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Previous issue date: 2015-07-16 / The reduced dopamine production in Parkinson's disease (PD) substantially affects the motor
skills and other primary bodily functions, including mood, cognition and functional
performance. At the same time, losses occur in the autonomic nervous system. It is unknown
how the autonomic function is related to these losses and whether a walking program can
modify the heart rate variability (HRV) in this population.
The aim of this study was to assess HRV in patients with PD and its relationship with anxiety
and depression symptons, functional performance and severity of disease, and also the effect
of a walking program in autonomic modulation and functional capacity. In cross- sectional
phase were evaluated 26 patients (16 men / 10 women, 57.4 ?? 9.2 years) using the scales of
anxiety, depression (HADS-A and HADS-D) and disease severity (UPDRS motorexamination
and Hoehn and Yahrd scales). Functional performance was evaluated by the
Timed Up and Go test (TUG) and three tests from the Senior Fitness Tests. These results were
correlated with HRV indexes of time (RMSSD, SDNN) and frequency domain (HF, LF, LF /
HF, TP, HF / TP, LF / TP) and nonlinear analysis (SampEn and DFA1) measured in sitting and
standing position. The HRV variation from sitting to standing position (??? analysis) was also
considered. In longitudinal phase a walking group (WG, n = 13) and a control group (CG n =
6) were formed through a randomized controlled trial. The home-based walking program had
a duration of six weeks. The patients in the WG group were reassessed after 12 weeks of
training. Were observed high levels of anxiety (30.7%) and depression (34.6%) in the patients
evaluated. Depressive symptoms were associated to the parasympathetic activity: RMSSD (r
= - 0.382; p ??? 0.05), as the activity in the both sympathetic and parasympathetic branches:
LFseated (r = -0383; p ??? 0.05), LFstanding (r = -0.411; p ??? 0.05), TPstanding (r = -0, 504, p ???
0.05) and ??? SampEn (r = -0384, p ??? 0.05). The severity and duration of illness also were
negatively associated with autonomic function. RMSSDseated (r = -0.438; p ??? 0.05),
SDNNseated (r = -0.452; p ??? 0.05) SDNNstanding (r = -0.602, p ??? 0.01); LFstanding (r =
-0.603; p ??? 0.01); TPstanding (r = -0.504; p ??? 0.05) and LF/ TPstanding (r = -0.504; p ??? 0.05)
were negatively associated with time to perform the TUG test. Other significant correlations
(p ??? 0.05) of physical and functional tests and age HRV were observed . The six-weeks
walking program have promoted significant changes in SampEn index (which measures the
irregularity of HR data) in WG group compared to the CG group (20.47 vs -22.81%; CA and
CO, respectively; p = 0.033) as well as ???SampEn measure (-22.83% vs. 18.46; WG and CG,
respectively; p = 0.022), suggesting positive changes in autonomic function. At week 12, the
WG group patients exhibited increased ratios of HF/TPstanding (7.0%; p = 0.017) and
SampEn-standing (20.5%; p = 0.008; respectively), and reduction of the LF/HFstanding index
(-10.65%; p = 0.012 ) compared to the first week, suggesting improvements in autonomic
balance. There was an increase in sit-to-stand repetitions (10.50 ?? 1.93 to 13.25 ?? 1.58
repetitions; p = 0.021) and reduced time to perform the TUG test (7.34"?? 0.67 to 6.91" ?? 0.83,
p = 0.002). Several HRV indices measured before walking program (SDNN, RMSSD, LF, HF,
LF / TP) have shown correlations with the functional gain (r2
ranging from 0.62 to 0.81),
suggesting a role of autonomic function in neuromuscular adaptation to training. It follows
that HRV may work as an integrative measure and also as a peripheral marker of body's
adaptability and its self-regulatory capacity, besides a practical and sensitive tool e to the
disease progression. The home-based walking program have improved autonomic function of
participants, often hampered by the disease. This is particularly interesting in that many
bodily functions impaired in PD are mediated by autonomic function. / A redu????o da produ????o de dopamina na Doen??a de Parkinson (DP) afeta substancialmente a
motricidade e outras fun????es org??nicas primordiais, como humor e a cogni????o, bem como o
desempenho funcional. Paralelamente, ocorrem preju??zos no sistema nervoso aut??nomo. N??o
se sabe como a fun????o auton??mica se relaciona com estes preju??zos e se um programa de
caminhada pode modificar a variabilidade da frequ??ncia card??aca (VFC) desta popula????o. O
objetivo deste estudo foi avaliar a VFC de pacientes com DP e a sua rela????o com os sintomas
de ansiedade, depress??o, desempenho funcional e gravidade da doen??a, e tamb??m o efeito de
um programa de caminhada na modula????o auton??mica e na capacidade funcional. Na etapa
transversal foram avaliados 26 pacientes (16 homens/ 10 mulheres; 57,4 ?? 9,2 anos) pelas
escalas de ansiedade, depress??o (HADS-A e HADS-D) e gravidade da doen??a (UPDRSexame
motor e Hoehn e Yahrd). O desempenho funcional foi avaliado pelos testes Timed up
and Go (TUG) e tr??s testes da bateria Senior Fitness Test. Estes resultados foram
correlacionados com ??ndices da VFC no dom??nio do tempo (RMSSD, SDNN) e da frequ??ncia
(HF, LF, LF/HF, TP, HF/TP, LF/TP), e an??lise n??o linear (SampEn e DFA1) aferidos na
posi????o sentado e em p??. A varia????o da VFC da posi????o sentada para em p?? (valores em ??)
