Tarefa postural prolongada na doença de Parkinson: efeito agudo e do treinamento aeróbio
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Data
2020-07-31
Autores
Moretto, Gabriel Felipe
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Universidade Estadual Paulista (Unesp)
Resumo
Manter a postura vertical por longos períodos de tempo é uma tarefa comum no cotidiano das pessoas. Entretanto, este quadro pode ser mais agravado em populações que apresentam déficits no equilíbrio, como pessoas Doença de Parkinson (DP). Analisar como uma tarefa postural prolongada afeta o controle postural em idosos com DP pode contribuir para o melhor entendimento das estratégias que essa população utiliza para a manutenção do equilíbrio. Ainda, intervenções físicas, como a prática de exercício aeróbio, podem amenizar os déficits causados pela doença no controle postural. Assim, o objetivo geral desta dissertação é investigar o efeito de uma tarefa postural de longa duração no controle postural em idosos com DP e analisar o efeito agudo de uma intervenção de 12 semanas de exercício físico aeróbio no controle da postura em tarefas posturais de longa duração em idosos com DP. Para entender os efeitos de uma tarefa postural de longa duração e os efeitos do exercício aeróbio neste tipo de tarefa, dois estudos foram desenvolvidos. O primeiro estudo teve o objetivo de analisar o efeito agudo de uma tarefa postural prolongada em idosos com DP. Vinte e três idosos com DP e 23 idosos saudáveis, que formaram o grupo controle, realizaram 3 tentativas de postura curta (60 segundos) antes de realizar uma tarefa postural prolongada de 15 minutos. Foram utilizadas 4 câmeras da Vicon Motion System para mensurar a oscilação corporal na frequência de 100Hz. Um único marcador reflexivo foi posicionado na segunda vértebra lombar (L2) para mensurar as seguintes variáveis nas direções anteroposterior (AP) e médio-lateral (ML): amplitude, velocidade, root mean square (RMS), área de oscilação e o Detrended Fluctuations Analysis (DFA). Uma ANOVA one-way foi realizada para análise das tarefas de curta duração e uma ANOVA two-way com fator para grupo e momento. Os resultados encontrados mostraram que idosos com DP apresentam maiores amplitudes e velocidade de oscilação, RMS e valores de adaptabilidade nas direções AP e ML, porém, com redução na área de oscilação. Este estudo apontou que a tarefa postural prolongada em pé reduziu a adaptabilidade dos sistemas reguladores da postura em indivíduos com DP em comparação a idosos saudáveis e esse comportamento pode aumentar a chance de quedas devido a dificuldade em realizar ajustes posturais adequados por longos períodos devido aos déficits causados pela DP. O segundo estudo avaliou o efeito de uma intervenção de 12 semanas de exercício físico aeróbio na oscilação corporal durante uma tarefa postural prolongada em idosos com DP. Participaram do estudo 16 idosos com DP que realizaram o mesmo protocolo do estudo anterior para a avaliação postural antes e após realizar o protocolo de exercício aeróbio. Os equipamentos e variáveis analisadas foram iguais aos do estudo 1. Uma ANOVA two-way com fator para intervenção e momento foi realizada para analisar a tarefa postural prolongada. Após a intervenção, pacientes com DP diminuíram a velocidade e aumentaram a área de oscilação. A intervenção de exercício aeróbio contribuiu para alterar o comportamento postural de pacientes com DP de modo a manter uma postura com maior área de equilíbrio e possuindo maior controle da oscilação corporal.
