Treinamento resistido e locomoção de idosos saudáveis e pacientes com doença de Parkinson: explorando as variáveis específicas que beneficiam o desempenho da locomoção
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Data
2019-07-31
Autores
Rojas Jaimes, Diego Alejandro [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O treinamento resistido tem sido estudado no contexto do envelhecimento e da doença de Parkinson, mas há falta de exploração das características deste tipo de treinamento que contribuem na melhora da locomoção e da funcionalidade. A pergunta central desta tese é: Quais características do treinamento resistido no contexto do envelhecimento saudável e da doença de Parkinson permitem potenciar seus efeitos no desempenho locomotor? Para responder este questionamento foram desenvolvidos dois estudos. ESTUDO 1. Novos modelos de periodização do treinamento, como a periodização ondulatória e a periodização inversa, têm sido desenvolvidos, mas não há evidências sobre as vantagens da periodização ondulatória quando comparada com a periodização linear em idosos. Por outro lado, a periodização inversa não tem sido testada em idosos. Assim, o objetivo do presente estudo foi analisar os efeitos de dois treinamentos de força com periodizações diferentes na locomoção de idosos saudáveis. Participaram 69 idosos (70,23±6,81 anos, 72,58±5,51 Kg, 162,26±5,92 cm), cognitivamente preservados (27,40±1,20 pontos Mini-Exame de Estado Mental) e fisicamente ativos (12,64±3,15 pontos Baecke). A amostra foi distribuída em três grupos, grupo de treinamento de força com periodização inversa ondulatória (GPIO n=25), grupo de treinamento de força com periodização linear (GPL n=25) e grupo controle (GC n=19). Foram realizadas 20 semanas de treinamento resistido, 2 dias na semana, mais 1 dia de treinamento locomotor. GPIO realizou um treinamento decrescente iniciando com cargas de alta intensidade e depois com cargas de moderada a baixa intensidade, enquanto GPL realizou um treinamento progressivo. Volume e intensidade foram igualados para ambos grupos. O GC realizou atividades de dança no mesmo período. Foram estabelecidos dois momentos de avaliação (pré e pós) onde se registrou o comportamento nas tarefas de levantar e andar (índice de fluidez), iniciação do andar (velocidade do centro de pressão nos ajustes posturais antecipatórios) e andar (velocidade da passada). Todas as tarefas foram executadas em velocidade preferida e rápida. Além, foi mensurado o tempo do Timed Up and Go Test e a força isométrica máxima voluntária. MANOVAs de dois fatores grupo (GPL x GPIO x GC) e momento (pré x pós) e testes post hoc de Bonferroni foram empregados. Os resultados indicaram interação para o índice de fluidez na tarefa de levantar e andar na velocidade rápida (F2,50= 38,727; p<0,01), indicando que GPL e GPIO foram significativamente mais fluidos na execução da tarefa quando comparados com GC (F2,50=178,92; p<0,01). O tempo do Timed Up and Go Test apresentou interação (F2,50= 65,89; p <0,01), onde GPIO apresentou tempo menor que GPL no momento pós (p=0,02). Na força isométrica máxima voluntária, a taxa de desenvolvimento da força apontou interação (F2,50= 29,708; p<0,01), indicando valores médios maiores de GPL e GPIO quando comparados com GC (F2,50= 506,41; p<0,01). No andar em velocidade preferida foi observado efeito principal de momento (F2,50=3,786; p=0,01) na duração da passada, no tempo de apoio e no tempo de apoio duplo, observando incrementos significativos para todas as variáveis no momento pós quando comparados com o pré. Por outro lado, a iniciação do andar não apresentou resposta frente ao treinamento. O treinamento resistido combinado com o treinamento locomotor aumentou a capacidade de gerar força muscular e melhorou o desempenho em tarefas mais complexas como o Timed Up and Go Test e a tarefa de se levantar e andar. Além disso, a periodização das intervenções não foi um fator decisivo para a melhora na funcionalidade de idosos. ESTUDO 2. O baixo impacto do treinamento resistido isolado para as tarefas locomotoras de pessoas com doença de Parkinson tem sido evidenciado. O objetivo do presente estudo foi analisar os efeitos dos treinamentos de força com periodização linear e do treinamento de força com periodização linear combinado com exercícios de transferência para a locomoção sobre o comportamento em tarefas locomotoras de pacientes com doença de Parkinson. Participaram 22 pacientes (71,09±11,66 anos, 71,87±11,78 Kg, 162,4±10,59 cm), cognitivamente preservados (27,40±1,20 pontos Mini-Exame de Estado Mental), fisicamente ativos (6,69±6,40 