Made available in DSpace on 2016-06-02T20:19:20Z (GMT). No. of bitstreams: 1 4922.pdf: 4086370 bytes, checksum: 3a795076403080081fd96b159704569b (MD5) Previous issue date: 2013-02-26 / Financiadora de Estudos e Projetos / The assessment of respiratory muscles by the measure of maximal inspiratory (MIP) and expiratory (MEP) pressures, have been routinely applied in the physical therapy clinical practice. However, these measures, especially MEP, have been contraindicated in some situations because it is believed that the cardiovascular responses obtained in MEP are similar to found during Valsalva maneuver (VM). So, based in these similarities between the responses two studies were done. The first study had as principal purpose to evaluate the heart rate (HR) during MEP and VM in healthy young, at different postures, to identify whether and in which situation the MEP reproduces the responses obtained in VM and additionally, to estimate the workload (W) realized during the maneuver. Twelve healthy young men (25±2 years) participated in this study and were evaluated, instructed and familiarized with the maneuvers, which were performed at supine and sitting positions. The VM was characterized by an expiratory effort (40 mmHg) against a manometer for 15 s. The MEP measure has been performed according to the American Thoracic Society. The results obtained in this study show that heart rate variation (&#916;HR) was not influenced by the position, and during VM, the &#916;HR and the Valsalva index (VI) were higher than the &#916;HR and MEP index (MEPI) values (p<0.001). Besides, the estimated workload of the maneuvers was statistically different (p<0.001) between the maneuvers, being that the Wtotal was higher in VM and the Wisotime and Wisotime/&#916;FCisotime were higher in MEP. Based in these results it could be concluded that in the study conditions the MEP does not reproduces the HR response observed in the VM in healthy young men. However, the results obtained in the first study allowed comparing only the cardiac stress generated by the maneuvers in a specific age, doing that the blood pressure (BP), cardiac output (CO), stroke volume (SV) and peripheral vascular resistance (PVR) responses remain unknown. Furthermore, little is known about the cardiovascular response during MEP measure in others age and distinct clinical conditions, once that aging process promotes important structural and functional alterations in the respiratory, cardiovascular and autonomic systems. Therefore, the second study had as main purpose to compare the cardiovascular response by the analysis of mean arterial pressure (PAM), CO, SV, HR and PVR, during VM and MEP. In addition to evaluate the effect of aging process over the cardiovascular responses obtained during the different maneuvers by the young (YG) and middle-age group (MAG). Twenty-eight healthy volunteers of male gender participated in this study and were divided in two groups: YG (n=15) and MAG (n=13) with mean age of 25±5 years and 50±5 years, respectively. All volunteers were evaluated, instructed and familiarized with the maneuvers (VM and MEP), which were performed at sitting position following the same procedure used in the first study. The main results of this study show that: there isn t difference between CO responses during the maneuvers (p>0.05); the PAM responses (PAMpeak, PAMisotime, &#916;PAM and &#916;PAMisotime) and PVR (PVRisotime e &#916;PVRisotime) were higher during MEP measure, differently of SV (SVpeak, SVnadir, &#916;SV) and HR (HRpeak, HRnadir, HRisotime, &#916;HR, &#916;HRisotime and VI) which were higher during VM. Furthermore, it was observed that the MEP and PAM values were not influenced by the group (p>0.05), and the MAG have lower values than the YG to CO, HR, SV except to PVR. So, based in these results it could be concluded that the MEP measure generates cardiovascular responses similar to that observed during VM, relative to the CO, and higher values of PAM than that observed in VM. Besides, the maneuver execution time seems to be the great responsible for the activation of different physiological mechanisms involved on the control of these responses. Furthermore, it seems like the aging influences the HR and PVR responses during MV and MEP. / A avaliação dos músculos respiratórios