Maintaining a vertical posture for long periods of time is a common task in people's daily lives. However, this situation may be more aggravated in populations that have balance deficits, such as people with Parkinson's disease (pwPD). Analyzing the effect that a prolonged postural task has on pwPD can contribute to a better understanding of postural behavior and strategies that this population uses to maintain posture and whether interventions such as aerobic exercise can alleviate the deficits caused by the disease in the postural control. To understand the effects of the task of a prolonged stand task and the effects of aerobic exercise in this type of task, two studies were developed: the first aimed to analyze the acute effect of a prolonged postural task in pwPD. Thus, the general objective of this dissertation is to investigate the effect of a prolonged postural task on postural control in pwPD and to analyze the acute effect of a 12-week aerobic exercise intervention on posture control in prolonged standing tasks in elderly people with PD. To understand the effects of a long-term postural task and the effects of aerobic exercise on this type of task, two studies were developed. The first study aimed to analyze the acute effect of a prolonged stand task in elderly people with PD. 23 pwPD and 23 healthy elderly people who formed the control group made 3 trials at quiet posture (60 seconds) before performing a prolonged stand task of 15 minutes. 4 Vicon Motion System cameras were used to measure body oscillation at a frequency of 100Hz. A single reflective marker was placed on the second lumbar vertebra (L2) to measure the following variables in the anteroposterior (AP) and medial-lateral (ML) directions: amplitude, velocity, root mean square (RMS), oscillation area and non- linear as Detrended Fluctuations Analysis (DFA). A one-way ANOVA was performed to analyze a quiet stand tasks and a two-way ANOVA with factor for group and moment for prolonged stand. The results found showed that pwPD present greater amplitudes and oscillation velocity, RMS and adaptability values in the AP and ML directions, however, in a smaller oscillation area. This study pointed out that the prolonged standing postural task reduced the adaptability of the postural regulatory systems in individuals with PD compared to healthy elderly people and this behavior can increase the chance of falls due to the difficulty in making adequate postural adjustments for long periods due to deficits. caused by PD. The second study evaluated the effect of a 12-week aerobic exercise intervention on body sway during a prolonged postural task in pwPD. The study included 18 pwPD who made 3 quiet stand attempts followed by a prolonged 15-minute attempt before starting the intervention protocol and after performing the aerobic exercise protocol. The equipment and variables analyzed were the same as those in study 1. A one-way ANOVA was used to analyze short-term attempts and a two-way ANOVA with factor for intervention and moment was performed to analyze the prolonged postural task. The aerobic exercise intervention contributed to alter the postural behavior of patients with PD in order to maintain a posture with a greater balance area and with greater control of body sway.
Maintaining a vertical posture for long periods of time is a common task in people's daily lives. However, this situation may be more aggravated in populations that have balance deficits, such as people with Parkinson's disease (pwPD). Analyzing the effect that a prolonged postural task has on pwPD can contribute to a better understanding of postural behavior and strategies that this population uses to maintain posture and whether interventions such as aerobic exercise can alleviate the deficits caused by the disease in the postural control. To understand the effects of the task of a prolonged stand task and the effects of aerobic exercise in this type of task, two studies were developed: the first aimed to analyze the acute effect of a prolonged postural task in pwPD. Thus, the general objective of this dissertation is to investigate the effect of a prolonged postural task on postural control in pwPD and to analyze the acute effect of a 12-week aerobic exercise intervention on posture control in prolonged standing tasks in elderly people with PD. To understand the effects of a long-term postural task and the effects of aerobic exercise on this type of task, two studies were developed. The first study aimed to analyze the acute effect of a prolonged stand task in elderly people with PD. 23 pwPD and 23 healthy elderly people who formed the control group made 3 trials at quiet posture (60 seconds) before performing a prolonged stand task of 15 minutes. 4 Vicon Motion System cameras were used to measure body oscillation at a frequency of 100Hz. A single reflective marker was placed on the second lumbar vertebra (L2) to measure the following variables in the anteroposterior (AP) and medial-lateral (ML) directions: amplitude, velocity, root mean square (RMS), oscillation area and non- linear as Detrended Fluctuations Analysis (DFA). A one-way ANOVA was performed to analyze a quiet stand tasks and a two-way ANOVA with factor for group and moment for prolonged stand. The results found showed that pwPD present greater amplitudes and oscillation velocity, RMS and adaptability values in the AP and ML directions, however, in a smaller oscillation area. This study pointed out that the prolonged standing postural task reduced the adaptability of the postural regulatory systems in individuals with PD compared to healthy elderly people and this behavior can increase the chance of falls due to the difficulty in making adequate postural adjustments for long periods due to deficits. caused by PD. The second study evaluated the effect of a 12-week aerobic exercise intervention on body sway during a prolonged postural task in pwPD. The study included 18 pwPD who made 3 quiet stand attempts followed by a prolonged 15-minute attempt before starting the intervention protocol and after performing the aerobic exercise protocol. The equipment and variables analyzed were the same as those in study 1. A one-way ANOVA was used to analyze short-term attempts and a two-way ANOVA with factor for intervention and moment was performed to analyze the prolonged postural task. The aerobic exercise intervention contributed to alter the postural behavior of patients with PD in order to maintain a posture with a greater balance area and with greater control of body sway.
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Palavras-chave
Doença de Parkinson, Controle postural, Postura prolongada, Movimento humano, Parkinson's disease, Postural control, Prolonged posture, Human movement