Die Osteoporose ist charakterisiert durch einen progressiven Verlust an Knochengewebe und ist eine der häufigsten Komplikationen des Alters. Schätzungen zufolge sind weltweit etwa 200 Millionen Menschen an Osteoporose erkrankt, dies führte auch zur Aufnahme der Osteoporose in die WHO-Liste der 10 wichtigsten Volkskrankheiten. In einer Studie aus dem Jahr 2007 wurden die jährlichen Kosten für die Folgen dieser Erkrankung in Deutschland mit 5,4 Milliarden Euro beziffert. Osteoporose bedeutet vermehrter Knochenabbau. Ursachen sind u.a. postmenopausaler Estrogenmangel, der wiederum dazu führt, dass sich die Lebenszeit der für die Knochenresorption zuständigen Osteoklasten verlängert, während die Lebenszeit der knochenproduzierenden Osteoblasten verkürzt wird. Außerdem sind die verringerten mechanischen Reize am Knochen durch fehlende körperliche Bewegung und ein endemischer Vitamin-D-Mangel, unter dem ein Großteil der Weltbevölkerung leidet, als ursächlich für das Auftreten von Osteoporose zu nennen. Ziel dieser Arbeit ist es, herauszufinden, ob eine vertikale Ganzkörpervibrationstherapie in Kombination mit einer Gabe von Strontiumranelat oder Parathormon zu einer verbesserten Knochenstruktur im osteoporotischen Rattenfemur führt. Zu diesem Zweck werden die Femora der Ratten nach Ganzkörpervibration und/oder medikamentöser Therapie mit Strontiumranelat oder Parathormon untersucht. Nach der Tötung der Ratten wird die biomechanische Stabilität des Femur einem biomechanischen Kompressionstest unterzogen. Anschließend wird der jeweilige prozentuale Gehalt von Kalzium, Phosphat und Strontiumranelat im Knochen gemessen, um den Einfluss der Vibration in Kombination mit Strontiumranelat oder PTH auf diese Parameter zu erfassen. Abschließend erfolgt die mikroradiographische Untersuchung der Knochen, um die Veränderungen der Knochenstruktur im Bereich der Kortikalis und im trabekulären Netzwerk zu erfassen. Den Ergebnissen zufolge konnte nur durch die Gabe von Parathormon eine signifikante Verbesserung der Knochenstruktur erreicht werden, die die Bruchfestigkeit der osteoporotischen Knochen signifikant erhöhte. Strontiumranelat führte in diesem Experiment zu keiner Verbesserung der Knochenqualität. Letztlich sind weitere Studien erforderlich, um effektive Dosen und Therapiezeiträume zu ermitteln. Der Vergleich der Wirksamkeit zwischen Parathormon und Strontiumranelat zeigte, dass Parathormon schneller zu Therapieerfolgen führt als eine alleinige Therapie mit Strontiumranelat. Durch die Ganzkörpervibration konnten Verbesserungen der Knochenstruktur detektiert werden. Die Kombination aus medikamentöser Therapie mit Ganzkörpervibration zeigte keine signifikanten Therapieerfolge im Vergleich zur alleinigen Therapie mit Parathormon.

The purpose of this thesis was to investigate potential links between trunk stiffness, vibration transmission and whole-body vibration (WBV) injuries. The investigation was comprised of field and laboratory studies. Tri-planar trunk postures, operator injury histories and 6-degree-of-freedom (DOF) vibration exposure data were collected from eight forestry skidders during normal field operations in Northern Ontario. Using this skidder posture and vibration exposure data, the laboratory investigation examined interactions between WBV exposure levels and spectra, seated trunk postures, trunk muscle activity, and trunk stiffness on the transmission of 6-DOF vibration from the seat to several levels of the spine. The field study revealed that when driving, skidder operators were exposed to vibrations with higher accelerations and lower frequency exposures while adopting the most neutral postures. When dropping-off (DOAL), picking-up (PUAL) or ploughing a load, operators were exposed to vibrations with lower accelerations and higher frequency exposures while adopting the postures furthest away from neutral. Furthermore, operators who adopted the greatest lateral trunk bending and forward flexion for the greatest percentage of time reported low-back and neck pain, however, interestingly were not exposed to the greatest exposure accelerations. Operators who complained of neck pain as a result of twisting to see the rear of the vehicle while DOAL and PAUL experienced some of the highest translational and rotational vibration exposures during those operating conditions. This suggests that WBV exposures and postures may interact to produce operator injuries. The laboratory study revealed a number of interactions between vibration exposure (magnitude, spectra and axis), posture, muscle activity, trunk stiffness, vibration transmissibility, dominant transmission frequency and spinal level. In general, experiment conditions expected to increase trunk muscle activity and stiffness typically did. In contrast, the expected increase in vibration transmissibility and dominant transmission frequency with increased muscle activity and trunk stiffness was not present under many of the simulated field conditions. Trunk muscle activity patterns necessary to maintain required trunk postures were often out of phase with input accelerations, reducing trunk stiffness and increasing transmissibility. These results are contrary to findings from previous studies thus bringing into question the appropriateness of literature based vibration exposure guidelines.

