Efeitos do treinamento resistido em pacientes com Doença de Sjögren
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2024-08-01
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Tese de doutorado
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Introdução: O Treinamento Resistido (TR) é muito bem tolerado e tem sido promissor na diminuição da fadiga em várias doenças imunomediadas. Entretanto, os efeitos do TR nunca foram estudados em pacientes com Doença de Sjögren (DSj). O objetivo deste estudo foi analisar o efeito do exercício resistido na fadiga, dor, qualidade de vida, atividade da doença e sono, em mulheres com Doença de Sjögren em um ensaio clínico paralelo randomizado e cego.Método: 59 mulheres sedentárias acima de 18 anos que preencheram os Critérios Americano-Europeu para DSj foram randomizadas no Grupo Intervenção (GI n=30) ou Grupo Controle (GC n=29). O GI realizou 16 semanas de um programa de exercícios resistidos (2 sessões por semana) planejado para melhorar a força do corpo inteiro. O GC recebeu instrução de não realizar atividade física regular e mantiveram o tratamento farmacológico usual, além de serem orientadas com relação ao controle da doença e da dor, higiene do sono e atividades de vida diária. No momento inicial (T0) e após 16 semanas (TF) um avaliador cego aplicou os instrumentos: Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-Fatigue), Profile of Fatigue and Discomfort – Sicca Symptoms Inventory Short-form (PROFAD-SSI-SF), EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI), Visual Analogic Scale (VAS) para investigar fadiga; VAS para dor; Short Form-36 Health Survey (SF-36) para qualidade de vida; Pittsburg Sleep Quality Index (PSQI) e actigrafia para o sono; e o EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) para atividade da doença. Para comparar a variabilidade intragrupo e intergrupo, utilizamos análise de variância de medidas repetidas de um fator (ANOVA) e valores de p<0,05 foram considerados estatisticamente significantes. Resultados: Os grupos eram homogêneos no momento inicial. Vinte e oito pacientes dos trinta que participaram do grupo intervenção (ou seja 93%) melhoraram ao menos 2 pontos na escala VAS FADIGA e no domínio FADIGA do ESSPRI. Vinte e quatro pacientes melhoraram 5 pontos no FACIT. Os resultados significantes estão expostos pela diferença média (DM) entre o GI e GC no momento final (TF): VAS FADIGA: (DM: 4,31); ESSPRI FADIGA (DM: 4,84), FACIT (DM: 8,55). Dor avaliada pelo VAS: (DM: 3,33); ESSPRI dor: (DM 2,46); SF-36 domínio dor: (DM: 12,41), SF-36 capacidade funcional: (DM: 15,13), SF-36 aspectos emocionais: (DM: 30,17), SF-36 domínio vitalidade: (DM:15,74). Sonolência diurna PIT DAY (DM: -0,81). Após o período de treinamento, não foram notadas diferenças entre os grupos em relação às médias do ESSDAI, o que sustenta a hipótese de que o exercício não agrava a atividade da doença. Conclusão: O programa de treinamento resistido mostrou-se efetivo e seguro na melhora da fadiga, dor, capacidade funcional, aspectos emocionais, vitalidade e percepção subjetiva da doença pelas mulheres com Doença de Sjögren.
