Efeitos do treinamento aeróbio presencial e acompanhado à distância (home-based) em mulheres no tratamento hormonal para o câncer de mama
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Data
2020-12-18
Autores
Reis, Andréa Dias [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
O tratamento do câncer de mama (CM), apesar de combater o tumor e melhorar a sobrevida de pacientes, causa efeitos adversos como toxidade, dispneia, dor, fadiga e prejuízos à capacidade funcional (CF) e à qualidade de vida (QV). Em especial, o tratamento hormonal (TH) com Tamoxifeno (Tmx) e Inibidores de Aromatase (IA) que, além dos efeitos adversos apontados, também causam alteração na composição corporal (CCp) e no perfil lipídico (PL). Em contraponto, o treinamento aeróbio (TA) na modalidade home-based (HB) tem sido utilizado para minimizar esses efeitos, porém, ainda não está totalmente elucidada qual a real adaptação que o TA promove na CCp e PL de mulheres em TH. Objetivo: Comparar os efeitos do TA na modalidade presencial e home-based sobre variáveis de transferência lipídica para HDL, PL, glicemia, insulinemia, biomarcadores metabólicos (adiponectina e leptina), composição corporal, nível de atividade física, consumo alimentar, capacidade funcional e capacidade cardiorrespiratória, dor e qualidade de vida de mulheres que utilizam Tmx e IA para tratamento do CM. Método: Participaram do estudo 59 mulheres, na faixa etária de 30 a 75 anos, que foram alocadas em 4 grupos: mulheres em TH na modalidade presencial (MP) (HMP) (n=11) e HB (HHB) (n=14), mulheres sem câncer (SC) na MP (SCMP) (n=15) e HB (SCHB) (n=19). O TA teve duração de 24 semanas, com 3 sessões/semana, intensidade equivalente a 50-89% da frequência cárdica máxima. As modalidades HB e MP seguiram o mesmo protocolo de TA, como também a recomendação dietética realizada uma vez por semana. As avaliações foram realizadas antes da intervenção, após 12 e 24 semanas de TA e após 12 semanas do término das intervenções, conforme a descrição: transferência lipídica (TL) para HDL in vitro; PL (colesterol total, High Density lipoprotein (HDL-C), não-HDL, Low Density Lipoproteins (LDL-C) e triglicérides (TG)), glicemia e insulinemia (kit colorimétrico enzimático); Marcadores metabólicos (Adiponectina e leptina) (ELISA); CCp foi estimada por impedância bioelétrica; Nível de atividade física (NAF) por acelerômetros; CF e capacidade cardiorrespiratória (CCr) por teste de caminhada de 6min e teste ergométrico, respectivamente; Dor, QV e consumo alimentar (CA) por meio de questionários e registro alimentar, respectivamente. Os dados foram analisados por meio da ANOVA de medidas repetidas no software SPSS 25.0, com α de 5%. Resultados: A TL de colesterol estratificado (p=0,048) e esterificado (p=0,028) reduziu após 24 semanas apenas no HHB. O PL não apresentou alterações significativas nos grupos, porém houve algumas tendências de redução para os seguintes marcadores: Colesterol total para mulheres SC, TG para o grupo HHB e SCMP, além de níveis menores de glicose no HHB. Não houve alteração significante para marcadores metabólicos, CCp e dor, porém foram encontradas respostas positivas para CA, CF, CCr, QV (p<0,05) e tempo sedentário (min/sem) (ηp2=0,447). Conclusões: O treinamento HB apresentou resultados semelhantes (glicemia, insulinemia, biomarcadores metabólicos, CCp, NAF, CA, CCr e dor) e superiores (CF e QV) ao MP. A despeito desses resultados positivos proporcionados no HB, a resposta do TA a TL para HDL não foi suficiente para reverter os efeitos deletérios do Tmx e dos IA. Sendo assim, o TA na modalidade HB é uma estratégia efetiva e não farmacológica para melhora do CA, CF, NAF, CCr e QV de mulheres em TH para CM.
