Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

A evidência científica da cariologia atual vem apontando para a promoção de saúde bucal, técnicas preventivas, diagnóstico precoce da doença cárie e suas lesões nos elementos dentais, remineralização de lesões de cárie incipientes e a intervenção restauradora célere como procedimentos minimamente invasivos. Durante o ato de remoção de lesão de cárie, é comum remover-se inadvertidamente também tecido dental hígido durante a fase final, por ser um tanto quanto difícil precisar clinicamente os limites entre tecido dental comprometido e tecido dental viável. Usando-se a tecnologia com lasers de Érbio, uma dica clínica subjetiva é a mudança da percepção do som emitido pela ablação do tecido dental ao passar-se de substrato cariado para hígido (de grave para agudo), como uma forma adicional de saber que a ablação naquele ponto deve ser interrompida. Este estudo visa classificar estas diferenças sonoras em dentina e torná-las um parâmetro objetivo para odontologia de mínima intervenção ao usar-se lasers de Érbio. Para tanto, foram realizadas três fases do estudo: primeiramente, utilizaram-se vinte dentes posteriores humanos, sendo dez cariados e dez hígidos. A dentina foi irradiada com laser de Er:YAG sob os mesmos parâmetros, distância e refrigeração e um microfone monodirecional foi posicionado a 10cm da área operatória para captação e gravação dos sons produzidos pela ablação ao se operar tanto em dentina hígida quanto cariada. Dez pulsos por arquivo foram então analisados em um software (200 análises). Foram encontradas diferenças entre os padrões sonoros produzidos dos grupos cariados e hígidos e encontrado um ponto de corte para estas freqüências sonoras, que seria testado a seguir. Em outra segunda etapa, foi desenvolvido, testado e aplicado um software limitador de freqüência sonora, para que, em tempo real, avisasse o operador se o tecido dentinário que estava sendo ablacionado pelo laser de Érbio (Er:YAG e Er,Cr:YSGG) era cariado ou viável, e este evitasse o sobrepreparo, ou seja, desgastar o tecido sadio inadvertidamente, de acordo com os preceitos de mínima intervenção. Finalmente, em uma terceira etapa, o método foi validado através dos critérios visual-tátil e de fluorescência a laser; ilustrações representativas dos espécimes testados foram obtidas através de microscopia de luz e de microscopia eletrônica de varredura. Conclui-se que o som da ablação dentinária é um parâmetro objetivo que pode ser utilizado como um recurso adicional de orientação no processo de remoção de dentina cariada com lasers de Érbio e que a ferramenta desenvolvida para tanto foi efetiva, devendo ser aprimorada. O método foi validado exitosamente pelos critérios propostos. / Studies in cariology have been struggling for the development of health promotion, caries prevention techniques, precocious diagnoses of lesions, re-mineralization of incipient carious lesions and early restorative intervention with minimally invasive procedures. When removing caries lesion, healthy dental structure is often removed inadvertently during its final phase, for being quite difficult to clinically precise the limits between viable and decayed dental tissues. With laser technologies, a subjective clinical hint, often used to indicate when tissue ablation should be stopped is that different sounds are perceptive whether in carious (bass) or in healthy (treble) dental structure; when sound produced by ablation turned treble it would mean that healthy tissue was reached. This study aims to classify those audio differences and to turn them into objective parameters for a conservative operative dentistry with minimally invasive tissue removal when using Erbium lasers. For so, three phases of this study were needed: at first, twenty freshly extracted posterior human teeth were used (10 decayed and 10 sound teeth). Dentine was irradiated with Er:YAG laser under the same parameters, distance and refrigeration and a mono directional microphone was set 10cm far from the operative area in order to capture and record the ablation produced sounds when working either on carious or healthy dentine. Ten pulses per file were then analyzed in a computer software (200 analyses).It was permitted to draw differences between decayed and healthy produced sounds and also to establish a cut-off value for these sound frequencies, that would be tested later on. On a second phase, a piece of software which was able to border the sound frequency was then developed and tested. This tool was meant to warn the operator, in real-time basis, if sound dentine was reached, while it was ablated by Erbium lasers (either Er:YAG or Er,Cr:YSGG) and so one could avoid over-treatment, which means not to remove sound tissue inadvertently, according to minimal intervention dentistry concepts. Finally, on a third part of the study, the proposed guiding method for dentine caries removal was validated through visuo-tactile and laser fluorescence criteria. Representative illustrations of the tested specimens were obtained by light microscopy and scanning electron microscopy. As a conclusion, audio analysis came out to be a technical reliable objective parameter to determine whether laser ablated dentine substrates are decayed or sound; therefore it can be proposed as an additional conservative parameter to guide the clinician during dentine caries removal process, and that the tool developed for so was effective and should be sharpened. This method was successfully validated by the proposed criteria.

