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- ItemAcesso aberto (Open Access)Avaliação da taxa de sudorese de atletas de judô e sua associação com escores subjetivos de fome e apetite(Sociedade Brasileira de Medicina do Exercício e do Esporte, 2010-12-01) Barros, Jaqueline de; Fernandes, Ana Paula Oliveira; Oliveira, Juliana Valéria Serra; Stulbach, Tamara Eugenia; Garcia, Luciana da Silva; Peron, Alessandra Nunes; Dattilo, Murilo [UNIFESP]; Centro Universitário São Camilo; Centro de Nutrição do Programa Holístico de Emagrecimento; Universidade Federal de São Paulo (UNIFESP)Judo, as well as other types of sports involving weight categories, is a modality in which athletes have high risk of hypohydration due to involuntary /voluntary dehydration. Therefore, the aim of this study was evaluate the sweating rate (ml/min) of judokas in a training day and verify the impact of the dehydration degree upon subjective hunger and appetite rates. The sample was composed of 14 athletes (nine men and five women) with mean age of 19.6 ± 5.9 years. Body mass and subjective rates of hunger, appetite and effort were measured in a scale ranging from zero to 10, before and after training. Body mass was significantly lower after training (68.8 ± 18.1kg versus 66.9 ± 17.3kg; p < 0,01), with reduction of 2.6 ± 1.1%. Hunger and effort rates were significantly higher after exercise (2.1 ± 2.2 versus 4.8 ± 3.6, p = 0.02 and 0 versus 7.2 ± 1.3; p < 0,01), likewise craving for fruit rate (4.3 ± 3.8 versus 8.0 ± 2.8; p = 0.01). Positive correlations were obtained between: 1) effort scale and post-training craving for dairy products (r = 0.63; p < 0.05); 2) percentage of body mass reduction and hunger rate the in post-training period (r = 0.55, p < 0.05) and; 3) percentage of body mass reduction and craving for salty food in post-training period (r = 0.59; p < 0.05). It was concluded that the sweating rate mean represented moderate dehydration during a judo training session and that changes in hydration status may be associated with modifications in subjective perception of hunger and craving for certain food.
- ItemSomente MetadadadosEffects of oxygen supplementation on cerebral oxygenation during exercise in chronic obstructive pulmonary disease patients not entitled to long-term oxygen therapy(Wiley-Blackwell, 2012-01-01) Oliveira, Mayron F. [UNIFESP]; Rodrigues, Miguel K. [UNIFESP]; Treptow, Erika [UNIFESP]; Cunha, Thulio M. [UNIFESP]; Ferreira, Eloara M. V. [UNIFESP]; Neder, J. Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: the rate of change (Delta) in cerebral oxygenation (COx) during exercise is influenced by blood flow and arterial O-2 content (CaO2). It is currently unclear whether Delta COx would (i) be impaired during exercise in patients with chronic obstructive pulmonary disease (COPD) who do not fulfil the current criteria for long-term O-2 therapy but present with exercise-induced hypoxaemia and (ii) improve with hyperoxia (FIO2 = 0.4) in this specific sub-population.Methods: A total of 20 non-hypercapnic men (FEV1 = 47.2 +/- 11.5% pred) underwent incremental cycle ergometer exercise tests under normoxia and hyperoxia with Delta COx (fold-changes from unloaded exercise in O(2)Hb) being determined by near-infrared spectroscopy. Pulse oximetry assessed oxyhaemoglobin saturation (SpO(2)), and impedance cardiography estimated changes in cardiac output (Delta QT).Results: Peak work rate and Delta COx in normoxia were lower in eight O-2 'desaturators' compared with 12 'non-desaturators' (P<0.05). Area under Delta COx during sub-maximal exercise was closely related to SpO2 decrements in 'desaturators' (r = 0.92, P<0.01). These patients showed the largest improvement in peak exercise capacity with hyperoxia (P<0.05). Despite a trend to lower sub-maximal Delta QT and mean arterial pressure with active intervention, Delta COx was significantly improved only in this group (0.57 +/- 0.20 versus 2.09 +/- 0.42 for 'non-desaturators' and 'desaturators', respectively; P<0.05).Conclusions: Delta COx was impaired in non-hypoxaemic patients with COPD who desaturated during exercise. Hyperoxic breathing was able to correct for these abnormalities, an effect related to enhanced CaO2 rather than improved central haemodynamics. This indicates that O-2 supplementation ameliorates exercise COx in patients with COPD who are not currently entitled to ambulatory O-2 therapy.
