Efeito do treinamento físico e da administração de óleo de peixe sobre o Transtorno do Déficit de Atenção e Hiperatividade em crianças
Data
2015-04-30
Autores
Marques, Viviane Grassmann 
Orientadores
Galduroz, Jose Carlos Fernandes
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
O transtorno do déficit de atenção e hiperatividade (TDAH) é um dos transtornos mais prevalentes entre crianças/adolescentes. Estas crianças/adolescentes apresentam alterações para manter a atenção, funções executivas e comportamento que comprometem a sua vida diária. Apesar de o tratamento medicamentoso ser bastante utilizado, alguns pais ainda buscam alternativas não medicamentosas para seu tratamento. Neste sentido, a literatura tem demonstrado que o tipo de ambiente e o estilo de vida têm forte influência sobre a saúde (física e mental). Dentre estes hábitos estão a alimentação e a prática de exercícios físicos. A sociedade moderna tem diminuído tanto o consumo de ômega-3 quanto tem cada vez mais diminuído as atividades físicas, o que parece ser extremamente prejudicial para a população. Estes hábitos parecem ser fundamentais desde a infância, uma vez que esta é a fase em que ocorre o desenvolvimento do sistema nervoso central. O objetivo do presente estudo foi avaliar o efeito do treinamento físico e da administração de óleo de peixe sobre o comportamento, funções cognitivas e os níveis sérios de IGF-1, BDNF, TNF-? IL-6 e IL-10 em crianças com perfil comportamental de TDAH. Foram selecionadas 47 crianças com TDAH, do sexo masculino, com idade entre sete e 14 anos. Os voluntários foram distribuídos, aleatoriamente, em quatro grupos: Grupo Controle (GC), Grupo Treinamento (GT), Grupo Ômega (GO), e Grupo Treinamento + Ômega (GTO). O tratamento teve a duração de três meses. Os grupos GO e GTO receberam 1,1 g de óleo de peixe, duas vezes ao dia e os grupos GC e GT cápsulas idênticas, porém contendo óleo mineral. O estudo foi duplo-cego em relação à ingesta das cápsulas. Já os grupos GT e GTO realizaram o treinamento físico com múltiplos componentes, três vezes por semana, uma hora por dia em uma intensidade moderada. No início e ao final do protocolo foram realizadas avaliações comportamentais, sanguíneas e das funções cognitivas. O Grupo Ômega apresentou uma menor gravidade de TDAH; diminuiu o número de erros, aumentou o tempo até cometer um erro e o percentil na avaliação da atenção seletiva; diminuiu o tempo para realização da prancha 3 e o tempo até cometer um erro na prancha 2 no teste Stroop; e aumentou o número de acertos no subteste Procurar Símbolos após o tratamento. O Grupo Treino apresentou um valor maior nível de atividades e total de competências ao final do tratamento. O Grupo TO apresentou uma diminuição nos valores referentes à escala de deficiência de ácidos graxos essenciais, dos sintomas de desatenção, a gravidade do total de sintomas de TDAH, dos sintomas de lentidão cognitiva e de problemas de estresse pós-traumático e um aumento no desempenho escolar ao final do tratamento. Com relação às analises sanguíneas os grupos Ômega e TO demonstraram um aumento significativo nos níveis sérico de DHA e EPA, e uma diminuição das razões AA/DHA e AA/EPA ao final do tratamento. Tanto o Grupo Controle quanto o Grupo Treino aumentaram os níveis de IGF-1 se comparado ao valor inicial. Não houve diferenças significativas para as variáveis IL-10, IL-6, BDNF e TNF alfa. Desta forma podemos concluir que o tratamento com óleo de peixe melhorou os sintomas do TDAH, o controle inibitório, atenção seletiva, e as atividades diárias (pragmatismo útil), enquanto aumentou os níveis séricos de DHA e EPA e diminuiu as razões AA/DHA e AA/EPA. O treinamento físico melhorou os sintomas de TDAH, as atividades diárias (pragmatismo útil) e aumentou os níveis séricos de IGF-1. Já a combinação dos dois tratamentos melhorou (segundo os responsáveis) a atenção os sintomas do TDAH, o desempenho escolar, a lentidão cognitiva, os sintomas de estresse pós-traumático e os sintomas relacionados à deficiência de AGE, além de aumentar os níveis séricos de DHA e EPA e diminuir as razões AA/DHA e AA/EPA. Entretanto estas melhoras não parecem ser mediadas por alterações das citocinas pró ou anti-inflamatórias, xv IGF-1 ou BDNF. Já a melhora no controle inibitório no grupo que recebeu óleo de peixe parece estar relacionada ao aumento do DHA sérico.
Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in children/adolescents. These individuals have difficulties in executive functions, in attention, and in behavior that compromise their daily lives. Although pharmacological treatment is widely used, some parents are still seeking for a non-drug alternative for their treatment. In this sense, the literature has shown that the type of environment and lifestyle have a strong influence on health (physical and mental). Among these habits are the eating and the physical exercise. Modern society has diminished both the consumption of omega-3 and the practice of physical activity, which seems to be extremely harmful to the population. These habits appear to be critical in childhood because this is the phase when the development of the central nervous system occurs. The aim of this study was to evaluate the effect of exercise training and the consumption of fish oil on behavior, cognitive functions and serum levels of IGF-1, BDNF, TNF-α, IL-6 and IL-10 in children. We selected 47 children with behavioral profile of ADHD, male, aged between seven and 14 years. The volunteers were randomly divided into four groups: Control Group (CG), Training Group (TG), Omega Group (OG), and Training + Omega Group (TOG). The treatment lasted three months. The TOG, OG groups received 1.1 g of fish oil, twice a day, and the CG and TG received identical capsules, but containing mineral oil. The study was double-blind about the capsules intake. The TG and TOG groups did the physical training with multiples components, three times a week, one hour per day in a moderate intensity. At the beginning and at the end of the protocol, behavior, cognitive functions and blood assessments were conducted. The Omega Group had lower symptoms of ADHD; decreased the number of errors and increased the time to make an error and the percentile in the selective attention evaluation; decreased the time to perform the board 3 and time to make an error on the board 2 in the Stroop test, and also increased the number of correct responses in the subtest Symbol Search after the treatment. The Training Group showed a greater level of activity and total skills at the end of treatment. The TOG showed a decrease in the deficiency of essential fatty acids scale, symptoms of inattention, total ADHD symptoms, symptoms of sluggish cognition and post-traumatic stress problems; and an increase in academic performance after the treatment. With regard to blood analysis, the OG and TOG groups showed a significant increase in serum levels of DHA and EPA, and a decrease of the AA/DHA and AA/EPA ratios at the end of treatment. Both the Control Group and the Training Group increased IGF-1 levels compared to the initial value. There were no significant differences for IL-10, IL-6, TNF alpha and BDNF variables. Thus we can conclude that treatment with fish oil improved the inhibitory control, selective attention, ADHD symptoms, and daily activities (useful pragmatism), and increased the serum levels of DHA and EPA and decreased the AA/DHA and AA/EPA ratios. Physical training improved ADHD symptoms, daily activities (useful pragmatism) and increased serum levels of IGF-1. The combination of the two treatments improved (according to the parents) attention, ADHD symptoms, school performance, sluggish cognition symptoms, post-traumatic stress problems, PUFA deficiency symptoms, and increased serum DHA and EPA and decreased the AA/DHA and AA/EPA reasons. However, these improvements did not seem to be mediated by changes in pro- or anti-inflammatory cytokines, IGF-1 or BDNF. The improvement in the inhibitory control in the group that received fish oil seems to be related to increase of DHA serum.
Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in children/adolescents. These individuals have difficulties in executive functions, in attention, and in behavior that compromise their daily lives. Although pharmacological treatment is widely used, some parents are still seeking for a non-drug alternative for their treatment. In this sense, the literature has shown that the type of environment and lifestyle have a strong influence on health (physical and mental). Among these habits are the eating and the physical exercise. Modern society has diminished both the consumption of omega-3 and the practice of physical activity, which seems to be extremely harmful to the population. These habits appear to be critical in childhood because this is the phase when the development of the central nervous system occurs. The aim of this study was to evaluate the effect of exercise training and the consumption of fish oil on behavior, cognitive functions and serum levels of IGF-1, BDNF, TNF-α, IL-6 and IL-10 in children. We selected 47 children with behavioral profile of ADHD, male, aged between seven and 14 years. The volunteers were randomly divided into four groups: Control Group (CG), Training Group (TG), Omega Group (OG), and Training + Omega Group (TOG). The treatment lasted three months. The TOG, OG groups received 1.1 g of fish oil, twice a day, and the CG and TG received identical capsules, but containing mineral oil. The study was double-blind about the capsules intake. The TG and TOG groups did the physical training with multiples components, three times a week, one hour per day in a moderate intensity. At the beginning and at the end of the protocol, behavior, cognitive functions and blood assessments were conducted. The Omega Group had lower symptoms of ADHD; decreased the number of errors and increased the time to make an error and the percentile in the selective attention evaluation; decreased the time to perform the board 3 and time to make an error on the board 2 in the Stroop test, and also increased the number of correct responses in the subtest Symbol Search after the treatment. The Training Group showed a greater level of activity and total skills at the end of treatment. The TOG showed a decrease in the deficiency of essential fatty acids scale, symptoms of inattention, total ADHD symptoms, symptoms of sluggish cognition and post-traumatic stress problems; and an increase in academic performance after the treatment. With regard to blood analysis, the OG and TOG groups showed a significant increase in serum levels of DHA and EPA, and a decrease of the AA/DHA and AA/EPA ratios at the end of treatment. Both the Control Group and the Training Group increased IGF-1 levels compared to the initial value. There were no significant differences for IL-10, IL-6, TNF alpha and BDNF variables. Thus we can conclude that treatment with fish oil improved the inhibitory control, selective attention, ADHD symptoms, and daily activities (useful pragmatism), and increased the serum levels of DHA and EPA and decreased the AA/DHA and AA/EPA ratios. Physical training improved ADHD symptoms, daily activities (useful pragmatism) and increased serum levels of IGF-1. The combination of the two treatments improved (according to the parents) attention, ADHD symptoms, school performance, sluggish cognition symptoms, post-traumatic stress problems, PUFA deficiency symptoms, and increased serum DHA and EPA and decreased the AA/DHA and AA/EPA reasons. However, these improvements did not seem to be mediated by changes in pro- or anti-inflammatory cytokines, IGF-1 or BDNF. The improvement in the inhibitory control in the group that received fish oil seems to be related to increase of DHA serum.
Descrição
Citação
MARQUES, Viviane Grassmann. Efeito do treinamento físico e da administração de óleo de peixe sobre o Transtorno do Déficit de Atenção e Hiperatividade em crianças. 2015. 108 f. Tese (Doutorado em Psicobiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.