O diabetes mellitus tipo 1 (DM1) está associado com condições pró-oxidantes, próinflamatórias e elevado risco cardiovascular, enquanto o exercício físico pode ser considerado um dos melhores instrumentos não farmacológicas para o tratamento do DM1. Nesse contexto, exercícios que propiciem um menor risco hipoglicêmico e diversos benefícios sobre a saúde devem ser estimulados. Um dos objetivos da tese foi verificar a influência da realização de exercícios de força (SE) antes ou depois do exercício intervalado de alta intensidade (HIIE) sobre o comportamento glicêmico durante e logo após uma sessão de esforço (estudo transversal) (manuscrito original 1). Entretanto, o principal objetivo desta tese foi comparar os efeitos do treinamento intervalado de alta intensidade (HIIT), do treinamento de força (ST) e da combinação destes (ST+HIIT), sobre marcadores sanguíneos inflamatórios, de estresse oxidativo (OS) e metabolismo glicêmico em pacientes com DM1 através de um ensaio clínico randomizado (ECR) (manuscrito original 2). Com relação ao estudo transversal (manuscrito 1), em três visitas, adultos fisicamente ativos realizaram 30 min de SE antes de 30 min de HIIE ou realizaram a ordem inversa da sessão (HIIE+SE) ou permaneceram em repouso nesse período (REST). A glicemia capilar foi mensurada a cada 15 min durante e até 60 min da recuperação. Comparando-se com os valores basais, a condição HIIE+SE reduziu a glicemia em 30, 45 e 60 min, enquanto SE+HIIE adiou esta queda glicêmica para a partir de 60 min. HIIE+SE também acarretou uma maior glicemia em 105 min quando comparado a 60 min. A quantidade ingerida de carboidratos durante as sessões, bem como a dose insulínica no mesmo dia antes e depois dos protocolos, além dos episódios noturnos de hipoglicemia, foram similares entre as três condições. Conclui-se que pacientes com DM1 propensos a desenvolver hipoglicemia associada ao exercício devem realizar SE antes do HIIE na mesma sessão. Com relação ao estudo principal (ECR) (manuscrito original 2), após 4 semanas de um período controle, pacientes fisicamente inativos com DM1 foram randomizados para realização de 10 semanas de HIIT, ST ou ST+HIIT, praticados 3x/sem. As sessões de HIIT duraram 25 min, as de ST 40 min, e as de ST+HIIT ~65 min. Os desfechos foram analisados através do modelo de equações de estimativas generalizadas (GEE), com post hoc de Bonferroni. ST, HIIT e ST+HIIT melhoraram parâmetros glicêmicos e antioxidantes, mas não os marcadores plasmáticos de inflamação e de OS. Interessantemente, as intervenções reduziram as concentrações de receptores solúveis para produtos finais da glicação avançada. Entretanto, o conteúdo intracelular das proteínas de choque térmico de 70 kDa aumentou somente depois do HIIT. Enquanto a dose diária de insulina utilizada reduziu apenas no grupo ST+HIIT, todos os protocolos induziram benefícios antropométricos, cardiorrespiratórios e funcionais. Sob uma perspectiva prática, conclui-se que um maior volume (ST+HIIT) de treinamento é necessário para o benefício adicional da redução insulínica diária. Já o HIIT, por exemplo, é diretamente aplicável para pessoas que reclamam da falta de tempo, podendo ser recomendado devido a vantagem extra com relação a proteínas anti-inflamatórios em células imunológicas. / Type 1 diabetes mellitus (DM1) is associated with prooxidant and proinflammatory conditions, besides an increased cardiovascular risk, while exercise may be considered one of the best nonpharmacological tools for DM1 treatment. In this context, exercises linked with a lower hypoglycemic risk and several health benefits should be stimulated. One of the goals of this thesis was to verify the influence of performing strength exercises (SE) before or after highintensity interval exercise (HIIE) on glycaemia during and postexercise (cross-sectional study) (original manuscript 1). However, the main objective of this thesis was to compare the effects of high-intensity interval training (HIIT), strength training (ST) or their combination (ST+HIIT), on blood inflammatory, oxidative stress (OS) and glycemic markers in DM1 patients using a randomized clinical trial (ECR) (original manuscript 2). Regarding the crosssectional study (original manuscript 1), in three visits, physically