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
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2014-06-30
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Universidade Federal de Goiás
Resumo
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.
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SOARES, Viviane. 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. 2014. 135 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2014.