Background Whole-body vibration (WBV) as a training modality is established in the fields of sport, fitness, rehabilitation, and clinical intervention. WBV exercises are performed thereby while standing on a motor driven oscillating platform device. Therefore, the scientific interest in WBV is a steadily increasing field in sports science and research. It has been shown that WBV training elicits various biological and physiological effects in men. Nevertheless, there are only a small number of studies examining WBV effects on neuromuscular performance of the lower extremities in elderly people. Furthermore, the results of these studies show many discrepancies that may be caused by limitations referring to the different applied training protocols and vibration loads. In addition, there is still a deficit of information for effective but safe recommendations for WBV application for trunk and neck muscles. Therefore, this doctoral thesis deals with three major aspects of WBV as an exercise modality in strength training: (1) the recommendation of optimal vibration loads (VbLs) for the lower extremities as an essential element of the WBV exercise parameters in older adults, (2) the evaluation of these VbLs in a WBV training intervention for elderly people with regard to feasibility and chronic effects on neuromuscular performance of the lower limbs, and (3) the allocation of information for effective but safe advices for VbLs for trunk and neck muscles. These aspects are further specified toward five hypotheses (H1, H2, H3, H4, and H5) by findings and limitations of the current state of literature. Methods The five hypotheses are evaluated within three research papers (studies 1 to 3). The first study (S1) evaluated the optimal VbL determined by the combination of three biomechanical variables (vibration frequency, vibration amplitude, and knee angle) in older adults (H1). Therefore, the neuromuscular activity of the quadriceps femoris and hamstring muscles in 51 healthy subjects were measured during WBV exposure using surface electromyography (EMG). Maximal voluntary contractions (MVCs) were conducted prior to the measurements to normalise the EMG signals. A three-way mixed ANOVA was performed to analyse the different effects of the biomechanical variables on muscle activity. Study 2 (S2) represents a randomised controlled trial to assess the results of S1 implemented in a WBV training protocol and therefore to evaluate the feasibility and effectiveness of a six-week WBV intervention (H2, H3, and H4). A total of 21 subjects was allocated randomly into either a WBV training or control group. While the WBV group completed a six-week WBV training programme the control group was asked not to change their current level of physical activity during the study. Before and after the intervention period, jump height was measured during a countermovement jump (CMJ). In addition, isokinetic knee extension and flexion strength parameters were recorded using a motor-driven dynamometer. The Borg scale for ratings of perceived exertion (RPE scale) was used to evaluate the intensity of WBV exercises within each training session. Changes from pre- to posttest were analysed by a paired sample t-test (within-group comparisons) and independent sample t-test (between-group comparisons). The intention of study 3 (S3) was to analyse the impact of biomechanical variables on neuromuscular activity of different trunk and neck muscles during WBV (H5) filling the lack of information in current literature. Those biomechanical variables were assumed, which current literature suggests as having the lowest risk of negative side effects on the head. Surface EMG was used to record the neuromuscular activity in 28 healthy subjects. EMG signals were normalised to prior measured MVC. Different effects of the biomechanical variables were analysed by an ANOVA for repeated measurements. Results The findings of S1 showed that the biomechanical variables affect the level of neuromuscular activity of thigh muscles in older adults in different dimensions which confirms H1. The maximum levels of muscle activity were significantly reached at high amplitude and high frequency, whereas the factor “knee angle” only significantly affected the quadriceps femoris. Furthermore, WBV led to a higher muscle activation of the quadriceps femoris (74.1 % MVC) than of the hamstring muscles (27.3 % MVC). The main findings in S2 were an increased multi-joint strength performance of the lower limbs during a countermovement jump in the WBV group, whereas values