por meio das medidas de pressão respiratória máxima estática inspiratória (PImáx) e expiratória (PEmáx), tem sido rotineiramente aplicada na prática clínica da fisioterapia. Entretanto, a realização dessas medidas, principalmente a PEmáx tem sido contra indicada em diversas situações clínicas, pois acredita-se que as respostas cardiovasculares obtidas nessa medida são similares as encontradas na manobra de Valsalva (MV). Baseado nessa semelhança entre as repostas foram realizados dois estudos. O estudo I teve como objetivo principal avaliar a resposta da frequência cardíaca (FC) durante a medida da PEmáx e da MV em jovens saudáveis, em diferentes posturas, para identificar se e em qual condição a PEmáx reproduz as respostas obtidas na MV e, adicionalmente, estimar o trabalho realizado nas manobras (W). Este estudo contou com a participação de 12 jovens saudáveis (25±2 anos) os quais foram avaliados, orientados e familiarizados com as manobra, sendo estas, realizadas nas posturas supina e sentada. A MV foi composta por um esforço expiratório (40 mmHg) durante 15 s contra um manômetro. A PEmáx foi executada segundo a American Thoracic Society. Os resultados obtidos neste estudo mostram que as posturas não influenciaram a variação da frequência cardíaca (&#916;FC) e que durante a MV, a &#916;FC e os valores do índice de Valsalva (IV) foram maiores do que a &#916;FC e os valores do índice da PEmáx (IPEmáx) observados durante a PEmáx (p<0,001). Além disso, os trabalhos estimados das manobras foram estatisticamente diferentes (p<0,001) entre elas, sendo que o Wtotal foi maior na MV e o Wisotime e Wisotime/&#916;FCisotime maior na PEmáx. Baseado nestes resultados, pôde se concluir que nas condições estudadas a PEmáx não reproduziu as respostas da FC observadas durante a MV em jovens saudáveis. No entanto, os resultados obtidos no estudo I permitiram comparar apenas o estresse cardíaco gerado pelas manobras em uma faixa etária específica, fazendo com que as respostas da pressão arterial (PA), débito cardíaco (DC), volume sistólico (VS) e resistência vascular periférica (RVP) permanecessem desconhecidas. Além disso, ainda pouco se sabe sobre as respostas cardiovasculares durante esta medida em outras faixas etárias ou condições clínicas distintas, uma vez que o processo de envelhecimento promove alterações estruturais e funcionais importantes sobre os sistemas respiratório, cardiovascular e autonômico. Portanto, o estudo II teve como objetivo principal comparar as respostas cardiovasculares por meio da análise das respostas da pressão arterial média (PAM), DC, VS, FC e RVP, durante a execução da MV e da medida de PEmáx. Além de, avaliar o efeito do processo de envelhecimento sobre as respostas cardiovasculares obtidas por grupos jovem (GJ) e meia idade (GMI) durante as diferentes manobras. Participaram deste estudo 28 voluntários saudáveis, do gênero masculino, que foram divididos em: GJ (n=15) com idade média de 25±5 anos; e GMI (n=13) com idade média de 50±5 anos. Todos os voluntários foram avaliados, orientados e familiarizados com as manobras (MV e PEmáx), sendo estas realizadas na postura sentada seguindo o mesmo procedimento experimental do estudo I. Os principais achados deste estudo mostram que: não há diferença entre as variações do DC durante as manobras (p>0,05); as respostas da PAM (PAMpico, PAMisotime, &#916;PAM e &#916;PAMisotime) e RVP (RVPisotime e &#916;RVPisotime) são maiores durante a PEmáx; diferentemente do VS (VSpico, VSnadir, &#916;VS) e da FC (FCpico, FCnadir, FCisotime, &#916;FC, &#916;FCisotime e IV), que foram maiores durante a MV. Além disso, observou-se que os valores de PEmáx e PAM não sofrem influência dos grupos (p>0,05) e que o GMI apresenta valores menores que o GJ para o DC, FC, VS exceto para a RVP. Baseado nestes achados pode-se concluir que a medida da PEmáx gera respostas cardiovasculares semelhantes as observadas durante a MV, em relação ao DC, e respostas pressóricas (PAM) maiores que as da MV. Além disso, observou- se que o tempo de execução das manobras parece ser o grande responsável pela ativação de distintos mecanismos fisiológicos envolvidos sobre o controle destas respostas. Ainda, parece que o processo de envelhecimento influencia as respostas da FC e RVP obtidas durante a execução da MV e da medida de PEmáx.

