Diferentes tipos de treinamento físico em pacientes com DPOC: um follow-up de treinamento resistido e análise de satisfação e aderência a um circuito funcional
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2019-03-21
Autores
Silva, Isis Grigoletto
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Universidade Estadual Paulista (Unesp)
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Introdução: O exercício físico é um componente de extrema importância no tratamento de pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC). Sendo citados como modalidades de exercício físico, o treinamento resistido, o treinamento aeróbico e o treinamento funcional. O treinamento resistido com componentes elásticos é uma alternativa de baixo custo aos aparelhos de musculação convencional, e o treinamento aeróbico associado ao resistido habitualmente o mais utilizado. Apesar dos benefícios obtidos com tais exercícios, estes são reduzidos com o passar do tempo após a finalização dos treinamentos, além disso, a aderência destes pacientes é deficitária, sendo a monotonia dos exercícios um dos motivos para este fato. Dessa forma, estudos visam identificar modalidades de treinamento capazes de atrair e manter a satisfação desses pacientes. Assim, torna-se necessário verificar se um treinamento com resistência elástica é capaz de promover a manutenção dos ganhos obtidos pós-treinamento, e além disso, verificar se a inclusão de um treinamento funcional a um treinamento convencional pode ser uma alternativa para melhor adesão de pacientes com DPOC. Objetivo: Realizar dois estudos com os seguintes intuitos: 1) verificar se um treinamento com resistência elástica é capaz de promover a manutenção dos ganhos obtidos por pacientes com DPOC após a finalização dos treinamentos e 2) verificar se a inclusão de um treinamento funcional a um treinamento convencional (aeróbico e musculação) pode promover melhor satisfação e aderência de pacientes com DPOC a estes treinos. Métodos: Para atender o primeiro objetivo, 33 pacientes com DPOC foram randomizados em três grupos: Grupo Bandas Elásticas (GBE), Grupo Tubos Elásticos (GTE) ou Grupo aparelhos de musculação Convencional (GC). Os participantes realizaram três meses de intervenção e três meses de follow-up. Foram realizadas avaliações no momento basal, final e em três meses de follow-up: capacidade funcional (Teste de caminhada de seis minutos - TC6), nível de atividade física (Questionário de Baecke), qualidade de vida (Questionário de avaliação da DPOC - CAT e Mini Sleep Questionnaire – MSQ) e composição corporal (Bioimpedância, Octopolar InBody). Para atender o objetivo do segundo estudo, outros 21 pacientes com DPOC, não relacionados ao primeiro estudo, divididos em dois grupos: Grupo Treinamento Funcional (GTF) e Grupo Treinamento Convencional (GTC) após 8 semanas de treinamento, participaram de grupos focais para avaliação qualitativa de satisfação, e responderam a questionários quantitativos para avaliação dos aspectos do treinamento. Por fim, a aderência foi verificada pelo número de presença nas sessões. Resultados: Quanto ao primeiro estudo, em três meses de follow-up, foi observada manutenção da composição corporal (p>0.05), qualidade de vida (p>0,05) e nível de atividade física (p=0,98) nos três grupos (GBE, GTE e GC), e um declínio na capacidade funcional, com uma quase Diferença Mínima Clinicamente Importante (DMCI) em GTE. No segundo estudo, foi possível observar semelhante aderência (p=0,965) e satisfação (p=0,341) em ambos os grupos (GTF e GTC). Fatores como: aumento dos sintomas respiratórios, distância da casa ao centro de treinamento e problemas pessoais não interferiram na aderência e não apresentaram diferença entre os grupos (p>0,05). Na análise qualitativa, os fatores: manejo da doença, melhorias físicas e psicossociais, relacionamentos interpessoais e exercícios propostos foram relacionados a satisfação. Por fim, aspectos negativos: presença de dores, comorbidades, crenças e desmotivação pessoal interferiram na satisfação dos treinamentos. Conclusão: Três meses de follow-up após a finalização do treinamento resistido com componentes elásticos demonstrou manutenção da composição corporal, qualidade de vida e nível de atividade física de pacientes com DPOC, entretanto, houve declínio na capacidade funcional em GTE. Além disso, foi possível verificar que a inserção de um circuito de exercícios funcionais no treinamento convencional de pacientes com DPOC apresenta alta satisfação e aderência, no entanto de forma semelhante ao treinamento convencional.