pontos Baecke) e em estado moderado da doença (Escala de Hoehn & Yahr 2 (20 pacientes) e 3 (2 pacientes)). A amostra foi distribuída em dois grupos: grupo de treinamento de força com periodização linear e transferência (GTFPL-T) e grupo de treinamento de força com periodização linear (GTFPL). Foram realizadas 20 semanas de treinamento, 3 dias na semana e 60 minutos de duração. Ambos grupos realizaram o mesmo treinamento resistido com uma duração de 30 minutos. Porém, GTFPL-T iniciou com 30 minutos de treino resistido e logo após um treinamento locomotor também de 30 minutos. O GTFPL iniciou com um treinamento respiratório com atividades de baixa intensidade motora, sob orientação de um fisioterapeuta, nos primeiros 30 minutos e em seguida realizou o mesmo treinamento resistido. As avaliações seguiram a mesma estrutura do Estudo 1. MANOVAs de dois fatores grupo (GTFPL-T x GTFPL) e momento (pré x pós) e testes post hoc de Bonferroni foram empregados. Houve interação para o índice de fluidez da tarefa de levantar e andar em velocidade preferida (F1,20=2,76; p= 0,05), indicando que GTFPL-T foi mais fluido quando comparado com GTFPL após a aplicação do treinamento (p <0,01). Na iniciação do andar em ambas velocidades foram identificados efeitos principais de momento (F1,20= 79,59; p <0,01 e F1,20= 31,57; p <0,01) para a velocidade do centro de pressão. No caso do andar em velocidade rápida foi apontado efeito principal de momento (F1,20= 3,59; p= 0,02), embora a análise univariada não conseguiu detectar quais variáveis apresentaram resposta estatisticamente significativa. Houve interação para a taxa de desenvolvimento da força (F2,50= 84,757; p<0,01), indicando que GTFPL-T foi maior quando comparado com GTFPL (p <0,01) após a aplicação do treinamento. O tempo no Timed Up and Go Test não foi responsivo ao treinamento. A combinação do treinamento resistido com o locomotor foi capaz de aumentar a taxa de desenvolvimento da força de pacientes com DP e de promover a transferência das adaptações neuromusculares para as tarefas locomotoras. Nesse sentido, a soma destes resultados implica potenciais benefícios para a funcionalidade e independência dos pacientes com DP. De esta forma, é possivel reforçar a ideia dos benefícios do treinamento de força para a população idosa e de pacientes com DP. Embora identificando que os modelos de periodização não são decisivos para obter adaptações positivas no envelhecimento saudável, enquanto parece ser que a especifidade do treinamento e o processo de transferência parecem potenciar os efeitos do treinamento de força na população com DP.
Resistance training has been studied in the context of aging and Parkinson's disease, but there is a lack of exploration of the characteristics of this type of training that contribute to the improvement of locomotion and functionality. The central question of this thesis is: What characteristics of resistance training in the context of healthy aging and Parkinson's disease allow to enhance its effects on locomotor performance? To answer this question two studies were developed. STUDY 1. New models of training periodization, such as undulating periodization and inverse periodization, have been developed, but there is no evidence about the advantages of wave periodization compared to linear periodization in the elderly. On the other hand, inverse periodization has not been tested in the elderly. Thus, the aim of the present study was to analyze the effects of two strength training with different periodizations on the mobility of healthy elderly. Participants were 69 elderly (70.23 ± 6.81 years, 72.58 ± 5.51 Kg, 162.26 ± 5.92 cm), cognitively preserved (27.40 ± 1.20 points Mini Mental State Examination) and physically active (12.64 ± 3.15 Baecke points). The sample was divided into three groups, strength training group with inverse undulating periodization (IUPG n = 25), force training group with linear periodization (LPG n = 25) and control group (CG n = 19). We performed 20 weeks of resistance training, 2 days a week, plus 1 day of locomotor training. GPIO performed a decreasing training starting with high intensity loads and then with moderate to low intensity loads, while LPG performed a progressive training. Volume and intensity were equal for both groups. The CG performed dance activities in the same period. Two assessment moments (pre and post) were established, which recorded the behavior in the tasks of sit to walk (fluidity index), gait initiation (center of pressure velocity in anticipatory postural adjustments) and gait (stride speed). All tasks were performed