active adults performed 30 min of SE before 30 min of HIIE or performed the reverse order (HIIE+SE) or rested for 30 min (REST). Capillary glycaemia was measured each 15 min during and 60 min postexercise recovery. HIIE+SE lowered glycaemia at 30, 45 and 60 min compared with baseline concentrations, while SE+HIIE postponed this glucose decayment to 60 min and thereafter. HIIE+SE increased glycaemia at 105 min compared with 60 min. Carbohydrates ingested during exercise, insulin dosage at same day before and after protocols, and nocturnal hypoglycemia episodes were similar among the three conditions. DM1 patients prone to develop exercise-associated hypoglycemia should perform SE before HIIE in a single session. Regarding the main study (ECR) (original manuscript 2), after 4-week control period, physically inactive patients with DM1 were randomly assigned to 10-week HIIT, ST or ST+HIIT protocol, performed 3 x/week. HIIT sessions lasted 25 min, ST lasted 40 min and ST+HIIT sessions lasted ~65 min. Blood biochemical, anthropometric, strength and cardiorespiratory fitness variables were assessed. Outcomes were analyzed via generalized estimating equations (GEE), with Bonferroni post hoc analysis. ST, HIIT and ST+HIIT improved glycemic and antioxidant parameters, but not plasma inflammatory or OS markers. Noteworthy, interventions reduced soluble receptors for advanced glycation end products levels. However, intracellular heat shock protein 70 content increased only after HIIT. While daily insulin dosage decreased only in the ST+HIIT group, all training models induced anthropometric and functional benefits. From a practical clinical perspective, a higher volume (SE+HIIT) of training is required for the additional benefit of daily insulin reduction. The HIIT, for example, is directly applicable for people who claim lack of time, and it may be 13 recommended due to extra advantage concerning anti-inflammatory proteins at immunological cells.

La thérapie par faisceaux ultrasonores focalisés de forte intensité (HIFU / High Intensity Focused Ultrasound) est une nouvelle technique d’ablation tissulaire, fondée sur la focalisation de faisceaux ultrasonores de forte intensité pour réaliser une élévation de température capable de créer une nécrose thermique. Le cerveau a été jusqu’à présent peu accessible aux ultrasons car il est protégé par la boîte crânienne. Mais de nouvelles techniques de focalisation par correction des aberrations des faisceaux ultrasonores laissent espérer des applications prochaines en intracrânien, où l’HIFU pourrait constituer une intéressante alternative à la chirurgie et à la radiothérapie stéréotaxique. Le but général de ce travail a été de tester la thérapie HIFU contrôlée par Imagerie de Résonance Magnétique (IRM) pour le traitement des tumeurs cérébrales dans un modèle petit animal in vivo de tumeur cérébrale. Nous espérons ainsi fournir des apports sur la thérapie HIFU et ses effets biologiques sur le cerveau et les tumeurs cérébrales, connaissances nécessaires avant de passer à des études cliniques chez l’homme. Le plan de ce travail est le suivant : 1) développement d’un protocole de thérapie HIFU contrôlé par IRM sur le cerveau sain et sur un modèle de tumeur RG2 greffée en intracérébral chez le rat ; 2) étude des effets biologiques de l’HIFU par l’IRM et l’examen anatomo-pathologique sur le tissu cérébral sain et la tumeur RG2 en intracérébral, montrant une sensibilité variable des tissus à l’hyperthermie ; 3) étude de sécurité (tolérance et effets indésirables), démonstration d’efficacité sur la tumeur RG2 (ralentissement de l’évolution tumorale et augmentation de la survie des animaux traités). En conclusion, l’HIFU a montré sa précision et son efficacité dans le traitement de la tumeur RG2 greffée en intracérébral chez le rat. Cette technique n’est cependant pas exempte de complications, notamment un œdème périlésionnel et des hémorragies intratumorales. / High Intensity Focused Ultrasound (HIFU) therapy is an innovative approach for tissue ablation, based on high intensity focused ultrasound beams. At focus, HIFU induces a temperature elevation and the tissue can be thermally destroyed. For transcranial brain therapy, the skull bone is a major limitation but new adaptive