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Previous issue date: 2017-03-29 / Introdu??o: A asma ? uma das doen?as cr?nicas mais prevalentes do mundo e ? considerada um s?rio problema de sa?de p?blica. O seu tratamento se baseia em alcan?ar e manter um bom controle da doen?a. No entanto, na ?vida real?, o controle sub?timo da asma ? frequente. Nesse sentido, o treinamento muscular inspirat?rio (TMI) pode ser uma boa alternativa para complementar a tradicional terapia medicamentosa. Objetivo: Avaliar a efetividade e seguran?a do TMI em indiv?duos com asma. M?todos: Trata-se de ensaio cl?nico randomizado, duplo-cego. A amostra foi composta por 29 indiv?duos asm?ticos divididos em dois grupos: 14 participantes do grupo com carga leve (C15%) e 15 no grupo de treinamento com carga moderada (C50%). O TMI foi realizado 5 dias por semana, durante 6 semanas, com aparelho POWERbreathe?. As sess?es consistiram de 30 repeti??es duas vezes por dia. Os indiv?duos do C15% treinaram com carga de 15% da press?o inspirat?ria m?xima (PIm?x), enquanto o C50% treinou com 50% da PIm?x. Inicialmente, os participantes foram submetidos a avalia??es da fun??o pulmonar. Em seguida, foram aplicados o Asthma Quality of Life Questionnaire (AQLQ, Question?rio de Qualidade de Vida em Asma) e Asthma Control Questionnaire (ACQ, Question?rio de Controle da Asma). A for?a muscular respirat?ria foi obtida pela PIm?x e pela press?o expirat?ria m?xima (PEm?x). Foram avaliados ainda o n?vel de dispneia antes e ap?s o teste da caminhada de 6 minutos (TC6), atrav?s da escala de Borg CR10, e a capacidade funcional pela dist?ncia percorrida no TC6 (DTC6). Por fim, um di?rio de treinamento foi utilizado para registro de eventos adversos e ades?o as sess?es de TMI. As avalia??es foram realizadas no in?cio do estudo, ap?s 6 semanas de treinamento e seis semanas ap?s a cessa??o do treinamento. Resultados: Ap?s 6 semanas de TMI, a PIm?x aumentou 20,7 cmH2O e 33,1 cmH2O nos grupos C15% e C50%, respectivamente. A PEm?x mostrou um ganho de 10,4 cmH2O no grupo C50% e 8,1 cmH2O no grupo C15%. No AQLQ, foi observada uma prov?vel melhora cl?nica (acima de 0,5) em dois dom?nios (limita??o de atividade e fun??o emocional) no grupo C15% e em todos os dom?nios no grupo C50%. No grupo C50%, houve ainda uma potencial redu??o de 1,13 e 1,42 pontos na escala de Borg CR10 antes e ap?s o TC6, respectivamente. Ao final do TMI, n?o houve diferen?a no controle da asma, DTC6 e fun??o pulmonar para ambos os grupos. Durante o per?odo de treinamento, nenhum volunt?rio foi hospitalizado ou admitido em um servi?o de emerg?ncia, nem houve relato de crise asm?tica devido ao TMI. A ades?o ao TMI n?o foi analisada, uma vez que a grande maioria dos participantes n?o registraram as sess?es realizadas no di?rio de treinamento. Seis semanas ap?s a cessa??o do TMI, apenas 31% dos participantes retornaram para a avalia??o. Assim, n?o foi poss?vel incluir os efeitos da reversibilidade do treinamento em nossos resultados. Conclus?es: Em indiv?duos com asma, o TMI domiciliar com carga leve e moderada mostrou-se seguro e eficaz para aumentar a for?a dos m?sculos respirat?rios e melhorar a qualidade de vida. Al?m disso, o treinamento com carga moderada reduziu o n?vel de dispneia. / Background: Asthma is one of the most prevalent chronic diseases in the world and is considered a serious public health problem. Asthma treatment is based on achieving and maintaining adequate disease control. However, in "real life", suboptimal control of asthma is frequent. In this sense, inspiratory muscle training (IMT) may be a good alternative to complement traditional drug therapy. Objective: To evaluate the effectiveness and safety of the IMT in people with asthma. Methods: This was a double-blind randomized controlled trial. The sample consisted of 29 people with asthma divided into two groups: 14 participants in the low load group (L15%) and 15 in the moderate load group (L50%). IMT was performed 5 days a week for 6 weeks with POWERbreathe? device. The sessions consisted of 30 repetitions twice a day. The L15% group trained with a load of 15% of maximal inspiratory pressure (MIP), while L50% group trained with 50% of MIP. Initially, the participants were submitted to pulmonary function assessments. Then, the Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Questionnaire (ACQ) were applied. Respiratory muscle strength was obtained by MIP and by maximal expiratory pressure (MEP). The Borg CR10 scale and the distance walked in six-minute walk test (6MWD) were used to assess degree of dyspnea and functional capacity, respectively. Finally, a training diary was used to record adverse events and IMT adherence. Assessments were performed at baseline, after 6 weeks of training and six weeks after cessation of training. Results: After 6 weeks of IMT, MIP increased 20.7 cmH2O and 33.1 cmH2O in the L15% and L50% groups, respectively. MEP showed a gain of 10.4 cmH2O in the L50% group and 8.1 cmH2O in the L15% group. AQLQ showed a probable clinical improvement (above 0.5) in two domains (limitation of activity and emotional function) in the L15% group and in all domains in the L50% group. In the L50% group, there was a potential reduction of 1.13 and 1.42 points on the Borg CR10 scale before and after the 6MWT, respectively. At the end of the IMT, there was no difference in asthma control, 6MWD and pulmonary function for both groups. During the training period, no volunteers were hospitalized or admitted to an emergency department, nor was there an asthmatic crisis due to IMT. Adherence to IMT was not analyzed, since the majority of participants did not record the sessions performed in the training diary. Six weeks after cessation of IMT, only 31% of participants returned for evaluation. Thus, it was not possible to include the effects of training reversibility on our results. Conclusions: In individuals with asthma, home IMT with a low and moderate load proved to be safe and effective in increasing respiratory muscle strength and improving quality of life. In addition, moderate-load training reduced the level of dyspnea.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/23963 |
| Date | 29 March 2017 |
| Creators | Silva, Ivanizia Soares da |
| Contributors | 21268843334, http://lattes.cnpq.br/4934425482168899, Sousa, Catarina de Oliveira, 01214947484, http://lattes.cnpq.br/5522647106933904, Mendon?a, Karla Morganna Pereira Pinto de, 72298863415, http://lattes.cnpq.br/1736384836028397, Silva, Baldomero Antonio Kato da, 63747235115, http://lattes.cnpq.br/6675687901015335, Andriolo, Brenda Nazar? Gomes, 77466187234, http://lattes.cnpq.br/8839044871234164, Ferreira, Gard?nia Maria Holanda |
| Publisher | PROGRAMA DE P?S-GRADUA??O EM FISIOTERAPIA, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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