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Previous issue date: 2018-03-14 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / INTRODUCTION: Cystic fibrosis (CF) is an autosomal recessive genetic disease with chronic inheritance and systemic manifestations that compromises the normal function of several organs and systems, including the respiratory system. Thus, the progression of lung disease is still the factor of greater morbidity, leading to the reduction of exercise capacity.
OBJECTIVES: To evaluate the physical and muscular performance of individuals with cystic fibrosis.
METHODS: This is an observational cross-sectional study performed at a cystic fibrosis center. The sample was selected by convenience, including patients with clinical diagnosis of CF (sweat test and/or genetic evaluation) of both genders and aged ? 6 years. Patients were referred to perform the cardiopulmonary exercise test (CPET). In addition, demographic data (age and sex), anthropometric data (weight, height and BMI), pulmonary function (spirometry), genetic mutation and clinical information (pancreatic insufficiency and chronic colonization by Pseudomonas aeruginosa) were collected. At the end of the visit, the peripheral muscle strength test and the physical activity questionnaire were performed. Finally, the total number of days of antibiotic use (oral and intravenous) was recorded in the period of one year following CPET evaluation.
RESULTS: Thirty-five patients with CF were evaluated. In general, pulmonary function data (% of predicted) were within the limits of normality, obtaining a mean of 83.1 for the forced expiratory volume in the first second (FEV1) and 90.4 for the forced vital capacity (FVC). Only 15 and 10 subjects presented FEV1 and FVC scores below normal, respectively. Regarding CPET, the mean maximum oxygen consumption (VO2max) (%) in the anaerobic threshold was 67.3, heart rate (bpm) was 154.3 and maximum ventilation (L/min) was 30.8. At peak exercise, we found a mean HRmax (% predicted maximum) of 90.2, a respiratory exchange coefficient of 1.1 and VO2max (% predicted) of 102.3, indicating the performance of a maximum test. Only 5 participants presented VO2max results below normal. No subjects had desaturation during and/or after the test. In the evaluation of the peripheral muscle strength (Kgf), we found an average around 20, for both biceps and quadriceps
isometric strength. Regarding the physical activity questionnaire, we found habitual levels below recommended, obtaining a median of 30 and 102.5 minutes for moderate and vigorous activities, respectively. Of these, 10/24 were classified as inactive through this instrument. Although there were no correlations between FEV1 (p=0.063) and the use of antibiotic therapy with VO2max at peak exercise, there were weak and significant correlations of FVC with VO2max. Similarly, although there were no VO2max correlations at peak exercise with peripheral muscle strength data, we found moderate and significant correlations of VO2 at the anaerobic threshold with biceps and quadriceps isometric strength. No correlation was found between this variable and the strength of the hamstrings. Finally, subjects with a higher ventilatory reserve and lower resting heart rate did not require the use of antibiotics (ATB) one year after CPET. There was no significant differences FEV1 data were compared.
CONCLUSION: The findings of the study demonstrated significant correlations of VO2 at the anaerobic threshold with peripheral muscle strength, showing that the higher the level of physical conditioning, the greater the results of peripheral muscle strength. It was also found that after one year of the proposed evaluations, those who had lower resting heart rate and greater ventilatory reserve in CPET did not require antibiotic therapy. / INTRODU??O: A fibrose c?stica (FC) ? uma doen?a gen?tica, de heran?a autoss?mica recessiva, com manifesta??es sist?micas que comprometem a fun??o normal de diversos ?rg?os e sistemas, dentre eles o respirat?rio. Assim, a progress?o da doen?a pulmonar ainda ? o fator de maior morbidade, levando ? redu??o da capacidade de exerc?cio.
OBJETIVOS: Avaliar o desempenho f?sico e muscular de indiv?duos com fibrose c?stica.