of the control group remained unchanged after the intervention, thus confirming H2. There were no statistically significant differences in isokinetic maximal strength, mean power, or work values in knee extension or flexion in both groups (rejecting H3). In addition, the subjective perceived exertion of the WBV exercises and respective training parameters ranged between moderate rating levels of 7 and 13 of the Borg scale and indicate WBV intervention as a feasible and safe training program for elderly people, which is consistent with H4. Finally, the outcomes of S3 confirmed H5 as the biomechanical variables affect the level of neuromuscular activity of the trunk and neck in different dimensions. The maximum levels of muscle activity were significantly reached at high amplitude and high frequency, while knee angles had similar effects on the VbL. WBV led to a higher muscle activation of the lower back muscles (27.2% MVC) than of neck muscles (8.5 % MVC) and the abdominal muscles (3.6 % MVC). Conclusion A maximised VbL for WBV training in older adults depends on specific combinations of the biomechanical variables (vibration frequency, vibration amplitude, and knee angle). In addition, a WBV training based on this age-specific high VbL is a feasible, suitable and effective training program for elderly people to prevent age-related reduction of muscle performance in the lower extremities. Furthermore, the combination of biomechanical variables recommended in literature as safe for preventing harmful transmissions to the head, only elicit low to moderate muscle activation of the upper body. The findings of this thesis represent fundamental research in the field of WBV and may help to improve further research in this area. Finally, this thesis may help coaches and therapists to enhance the quality of WBV training in practical application. / Hintergrund Ganzkörpervibration (Whole-Body Vibration, WBV) hat sich als Trainingsanwendung im Sport-, Fitness, Rehabilitationsbereich und klinischen Bereich etabliert, wobei die Übungen dabei im Stehen auf einer Vibrationsplatte durchgeführt werden. In diesem Zusammenhang ist auch das wissenschaftliche Interesse am Vibrationstraining ein stetig wachsendes Feld in den Bereichen der Sportwissenschaft und Forschung. Bisher konnte gezeigt werden, dass Vibrationstraining verschiedene biologische als auch physiologische Reaktionen beim Menschen hervorruft. Dennoch gibt es nur wenige Untersuchungen, die sich mit den Auswirkungen des Vibrationstrainings auf die neuromuskuläre Leistung der unteren Extremitäten bei älteren Menschen beschäftigen. Des Weiteren weißen die Ergebnisse dieser wenigen Studien viele Widersprüchlichkeiten auf, welche durch die unterschiedlich verwendeten Trainingsvorgaben und Vibrationsbelastungen verursacht sein könnten. Darüber hinaus besteht noch ein großes Defizit an grundlegenden Informationen hinsichtlich effektiver, aber dennoch sicherer Vorgaben in der Anwendung des Vibrationstrainings im Bereich der Rumpf- und Nackenmuskulatur. Vor diesem Hintergrund beschäftigt sich die vorliegende Dissertation mit drei wesentlichen Aspekten des Vibrationstrainings: (1) die Empfehlung von optimalen Vibrationsbelastungen (VbL) als wesentlicher Bestandteil des Vibrationstrainingsplans der unteren Extremitäten älterer Menschen, (2) die Evaluierung dieser VbL anhand einer auf Vibrationstraining basierter Intervention mit älteren Menschen hinsichtlich Durchführbarkeit und Auswirkungen auf die neuromuskuläre Leistung der unteren Gliedmaßen, und (3) Angaben für effektive und sichere VbL für Rumpf- und Nackenmuskulatur bereitzustellen. Mit der Aufarbeitung von Ergebnissen und Defiziten des aktuellen Forschungsstands werden diese Aspekte durch die Formulierung von fünf Hypothesen (H1, H2, H3, H4, and H5) weiter spezifiziert. Methodik Die fünf Hypothesen werden in drei wissenschaftlichen Veröffentlichungen (Studie 1 bis 3) untersucht. Die erste Studie (S1) befasste sich mit der optimalen VbL für ältere Personen (H1), welche durch die Kombination von drei biomechanischen Variablen (Vibrationsfrequenz, Vibrationsamplitude und Kniewinkel) bestimmt wird. Hierzu wurde die neuromuskuläre Aktivität der vorderen und hinteren Oberschenkelmuskulatur von 51 gesunden Probanden unter Vibration mittels Oberflächen-Elektromyografie (EMG) gemessen. Vor den Messungen wurden maximale muskuläre Kontraktionen durchgeführt, um die EMG zu normalisieren. Um die unterschiedlichen Auswirkungen der biomechanischen Variablen zu analysieren wurde eine drei-faktorielle Varianzanalyse