Efeito de um programa de exercício físico na resposta inflamatória de pacientes com doença falciforme
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Data
2021-07-14
Autores
Rossi, Daniele Andreza Antonelli
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A doença falciforme é uma desordem hematológica hereditária na qual ocorre uma mutação, originando a hemoglobina S. Existe na doença um ambiente vascular pró-inflamatório, disfunção endotelial e ambiente pró-oxidativo. O efeito benéfico do exercício físico na capacidade funcional e na resposta inflamatória é bem conhecido nas doenças cardiovasculares, mas são raros os estudos com doença falciforme. Elaborou-se a hipótese de que o exercício físico pode exercer efeito favorável na resposta inflamatória de pacientes com doença falciforme, contribuindo para a melhora da qualidade de vida desses pacientes. Objetivo: avaliar o efeito de um programa de exercício físico regular na resposta anti-inflamatória em pacientes com doença falciforme. Casuística e Métodos: Foi realizado ensaio clínico, incluindo pacientes com diagnóstico de doença falciforme em seguimento no Ambulatório de Hemoglobinopatias do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP. Os pacientes foram divididos em dois grupos: Grupo Exercício: realizaram um programa de exercício físico, três vezes por semana, por um período de oito semanas e Grupo Controle: realizaram atividade física de rotina. Todos os pacientes foram submetidos inicialmente e após oito semanas de protocolo, aos seguintes procedimentos: avaliação clínica, avaliação física, avaliação laboratorial, avaliação de qualidade de vida e avaliação ecocardiográfica. Análise estatística: as comparações entre os grupos foram feitas pelo teste t de Student, Mann-Whitney, teste de Chi-quadrado ou teste exato de Fisher. Foi realizada análise por coeficiente de correlação de Spearman. Nível de significância p<0,05. Resultados: Não foi observada diferença significante da resposta inflamatória entre os grupos controle e exercício. No grupo exercício, houve melhora dos valores de VO2 pico (p<0,001), aumento na distância percorrida (p<0,001), melhora no domínio limitação por aspectos físicos do questionário de qualidade de vida SF-36 (p=0,022) e aumento da atividade física relacionada com lazer (p<0,001) e caminhada (p=0,024) no questionário internacional de atividade física (IPAQ). Houve correlação negativa entre os valores de IL-6 com distância percorrida na esteira (coeficiente de correlação -0,444; p=0,020) e com valores de VO2 pico estimado (coeficiente de correlação -0,480; p=0,013) nos pacientes com doença falciforme de ambos os grupos. Conclusões: O programa de exercícios aeróbicos não alterou o perfil de resposta inflamatória dos pacientes com doença falciforme nem apresentou efeitos desfavoráveis nos parâmetros avaliados, sendo que os pacientes com menor capacidade funcional são os que apresentam os níveis mais elevados de IL-6 circulante.
Introduction: Sickle cell disease is a hereditary hematological disorder in which a mutation occurs, leading to hemoglobin S (HbS). There is a pro-inflammatory vascular environment, endothelial dysfunction, and a pro-oxidative environment in the disease. The beneficial effect of physical exercise on functional capacity and inflammatory response is well known in cardiovascular diseases, but studies with sickle cell disease are rare. It was hypothesized that physical exercise may exert a favorable effect on the inflammatory response of patients with sickle cell disease, contributing to improve the quality of life of these patients. Objective: to evaluate the effect of a regular physical exercise program on anti-inflammatory response in patients with sickle cell disease. Methods: A clinical trial was carried out, including patients diagnosed with sickle cell disease, being followed up at the Hemoglobinopathies Outpatient Clinic of Hospital das Clínicas, Botucatu Medical School - UNESP. The patients were divided into two groups: Exercise Group: they performed a physical exercise program, three times a week, for a period of eight weeks and Control Group: they performed routine physical activity. All patients were submitted initially and after eight weeks of protocol, to the following procedures: clinical evaluation, physical evaluation, laboratory evaluation, quality of life evaluation and echocardiographic evaluation. Statistical analysis: comparisons between groups were made using Student's t-test, Mann-Whitney test, Chi-square test or Fisher's exact test. Spearman correlation coefficient was performed. Significance level p <0.05. Results: There was no significant difference in the inflammatory response between the control and exercise groups. In the exercise group, there was an improvement in peak VO2 values (p<0.001), an increase in the distance walked (p<0.001), an improvement in the limitation domain due to physical aspects of the SF-36 quality of life questionnaire (p= 0.022) and an increase of physical activity related to leisure (p<0.001) and walking (p=0.024) in the International Physical Activity Questionnaire (IPAQ). There was a negative correlation between the IL-6 values with distance walked on the treadmill (correlation coefficient -0.444, p=0.020) and with estimated peak VO2 values (correlation coefficient -0.480; p= 0.013) in patients with sickle cell disease both groups. Conclusions: The aerobic exercise program did not change the inflammatory response profile of patients with sickle cell disease, nor did it show unfavorable effects on the parameters evaluated, and patients with lower functional capacity are those with the highest levels of circulating IL-6.
Introduction: Sickle cell disease is a hereditary hematological disorder in which a mutation occurs, leading to hemoglobin S (HbS). There is a pro-inflammatory vascular environment, endothelial dysfunction, and a pro-oxidative environment in the disease. The beneficial effect of physical exercise on functional capacity and inflammatory response is well known in cardiovascular diseases, but studies with sickle cell disease are rare. It was hypothesized that physical exercise may exert a favorable effect on the inflammatory response of patients with sickle cell disease, contributing to improve the quality of life of these patients. Objective: to evaluate the effect of a regular physical exercise program on anti-inflammatory response in patients with sickle cell disease. Methods: A clinical trial was carried out, including patients diagnosed with sickle cell disease, being followed up at the Hemoglobinopathies Outpatient Clinic of Hospital das Clínicas, Botucatu Medical School - UNESP. The patients were divided into two groups: Exercise Group: they performed a physical exercise program, three times a week, for a period of eight weeks and Control Group: they performed routine physical activity. All patients were submitted initially and after eight weeks of protocol, to the following procedures: clinical evaluation, physical evaluation, laboratory evaluation, quality of life evaluation and echocardiographic evaluation. Statistical analysis: comparisons between groups were made using Student's t-test, Mann-Whitney test, Chi-square test or Fisher's exact test. Spearman correlation coefficient was performed. Significance level p <0.05. Results: There was no significant difference in the inflammatory response between the control and exercise groups. In the exercise group, there was an improvement in peak VO2 values (p<0.001), an increase in the distance walked (p<0.001), an improvement in the limitation domain due to physical aspects of the SF-36 quality of life questionnaire (p= 0.022) and an increase of physical activity related to leisure (p<0.001) and walking (p=0.024) in the International Physical Activity Questionnaire (IPAQ). There was a negative correlation between the IL-6 values with distance walked on the treadmill (correlation coefficient -0.444, p=0.020) and with estimated peak VO2 values (correlation coefficient -0.480; p= 0.013) in patients with sickle cell disease both groups. Conclusions: The aerobic exercise program did not change the inflammatory response profile of patients with sickle cell disease, nor did it show unfavorable effects on the parameters evaluated, and patients with lower functional capacity are those with the highest levels of circulating IL-6.
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Palavras-chave
Hemoglobinopatias, Capacidade funcional, Atividade física, Inflamação, Hemoglobinopathies, Functional capacity, Physical activity, Inflammation