Nível de atividade física associado a qualidade do sono e sistema nervoso autônomo de tabagistas e efeitos do exercício físico no sucesso da cessação do tabagismo
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Data
2019-12-12
Autores
Trevisan, Iara Buriola [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Estudos vem investigando a relação do nível da atividade física com a melhora da qualidade do sono de tabagistas, além da utilização do exercício físico para aumentar o sucesso da cessação do tabagismo. No entanto, faz-se necessário investigar a relação da qualidade do sono e sistema nervoso autônomo (SNA) de acordo com o nível de atividade física habitual de tabagistas, para promover a identificação de possíveis mecanismos responsáveis pelos distúrbios do sono desta população, além disso os efeitos do exercício físico no sucesso da cessação do tabagismo ainda é pouco compreendida indicando pequenas taxas de adesão e abstinência ao final do tratamento. Objetivos: Identificar a relação entre a qualidade do sono de tabagistas com o nível de atividade física habitual e modulação do SNA. Além disso, comparar dois tipos de exercícios associados à terapia cognitivo-comportamental (TCC) no sucesso da cessação do tabagismo. Métodos: Trata-se de dois estudos, sendo o primeiro transversal realizado com 42 tabagistas divididos em dois grupos de acordo com o percentil 50% do nível de atividade física de moderada à vigorosa (AFMV) avaliada por meio da acelerometria; onde a qualidade do sono foi avaliada por meio do questionário Mini-Sleep e a modulação do SNA por meio de índices da variabilidade da frequência cardíaca (VFC). Para as análises dos dados foi utilizado análise de covariância (ANCOVA) ajustado para idade, sexo, composição corporal, anosmaço, medicamentos beta-bloqueadores, ansiedade e depressão em log base 10, exceto para dados qualitativos como sexo e beta-bloqueadores. As correlações foram feitas utilizando o teste de Spearman. Já o segundo estudo trata-se de um ensaio clínico realizado com 41 tabagistas randomizados para os grupos: exercício aeróbio (EA: n=16), exercício resistido (ER: n=14) e TCC (n=11). Todos os grupos receberam uma intervenção de 15 semanas, sendo que os grupos EA e ER realizaram exercícios três vezes semanais com duração de 60 minutos a sessão. Além disso, todos os grupos receberam a TCC em grupo associado ao apoio medicamentoso, totalizando 13 sessões. Os acompanhamentos para avaliação da abstinência, sintomas de ansiedade e depressão e nível de atividade física foram realizados ao final do tratamento (3 meses pós-data da parada) e após 6 meses pós-data da parada. Para análise dos dados, foi utilizado o teste qui-quadrado para comparar as proporções do número de abstinentes entre os grupos. Resultados: No primeiro estudo os tabagistas menos ativos apresentaram pior qualidade do sono (p = 0,048) e insônia (p=0,045). Além disso, o grupo menos ativo apresentou diminuição da modulação parassimpática [HF(un; p=0,049); RMSSD (ms; p=0,047) e SD1 (ms; p=0,047)] e aumento de LF (un; p=0,033) e relação LF/HF (p=0,040). Houve correlação positiva entre a pontuação total do Mini-Sleep com o índice LF (un; r=0,317, p=0,041) e relação LF/HF (r=0,318, p=0,040), e correlação negativa com HF (un; r= -0,322, p=0,038). No segundo estudo observou-se que o grupo EA apresentou maior taxa de abstinentes comparado com os grupos ER e TCC (56,3%, 7,1% e 27,3%, respectivamente, p=0,015) em 6 meses pós-data da parada. Conclusões: Tabagistas com menor nível de atividade física habitual apresentaram pior qualidade do sono e alterações na modulação do sistema nervoso autônomo. E o exercício aeróbio supervisionado associado à TCC e terapia medicamentosa aumenta as taxas de abstinência até 6 meses pós-data da parada do cigarro.