durchgeführt. Studie 2 (S2) entspricht einer randomisierten kontrollierten Studie, welche die Ergebnisse aus S1 in einem Trainingsplan verwendet, um die Durchführbarkeit und Effektivität eines sechs wöchigen Vibrationstrainings zu untersuchen (H2, H3, und H4). Hierfür wurden 21 Probanden zufällig einer Vibrationstrainings- oder einer Kontrollgruppe zugeteilt. Während die Vibrationsgruppe ein sechs wöchiges Vibrationstraining absolvierte, wurden die Teilnehmer der Kontrollgruppe gebeten ihre körperliche Aktivität während des Studienzeitraums nicht zu verändern. Vor und nach dem Untersuchungszeitraums wurde die Sprunghöhe während eines „countermovement jump“ (CMJ) erfasst. Weiterhin wurden isokinetische Kraftmessgrößen der Kniegelenkbeugung und –streckung an einem Dynamometer ermittelt. Die Borgskala zur Erfassung des subjektiven Belastungsempfindens wurde eingesetzt, um die Intensität der Übungen des Vibrationstrainings innerhalb einer Trainingseinheit zu messen. Veränderungen der Messgrößen zwischen Eingangs- und Abschlusstest wurden statistisch mit einem t-Test für abhängige (innerhalb einer Gruppe) und einem t-Test für unabhängige Stichproben (zwischen den Gruppen) untersucht. Ziel der dritten Studie (S3) war es den Einfluss der biomechanischen Variablen auf die muskuläre Aktivierung verschiedener Rumpf- und Nackenmuskeln (H5). Hierzu wurden solche biomechanische Variablen ausgesucht, welche laut derzeitigem Wissensstand jeweils das geringste Risiko von Nebenwirkungen für den Kopf ausüben. Mittels Oberflächen-EMG wurde die muskuläre Aktivität von 28 Probanden erfasst. EMG Signale wurden zu vorangegangenen MVC Messungen normalisiert. Die Unterschiedlichen Effekte der biomechanischen Variablen wurden mittels einer Varianzanalyse für Messwiederholungen analysiert. Ergebnisse Die Ergebnisse von S1 konnten zeigen, dass die biomechanischen Variablen den neuromuskulären Aktivierungsgrad der Oberschenkelmuskulatur bei älteren Personen unterschiedlich beeinflussen und somit H1 bestätigen. Der höchste Grad der Aktivierung wurde deutlich mit einer großen Amplitude und hohen Frequenz erreicht, wobei der Kniewinkel ausschließlich die vordere Oberschenkelmuskulatur beeinflusst. Zudem, führte der Vibrationseinfluss zu einer größeren Muskelaktivität der Oberschenkelvorderseite (74.1 % MVC) als der –rückseite (27.3 % MVC). Die Resultate von S2 hinsichtlich des CMJ Tests bestätigen H2, da es in der Vibrationstrainingsgruppe zu einer gesteigerten gelenksübergreifender Kraftleistung in den Beinen kam, aber keine Veränderungen in der Kontrollgruppe feststellbar waren. Hingegen kam es in keiner Gruppe zu statistisch signifikanten Veränderungen der isokinetischen Messgrößen (Maximalkraft, Kraftleistung, Muskelarbeit), wodurch H3 abgelehnt wird. Das subjektive Belastungsempfinden der Übungen und des Belastungsgefüges des Vibrationstrainings liegt zwischen moderaten Bewertungsstufen von 7 bis 13 der Borgskala und weist daraufhin, dass Vibrationstraining ein praktikables und sicheres Übungsprogramm für ältere Menschen ist und somit H4 bestätigt. Die Ergebnisse von S3 konnten H5 bestätigen, da die biomechanischen Variablen den neuromuskulären Rumpf- und Nackenmuskulatur unterschiedlich beeinflussen. Der höchste Grad der Aktivierung wurde deutlich mit einer großen Amplitude und hohen Frequenz erreicht, wobei der Kniewinkel sich ähnlich auf die VbL auswirkt. Der Vibrationsstimulus führte zudem zu einer höheren Aktivierung der unteren Rückenmuskulatur (27.2% MVC) als der Nacken- (8.5 % MVC) und Bauchmuskulatur (3.6 % MVC). Schlussfolgerungen Die maximale muskuläre Belastung älterer Personen in einem Vibrationstrainings hängt von bestimmten Kombinationen der biomechanischen Variablen (Vibrationsfrequenz, Vibrationsamplitude und Kniewinkel). Zudem ist ein Vibrationstraining, das auf altersspezifischen Vibrationsbelastungen basiert ein machbares, angemessenes und effektives Trainingsprogramm für älteren Menschen, um einem altersbedingten Abnehmen der muskulären Leistungsfähigkeit vorzubeugen. Weiterhin führt die Verbindung von biomechanischen Variablen, welche laut bisherigem Forschungsstand als sicher gegen schädliche Vibrationsübertragungen zum Kopf gelten, nur zu leichten bis moderaten Muskelaktivierung im Oberkörper. Die Ergebnisse dieser Dissertation liefern einen Beitrag zur Grundlagenforschung auf dem Gebiet des Vibrationstrainings und können weiteren Forschungsarbeiten hilfreich sein. Darüber hinaus kann diese Arbeit helfen die Qualität von Vibrationstrainingsangeboten zu verbessern und somit zum praktischen Nutzen beitragen.