tamb??m foi considerada. Na etapa longitudinal foram formados um grupo de caminhada (CA;
n=13) e um grupo controle (CO; n=6), a partir de um ensaio cl??nico randomizado. O programa
de caminhada home-based teve dura????o de seis semanas. Os pacientes do grupo CA foram
reavaliados ap??s 12 semanas de treinamento. Foram observados elevados n??veis de ansiedade
(30,7%) e depress??o (34,6%) nos pacientes avaliados. Os sintomas depressivos associaram-se
tanto ?? atividade parassimp??tica: RMSSD (r= - 0,382; p ??? 0,05), quanto ?? atividade conjunta
nos ramos simp??tico e parassimp??tico: LFsent (r= -0.383; p ??? 0,05), LFem p?? (r= -0,411; p ???
0,05), TPemp?? (r= -0, 504; p ??? 0,05) e ?? SampEn (r= -0.384; p ??? 0,05). A gravidade e tempo
da doen??a tamb??m se associaram negativamente ?? fun????o auton??mica. RMSSDsentado (r=
-0,438; p ??? 0,05), SDNNsentado (r= -0,452; p ??? 0,05) e SDNNemp?? (r= -0,602; p ??? 0,01);
LFemp?? (r= -0,603; p ??? 0,01); TPemp?? (r= -0,504; p ??? 0,05) e LF/TPemp?? (r= -0,504; p ???
0,05) foram negativamente associados ao tempo no teste TUG. Outras correla????es
significativas dos testes f??sico-funcionais e da idade com a VFC foram observadas. O
programa de seis semanas de caminhada promoveu varia????es significativas do ??ndice SampEn
(que mede a irregularidade dos dados de FC) no grupo CA em rela????o ao grupo CO (20,47 vs
???22,81%; CA e CO, respectivamente; p=0,033), assim como o ??ndice ??SampEn (-22,83 vs
18,46%; CA e CO, respectivamente; p=0,022), sugerindo mudan??as positivas na fun????o
auton??mica. Na 12?? semana, os pacientes do grupo CA exibiram aumento dos ??ndices
HF/TPemp?? (7,0%; p=0,017) e SampEn-em p?? (20,5%, p= 0,008), respectivamente) e
redu????o do ??ndice LF/HFemp?? (-10,65 %; p=0,012) em rela????o ?? 1?? semana, sugerindo
melhoras no equil??brio auton??mico. Houve aumento no n??mero de agachamentos (de 10,50 ??
1,93 para 13,25 ?? 1,58 repeti????es; p= 0,021) e redu????o no tempo para realizar o TUG ( de
7,34??? ?? 0,67 para 6,91 ?? 0,83, p=0,002). V??rios ??ndices de VFC aferidos na tes do programa
de caminhada (SDNN, RMSSD, LF, HF, LF/TP) mostraram correla????es com o ganho
funcional (r2 variando de 0,62 a 0,81), sugerindo papel da fun????o auton??mica na adapta????o
neuromuscular ao treinamento. Conclui-se que a VFC pode funcionar como medida
integrativa e marcador perif??rico da adaptabilidade do organismo e da sua capacidade autoregulat??ria,
al??m de recurso de avalia????o pr??tico e sens??vel ?? progress??o da doen??a. O
programa de caminhada home-based melhorou a fun????o auton??mica dos participantes,
frequentemente prejudicada pela doen??a. Isto ?? particularmente interessante na medida em
que v??rias fun????es org??nicas debilitadas na DP s??o mediadas pela fun????o auton??mica.
| Identifer | oai:union.ndltd.org:IBICT/oai:bdtd.ucb.br:tede/2039 |
| Date | 16 July 2015 |
| Creators | Rodrigues, Fabio Barreto |
| Contributors | Campbell, Carmen S??lvia Grubert, Lopes, Daniel de Paula Lima e Oliveira |
| Publisher | Universidade Cat??lica de Bras??lia, Programa Strictu Sensu em Educa????o F??sica, UCB, Brasil, Escola de Sa??de e Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UCB, instname:Universidade Católica de Brasília, instacron:UCB |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 6095716513072507778, 500, 500, 600, 3870802503144686128, 5178284805913411594 |
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