Studies has been investigating the relationship of habitual physical activity with improved of sleep quality in smokers, in addition to using exercise to increase the success of smoking cessation. However, it is necessary to investigate the relationship between sleep quality and autonomic nervous system (ANS) according to the level of habitual physical activity of smokers, to promote the identification of possible mechanisms responsible for sleep disorders in this population. The effects of physical exercise on smoking cessation success, it is still poorly understood, indicating low adherence and abstinence rates at the end of treatment. Objectives: To identify changes in the sleep quality of smokers and its relation with habitual physical activity level and ANS modulation. Also, compare two types of exercise associated with cognitive behavior therapy (CBT) in successful smoking cessation. Methods: These are two studies, the first cross-sectional study conducted with 42 smokers divided into two groups according to the 50th percentile of the moderate-to-vigorous physical activity (MVPA) assessed by accelerometry; where the sleep quality was assessed using the Mini-sleep Questionnaire and the ANS modulation was assessed by indices of heart rate variability (HRV). For the analysis of possible mean differences analysis of covariance (ANCOVA) was used adjusting for age, sex, body composition, pack-years, beta-blockers, anxiety, and depression in log base 10. Correlations were made by using the Spearman rank correlation. The second study is a clinical trial conducted with 41 smokers randomized to the groups: aerobic exercise (AE: n = 16), resistance exercise (RE: n = 14) and CBT (n = 11). All groups received a 15-week intervention, and the groups EA and ER performed exercises three times a week with a duration of 60 minutes per session. In addition, all groups received group CBT associated with drug support, totaling 13 sessions. Follow-up to assess abstinence, anxiety and depression symptoms, and level of physical activity was performed at the end of treatment (3 months after stopping date) and after 6 months after quitting smoking. For data analysis, the chi-square test was used to compare the proportions of the number of abstinent between the groups. Results: The first study the smokers who were less active showed poor sleep quality (p=0.048) and insomnia (p=0.045). Furthermore, the less active group presented decreased parasympathetic modulation [HF (un; p=0.049); RMSSD (ms; p=0.047) and SD1 (ms; p=0.047)] and an increased LF(un) index (p=0.033) and LF/HF ratio (p=0.040). There was positive correlation between the total Mini-sleep score with LF (un) index (r=0.317, p=0.041) and LF/HF ratio (r=0.318, p=0.040) and negative correlation with HF (un) index (r= -0.322, p=0.038). In the second study, it was observed that the EA group had a higher abstinent rate compared to the ER and CBT groups (56.3%, 7.1% and 27.3%, respectively, p = 0.015) at 6 months after quitting smoking. Conclusions: Smokers with lower level of habitual physical activity showed poor sleep quality and alterations in autonomic nervous system modulation. And supervised aerobic exercise associated with CBT and drug therapy increases abstinence rates up to 6 months after the date of smoking cessation.
Studies has been investigating the relationship of habitual physical activity with improved of sleep quality in smokers, in addition to using exercise to increase the success of smoking cessation. However, it is necessary to investigate the relationship between sleep quality and autonomic nervous system (ANS) according to the level of habitual physical activity of smokers, to promote the identification of possible mechanisms responsible for sleep disorders in this population. The effects of physical exercise on smoking cessation success, it is still poorly understood, indicating low adherence and abstinence rates at the end of treatment. Objectives: To identify changes in the sleep quality of smokers and its relation with habitual physical activity level and ANS modulation. Also, compare two types of exercise associated with cognitive behavior therapy (CBT) in successful smoking cessation. Methods: These are two studies, the first cross-sectional study conducted with 42 smokers divided into two groups according to the 50th percentile of the moderate-to-vigorous physical activity (MVPA) assessed by accelerometry; where the sleep quality was assessed using the Mini-sleep Questionnaire and the ANS modulation was assessed by indices of heart rate variability (HRV). For the analysis of possible mean differences analysis of covariance (ANCOVA) was used adjusting for age, sex, body composition, pack-years, beta-blockers, anxiety, and depression in log base 10. Correlations were made by using the Spearman rank correlation. The second study is a clinical trial conducted with 41 smokers randomized to the groups: aerobic exercise (AE: n = 16), resistance exercise (RE: n = 14) and CBT (n = 11). All groups received a 15-week intervention, and the groups EA and ER performed exercises three times a week with a duration of 60 minutes per session. In addition, all groups received group CBT associated with drug support, totaling 13 sessions. Follow-up to assess abstinence, anxiety and depression symptoms, and level of physical activity was performed at the end of treatment (3 months after stopping date) and after 6 months after quitting smoking. For data analysis, the chi-square test was used to compare the proportions of the number of abstinent between the groups. Results: The first study the smokers who were less active showed poor sleep quality (p=0.048) and insomnia (p=0.045). Furthermore, the less active group presented decreased parasympathetic modulation [HF (un; p=0.049); RMSSD (ms; p=0.047) and SD1 (ms; p=0.047)] and an increased LF(un) index (p=0.033) and LF/HF ratio (p=0.040). There was positive correlation between the total Mini-sleep score with LF (un) index (r=0.317, p=0.041) and LF/HF ratio (r=0.318, p=0.040) and negative correlation with HF (un) index (r= -0.322, p=0.038). In the second study, it was observed that the EA group had a higher abstinent rate compared to the ER and CBT groups (56.3%, 7.1% and 27.3%, respectively, p = 0.015) at 6 months after quitting smoking. Conclusions: Smokers with lower level of habitual physical activity showed poor sleep quality and alterations in autonomic nervous system modulation. And supervised aerobic exercise associated with CBT and drug therapy increases abstinence rates up to 6 months after the date of smoking cessation.
Descrição
Palavras-chave
Tabagismo, Sono, Doenças do sistema nervoso autônomo, Atividade física, Abandono do uso de tabaco, Smoking, Sleep, Autonomic nervous system diseases, Physical activity, Tobacco use cessation