Um experimentell zu klären, ob bestimmte Vibrationsfrequenzen zur osteoanabolen Stimulation des Knochens und speziell zur Verbesserung der Frakturheilung bei Osteoporose geeigneter sind als andere, wurde in dieser Arbeit die Frakturheilung an der proximalen Tibiametaphyse der ovarektomierten Ratte unter einer vertikalen Vibrationsbehandlung mit Frequenzen von 35, 50, 70 und 90 Hz vergleichend untersucht. Die Tiere wurden dafür nach Tibiaosteotomie und Plattenosteosynthese über 30 Tage für jeweils 15 Minuten der für ihre Gruppe spezifischen Vibrationsfrequenz ausgesetzt. Die Amplitude der Vibration betrug dabei stets 0,5 mm. Die quantitative Analyse des Frakturkallus mittels Mikroradiographie und Micro-CT ergab deutliche Anhaltspunkte für eine überlegene osteoanabole Potenz der 70Hz-Vibration in Gestalt einer gegenüber allen anderen Vibrationsgruppen signifikant erhöhten endostalen Kallusdichte sowie einer gegenüber der nichtvibrierten OVX-Gruppe signifikant erhöhten periostalen Kallusdichte und -dicke. Auch kortikaler und trabekulärer Knochen profitierten von der 70Hz-Vibration, was sich in der unter dieser Frequenz - zumindest hinsichtlich der Belastbarkeit - besten Kallusqualität widerspiegelte.  Die 35Hz-Vibration kann die Kallusbildung ebenfalls anregen und damit auch die biomechanischen Eigenschaften des Kallus (Steifheit) verbessern. Kallus und kortikaler Knochen werden durch 35 Hz aber schlechter stimuliert als durch alle anderen untersuchten Frequenzen. Die 50Hz-Vibration verbessert die biomechanischen Eigenschaften in ähnlicher Weise, sie stimuliert Kallus und Kortikalis dabei etwas besser als 35 Hz, aber deutlich schlechter als 70 Hz. Auch die 90Hz-Vibration hat einen stimulierenden Effekt auf Kallus, Kortikalis und trabekulären Knochen, insbesondere die Kallusstimulation ist aber wieder deutlich schlechter als unter der Frequenz von 70 Hz. Die 90Hz-Vibration hat zudem eine übermäßige Reizung des Kallus zur Folge, die sich in den schlechtesten biomechanischen Eigenschaften aller untersuchten Frequenzen manifestiert.  Als Synthese der mit den verschiedenen Untersuchungsverfahren dieser Arbeit gewonnenen Ergebnisse kann eine Überlegenheit der Vibrationsfrequenz von 70 Hz für die Stimulation der Frakturheilung bei Osteoporose festgestellt werden. Diese Ergebnisse am Rattentiermodell sollten - vor Beginn einer klinischen Studie - am Großtiermodell verifiziert werden.

Background: Whole-body Computed Tomography (CT) scan today is considered a crucial imaging technique in the diagnostic work-up of polytrauma patients implicating a potential survival benefit. Apart from prompt identification of life threatening injuries this imaging technique provides an additional benefit by diagnosing incidental non-trauma associated medical diseases. These incidental findings might be also life threatening and warrant urgent therapy. The downside of whole-body CT is a relatively high radiation exposure that might result in an increased life time cancer risk. The aim of this study was to investigate the frequency and type of non trauma associated incidental medical findings in relation to patient age and potential clinical relevance. Methods: Between January 1st 2011 and December 15th 2012, a total of 704 trauma patients were referred to our hospital’s emergency room that triggered trauma room alarm according to our trauma mechanism criteria. Of these 534 (75.8%) received a whole-body CT according to our dedicated multiple trauma protocol. Incidental Findings (IF) were assigned in three groups according to their clinical relevance. Category 1: IF with high medical relevance (urgent life threatening conditions, unless treated) needing early investigations and intervention prior to or shortly after hospital discharge. Category 2: IF with intermediate or low medical relevance, warranting further investigations. Category 3: IF without clinical relevance. Results: Overall 231 IFs (43.3%) were identified, 36 (6.7%) patients had IFs with a high clinical relevance, 48 (9.0%) with a moderate or minor clinical relevance and 147 (27.5%) with no clinical relevance. The distribution of incidental findings with high or moderate relevance according to age showed an incidence of 2.6%, 6.6% and 8.8% for patients younger than 40 years, 40 to 60 years and older than 60 years, respectively. Conclusion: Whole-body CT scans of trauma patients demonstrate a high rate of incidental findings. Potentially life-threatening, medical findings were found in approximately every 15th patient, predominantly aged over 40 years and presenting with minor to moderate injuries and an Injury Severity Score (ISS) of 10 or less.

