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Doctoral Thesis
DOI
https://doi.org/10.11606/T.17.2022.tde-01112022-174813
Document
Author
Full name
Daniele Oliveira dos Santos
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2022
Supervisor
Committee
Gastaldi, Ada Clarice (President)
Cetlin, Andrea de Cassia Vernier Antunes
Ramos, Ercy Mara Cipulo
Weber, Karina Tavares
Title in Portuguese
Efeitos do exercício sobre o transporte de secreções, inflamação, resistência do sistema respiratório e qualidade de vida em pacientes com bronquiectasias
Keywords in Portuguese
Bronquiectasias
Capacidade funcional de exercícios
Fisioterapia
Reabilitação pulmonar
Abstract in Portuguese
Introdução: Bronquiectasias são caracterizadas pela dilatação anormal, permanente e irreversível dos brônquios. A tosse com produção exacerbada de secreção é o principal sintoma. Os pacientes podem se beneficiar de técnicas de fisioterapia específicas para remoção de secreções, bem como de exercícios, no entanto, poucos estudos descrevem os mecanismos envolvidos nos efeitos benéficos associados a esta intervenção. Objetivo: Avaliar os efeitos do exercício sobre o transporte de secreções, inflamação e resistência do sistema respiratório, sistema nervoso autônomo e suas repercussões sobre a qualidade de vida em pacientes com bronquiectasias. Métodos: Trata-se de um RCT em que voluntários com bronquiectasias (BCQ: n=12) e saudáveis (SAU: n=9) participaram de um Programa de reabilitação Pulmonar (PRP). Foram realizadas avaliação da função pulmonar; tempo de transporte da sacarina (TTS); fração exalada de óxido nítrico (FENO); teste cardiopulmonar (CPET); teste de caminhada de seis minutos (TC6); teste das pressões respiratórias máximas; variabilidade da frequência cardíaca (VFC) e qualidade de vida (QV). Resultados: A comparação inicial entre os grupos BCQ e SAU mostrou diferença entre todas as variáveis analisadas na espirometria; no IOS entre as variáveis R5-R20, FRES e AX, p<0,02); na PE% (p=0,02) e distância máxima percorrida no TC6 (DMPTC6), p=0,0002, na avaliação inicial. A comparação antes e após o PRP não mostrou diferença para as variáveis FENO, do CPET e VFC. Na avaliação do TTS 58% do grupo BCQ relatou sentir o gosto da sacarina na avaliação inicial, contra 83% na avaliação final. No grupo BCQ houve diferença na DMPTC6 (p<0,001). Conclusão: Como esperado, o PRP foi eficaz para melhorar a tolerância ao exercício no grupo BCQ e este aumento, maior que a DMCI (35m), pode impactar diretamente as AVDs nesses pacientes. Além disso, também houve melhora no transporte mucociliar, que contribui para maior eficácia dos mecanismos de remoção de secreções e melhora da QV destes pacientes.
Title in English
Effects of exercise on secretion transport, inflammation, respiratory system resistance and quality of life in patients with bronchiectasis
Keywords in English
Bronchiectasis
Functional exercise capacity
Physiotherapy
Pulmonary rehabilitation
Abstract in English
Introduction: Bronchiectasis are characterized by abnormal, permanent and irreversible dilation of the bronchi. Cough with excessive production of secretion is the main symptom. Patients can benefit from specific physiotherapy techniques for secretion removal, as well as from exercises, however, few studies describe the mechanisms involved in the beneficial effects associated with this intervention. Objective: To evaluate the effects of exercise on the transport of secretions, inflammation and resistance of the respiratory system, autonomic nervous system and its repercussions on quality of life in patients with bronchiectasis. Methods: This is an RCT in which volunteers with bronchiectasis (BCQ: n=12) and healthy (SAU: n=9) participated in a Pulmonary Rehabilitation Program (PRP). Pulmonary function assessments were performed; saccharin transport time (TTS); exhaled fraction of nitric oxide (FENO); cardiopulmonary test (CPET); six-minute walk test (6MWT); maximal respiratory pressures test; heart rate variability (HRV) and quality of life (QL). Results: The initial comparison between the BCQ and SAU groups showed a difference between all the variables analyzed in the spirometry; in IOS between variables R5-R20, FRES and AX, p<0.02); in PE% (p=0.02) and maximum distance covered in the 6MWT (DMPTC6), p=0.0002, in the initial evaluation. The comparison before and after PRP showed no difference for the FENO, CPET and HRV variables. In the TTS assessment, 58% of the BCQ group reported tasting saccharin in the initial assessment, against 83% in the final assessment. In the BCQ group, there was a difference in DMPTC6 (p<0.001). Conclusion: As expected, PRP was effective in improving exercise tolerance in the BCQ group and this increase, greater than DMCI (35m), can directly impact ADLs in these patients. In addition, there was also an improvement in mucociliary transport, which contributes to greater effectiveness of the secretion removal mechanisms and improvement in the QoL of these patients.
 
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Publishing Date
2022-11-01
 
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