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Doctoral Thesis
DOI
10.11606/T.5.2017.tde-05042017-151025
Document
Author
Full name
Magda Maria Maia
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2016
Supervisor
Committee
Silva, Clovis Artur Almeida da (President)
Aikawa, Nádia Emi
Borba Neto, Eduardo Ferreira
Len, Cláudio Arnaldo
Title in Portuguese
Teste cardiopulmonar de exercício em pacientes com fibromialgia juvenil
Keywords in Portuguese
Adolescente
Criança
Disfunção autonômica
Estudos de coorte
Fibromialgia
Qualidade de vida
Reserva cronotópica
Sistema nervoso autônomo
Teste de esforço
Tolerância ao exercício
Abstract in Portuguese
Introdução: A disfunção do sistema nervoso autônomo (disfunção autonômica ou dissautonomia) tem sido associada à fisiopatologia da fibromialgia em pacientes adultos. A modulação cardíaca em resposta ao exercício foi demonstrada em uma série de estudos em adultos com fibromialgia que evidenciaram reduzida capacidade aeróbia, assim como o comprometimento autonômico cardíaco e incompetência cronotrópica, que é a incapacidade de aumentar a frequência cardíaca concomitante ao aumento da intensidade do exercício. No entanto, a capacidade aeróbica e a disautonomia, definidas a partir da avaliação dos parâmetros do teste de exercício cardiopulmonar, não foram estudadas em pacientes adolescentes com síndrome da fibromialgia (FMJ). Objetivo: Avaliar os parâmetros do teste de exercício cardiopulmonar em pacientes com FMJ e controles saudáveis e as possíveis correlações entre estes parâmetros e a qualidade de vida relacionada à saúde (QVRS), capacidade funcional e dor nos pacientes FMJ. Métodos: Estudo transversal multicêntrico incluindo 25 pacientes com FMJ e 25 controles saudáveis. Ambos os grupos participavam somente das aulas de educação física na escola. O teste de exercício cardiopulmonar de esforço em esteira permitiu avaliar a resposta cardiorrespiratória durante o exercício. A resposta cronotrópica foi avaliada pela medida da reserva cronotrópica. Foram avaliados dor, capacidade funcional e QVRS. Resultados: A mediana da idade atual foi similar nos pacientes com FMJ e controles saudáveis (15 vs. 15 anos, p=0,890), assim como o índice de massa corporal (p=0,332), gênero feminino (p=1,000) e estágios de Tanner (p=0,822). A mediana dos parâmetros da QVRS (escore total de saúde física e saúde psicossocial) foi significativamente menor nos pacientes com FMJ versus controles, de acordo com o autorrelato dos pacientes e de seus pais (p < 0,001). A mediana do pico FC [181 (150-198) vs. 197 (181-202) bpm, p < 0,001], da reserva cronotrópica (RC) [84 (53-98) vs. 99 (84-103) %, p < 0,001] e da FC de repouso à FC de pico [96 (65-181) vs. 127 (61-185) bpm, p=0,010] foram significantemente menores nos pacientes com FMJ quando comparados aos controles saudáveis. A mediana do ?FCR1 [15 (3-39) vs. 35 (9-52) bpm, p < 0,001], deltaFCR2 [37 (20-57) vs. 51 (32-94) bpm, p < 0,001], VO2 de pico [32.34 (24.24-39.65) vs. 36.4 (28.56-52.71) ml/kg/min, p=0,005], velocidade máxima [5 (4-6.3) vs. 5.9 (4.0-6.3) mph, p=0,001], tempo de exaustão [11.5 (8.5-14.5) vs. 14 (11-18) minutos, p < 0,001] e capacidade de trabalho [3.37 (2.04-5.6) vs. 3.89 (2.91-6.55) W/kg, p=0,006] foram significativamente menores nos pacientes com FMJ quando comparados aos controles. A frequência da incompetência cronotrópica (<= 80%) foi significativamente maior nos pacientes com FMJ versus controles (p=0,0006). Conclusões: Este estudo identificou incompetência cronotrópica e recuperação atenuada da FC em pacientes com FMJ, indicando disfunção autonômica
Title in English
Cardiopulmonary Exercise Test in patients with Juvenile fibromyalgia syndrome
Keywords in English
Adolescent
Autonomic dysfunction
Autonomic nervous system
Child
Chronotropic reserve
Cross-sectional studies
Exercise test
Exercise tolerance
Fibromyalgia
Quality of life
Abstract in English
Introdução: Autonomic nervous system dysfunction (also named autonomic disturbance or dysautonomia) has been linked to physiopathology of adult patients with fibromyalgia. Cardiac modulation in response to exercise in case series of adult fibromyalgia revealed reduced aerobic capacity, as well as cardiac autonomic impairment and chronotropic incompetence, which is the inability to increase heart rate with an increase in exercise intensity. However, to our knowledge treadmill cardiorespiratory test and to assess aerobic capacity and dysautonomia has not been studied in adolescents with JFM patients. Objective: To assess cardiorespiratory exercise test parameters in Juvenile fibromyalgia syndrome (JFM) patients and healthy controls and possible correlations between these parameters and health-related quality of life (HRQL), functional ability and pain in JFM patients. Methods: A multicenter cross-sectional study included 25 JFM patients and 25 healthy controls. Both groups were engaged only in the physical education classes in school. A treadmill graded cardiorespiratory test was performed and heart-rate (HR) response during exercise was evaluated by the chronotropic reserve (CR). Pain, functional ability and HRQL were assessed. Results: The median current age was similar in JFM and controls (15 vs. 15years, p=0.890), as well as body mass index (p=0.332), female gender (p=1.000) and Tanner stages (p=0.822). The medians of HRQL parameters (total score/physical health/psychosocial health) were significantly lower in JFM versus controls according to patient and parent self-reports (p<0.001). The median of peak HR [181 (150-198) vs. 197 (181-202) bpm, p < 0.001], chronotropic reserve [84 (53-98) vs. 99 (84-103)%, p < 0.001] and resting to peak [96 (65-181) vs. 127 (61-185) bpm, p=0.010] were significantly lower in JFM compared to controls. The median of ?HRR1 [15 (3-39) vs. 35 (9-52) bpm, p < 0.001], deltaHRR2 [37 (20-57) vs. 51 (32-94) bpm, p < 0.001], peak VO2 [32.34 (24.24-39.65) vs. 36.4 (28.56-52.71) ml/kg/min, p=0.005]; peak speed [5 (4-6.3) vs. 5.9 (4.0-6.3) km/h, p=0.001], time to exhaustion [11.5 (8.5-14.5) vs. 14 (11-18) minutes, p < 0.001] and working capacity on power [3.37 (2.04-5.6) vs. 3.89 (2.91-6.55) W/kg, p=0.006] were significantly lower in JFM compared to controls. The frequency of chronotropic incompetence ( <= 80%) was significantly higher in JFM versus controls (p=0.0006). Conclusions: This study identified chronotropic incompetence and delayed HR recovery in JFM patients, indicating autonomic dysfunction
 
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