de agilidade, força e capacidade aeróbia e, ainda, a capacidade de produzir torque e latência muscular. Estes resultados indicam que o aumento causado na força muscular... / Aging and a sedentary life style exhibit several structural, functional and behavioral changes. A good postural control performance depends on the integrity of the sensory and motor systems, deterioration of these systems occurring with aging could influence the postural control performance, specifically in older adults that are more susceptible to falls. However, it is still unclear which sensory and motor functional changes can be affected by a physical fitness program, neither the relationship between these changes and the changes of the performance of postural control in older adults. Therefore, the purpose of this study was to examine the effects of a exercise training program in the performance of the sensory and motor systems and postural control in older adults and to investigate the relationship between changes in these systems and postural control in this population. Thirteen older adults with age from 60 to 70 years old were submitted to sensory, motor and postural control assessments. Sensory assessments were composed of visual (acuity and contrast sensitivity) and somatosensory assessments (tactile sensitivity of and sensitivity to passive motion). Motor assessments consisted of measurements of joint torque and muscular activity latency after displacement of support surface. Postural control assessments consisted of measuring the body oscillation during maintenance of the upright stance (semi-tandem stance) and de functional capacity where measured by the Functional fitness tests of AAHPERD. The results indicated that the training program improved de agility, strength and aerobic capacity of the functional capacity, the torque capacity and a reduction of the muscular latency. The absence of training effects on the postural control can indicate that the processing of sensory information can be more weight on de stand stance than the physical capabilities. The present study shows...(Complete abstract click electronic access below)