- ItemSomente MetadadadosHaemodynamic effects of proportional assist ventilation during high-intensity exercise in patients with chronic obstructive pulmonary disease(Wiley-Blackwell, 2010-11-01) Carrascossa, Claudia R. [UNIFESP]; Oliveira, Cristino C. [UNIFESP]; Borghi-Silva, Audrey [UNIFESP]; Ferreira, Eloara M. V. [UNIFESP]; Maya, Joyce [UNIFESP]; Queiroga, Fernando [UNIFESP]; Berton, Danilo C. [UNIFESP]; Nery, Luiz E. [UNIFESP]; Alberto Neder, J. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de São Carlos (UFSCar)Background and objective: Proportional assist ventilation (PAV) has been proposed as a more physiological modality of non-invasive ventilation, thereby reducing the potential for deleterious cardio-circulatory effects during exercise, in patients with COPD. We therefore evaluated whether PAV modulates the kinetic and 'steady-state' haemodynamic responses to exercise in patients with moderate-to-severe COPD.Methods: Twenty patients underwent constant-load (75-80% peak work rate) cycle ergometer exercise testing to the limit of tolerance (T(lim)), while receiving PAV or breathing spontaneously. Stroke volume (SV), heart rate (HR) and cardiac output (CO) were monitored by impedance cardiography.Results: Compared with unassisted breathing, PAV increased T(lim) in 8/20 patients (median improvement 113% (range 8 to 212) vs -20% (range -40 to -9)). PAV had no significant effects on 'steady-state' haemodynamic responses either in patients with or those without increased T(lim) (P > 0.05). However, at the onset of exercise, SV kinetics were slowed with PAV, in 13/15 patients with analysable data. HR dynamics remained unaltered or failed to accelerate sufficiently in nine of these patients, thereby slowing CO kinetics (T(1/2) 61 s (range 81-30) vs 89 s (range 100-47)). These deleterious effects were not, however, associated with PAV-induced changes in T(lim) (P > 0.05).Conclusions: PAV slowed the SV and CO kinetics at the onset of high-intensity exercise in selected patients with moderate-to-severe COPD. However, these adverse effects of PAV disappeared during the stable phase of exercise, and were not related to the ergogenic potential of PAV in this patient population.
- ItemAcesso aberto (Open Access)Neuromuscular electrical stimulation improves exercise tolerance in chronic obstructive pulmonary disease patients with better preserved fat-free mass(Faculdade de Medicina / USP, 2011-01-01) Napolis, Lara Maris [UNIFESP]; Dal Corso, Simone [UNIFESP]; Neder, Jose Alberto [UNIFESP]; Malaguti, Carla [UNIFESP]; Gimenes, Ana Cristina Oliveira [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); University Nove de Julho Division of RehabilitationBACKGROUND: High-frequency neuromuscular electrical stimulation increases exercise tolerance in patients with advanced chronic obstructive pulmonary disease (COPD patients). However, it is conceivable that its benefits are more prominent in patients with better-preserved peripheral muscle function and structure. OBJECTIVE: To investigate the effects of high-frequency neuromuscular electrical stimulation in COPD patients with better-preserved peripheral muscle function. Design: Prospective and cross-over study. METHODS: Thirty COPD patients were randomly assigned to either home-based, high-frequency neuromuscular electrical stimulation or sham stimulation for six weeks. The training intensity was adjusted according to each subject's tolerance. Fat-free mass, isometric strength, six-minute walking distance and time to exercise intolerance (Tlim) were assessed. RESULTS: Thirteen (46.4%) patients responded to high-frequency neuromuscular electrical stimulation; that is, they had a post/pre Δ Tlim >10% after stimulation (unimproved after sham stimulation). Responders had a higher baseline fat-free mass and six-minute walking distance than their seventeen (53.6%) non-responding counterparts. Responders trained at higher stimulation intensities; their mean amplitude of stimulation during training was significantly related to their fat-free mass (r = 0.65; p<0.01). Logistic regression revealed that fat-free mass was the single independent predictor of Tlim improvement (odds ratio [95% CI] = 1.15 [1.04-1.26]; p<0.05). CONCLUSIONS: We conclude that high-frequency neuromuscular electrical stimulation improved the exercise capacity of COPD patients with better-preserved fat-free mass because they tolerated higher training stimulus levels. These data suggest that early training with high-frequency neuromuscular electrical stimulation before tissue wasting begins might enhance exercise tolerance in patients with less advanced COPD.