Background: A squat is a common exercise that is used in many areas of strength training and for different purposes and the literature is inconclusive when it comes to whether the weight lifting belt (WB) affects performance and/or is injury-preventing. The use of breathing techniques is common during heavy lifting and therefore the practice of the breathing teqnice; valsalva maneuver (VM) may be of interest to study and if this along with the WB can provide some advantages in power output and velocity. Aim: The specific aim of the study was to evaluate whether the velocity in the eccentric and the concentric phase of the squat, and the peak velocity in the concentric phases are affected in power output through the use of the VM when the subjects use or did not use a WB. Method: Fifteen subjects (10 men and 5 women) volunteered freely to participate and did a total of 12 squats divided in four different sets with three repetitions each on 75% of their self-reported one repetition maximum (1RM). The first two sets were either with or without WB and the third and fourth sets were either with or without the practice of the VM. The three conditions (with WB, with WB + VM and VA only) were compared to each other and to the control group (without any instructions and no WB) in terms of power output and velocity in the eccentric, concentric and peak velocity in the concentric phase of the squat. Result: There was no significant difference in power output when comparing the four different test conditions. The velocity in the eccentric, concentric and peak velocity in the concentric phase did not have a significant difference between the different test conditions. Conclusions: This study shows a different output compared to previous literature. The WB and the practice of VM did not affect the power output and velocity in a squat, alone or together. / Bakgrund: Det finns många olikheter i litteraturen när det gäller huruvida tyngdlyftarbältet påverkar prestationen och/eller om det minskar skaderisken. En knäböj är en vanlig övning som används inom många områden av styrketräning och för olika ändamål. Användning av andningstekniker är vanligt vid tunga lyft och därför kan utförandet av andningstekniken; valsalvamanövern vara av intresse att studera och om det tillsammans med lyftbältet kan ge effekt på effektutveckling och hastighet i lyft. Syfte: Syftet med studien var att utvärdera hastigheten i en knäböjs olika faser (excentriska, koncentriska och topphastigheten i den koncentriska fasen) och hur effektutvecklingen påverkas av lyftarbälte och valsalvamanövern. Metod: Femton personer (10 män och 5 kvinnor) deltog frivilligt och utförde totalt 12 knäböj i fyra olika sets med tre repetitioner på 75 % av testpersonernas självrapporterade 1RM. De första två seten var utförda antingen med eller utan tyngdlyftarbälte och de tredje och fjärde seten var utförda antingen med eller utan utövande av valsalvamanövern. Dessa tre förhållanden ( med lyftarbälte, med lyftarbälte + VA och VA endast) jämfördes med varandra och med kontrollgruppen ( ingen VM och inget lyftarbälte) med avseende på effektutveckling och hastigheten i den excentriska, koncentriska och topphastighet i knäböjens koncentriska fas. Resultat: Effektutvecklingen gav ingen signifikant skillnad i någon av de fyra olika förutsättningarna (med lyftarbälte, utan lyftarbälte, med bälte och valsalvamanövern och utan bälte och valsalvamanövern). Hastigheten i den excentriska, koncentriska och topphastigheten i den koncentriska fasen visade ingen signifikant skillnad mellan de fyra olika seten. Konklusion: Studien visade ingen skillnad vilket kan jämföras med tidigare litteratur där en skillnad fanns. Lyftarbältet och utförandet av valsalva manövern påverkade inte effektutvecklingen och/eller hastigheten när en knäböj utfördes.

Brass musicians are known to experience a performance problem that is sometimes called valsalva maneuver or musical stuttering. This problem is known to cause difficulty starting a first note, tension in the throat, and tightness in the chest. Unfortunately, the research literature lacks sufficient details for evidence-based interventions. Therefore, the purpose of this study is to characterize and define this performance problem as experienced by brass musicians. An online epidemiologic survey was developed and deployed to collect data from brass musicians who have experienced this problem in their own playing. The survey was designed to acquire data in order to characterize and define the phenomenon through a biopsychosocial framework. The survey was also designed to assess whether this problem aligns with Altenmuller's heuristic model of motor control disruptions. A diverse group of brass musicians (n = 252) participated and offered relevant details for characterizing and defining this problem. Analysis of characteristic data suggests this problem is not a form of musical stuttering. Considering these data through Altenmuller's model suggests that this problem is experienced as a spectrum of motor disruptions that can develop into a unique type of musician's dystonia. While additional research is warranted, the results of this study are applicable to brass musicians, brass pedagogues, music educators, and performing arts health clinicians.