Objective: Resistance training (RT) is well tolerated and has shown promising to decrease fatigue in multiple autoimmune diseases. However, it has never been examined in Sjögren’s Disease (SjD). The purpose of this study was to analyse the effect of resistance exercise in fatigue, pain, quality of life, disease activity and sleep in women with SjD in a parallel, single-blind randomized trial. Methods: 59 sedentary women aged 18 years or older, fulfilling the American European Consensus Criteria for SjD were randomized to an intervention group (IG n=30) or control group (CG n=29). The IG underwent a 16-week resistance exercise program (with two sessions per week) designed to improve whole-body strength. The CG was instructed not to perform regular physical activity and maintained the usual pharmacological treatment, in addition to receiving guidance regarding disease and pain control, sleep hygiene and activities of daily living. The CG received usual pharmacological treatment and instructions regarding the disease control, pain management, sleep hygiene, and activities of daily living. The evaluations were performed by a blind evaluator at baseline (T0) and after 16 weeks (TF) using Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-Fatigue) Profile of Fatigue and Discomfort – Sicca Symptoms Inventory Short-form (PROFAD-SSI-SF), EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI), Visual Analogic Scale (VAS) to investigate fatigue, Pain by VAS, quality of life with Short Form-36 Health Survey (SF-36), sleep with The Pittsburg Sleep Quality Index (PSQI) and actigraphy, and disease activity by EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI). To compare intergroup and intragroup variability a one-factor repeated-measures analysis of variance (ANOVA) was used and P values < 0.05 were considered to be statistically significant. Results: The 2 groups were homogeneous at baseline. Twenty-eight patients of the thirty whom participated in the group intervention (93%) improved at least 2 points on the VAS FATIGUE scale and in the FATIGUE domain of the ESSPRI, and twenty-four patients improved 5 points on the FACIT. Significant results are shown by the mean difference (MD). IG improved fatigue on VAS fatigue: (MD: 4,31); FACIT (MD: 8,55); ESSPRI– fatigue domain (MD: 4,84), VAS pain: (MD: 3,33); ESSPRI pain: (MD 2,46); SF-36 – pain domain: (MD: 12,41), SF-36-functional capacity: (MD: 15,13), SF-36–emotional aspects: (MD: 30,17), SF-36 vitality domain: (MD:15,74). After the training period, no differences in ESSDAI means are noted between groups, which supports the hypotesis that exercise does not worsen disease activity. Conclusion: A Resistance Training program was safe and effective in improving fatigue, pain, functional capacity, emotional aspects, vitality, and subjective perception of disease by women with SjD.
Objective: Resistance training (RT) is well tolerated and has shown promising to decrease fatigue in multiple autoimmune diseases. However, it has never been examined in Sjögren’s Disease (SjD). The purpose of this study was to analyse the effect of resistance exercise in fatigue, pain, quality of life, disease activity and sleep in women with SjD in a parallel, single-blind randomized trial. Methods: 59 sedentary women aged 18 years or older, fulfilling the American European Consensus Criteria for SjD were randomized to an intervention group (IG n=30) or control group (CG n=29). The IG underwent a 16-week resistance exercise program (with two sessions per week) designed to improve whole-body strength. The CG was instructed not to perform regular physical activity and maintained the usual pharmacological treatment, in addition to receiving guidance regarding disease and pain control, sleep hygiene and activities of daily living. The CG received usual pharmacological treatment and instructions regarding the disease control, pain management, sleep hygiene, and activities of daily living. The evaluations were performed by a blind evaluator at baseline (T0) and after 16 weeks (TF) using Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-Fatigue) Profile of Fatigue and Discomfort – Sicca Symptoms Inventory Short-form (PROFAD-SSI-SF), EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI), Visual Analogic Scale (VAS) to investigate fatigue, Pain by VAS, quality of life with Short Form-36 Health Survey (SF-36), sleep with The Pittsburg Sleep Quality Index (PSQI) and actigraphy, and disease activity by EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI). To compare intergroup and intragroup variability a one-factor repeated-measures analysis of variance (ANOVA) was used and P values < 0.05 were considered to be statistically significant. Results: The 2 groups were homogeneous at baseline. Twenty-eight patients of the thirty whom participated in the group intervention (93%) improved at least 2 points on the VAS FATIGUE scale and in the FATIGUE domain of the ESSPRI, and twenty-four patients improved 5 points on the FACIT. Significant results are shown by the mean difference (MD). IG improved fatigue on VAS fatigue: (MD: 4,31); FACIT (MD: 8,55); ESSPRI– fatigue domain (MD: 4,84), VAS pain: (MD: 3,33); ESSPRI pain: (MD 2,46); SF-36 – pain domain: (MD: 12,41), SF-36-functional capacity: (MD: 15,13), SF-36–emotional aspects: (MD: 30,17), SF-36 vitality domain: (MD:15,74). After the training period, no differences in ESSDAI means are noted between groups, which supports the hypotesis that exercise does not worsen disease activity. Conclusion: A Resistance Training program was safe and effective in improving fatigue, pain, functional capacity, emotional aspects, vitality, and subjective perception of disease by women with SjD.
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Citação
DARDIN, Luciana Paula. Efeitos do treinamento resistido em pacientes com Doença de Sjögren. 2024. 139 f. Tese (Doutorado em Saúde Baseada em Evidências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.