- ItemSomente MetadadadosReference values for dynamic responses to incremental cycle ergometry in males and females aged 20 to 80(Amer Thoracic Soc, 2001-10-15) Neder, Jose Alberto [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Peres, Clovis de Araujo [UNIFESP]; Whipp, Brian J.; Univ Glasgow; Universidade Federal de São Paulo (UNIFESP); Univ London St Georges HospInterpretation of incremental cardiopulmonary;exercise tests (CPET) might be enhanced by considering the simultaneous rates of change of certain key variables, e.g.,Delta oxygen uptake/Delta work rate (Delta (V) over dot o(2)/Delta WR), A heart rate/DeltaV o(2) (Delta HR/Delta (V) over dot o(2)),Delta ventilation/Delta carbon dioxide production (Delta (V) over dot E/Delta (V) over dot co(2)), and the linearized A tidal volume/Delta (V) over dot E (Delta (V) over dot T/Delta In(V) over dot E) relationships. However, there are no published age- and sex-dependent reference values for these relationships that were appropriately obtained in randomly selected subjects. We therefore prospectively evaluated 120 sedentary individuals (60 male, 60 female, age 20 to 80 yr) who were randomly selected from more than 8,000 subjects, and submitted to standard ramp-incremental CPET on an electronically braked cycle ergometer. We found that sex and age significantly influenced several of the dynamic relationships, in addition to anthropometric attributes (p < 0.05). A comprehensive set of linear prediction equations is provided; the limits of normality (at the 95% confidence level) differed substantially from previous recommendations based on single discrete values. These data therefore provide a frame of reference for assessing the normalcy of the response profiles of four standard indices of metabolic, cardiovascular, and ventilatory function during rapidly incremental cycle ergometry in sedentary males and females up to 80 yr of age.
- ItemSomente MetadadadosSignal-morphology impedance cardiography during incremental cardiopulmonary exercise testing in pulmonary arterial hypertension(Wiley-Blackwell, 2012-09-01) Ferreira, Eloara M. [UNIFESP]; Ota-Arakaki, Jaquelina S. [UNIFESP]; Barbosa, Priscila B. [UNIFESP]; Siqueira, Ana Cristina B. [UNIFESP]; Bravo, Daniela M. [UNIFESP]; Kapins, Carlos Eduardo B. [UNIFESP]; Silva, Celia Maria C. [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Alberto Neder, J. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background Haemodynamic responses to exercise are related to physical impairment and worse prognosis in patients with pulmonary arterial hypertension (PAH). It is clinically relevant, therefore, to investigate the practical usefulness of non-invasive methods of monitoring exercise haemodynamics in this patient population. Methods Using a novel impedance cardiography (ICG) approach that does not require basal impedance estimations and relies on a morphological analysis of the impedance signal (Signal-Morphology-ICG (TM)), stroke volume (SV) and cardiac index (CI) were evaluated in 50 patients and 21 age-matched controls during a ramp-incremental cardiopulmonary exercise testing. Results Technically unacceptable readings were found in 12 of 50 (24%) patients. in the remaining subjects, early decrease (N = 9) or a plateau in SV (N = 8) and Delta (peak-unloaded exercise) SV <10 ml were markers of more advanced PAH (P<0.05). Delta CI = 1.5-fold and early estimated lactate threshold were the only independent predictors of a severely reduced peak oxygen uptake ((V) over dotO(2)) in patients (R-2 = 0.71, P<0.001). the finding of Delta CI = 1.5-fold plus peak (V) over dot O-2 < 50% predicted was associated with a number of clinical and functional markers of disease severity (P<0.001). in addition, abnormal SV responses and Delta CI = 1.5-fold were significantly related to 1-year frequency of PAH-related adverse events (death and balloon atrial septostomy, N = 8; P<0.05). Conclusions Qualitative and semi-quantitative signal-morphology impedance cardiography (TM) (PhysioFlow (TM)) during incremental exercise provided clinically useful information to estimate disease severity and short-term prognosis in patients with PAH in whom acceptable impedance signals could be obtained.