at preferred and fast speed. In addition, the time of the Timed Up and Go Test and the voluntary maximum isometric force were measured. Two-factor MANOVAs group (LPG x IUPG x CG) and momentum (pre x post) and Bonferroni post hoc tests were employed. The results indicated interaction for the fluidity index in the task of sit to walk at fast speed (F2.50= 38.727; p <0.01), indicating that LPG and IUPG were significantly more fluid in the task execution when compared to CG ( F2.50= 178.92; p <0.01). The time of the Timed Up and Go Test showed interaction (F2.50= 65.89; p <0.01), where GPIO presented less time than LPG at the post-intervention moment (p = 0.02). In the voluntary maximum isometric force, the force development rate indicated interaction (F2.50= 29.708; p <0.01), indicating higher mean values of LPG and GPIO when compared to CG (F2.50= 506.41; p <0.01). In the preferred speed walking, the main moment effect (F2.50= 3.786; p= 0.01) was observed in the stride duration, the support time and the double support time, observing significant increments for all variables in the post-intervention moment when compared with pre. On the other hand, the gait initiation showed no response to training. Resistance training combined with locomotor training increased the ability to generate muscle strength and improved performance on more complex tasks such as the Timed Up and Go Test and the task of sit to walk. In addition, the periodization of interventions was not a decisive factor for improving the functionality of the elderly. STUDY 2. The low impact of isolated resistance training for the locomotor tasks of people with Parkinson's disease has been evidenced. The aim of the present study was to analyze the effects of linear periodization strength training and linear periodization strength training combined with transference exercises for locomotion on the behavior in locomotor tasks of patients with Parkinson's disease. Twenty-two patients (71.09 ± 11.66 years, 71.87 ± 11.78 kg, 162.4 ± 10.59 cm), cognitively preserved (27.40 ± 1.20 points Mini Mental State Examination) participated in the study. physically active (6.69 ± 6.40 Baecke points) and in a moderate state of disease (Hoehn & Yahr 2 (20 patients) and 3 (2 patients)). The sample was divided into two groups: linear periodization strength training and transfer group (LPSTG-T) and linear periodization strength training group (LPSTG). There were 20 weeks of training, 3 days a week and 60 minutes duration. Both groups performed the same resistance training lasting 30 minutes. However, LPSTG-T started with 30 minutes of resistance training and soon after a 30-minute locomotor training. The LPSTG started with respiratory training with low motor intensity activities, under the guidance of a physiotherapist, in the first 30 minutes and then performed the same resistance training. The evaluations followed the same structure as Study 1. Two-way MANOVAs group (LPSTG-T x LPSTG) and momentum (pre x post) and Bonferroni post hoc tests were employed. There was interaction for the fluidity index of the sit to walk task at a preferred speed (F1.20 =2.76; p= 0.05), indicating that LPSTG-T was more fluid when compared to LPSTG after training (p <0.01). At the gait initiation at both speeds, main moment effects were identified (F1.20= 79.59; p <0.01 and F1.20= 31.57; p <0.01) for the center of pressure velocity. In the case of fast speed walking, the main moment effect was pointed out (F1.20= 3.59; p= 0.02), although univariate analysis failed to detect which variables showed a statistically significant response. There was interaction for the force development rate (F1.20= 84.757; p <0.01), indicating that LPSTG-T was higher when compared to LPSTG (p <0.01) after the training application. Time on the Timed Up and Go Test was not responsive to training. The combination of resistance training with locomotor was able to increase the rate of strength development of PD patients and to promote the transfer of neuromuscular adaptations to locomotor tasks. In this sense, the sum of these results implies potential benefits for the functionality and independence of Parkinson´s patients. In this way, it is possible to reinforce the idea of the benefits of strength training for the elderly population and patients with Parkinson´s disease. Although identifying that periodization models are not decisive to obtain positive adaptations in healthy aging, while it seems that the specificity of training and the transference process seem to enhance the effects of strength training in the Parkinson´s population.