techniques for focusing ultrasound through the skull are underway and in the near future HIFU therapy could be an interesting alternative to brain surgery and radiotherapy.The overall aim of this work is to test HIFU therapy guided by Magnetic Resonance Imaging (MRgHIFU) for the treatment of brain tumors in an in vivo brain tumor model in rodent in order to provide inputs for future regulatory approval for clinical trial with a clinical prototype. In this work: 1) a dedicated system for transcranial MRgHIFU in an in vivo rat brain tumor model was developed, and a full protocol was applied in healthy brain tissue of rats and in transplanted tumors; 2) the biological effects of HIFU therapy was evaluated using MRI and histology in healthy brain tissue and in RG2 brain tumor, showing a different tissue sensibility for hyperthermia; 3) tolerance and side effects were investigated and the treatment was shown to improve the animal survival time by 50%. In conclusion, HIFU therapy has proved its accuracy and efficacy in the treatment of the RG2 brain tumor transplanted intracerebral in rats. However this technique is not free of complications, in particular edema and hemorrhages.

Syfte och frågeställningar: Syftet är att studera om träning på olika intensitetsnivåer påverkar upplevd stress hos kvinnor i Sverige. Denna studie kommer svara på dessa frågeställningar:  <ol type="1">Finns det någon skillnad i upplevd stress hos kvinnor som deltar på lågintensiv träning i form av promenader jämfört med kvinnor som deltar på högintensiv träning i form av löpning? Finns det någon skillnad i upplevd stress hos kvinnor som deltar på högintensiv träning i form av löpning jämfört med kvinnor som inte tränar alls? Finns det någon skillnad i upplevd stress hos kvinnor som deltar på lågintensiv träning i form av promenader jämfört med kvinnor som inte tränar alls?           Metod: Studien är en tvärsnittsstudie, genom enkätundersökningar har skillnader i upplevd stress jämförts på kvinnor med medelålder 39,03 år ( ± 14,44), som antingen tränat högintensivt eller lågintensivt. Resultaten har jämförts med en referensgrupp bestående av kvinnor som inte tränar alls. Perceived Stress Scale-10 (PSS10) inklusive tio stycken intensitets-frågor för inklusion i studien skickades ut via sociala medier, Facebook. Resultat: En signifikant skillnad sågs vid jämförandet av kvinnor som tränar högintensivt och referensgrupp, (p=0,001), poängmässig skillnad i PSS10; 7,67 poäng. Ingen signifikant skillnad redovisades mellan högintensiv och lågintensiv grupp (p=0,737), detsamma gällde lågintensiv och referensgrupp (p=0,081). Slutsats: Högintensiva kvinnor hade reducerad upplevd stress jämfört med kvinnor som inte tränade alls. Ingen skillnad i upplevd stress kunde urskiljas mellan kvinnor som tränar lågintensivt och kvinnor som tränade högintensivt. Samma gällde kvinnor som tränade på låg intensitet jämfört med kvinnor som inte tränade alls, ingen skillnad i upplevd stress. / Purpose and aims: The aim is to study if different exercise-intensities affects perceived stress in Swedish women. This study will answer the following questions: <ol type="1">Is there a difference in perceived stress in women who participate in low-intensity exercise in the form of walking compared to women who participate in high-intensity exercise in the form of running? Is there a difference in perceived stress in women who participate in high-intensity exercise in the form of running compared to women who do not exercise at all? Is there a difference in perceived stress in women who participate in low-intensity exercise in the form walking compared to women who do not exercise at all?           