Influência do treinamento muscular inspiratório sobre a função respiratória e qualidade de vida de pacientes com doença renal crônica em hemodiálisee a relação com a composição corporal e com a capacidade aeróbia

• Autor(a) principal: Soares, Viviane
• Data de Publicação: 2014
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• dARK ID: ark:/38995/00130000048qz
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tede/3987
• topic: Composição corporal; Força muscular respiratória; Função pulmonar; Consumo de oxigênio (VO 2 pico); Treinamento muscular inspiratório; Hemodiálise; Body composition; Respiratory muscle strenght; Pulmonary function; Oxygen uptake ( peak VO2); Inspiratory muscle training; Hemodialysis; CIENCIAS DA SAUDE::MEDICINA

Chronic kidney disease (CKD) and its treatment, hemodialysis, favors the increase of comorbidities to patients and the protein-energy malnutrition is the main complication, with consequent wasting of muscle tissue that reduce muscle strength, lung function and oxygenation of body tissues resulting in poor functional capacity, cardiorespiratory fitness and quality of life of these patients. Therefore, the objective of this study was to compare body composition between hemodialysis patients and healthy subjects, to evaluate cardiorespiratory fitness by oxygen uptake ( peak VO2  ) and the effects of inspiratory muscle training (IMT) on respiratory function and quality of life of male patients on hemodialysis. A clinical trial was conducted with 62 patients, aged 22-71 years. Body composition was estimated by vectorial bioelectrical impedance and anthropometric measures. Respiratory muscle strength was assessed by manometer to obtain the maximal inspiratory (Pimax) and expiratory pressures (Pemax). Pulmonary function and classification of respiratory disorders were examined by spirometry. Cardiorespiratory fitness was assessed by cardiopulmonary exercise test performed on a treadmill using the Bruce protocol which was adapted to estimate peak oxygen uptake ( peak OV 2  ). The aspects of quality of life were assessed by questionnaire KDQOL - SF (Kidney Disease Quality of Life - Short Form). The IMT was held for six months during the sessions and always at the first two hours of hemodialysis. Two training devices were used: a specific trainer and a respiratory incentive associated with two breathing exercises. The respiratory function of patients was evaluated before, during and after the inspiratory muscle training. The results were presented in three studies. In the first study, the comparison of body composition between hemodialysis patients and healthy subjects indicated differences for triceps skin fold (p<0.001) and arm circumference (p<0.001), but not for arm muscle circumference and area. The vectorial bioelectrical impedance indicated patients in dehydration and reduced body cell mass when compared with healthy subjects. In the second study was analyzed the usefulness of respiratory parameters to detect patients with poor functional capacity ( peak OV 2  below 70 % of predicted). The Pimax (β=-0.037, p=0.014) and percentage of predicted forced vital capacity - FVC % (β=-0.056, p=0.025) were significant to identify patients with poor functional capacity predictors and the ROC curve established cutoff points for MIP (<74 cmH2O) and % FVC (<79%). In the third study were verified the effects of IMT on respiratory muscle strength, lung function and quality of life of hemodialysis patients. After training muscle strength was found significant increase in respiratory strength in both groups. The group that used incentive spirometry had greater increment to inspiratory strength (39.80%) than the group that used the specific trainer (28.30%). The aspects related to quality of life, found significant differences for the dimensions cognitive function (p=0.03), sexual function (p=0.009) and social function (p=0.04) in the group that trained with specific trainer, and to physical function (p=0.03) in the group that trained with incentive spirometry. The results of this study show that male patients in hemodialysis exhibit differences in body composition when compared with healthy subjects; inspiratory muscle strength and percent of vital capacity predicted for age can be used as predictors of poor functional capacity in this group of patients; and finally, inspiratory muscle training improved inspiratory muscle strength and aspects related to the quality of life of the two trained groups.