Resistance training has been studied in the context of aging and Parkinson's disease, but there is a lack of exploration of the characteristics of this type of training that contribute to the improvement of locomotion and functionality. The central question of this thesis is: What characteristics of resistance training in the context of healthy aging and Parkinson's disease allow to enhance its effects on locomotor performance? To answer this question two studies were developed. STUDY 1. New models of training periodization, such as undulating periodization and inverse periodization, have been developed, but there is no evidence about the advantages of wave periodization compared to linear periodization in the elderly. On the other hand, inverse periodization has not been tested in the elderly. Thus, the aim of the present study was to analyze the effects of two strength training with different periodizations on the mobility of healthy elderly. Participants were 69 elderly (70.23 ± 6.81 years, 72.58 ± 5.51 Kg, 162.26 ± 5.92 cm), cognitively preserved (27.40 ± 1.20 points Mini Mental State Examination) and physically active (12.64 ± 3.15 Baecke points). The sample was divided into three groups, strength training group with inverse undulating periodization (IUPG n = 25), force training group with linear periodization (LPG n = 25) and control group (CG n = 19). We performed 20 weeks of resistance training, 2 days a week, plus 1 day of locomotor training. GPIO performed a decreasing training starting with high intensity loads and then with moderate to low intensity loads, while LPG performed a progressive training. Volume and intensity were equal for both groups. The CG performed dance activities in the same period. Two assessment moments (pre and post) were established, which recorded the behavior in the tasks of sit to walk (fluidity index), gait initiation (center of pressure velocity in anticipatory postural adjustments) and gait (stride speed). All tasks were performed at preferred and fast speed. In addition, the time of the Timed Up and Go Test and the voluntary maximum isometric force were measured. Two-factor MANOVAs group (LPG x IUPG x CG) and momentum (pre x post) and Bonferroni post hoc tests were employed. The results indicated interaction for the fluidity index in the task of sit to walk at fast speed (F2.50= 38.727; p <0.01), indicating that LPG and IUPG were significantly more fluid in the task execution when compared to CG ( F2.50= 178.92; p <0.01). The time of the Timed Up and Go Test showed interaction (F2.50= 65.89; p <0.01), where GPIO presented less time than LPG at the post-intervention moment (p = 0.02). In the voluntary maximum isometric force, the force development rate indicated interaction (F2.50= 29.708; p <0.01), indicating higher mean values of LPG and GPIO when compared to CG (F2.50= 506.41; p <0.01). In the preferred speed walking, the main moment effect (F2.50= 3.786; p= 0.01) was observed in the stride duration, the support time and the double support time, observing significant increments for all variables in the post-intervention moment when compared with pre. On the other hand, the gait initiation showed no response to training. Resistance training combined with locomotor training increased the ability to generate muscle strength and improved performance on more complex tasks such as the Timed Up and Go Test and the task of sit to walk. In addition, the periodization of interventions was not a decisive factor for improving the functionality of the elderly. STUDY 2. The low impact of isolated resistance training for the locomotor tasks of people with Parkinson's disease has been evidenced. The aim of the present study was to analyze the effects of linear periodization strength training and linear periodization strength training combined with transference exercises for locomotion on the behavior in locomotor tasks of patients with Parkinson's disease. Twenty-two patients (71.09 ± 11.66 years, 71.87 ± 11.78 kg, 162.4 ± 10.59 cm), cognitively preserved (27.40 ± 1.20 points Mini Mental State Examination) participated in the study. physically active (6.69 ± 6.40 Baecke points) and in a moderate state of disease (Hoehn & Yahr 2 (20 patients) and 3 (2 patients)). The sample was divided into two groups: linear periodization strength training and transfer group (LPSTG-T) and linear periodization strength training group (LPSTG). There were 20 weeks of training, 3 days a week and 60 minutes duration. Both groups performed the same resistance training lasting 30 minutes. However, LPSTG-T started with 30 minutes of resistance training and soon after a 30-minute locomotor training. The LPSTG started with respiratory training with low motor intensity activities, under the guidance of a physiotherapist, in the first 30 minutes and then performed the same resistance training. The evaluations followed the same structure as Study 1. Two-way MANOVAs group (LPSTG-T x LPSTG) and momentum (pre x post) and Bonferroni post hoc tests were employed. There was interaction for the fluidity index of the sit to walk task at a preferred speed (F1.20 =2.76; p= 0.05), indicating that LPSTG-T was more fluid when compared to LPSTG after training (p <0.01). At the gait initiation at both speeds, main moment effects were identified (F1.20= 79.59; p <0.01 and F1.20= 31.57; p <0.01) for the center of pressure velocity. In the case of fast speed walking, the main moment effect was pointed out (F1.20= 3.59; p= 0.02), although univariate analysis failed to detect which variables showed a statistically significant response. There was interaction for the force development rate (F1.20= 84.757; p <0.01), indicating that LPSTG-T was higher when compared to LPSTG (p <0.01) after the training application. Time on the Timed Up and Go Test was not responsive to training. The combination of resistance training with locomotor was able to increase the rate of strength development of PD patients and to promote the transfer of neuromuscular adaptations to locomotor tasks. In this sense, the sum of these results implies potential benefits for the functionality and independence of Parkinson´s patients. In this way, it is possible to reinforce the idea of the benefits of strength training for the elderly population and patients with Parkinson´s disease. Although identifying that periodization models are not decisive to obtain positive adaptations in healthy aging, while it seems that the specificity of training and the transference process seem to enhance the effects of strength training in the Parkinson´s population.
Descrição
Palavras-chave
Envelhecimento, Doença de Parkinson, Exercícios físicos, Força muscular, Distúrbios da locomoção, Doenças neurodegenerativas, Treinamento resistido, Periodização, Transferência, Andar, Iniciação do andar, Levantar-se e andar, Aging, Neurodegenerative diseases, Resistance training, Periodization, Transference, Walking, Gait initiation, Sit to walk