METODOS: Trata-se de um estudo observacional, do tipo transversal, realizado em um centro de fibrose c?stica. A amostra foi selecionada por conveni?ncia, incluindo pacientes com diagn?stico cl?nico de FC (teste do suor e/ou avalia??o gen?tica), de ambos os sexos e com idade ? 6 anos. Os pacientes foram encaminhados para realizar o teste de exerc?cio cardiopulmonar (TECP). Ainda, foram coletados os dados demogr?ficos (idade e sexo), antropom?tricos (peso, altura e IMC), de fun??o pulmonar (espirometria), gen?ticos (muta??o gen?tica) e as informa??es cl?nicas (insufici?ncia pancre?tica e coloniza??o cr?nica por Pseudomonas aeruginosa). No final da consulta, foram realizados o teste de for?a muscular perif?rica e o question?rio de atividade f?sica. Por fim, foi registrado o total de dias de uso de antibi?ticos (oral e endovenoso) no per?odo de um ano subsequente ? avalia??o do TECP.
RESULTADOS: Foram avaliados 35 pacientes com diagn?stico de FC. De maneira geral, os dados de fun??o pulmonar (% do previsto) encontraram-se dentro dos limites da normalidade, obtendo-se uma m?dia de 83,1 de volume expirat?rio for?ado no primeiro segundo (VEF1) e de 90,4 de capacidade vital for?ada (CVF). Somente 15 e 10 sujeitos apresentaram resultados de VEF1 e CVF abaixo da normalidade, respectivamente. Quanto ao TECP, a m?dia do consumo m?ximo de oxig?nio (VO2m?x) (%) no limiar anaer?bio foi de 67,3, da frequ?ncia card?aca (bpm) de 154,3 e da ventila??o m?xima (L/min) de 30,8. No pico do exerc?cio, encontrou-se uma m?dia de 90,2 de FCm?x (% da m?xima prevista), de 1,1 para o coeficiente de troca respirat?ria e de 102,3 para o VO2m?x (% do previsto), indicando ser um teste
de desempenho m?ximo. Apenas 5 participantes apresentaram resultados de VO2m?x abaixo da normalidade. Nenhum sujeito apresentou dessatura??o durante e/ou ap?s a realiza??o do teste. Na avalia??o da for?a muscular perif?rica (Kgf), encontrou-se uma m?dia em torno dos 20, tanto para a for?a isom?trica do b?ceps, quanto do quadr?ceps. J? quanto ao question?rio de atividade f?sica, foram encontrados n?veis habituais abaixo do recomendado, obtendo-se uma mediana de 30 e de 102,5 minutos para atividades moderadas e vigorosas, respectivamente. Destes, 10/24 foram classificados como inativos atrav?s desse instrumento. Embora n?o houve correla??es do VEF1 (p=0,063) e do uso de antibioticoterapia com o VO2m?x no pico do exerc?cio, encontrou-se correla??es fracas e significativas da CVF com o VO2m?x no TECP. Da mesma forma, apesar de n?o haver correla??es do VO2m?x no pico do exerc?cio com os dados de for?a muscular perif?rica, encontrou-se correla??es moderadas e significativas do VO2 no limiar anaer?bio com a for?a isom?trica do b?ceps e quadr?ceps. N?o foi encontrada correla??o dessa vari?vel com a for?a dos isquiotibiais. Por fim, os sujeitos com maior reserva ventilat?ria e menor frequ?ncia card?aca de repouso n?o necessitaram do uso de antibi?tico (ATB) um ano depois da realiza??o do TECP. N?o houve diferen?a significativa na compara??o dos dados quanto ao VEF1.
CONCLUS?O: Os achados do estudo demonstraram correla??es significativas do VO2 no limiar anaer?bico com os dados de for?a muscular perif?rica, mostrando que quanto maior ? o n?vel de condicionamento f?sico, maior s?o os resultados de for?a muscular perif?rica. Constatou-se ainda que ap?s um ano das avalia??es propostas aqueles que possu?am frequ?ncia card?aca de repouso mais baixa e maior reserva ventilat?ria no TECP n?o necessitaram de antibioticoterapia.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/8264 |
| Date | 14 March 2018 |
| Creators | Bueno, Gabriela Sabino |
| Contributors | Donadio, Marcio Vinicius Fagundes |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?a, PUCRS, Brasil, Escola de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 3098206005268432148, 500, 500, 500, 600, 600, 600, -224747486637135387, -969369452308786627, -4563701660031038789, -8067417953925345752, 2075167498588264571 |
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