Method: The study is a cross-sectional study, through questionnaires, differences in perceived stress have been compared in women with a mean age of 39,03 years (± 14,44), who either exercised with high intensity or with low intensity. The results have been compared to a reference group consisting of non-training women. Perceived Stress Scale-10 (PSS10) together with ten intensity-questions for inclusion in the study was sent out via social media, Facebook. Results: A significant difference was detected in the comparison of the high intensity group and the reference group, (p=0.001), score difference in PSS10; 7,67 points. No significant difference between the high-intensity group and the low-intensity group (p=0.737), the same applied to the low-intensity group and the reference group (p=0,081). Conclusions: Women who participated in high intensity exercise had reduced percieved stress compared to women who did not exercise at all. No difference in percieved stress was observed between women who participated in low intensity exercise and women who participated in high intensity exercise. Similarly, no difference in percieved stress in women who participated in low intensity exercise and women who did not exercise at all.

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Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

[Truncated abstract] Broadly, research literature on the physiological aspects of water polo game play is limited, but particularly so in the women's game. Moreover, significant changes to game rules in recent years are likely to have had an impact on the game demands. Therefore, this research project sought to investigate the physiological characteristics of contemporary elite female water polo players and the demands of match play. Overall, the five studies comprising this thesis aimed to improve the practical knowledge of coaches and sport scientists concerning the training and monitoring of players. Study one (Chapter 3) compared two water polo-specific field tests of aerobic and/or match fitness (MSST, multistage shuttle swim test; and WIST, water polo intermittent shuttle test) with a traditional incremental swimming test to exhaustion (IST, 5 x 200 m). Prior to this study, the physiological responses to the MSST and WIST were not well understood. Additionally, the degree of association between these two tests was unknown. Therefore, 14 Australian National Women's Water Polo Squad players performed the MSST and WIST, and 13 players from a National Water Polo League club performed the MSST, WIST and IST, on separate occasions. Peak heart rate, blood lactate and ratings of perceived exertion were obtained for all tests. Expired air was collected post test for the National League players. The results showed that the National Squad players performed significantly better in the MSST (636 ± 114 vs. 437 ± 118 m, p < 0.001) and WIST (270 ± 117 vs. 115 ± 57 m, p < 0.001) than the National League players. ... Absolute decrement yielded TE of 0.55 s (-0.42-0.81), CV of 26.0% (19.3-41.0) and ICC of -0.002 (-0.44-0.44). Relative (%) decrement yielded TE of 1.6% (1.2-2.3), CV of 27.2% (20.1-42.9) and ICC of -0.02 (-0.46-0.42). Results indicate that total time was a reliable measure, whilst decrement was not. Similar to land-based RSA tests, total time should be the criterion measure of performance in the RST. The RST can form part of a specific battery of field tests for water polo, and can also be used as a conditioning tool. The final study (Chapter 7) was a nutritional-intervention study. Based on the time-motion data from study three, a 59-min match simulation test (MST) was designed to mimic the activity profiles and physical demands of water polo match play. Using a randomized cross-over double-blind design, 12 Australian National Women's Water Polo Squad players ingested 0.3 g·kg-1 of NaHCO3 or placebo, 90 min before performing the MST, which included 56 x 10-m maximal-sprint swims as the performance measure. Although pre-exercise ingestion of NaHCO3 was effective in enhancing extracellular pH and bicarbonate levels, the percentage difference in mean sprint times between trials showed no substantial effects of NaHCO3 (0.4; ±0.9%, effect size = 0.09; ±0.23, p = 0.51). The results suggest that elite water polo players should not expect enhancement in intermittent-sprint performance from NaHCO3 supplementation. These findings are contrary to previous NaHCO3 studies on simulated team-sport performance, but this investigation is unique in that it examined highly-trained athletes performing sport-specific tasks. In conclusion, the findings of this thesis add to the existing literature on the applied physiology of women's water polo. It is hoped that the knowledge gained from these findings will lead to more appropriate conditioning, testing and selection outcomes.