Diss. (sammanfattning) Uppsala : Univ., 2007. / Härtill 4 uppsatser.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-04-27T18:08:23Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) vanessa_goncalves_cesar_ribeiro.pdf: 3322252 bytes, checksum: a93b547b99b52d508c5eb5111bb065f0 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-05-16T19:39:36Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) vanessa_goncalves_cesar_ribeiro.pdf: 3322252 bytes, checksum: a93b547b99b52d508c5eb5111bb065f0 (MD5) / Made available in DSpace on 2017-05-16T19:39:36Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) vanessa_goncalves_cesar_ribeiro.pdf: 3322252 bytes, checksum: a93b547b99b52d508c5eb5111bb065f0 (MD5) Previous issue date: 2016 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / Funda??o de Amparo ? Pesquisa do Estado de Minas Gerais (FAPEMIG) / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq) / A fibromialgia (FM) est? associada a altera??es na resposta inflamat?ria e estudos demonstram aumento da concentra??o de biomarcadores pr? inflamat?rios em pacientes com a doen?a. Estes biomarcadores podem induzir v?rios sintomas, tais como fadiga, falta de sono, dor e mialgia. A vibra??o de corpo inteiro (VCI) pode ser uma estrat?gia terap?utica para o tratamento dessa doen?a por ser um est?mulo de curta dura??o e baixa intensidade. Os objetivos do presente estudo foram: 1) Caracterizar a intensidade do est?mulo de vibra??o de corpo inteiro em mulheres diagnosticadas com FM comparadas com o grupo de mulheres saud?veis (CT) pareados por idade e caracter?sticas antropom?tricas; e 2) Investigar o efeito de uma ?nica sess?o de VCI na resposta inflamat?ria destes grupos. As concentra??es plasm?ticas de leptina, adiponectina, resistina, receptores sol?veis do fator de necrose tumoral (sTNFR1 e sTNFR2) e BDNF foram mensuradas pelo m?todo ELISA e IL-8 por t?cnica cytrometric bead arrays (CBA) ambas conforme instru??es do fabricante. O consumo de oxig?nio (VO2) e a frequ?ncia card?aca (FC) foram registrados em repouso e durante todo o protocolo experimental. A percep??o subjetiva de esfor?o (PSE) foi registrada por meio da Escala de percep??o subjetiva de esfor?o de Borg. A sess?o aguda de VCI promoveu aumento do VO2 e FC de forma semelhante em ambos os grupos e esse est?mulo foi caracterizado como de intensidade leve. No entanto, houve intera??o (doen?a vs vibra??o) na PSE (P = 0,0078) demostrando que indiv?duos com FM apresentam maior PSE comparadas com mulheres saud?veis em repouso; al?m disso, o est?mulo de VCI promoveu aumento dessa percep??o no grupo FM, mantendo-se inalterado no grupo CT. Em repouso, os indiv?duos com FM apresentaram maiores concentra??es plasm?ticas de IL-8, de adiponectina e do receptor sol?vel de TNF, sTNFR1, e menores concentra??es plasm?ticas do receptor sol?vel sTNFR2 comparados com o grupo controle. N?o houve diferen?a entre os grupos quanto ?s concentra??es plasm?ticas de leptina, resistina e BDNF no estado basal. O est?mulo de VCI promoveu diminui??o das concentra??es plasm?ticas de adiponectina, sTNFR1e aumento das concentra??es de sTNFR2 no grupo FM. No grupo controle, o est?mulo de vibra??o promoveu aumento das concentra??es plasm?ticas de leptina, resistina e de sTNFR1. Houve intera??o (doen?a vs vibra??o) nas concentra??es plasm?ticas de adiponectina (P = 0,0001), sTNFR1 (P= 0,000001), sTNFR2 (P =0,0052), leptina (P = 0,0007), resistina (P = 0,0166) e BDNF (P = 0,0179). Os achados deste estudo s?o relevantes em termos cl?nicos uma vez que evidenciam que este est?mulo, considerado de baixa intensidade, parece ser suficiente para causar intera??o (doen?a versus est?mulo) e, consequentemente, modula??o de marcadores inflamat?rios, no sentido de ajuste da homeostase da inflama??o. O mecanismo neuroend?crino parece ser uma modula??o induzida pelo exerc?cio no sentido de maior adapta??o ? resposta inflamat?ria e de estresse destes pacientes. / Disserta??o (Mestrado) ? Programa Multic?ntrico de P?s-gradua??o em Ci?ncias Fisiol?gicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / Fibromyalgia (FM) is associated with neuroendocrine and inflammatory feedback dysregulation. Whole body vibration (WBV) provides an acute stimulus that could be of therapeutic value for these patients. The aims of this study were 1) to characterize the intensity of the vibration stimulation in women diagnosed with FM compared to a control group of healthy women (HW) matched by age and anthropometric parameters and 2) to investigate the effect of a single session of WBV on inflammatory responses. Levels of adipokines, soluble tumor necrosis factor receptors (sTNFr)1, sTNFr2, and brain-derived neurotrophic factor (BDNF) were determined by enzyme-linked immunosorbent assay. Oxygen consumption (VO2) was estimated by a portable gas analysis system measured breath by breath, heart rate (HR) was measured using a HR monitor, and perceived exertion (RPE) was evaluated using the Borg scale of perceived exertion. Acutely mild WBV increased VO2 and HR similarly in both groups. There was an interaction (disease vs. vibration) in RPE (P = 0.0078), showing a higher RPE in FM compared to HW at rest, which further increased in FM after acute WBV, whereas it remained unchanged in HW. In addition, there was an interaction (disease vs. vibration) in plasma levels of adiponectin (P = 0.0001), sTNFR1 (P = 0.000001), sTNFR2 (P = 0.0052), leptin (P = 0.0007), resistin (P = 0.0166), and BDNF (P = 0.0179). In conclusion, a single acute session of mild and short WBV can improve the inflammatory status in patients with FM, reaching values close to those of matched HW at their basal status. The neuroendocrine mechanism seems to be an exercise-induced modulation towards greater adaptation to stress response in these patients.

