Efeito do treinamento resistido unilateral sobre o controle neural do coração e bioquímica do sangue de pacientes em fase crônica de acidente vascular encefálico
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Data
2020-12-04
Autores
Rodrigues, Pedro Henrique [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: O acidente vascular encefálico (AVE) é uma disfunção neurológica com ocorrência repentina ou rápida de sinais e sintomas clínicos, gerando variadas sequelas que incluem alterações no campo sensorial, cognitivo, motor e disfunção no sistema nervoso autonômico (SNA), porém o nível de comprometimento do controle simpático e parassimpático do coração não está totalmente esclarecido na literatura. O treinamento resistido (TR) tem sido proposto como terapia não-farmacológica, cujos efeitos podem influenciar sobre a força muscular e melhorar o controle do SNA sobre as variáveis cardiocirculatórias. Objetivo: Investigar os efeitos do treinamento físico resistido unilateral do hemicorpo parético sobre índices não-lineares da variabilidade da frequência cardíaca em pacientes em fase crônica de acidente vascular encefálico isquêmico. Metodologia: Foram estudados 27 homens, com idade de 59,8±5,4 anos, os quais compuseram três grupos: dois grupos de indivíduos acometidos por AVE isquêmico há pelo menos seis meses e com hemiparesia, sendo um grupo experimental (GE , N=9) e outro controle (GC, N=9). O terceiro grupo foi composto por indivíduos saudáveis (GS, N= 9). Para o GE e GC, foram triados pacientes do serviço de neurologia da Clínica de Fisioterapia do Centro de Estudos em Saúde (CEES), do Estágio Supervisionado de Distúrbios da Linguagem, Fala e Deglutição em Lesados Encefálicos da Universidade Estadual Paulista de Marília, São Paulo, Brasil. O GS foi triado através de chamada pública. Foram feitas as medidas antropométricas e registro dos batimentos cardíacos com um cardiofrequêncimetro (Polar RS800), por 10 minutos, na posição supina, durante respiração espontânea e analisados os índices não lineares da variabilidade da frequência cardíaca (VFC). O GE foi submetido a 13 semanas de treinamento com exercícios resistidos, sendo que 11 dessas foram compostas de três sessões semanais de exercício e duas semanas utilizadas para testagem de 1RM (duas sessões por semana de testagem) com objetivo de ajuste das cargas de treinamento. Resultados: Não foram observadas diferenças estatísticas dos índices da VFC entre os grupos, tanto no momento pré quanto no pós-intervenção. Foram observadas diferenças estatísticas (p=0,039) apenas para o índice 1V% na análise de interação grupo versus tempo para o GS (pré =49,2±4,5% e pós= 43,7±8%), com η2 apontando tamanho de efeito médio (0,237). Quanto a avaliação qualitativa por gráficos de recorrência, uma apresentação com mais padrões geométricos pode ser observada no GE e GC, comparado ao GS. Conclusão: Homens com mais de seis meses de AVE isquêmico apresentam modulação autonômica cardíaca similar a indivíduos saudáveis e o controle neural cardíaco não é alterado após 13 semanas de treinamento resistido com o hemicorpo parético.
Introduction: Stroke is a neurological dysfunction with a sudden or rapid occurrence of clinical signs and symptoms, causing various sequels that include changes in the sensory, cognitive, motor and dysfunction in the autonomic nervous system (ANS), however the level of impairment of sympathetic and parasympathetic control of the heart is not fully understood in the literature. Resistance training (RT) has been proposed as a non-pharmacological therapy, thus leading to a reduction in functional limitations, which would reflect on better control of the ANS over cardiocirculatory variables. Objective: To investigate the effects os unilateral resistance training of the paretic hemibody on non-linear indexes of heart rate variability in patients in the chronic phase of ischemic stroke. Methodology: 27 men studied, aged 59.8±5.4 years, which comprised three groups: two groups of people affected by ischemic stroke for at least six months and with hemiparesis, one being an experimental group (EG, N = 9) and another control group (CG, N = 9). The third group was composed of healthy owners (HG, N = 9). Patients from the neurology service of the Physiotherapy Clinic of the Center for Health Studies (CEES), from the Supervised Internship of Language, Speech and Swallowing Disorders in Brain Injuries at the São Paulo State University (Marília, São Paulo, Brazil). Anthropometric measurements were made and heart rates were recorded with a cardiofrequency monitor (Polar RS800), in the supine position and with spontaneous breathing and an analysis of the nonlinear indices of heart rate variability (HRV). The resistance exercise program was carried out in 13 weeks, 11 of which consisted of three weekly sessions of exercise and two weeks used for testing 1RM (two sessions per week of testing) in order to adjust the training loads. Results: There were no statistical differences in HRV indices between groups, either before or after the intervention. Statistical differences were observed (p = 0.039) only for the 1V% index in the interaction analysis (group versus time) for the HG (pre = 49.2 ± 4.5% and post = 43.7 ± 8%), with η2 pointing medium effect size (0.237). As for the qualitative evaluation by recurrence graphs, a presentation with more geometric patterns could be observed in the EG and CG, compared to the HG. Conclusion: Men with more than six months of ischemic stroke have cardiac autonomic modulation similar to healthy individuals and cardiac neural control is not altered after 13 weeks of resistance training with the paretic hemibody.
Introduction: Stroke is a neurological dysfunction with a sudden or rapid occurrence of clinical signs and symptoms, causing various sequels that include changes in the sensory, cognitive, motor and dysfunction in the autonomic nervous system (ANS), however the level of impairment of sympathetic and parasympathetic control of the heart is not fully understood in the literature. Resistance training (RT) has been proposed as a non-pharmacological therapy, thus leading to a reduction in functional limitations, which would reflect on better control of the ANS over cardiocirculatory variables. Objective: To investigate the effects os unilateral resistance training of the paretic hemibody on non-linear indexes of heart rate variability in patients in the chronic phase of ischemic stroke. Methodology: 27 men studied, aged 59.8±5.4 years, which comprised three groups: two groups of people affected by ischemic stroke for at least six months and with hemiparesis, one being an experimental group (EG, N = 9) and another control group (CG, N = 9). The third group was composed of healthy owners (HG, N = 9). Patients from the neurology service of the Physiotherapy Clinic of the Center for Health Studies (CEES), from the Supervised Internship of Language, Speech and Swallowing Disorders in Brain Injuries at the São Paulo State University (Marília, São Paulo, Brazil). Anthropometric measurements were made and heart rates were recorded with a cardiofrequency monitor (Polar RS800), in the supine position and with spontaneous breathing and an analysis of the nonlinear indices of heart rate variability (HRV). The resistance exercise program was carried out in 13 weeks, 11 of which consisted of three weekly sessions of exercise and two weeks used for testing 1RM (two sessions per week of testing) in order to adjust the training loads. Results: There were no statistical differences in HRV indices between groups, either before or after the intervention. Statistical differences were observed (p = 0.039) only for the 1V% index in the interaction analysis (group versus time) for the HG (pre = 49.2 ± 4.5% and post = 43.7 ± 8%), with η2 pointing medium effect size (0.237). As for the qualitative evaluation by recurrence graphs, a presentation with more geometric patterns could be observed in the EG and CG, compared to the HG. Conclusion: Men with more than six months of ischemic stroke have cardiac autonomic modulation similar to healthy individuals and cardiac neural control is not altered after 13 weeks of resistance training with the paretic hemibody.
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Palavras-chave
Acidente Vascular Encefálico, Treinamento resistido, Sistema nervoso autônomo, Simpático, Parassimpático, Stroke, Resistance training, Autonomic nervous system, Sympathetic, Parasympathetic