O diabetes mellitus tipo 1 (DM1) está associado com condições pró-oxidantes, próinflamatórias e elevado risco cardiovascular, enquanto o exercício físico pode ser considerado um dos melhores instrumentos não farmacológicas para o tratamento do DM1. Nesse contexto, exercícios que propiciem um menor risco hipoglicêmico e diversos benefícios sobre a saúde devem ser estimulados. Um dos objetivos da tese foi verificar a influência da realização de exercícios de força (SE) antes ou depois do exercício intervalado de alta intensidade (HIIE) sobre o comportamento glicêmico durante e logo após uma sessão de esforço (estudo transversal) (manuscrito original 1). Entretanto, o principal objetivo desta tese foi comparar os efeitos do treinamento intervalado de alta intensidade (HIIT), do treinamento de força (ST) e da combinação destes (ST+HIIT), sobre marcadores sanguíneos inflamatórios, de estresse oxidativo (OS) e metabolismo glicêmico em pacientes com DM1 através de um ensaio clínico randomizado (ECR) (manuscrito original 2). Com relação ao estudo transversal (manuscrito 1), em três visitas, adultos fisicamente ativos realizaram 30 min de SE antes de 30 min de HIIE ou realizaram a ordem inversa da sessão (HIIE+SE) ou permaneceram em repouso nesse período (REST). A glicemia capilar foi mensurada a cada 15 min durante e até 60 min da recuperação. Comparando-se com os valores basais, a condição HIIE+SE reduziu a glicemia em 30, 45 e 60 min, enquanto SE+HIIE adiou esta queda glicêmica para a partir de 60 min. HIIE+SE também acarretou uma maior glicemia em 105 min quando comparado a 60 min. A quantidade ingerida de carboidratos durante as sessões, bem como a dose insulínica no mesmo dia antes e depois dos protocolos, além dos episódios noturnos de hipoglicemia, foram similares entre as três condições. Conclui-se que pacientes com DM1 propensos a desenvolver hipoglicemia associada ao exercício devem realizar SE antes do HIIE na mesma sessão. Com relação ao estudo principal (ECR) (manuscrito original 2), após 4 semanas de um período controle, pacientes fisicamente inativos com DM1 foram randomizados para realização de 10 semanas de HIIT, ST ou ST+HIIT, praticados 3x/sem. As sessões de HIIT duraram 25 min, as de ST 40 min, e as de ST+HIIT ~65 min. Os desfechos foram analisados através do modelo de equações de estimativas generalizadas (GEE), com post hoc de Bonferroni. ST, HIIT e ST+HIIT melhoraram parâmetros glicêmicos e antioxidantes, mas não os marcadores plasmáticos de inflamação e de OS. Interessantemente, as intervenções reduziram as concentrações de receptores solúveis para produtos finais da glicação avançada. Entretanto, o conteúdo intracelular das proteínas de choque térmico de 70 kDa aumentou somente depois do HIIT. Enquanto a dose diária de insulina utilizada reduziu apenas no grupo ST+HIIT, todos os protocolos induziram benefícios antropométricos, cardiorrespiratórios e funcionais. Sob uma perspectiva prática, conclui-se que um maior volume (ST+HIIT) de treinamento é necessário para o benefício adicional da redução insulínica diária. Já o HIIT, por exemplo, é diretamente aplicável para pessoas que reclamam da falta de tempo, podendo ser recomendado devido a vantagem extra com relação a proteínas anti-inflamatórios em células imunológicas. / Type 1 diabetes mellitus (DM1) is associated with prooxidant and proinflammatory conditions, besides an increased cardiovascular risk, while exercise may be considered one of the best nonpharmacological tools for DM1 treatment. In this context, exercises linked with a lower hypoglycemic risk and several health benefits should be stimulated. One of the goals of this thesis was to verify the influence of performing strength exercises (SE) before or after highintensity interval exercise (HIIE) on glycaemia during and postexercise (cross-sectional study) (original manuscript 1). However, the main objective of this thesis was to compare the effects of high-intensity interval training (HIIT), strength training (ST) or their combination (ST+HIIT), on blood inflammatory, oxidative stress (OS) and glycemic markers in DM1 patients using a randomized clinical trial (ECR) (original manuscript 2). Regarding the crosssectional study (original manuscript 1), in three