Pilotos agrícolas atuam em condições de trabalho que podem acometê-los de doenças e contribuir para ocorrência de acidentes de trabalho. Nesse contexto, estudos têm direcionado seus esforços para compreender os efeitos de diversos fatores no desempenho do piloto, na saúde e/ou na segurança de voo. Exemplos típicos incluem, principalmente, a exposição aos defensivos agrícolas, seguido da exposição ao ruído ambiental e condições térmicas desfavoráveis, bem como a distribuição das responsabilidades entre os profissionais envolvidos. Outros problemas relacionados ao trabalho de pilotos agrícolas, como a operação em áreas improvisadas e o efeito dessa condição de trabalho na exposição às vibrações não é explorado. Além disso, observa-se que as queixas de dores na coluna são comuns entre os profissionais e, em função das condições de trabalho, é possível que estes tenham um risco aumentado de problemas na coluna vertebral. O objetivo dessa tese é de explorar a exposição dos pilotos agrícolas à Vibração de Corpo Inteiro (VCI) e identificar os efeitos desta na saúde, principalmente, no que diz respeito aos sintomas musculoesqueléticos da coluna vertebral. A metodologia compreendeu três etapas que incluem: uma pesquisa de campo orientada ao entendimento das condições de trabalho dos pilotos agrícolas, principalmente sobre os fatores capazes de influenciar na exposição ocupacional à VCI e na ocorrência de distúrbios musculoesqueléticos; a coleta e análise de dados sobre a exposição ocupacional dos pilotos agrícolas à VCI; e, a coleta e análise de dados sobre os sintomas musculoesqueléticos da coluna vertebral. Como resultados da pesquisa de campo, são apresentados dados sobre a rugosidade da superfície das áreas de pouso, perfil de exposição à VCI e prevalência de sintomas musculoesqueléticos em pilotos agrícolas. Os fatores significativos identificados como na exposição dos pilotos agrícolas à VCI foram o modelo de aeronave usada, as condições de rugosidade superficial das áreas de pouso, bem como as etapas do voo. Com relação à saúde da coluna vertebral dos pilotos, apenas a exposição ocupacional à VCI se apresentou como significativa. Dada a complexidade das relações de trabalho no contexto da aviação agrícola, com o envolvimento de diferentes tipos de trabalhadores, são incluídos três tipos de soluções para prevenir a ocorrência de distúrbios musculoesqueléticos em pilotos agrícolas: a manutenção frequente das áreas de pouso, de responsabilidade dos produtores rurais; a gestão do tempo de exposição diário, de responsabilidade dos gestores operacionais e de segurança operacional; e, alterações no projeto de aeronaves, seja na interface com o piloto, para atenuar a transmissibilidade das vibrações oriundas da aeronave, ou, nos sistemas de amortecimento, capazes de isolar a fonte das vibrações, impedindo sua propagação. / Agricultural pilots work in conditions that can affect them and contribute to the occurrence of work-related accidents. In this context, earlier studies have focused their efforts on the understanding of the effects of many factors on pilot performance, health and/or flight safety. Typical examples include exposure to pesticides, exposure to environmental noise and unfavorable thermal conditions, as well as the distribution of responsibilities among the professionals involved with the aerial application. Other problems related to the work of agricultural pilots, such as operation on improvised runways and the effect of this working condition on exposure to vibrations is not explored. In addition, it is noted that complaints of pain in the spine are common among professionals and, depending on working conditions, they may have an increased risk of spinal problems. The objective of this thesis is to explore the exposure of agricultural pilots to Whole-Body Vibrations (WBV) and to identify the effects of this on health, especially regarding to musculoskeletal symptoms of the spine. The methodology consisted of three stages: a field research aimed at understanding the working conditions of agricultural pilots, mainly on the factors capable of influencing the occupational exposure to WBV and the occurrence of musculoskeletal disorders; The data collection and analysis about occupational exposure of agricultural pilots to WBV; and, the data collection and analysis about musculoskeletal symptoms of the spine. As results of the field research, data are presented on surface roughness of landing fields, exposure to WBV and prevalence of musculoskeletal symptoms in agricultural pilots. The significant factors identified as in the exposure of the agricultural pilots to the WBV were the aircraft model used, the surface roughness conditions of the landing areas, as well as the flight stages. Regarding the health of the spine of the pilots, only the occupational exposure to the WBV was presented as significant. Given the complexity of labor relations in the context of agricultural aviation with the involvement of different types of workers, three types of solutions are included to prevent the occurrence of musculoskeletal disorders in agricultural pilots: frequent maintenance of landing areas, farmers; The management of the daily exposure time, the responsibility of the operational managers and operational safety; And changes in aircraft design, either at the interface with the pilot, to mitigate the transmissibility of vibrations from the aircraft, or, in damping systems, capable of isolating the source from vibrations, preventing their propagation.