The treatment of breast cancer (BC), despite fighting against the tumor and improving the survival of patients, causes adverse effects such as toxicity, dyspnea, pain, fatigue and impaired functional capacity (FC) and quality of life (QL). In particular, hormone treatment (HT) with Tamoxifen (Tmx) and Aromatase Inhibitors (AI), in addition to the adverse effects mentioned, they also cause changes in body composition (BCp) and lipid profile (LP). In contrast, aerobic training (AT) in home-based mode (HB) has been used to minimize these effects. However, the real adaptation of what AT promotes in the BCp and LP of women in HT. Objective: To compare the effects of AT in the face-to-face and home-based modality on lipid transfer variables for HDL, LP, blood glucose, insulinemia, metabolic biomarkers (adiponectin and leptin), body composition, level of physical activity, food consumption, functional capacity and cardiorespiratory capacity, pain and quality of life of women using Tmx and AI to treat BC. Method: 59 women participated in the study, aged between 30 and 75 years old, who were allocated in 4 groups: women in HT in the face-to-face modality (FF) (HFF) (n= 11) and HB (HHB) (n= 14), women without cancer (WC) in FF (WCFF) (n= 15) and HB (WCHB) (n= 19). The AT lasted 24 weeks, with 3 sessions/week, intensity equivalent to 50-89% of the maximum cardiac frequency. HB and FF modalities followed the same AT protocol, as well as the dietary recommendation made once a week. The evaluations were carried out before the intervention, after 12 and 24 weeks of AT, and after 12 weeks after the end of the interventions, according to the description: lipid transfer (LT) to HDL in vitro; LP (total cholesterol, high density lipoprotein (HDL-C), non-HDL, low density lipoproteins (LDL-C) and triglycerides (TG)), glycemia and insulinemia (enzyme colorimetric kit); Metabolic markers (adiponectin and leptin) (ELISA); BCp was estimated by bioelectrical impedance; Physical activity level (PAL) by accelerometers; FC and cardiorespiratory capacity (CrC) by 6-minute walk test and exercise test, respectively; Pain, QL and food consumption (FCn) through questionnaires and food records, respectively. Data were analyzed using repeated measures ANOVA using SPSS 25.0 software, with α of 5%. Results: TL of stratified (p= 0.048) and esterified (p= 0.028), cholesterol decreased after 24 weeks only in HHB. The LP did not show significant changes in the groups, however, there were some reduction trends for the following markers: Total cholesterol for women WC, TG for the group HHB and WCFF, in addition to lower glucose levels in HHB. There was no significant change for metabolic markers, BCp and pain, but positive responses were found for FCn, FC, CrC, QL (p<0.05) and sedentary time (min/week) (ηp2= 0.447). Conclusion: The HB training showed similar results (glycemia, insulinemia, metabolic biomarkers, BCp, PAL, FCn, CrC and pain) and superior (FC and QL) to the FF. Despite these positive results provided in HB, the response from AT to LT to HDL was not sufficient to reverse the deleterious effects of Tmx and AI. Thus, AT in HB modality is an effective and non-pharmacological strategy for improving the FCn, FC, PAL, CrC and QL of women in HT for BC.
The treatment of breast cancer (BC), despite fighting against the tumor and improving the survival of patients, causes adverse effects such as toxicity, dyspnea, pain, fatigue and impaired functional capacity (FC) and quality of life (QL). In particular, hormone treatment (HT) with Tamoxifen (Tmx) and Aromatase Inhibitors (AI), in addition to the adverse effects mentioned, they also cause changes in body composition (BCp) and lipid profile (LP). In contrast, aerobic training (AT) in home-based mode (HB) has been used to minimize these effects. However, the real adaptation of what AT promotes in the BCp and LP of women in HT. Objective: To compare the effects of AT in the face-to-face and home-based modality on lipid transfer variables for HDL, LP, blood glucose, insulinemia, metabolic biomarkers (adiponectin and leptin), body composition, level of physical activity, food consumption, functional capacity and cardiorespiratory capacity, pain and quality of life of women using Tmx and AI to treat BC. Method: 59 women participated in the study, aged between 30 and 75 years old, who were allocated in 4 groups: women in HT in the face-to-face modality (FF) (HFF) (n= 11) and HB (HHB) (n= 14), women without cancer (WC) in FF (WCFF) (n= 15) and HB (WCHB) (n= 19). The AT lasted 24 weeks, with 3 sessions/week, intensity equivalent to 50-89% of the maximum cardiac frequency. HB and FF modalities followed the same AT protocol, as well as the dietary recommendation made once a week. The evaluations were carried out before the intervention, after 12 and 24 weeks of AT, and after 12 weeks after the end of the interventions, according to the description: lipid transfer (LT) to HDL in vitro; LP (total cholesterol, high density lipoprotein (HDL-C), non-HDL, low density lipoproteins (LDL-C) and triglycerides (TG)), glycemia and insulinemia (enzyme colorimetric kit); Metabolic markers (adiponectin and leptin) (ELISA); BCp was estimated by bioelectrical impedance; Physical activity level (PAL) by accelerometers; FC and cardiorespiratory capacity (CrC) by 6-minute walk test and exercise test, respectively; Pain, QL and food consumption (FCn) through questionnaires and food records, respectively. Data were analyzed using repeated measures ANOVA using SPSS 25.0 software, with α of 5%. Results: TL of stratified (p= 0.048) and esterified (p= 0.028), cholesterol decreased after 24 weeks only in HHB. The LP did not show significant changes in the groups, however, there were some reduction trends for the following markers: Total cholesterol for women WC, TG for the group HHB and WCFF, in addition to lower glucose levels in HHB. There was no significant change for metabolic markers, BCp and pain, but positive responses were found for FCn, FC, CrC, QL (p<0.05) and sedentary time (min/week) (ηp2= 0.447). Conclusion: The HB training showed similar results (glycemia, insulinemia, metabolic biomarkers, BCp, PAL, FCn, CrC and pain) and superior (FC and QL) to the FF. Despite these positive results provided in HB, the response from AT to LT to HDL was not sufficient to reverse the deleterious effects of Tmx and AI. Thus, AT in HB modality is an effective and non-pharmacological strategy for improving the FCn, FC, PAL, CrC and QL of women in HT for BC.
Descrição
Palavras-chave
Neoplasias da mama, Exercício, Lipídeos, Composição corporal, Desempenho físico funcional, Qualidade de vida, Saúde, Breast neoplasms, Exercise, Lipids, Body composition, Functional physical performance, Quality of life, Health