Introduction: The physical exercise is an important component in the treatment of patients with Chronic Obstructive Pulmonary Disease (COPD). Some modalities of physical exercise are resistance training, aerobic training, and functional training. Elastic resistance training is a low-cost alternative to resistance training with conventional weight machines, and aerobic training combined with resistance training, that are the most popular approaches. Although the benefits obtained by these exercises are diminished over the time after the training finalization, another issue is the unsatisfactory training adherence of these patients due to the exercise monotony. Therefore, studies aim to identify modalities of trainings able to attract and maintain the satisfaction of these patients. Thus, verifies if a resistance training with elastic components can promote the maintenance of the gains obtained after training, in addition, to verify if the inclusion of the functional training to a habitual training can be an alternative to improve the adherence of patients with COPD. Objective: To realize two studies with the following objectives: 1) to verify if a resistance training with elastic components is able to promote the maintenance of the gains obtained by patients with COPD after the finalization of the training and 2) to verify if the inclusion of a functional training to a conventional training (aerobic and resistance) can promote better satisfaction and adherence of patients with COPD. Methods: In order to attend the first objective, 33 patients with COPD were randomized into three groups: Elastic Band training Group (EBG), Elastic Tube training Group (ETG) and training Group with Conventional weight machines (CG). Participants performed three months of intervention and three months of follow-up. The functional capacity (six-minute walk test – 6MWT), physical activity level (Baecke's questionnaire), quality of life (COPD assessment questionnaire - CAT and Mini Sleep Questionnaire - MSQ) and body composition (Bioimpedance, Octopolar InBody) was assessed before and after at the training finalization and in three months of follow-up. In order to attend the second objective, other 21 patients with COPD, not related to the first study, were divided into two groups: Functional Training Group (FTG) and Conventional Training Group (CTG), after eight weeks of training focus groups was conducted to assess the satisfaction, and participants answered quantitative questionnaires to evaluate the aspects of the training. Finally, the adherence was verified by sessions’ attendance. Results: In the first study, at three months of follow-up, was observed a maintenance in body composition (p>0.05), quality of life (p>0.05) and in the level of physical activity (p=0.98) in the groups (EBG, ETG and CG), and a decline in functional capacity, with Minimum Clinically Important Difference (MCID) on the ETG group. In the second study was observed a similar adherence (p=0.965) and satisfaction (p=0,341) in both groups (FTG and CTG). The increase in respiratory symptoms, distance from home to training centre and personal problems did not interfere in the adherence and presented no difference between groups (p> 0.05). Disease management, physical and psychosocial improvements, interpersonal relationships and proposed exercises were factors related to satisfaction. However, presence of pain, comorbidities, beliefs and personal lack of motivation interfered in the satisfaction training. Conclusion: At three months follow-up after the finalization of resistance training with elastic components, there were the maintenance in body composition, quality of life and level of physical activity of patients with COPD, however, there was a decline in functional capacity in ETG. Additionally, was verified that an insertion of functional exercises in conventional training of patients with COPD presented high satisfaction and adherence, however, similar with conventional training.
Introduction: The physical exercise is an important component in the treatment of patients with Chronic Obstructive Pulmonary Disease (COPD). Some modalities of physical exercise are resistance training, aerobic training, and functional training. Elastic resistance training is a low-cost alternative to resistance training with conventional weight machines, and aerobic training combined with resistance training, that are the most popular approaches. Although the benefits obtained by these exercises are diminished over the time after the training finalization, another issue is the unsatisfactory training adherence of these patients due to the exercise monotony. Therefore, studies aim to identify modalities of trainings able to attract and maintain the satisfaction of these patients. Thus, verifies if a resistance training with elastic components can promote the maintenance of the gains obtained after training, in addition, to verify if the inclusion of the functional training to a habitual training can be an alternative to improve the adherence of patients with COPD. Objective: To realize two studies with the following objectives: 1) to verify if a resistance training with elastic components is able to promote the maintenance of the gains obtained by patients with COPD after the finalization of the training and 2) to verify if the inclusion of a functional training to a conventional training (aerobic and resistance) can promote better satisfaction and adherence of patients with COPD. Methods: In order to attend the first objective, 33 patients with COPD were randomized into three groups: Elastic Band training Group (EBG), Elastic Tube training Group (ETG) and training Group with Conventional weight machines (CG). Participants performed three months of intervention and three months of follow-up. The functional capacity (six-minute walk test – 6MWT), physical activity level (Baecke's questionnaire), quality of life (COPD assessment questionnaire - CAT and Mini Sleep Questionnaire - MSQ) and body composition (Bioimpedance, Octopolar InBody) was assessed before and after at the training finalization and in three months of follow-up. In order to attend the second objective, other 21 patients with COPD, not related to the first study, were divided into two groups: Functional Training Group (FTG) and Conventional Training Group (CTG), after eight weeks of training focus groups was conducted to assess the satisfaction, and participants answered quantitative questionnaires to evaluate the aspects of the training. Finally, the adherence was verified by sessions’ attendance. Results: In the first study, at three months of follow-up, was observed a maintenance in body composition (p>0.05), quality of life (p>0.05) and in the level of physical activity (p=0.98) in the groups (EBG, ETG and CG), and a decline in functional capacity, with Minimum Clinically Important Difference (MCID) on the ETG group. In the second study was observed a similar adherence (p=0.965) and satisfaction (p=0,341) in both groups (FTG and CTG). The increase in respiratory symptoms, distance from home to training centre and personal problems did not interfere in the adherence and presented no difference between groups (p> 0.05). Disease management, physical and psychosocial improvements, interpersonal relationships and proposed exercises were factors related to satisfaction. However, presence of pain, comorbidities, beliefs and personal lack of motivation interfered in the satisfaction training. Conclusion: At three months follow-up after the finalization of resistance training with elastic components, there were the maintenance in body composition, quality of life and level of physical activity of patients with COPD, however, there was a decline in functional capacity in ETG. Additionally, was verified that an insertion of functional exercises in conventional training of patients with COPD presented high satisfaction and adherence, however, similar with conventional training.
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Doença Pulmonar Obstrutiva Crônica, Exercício Físico, Reabilitação, Composição Corporal, Qualidade de vida, Distúrbios do sono, Satisfação do Paciente, Aderência do Paciente, Pesquisa Qualitativa, Avaliação Quantitativa, Chronic Obstructive Pulmonary Disease, Physical Exercise, Rehabilitation, Body Composition, Quality of Life, Sleep Disorders, Patient Satisfaction, Patient Adherence, Qualitative Research, Quantitative Evaluation