Made available in DSpace on 2014-10-09T12:34:47Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:03:29Z (GMT). No. of bitstreams: 0 / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Pilotos agrícolas atuam em condições de trabalho que podem acometê-los de doenças e contribuir para ocorrência de acidentes de trabalho. Nesse contexto, estudos têm direcionado seus esforços para compreender os efeitos de diversos fatores no desempenho do piloto, na saúde e/ou na segurança de voo. Exemplos típicos incluem, principalmente, a exposição aos defensivos agrícolas, seguido da exposição ao ruído ambiental e condições térmicas desfavoráveis, bem como a distribuição das responsabilidades entre os profissionais envolvidos. Outros problemas relacionados ao trabalho de pilotos agrícolas, como a operação em áreas improvisadas e o efeito dessa condição de trabalho na exposição às vibrações não é explorado. Além disso, observa-se que as queixas de dores na coluna são comuns entre os profissionais e, em função das condições de trabalho, é possível que estes tenham um risco aumentado de problemas na coluna vertebral. O objetivo dessa tese é de explorar a exposição dos pilotos agrícolas à Vibração de Corpo Inteiro (VCI) e identificar os efeitos desta na saúde, principalmente, no que diz respeito aos sintomas musculoesqueléticos da coluna vertebral. A metodologia compreendeu três etapas que incluem: uma pesquisa de campo orientada ao entendimento das condições de trabalho dos pilotos agrícolas, principalmente sobre os fatores capazes de influenciar na exposição ocupacional à VCI e na ocorrência de distúrbios musculoesqueléticos; a coleta e análise de dados sobre a exposição ocupacional dos pilotos agrícolas à VCI; e, a coleta e análise de dados sobre os sintomas musculoesqueléticos da coluna vertebral. Como resultados da pesquisa de campo, são apresentados dados sobre a rugosidade da superfície das áreas de pouso, perfil de exposição à VCI e prevalência de sintomas musculoesqueléticos em pilotos agrícolas. Os fatores significativos identificados como na exposição dos pilotos agrícolas à VCI foram o modelo de aeronave usada, as condições de rugosidade superficial das áreas de pouso, bem como as etapas do voo. Com relação à saúde da coluna vertebral dos pilotos, apenas a exposição ocupacional à VCI se apresentou como significativa. Dada a complexidade das relações de trabalho no contexto da aviação agrícola, com o envolvimento de diferentes tipos de trabalhadores, são incluídos três tipos de soluções para prevenir a ocorrência de distúrbios musculoesqueléticos em pilotos agrícolas: a manutenção frequente das áreas de pouso, de responsabilidade dos produtores rurais; a gestão do tempo de exposição diário, de responsabilidade dos gestores operacionais e de segurança operacional; e, alterações no projeto de aeronaves, seja na interface com o piloto, para atenuar a transmissibilidade das vibrações oriundas da aeronave, ou, nos sistemas de amortecimento, capazes de isolar a fonte das vibrações, impedindo sua propagação. / Agricultural pilots work in conditions that can affect them and contribute to the occurrence of work-related accidents. In this context, earlier studies have focused their efforts on the understanding of the effects of many factors on pilot performance, health and/or flight safety. Typical examples include exposure to pesticides, exposure to environmental noise and unfavorable thermal conditions, as well as the distribution of responsibilities among the professionals involved with the aerial application. Other problems related to the work of agricultural pilots, such as operation on improvised runways and the effect of this working condition on exposure to vibrations is not explored. In addition, it is noted that complaints of pain in the spine are common among professionals and, depending on working conditions, they may have an increased risk of spinal problems. The objective of this thesis is to explore the exposure of agricultural pilots to Whole-Body Vibrations (WBV) and to identify the effects of this on health, especially regarding to musculoskeletal symptoms of the spine. The methodology consisted of three stages: a field research aimed at understanding the working conditions of agricultural pilots, mainly on the factors capable of influencing the occupational exposure to WBV and the occurrence of musculoskeletal disorders; The data collection and analysis about occupational exposure of agricultural pilots to WBV; and, the data collection and analysis about musculoskeletal symptoms of the spine. As results of the field research, data are presented on surface roughness of landing fields, exposure to WBV and prevalence of musculoskeletal symptoms in agricultural pilots. The significant factors identified as in the exposure of the agricultural pilots to the WBV were the aircraft model used, the surface roughness conditions of the landing areas, as well as the flight stages. Regarding the health of the spine of the pilots, only the occupational exposure to the WBV was presented as significant. Given the complexity of labor relations in the context of agricultural aviation with the involvement of different types of workers, three types of solutions are included to prevent the occurrence of musculoskeletal disorders in agricultural pilots: frequent maintenance of landing areas, farmers; The management of the daily exposure time, the responsibility of the operational managers and operational safety; And changes in aircraft design, either at the interface with the pilot, to mitigate the transmissibility of vibrations from the aircraft, or, in damping systems, capable of isolating the source from vibrations, preventing their propagation.