visits, physically active adults performed 30 min of SE before 30 min of HIIE or performed the reverse order (HIIE+SE) or rested for 30 min (REST). Capillary glycaemia was measured each 15 min during and 60 min postexercise recovery. HIIE+SE lowered glycaemia at 30, 45 and 60 min compared with baseline concentrations, while SE+HIIE postponed this glucose decayment to 60 min and thereafter. HIIE+SE increased glycaemia at 105 min compared with 60 min. Carbohydrates ingested during exercise, insulin dosage at same day before and after protocols, and nocturnal hypoglycemia episodes were similar among the three conditions. DM1 patients prone to develop exercise-associated hypoglycemia should perform SE before HIIE in a single session. Regarding the main study (ECR) (original manuscript 2), after 4-week control period, physically inactive patients with DM1 were randomly assigned to 10-week HIIT, ST or ST+HIIT protocol, performed 3 x/week. HIIT sessions lasted 25 min, ST lasted 40 min and ST+HIIT sessions lasted ~65 min. Blood biochemical, anthropometric, strength and cardiorespiratory fitness variables were assessed. Outcomes were analyzed via generalized estimating equations (GEE), with Bonferroni post hoc analysis. ST, HIIT and ST+HIIT improved glycemic and antioxidant parameters, but not plasma inflammatory or OS markers. Noteworthy, interventions reduced soluble receptors for advanced glycation end products levels. However, intracellular heat shock protein 70 content increased only after HIIT. While daily insulin dosage decreased only in the ST+HIIT group, all training models induced anthropometric and functional benefits. From a practical clinical perspective, a higher volume (SE+HIIT) of training is required for the additional benefit of daily insulin reduction. The HIIT, for example, is directly applicable for people who claim lack of time, and it may be 13 recommended due to extra advantage concerning anti-inflammatory proteins at immunological cells.

L’activité physique (AP) induit des nombreux bénéfices sur la santé. Cependant, le niveau d’inactivité reste important : 42% des Français ne pratiquent aucune AP de loisir. Plusieurs facteurs déterminent l’engagement durable dans l’AP. Cette thèse a pour objectif d’évaluer certains des facteurs susceptibles d’améliorer cet engagement : modalité d’exercice, réponse affective à l’exercice, motivation pour l’AP, et d’optimiser les réponses physiologique et affective à l’exercice.L’oxydation des lipides joue un rôle important dans la prévention et le traitement de certaines pathologies cardio-métaboliques. Des travaux récents montrent l’intérêt potentiel d’un programme d’exercice intermittent intense (EII) sur la diminution de la masse grasse. Nous avons tenté d’optimiser l’oxydation lipidique survenant au cours d’un exercice combiné (COMB : 10-min d’EII + 35-min d’exercice d’intensité modérée continu, EIMC) comparé à une séance d’EIMC prolongé. Ce protocole original induit une oxydation lipidique plus importante (1,5 fois) dans la phase de 35-min d’EIMC au cours de COMB que celle obtenue au cours d’un EIMC prolongé isocalorique. Cette étude montre l’intérêt de l’EII pour augmenter le métabolisme lipidique.La modalité d’exercice ainsi que la réponse affective à l’exercice sont importants pour l’engagement durable dans l’AP. L’étape suivante de ce travail de thèse a consisté donc à évaluer la réponse affective aux différentes modalités d’exercice aigus (EIMC vs EII, avec pic d’intensité au début, au milieu et à la fin, avec ou sans soutien de l’autonomie) chez les individus en surpoids/obèses et chez la personne âgée. Ces populations ont été choisies car elles sont peu enclines à faire de l’AP régulière, alors qu’elle est importante pour eux. Les résultats de ces études montrent que la réponse affective diminue progressivement au cours de l’exercice dans toutes les conditions. Cependant, cette diminution est moins importante dans les conditions avec soutien de l’autonomie (chez la personne âgée et chez les sujets sains) indiquant l’importance de ce facteur. D’autre part, le moment auquel le pic d’intensité apparait détermine la réponse affective qui est plus négative quand la séance se termine avec l’exercice le plus intense.Après avoir évalué les effets de l’exercice aigu sur la réponse affective à l’exercice chez la personne en surpoids/obèse, nous nous sommes intéressés aux effets de l’entraînement sur la condition physique, les variables cardio-métaboliques, la réponse affective et la motivation. Ainsi, la dernière partie de travail de recherche a consisté alors à examiner les effets à court et long terme de l’entrainement (exercice intermittent intense sans : EII, et avec soutien de l’autonomie : EII+SA vs EIMC et groupe contrôle). Les résultats montrent qu’après les deux modalités d’entrainement intermittent intense la condition physique était améliorée après 24 séances. Ce type d’exercice influence positivement la composition corporelle. Cependant, les indicateurs de santé cardio-métabolique n’ont pas été modifiés. L’EII induit un moindre niveau de difficulté perçu de l’effort quand il est combiné avec un soutien de l’autonomie.Cette thèse montre que certaines modalités d’exercice (EII et/ou exercice qui se termine avec une intensité moins importante) ainsi que le soutien de l’autonomie favorisent une réponse affective positive qui pourrait influencer un engagement durable à l’AP. Ceci reste cependant à être démontré. / Regular physical activity (PA) induces many health benefits. However, the level of inactivity remains high: in France 42% of the population do not engage in any sport or leisure time PA. Many factors are responsible for the long-term involvement in PA. The main objective of this thesis was to evaluate some of those factors (exercise modality, affective response to exercise, PA motivation) and to optimize the physiological and affective responses to exercise.Lipid oxidation plays an important role in the prevention and in the treatment of metabolic diseases. Recent studies show the effectiveness of high intensity intermittent exercise (HIIE) on body fat. In this study we sought to optimize the lipid oxidation during a combined exercise (COMB: 10-min HIIE + 35-min prolonged moderate intensity continuous exercise, MICE). The results of this innovative study shows that fat oxidation can be increased (1.5 times) during 35-min MICE of COMB compared to the same period of a prolonged MICE if it’s performed after high intensity interval exercise (HIIE) vs an isocaloric MICE alone. This study shows the importance of HIIE to increase fat metabolism.The type of exercise, as well as affective response to exercise are important in order to increase regular PA participation. In the next part of this thesis, we assessed the affective response to different exercise modalities (MICE vs HIIE, peak of intensity at the beginning, in the middle or at the end of exercise, exercise with or without autonomy support) in overweight/obese subjects and in older adults. These populations were chosen because of their low PA participation level despite of its importance for health. The results show the decrease of affective response in each type of exercise. However, this decrease was lower in all autonomy supportive conditions (in older adults and in healthy subjects) showing the importance of this factor. In addition, the peak intensity time influenced the affective response: more negative feelings were observed when the session ended with the peak of intensity.After examining the effects of acute exercise sessions on affective response in overweight/obese subjects, we focused on the effects of exercise training on physical fitness, cardio metabolic health, affective response and motivation. Hence, in the last part of this thesis we examined the short and long-term effects of HIIE training vs MICE and control group. The main results showed the increase in physical fitness after two high intensity conditions. In addition, HIIE improved body composition. However, the cardio metabolic health variables remained unchanged after 24 sessions. In addition, HIIE induced a lower level of perceived exertion during exercise when it was combined with autonomy support.The results of this thesis show that some of exercise modalities (HIIE and/or exercise that ends with lower intensity) and autonomy support promote more positive affective response and can potentially influence the long term PA engagement. But the latter needs to be demonstrated.