Desempenho físico em ambiente temperado: eficácia, mecanismos e aplicabilidade do pré-resfriamento local
Data
2024-12-17
Autores
Alvarenga, Paulo Estevão Franco 
Orientadores
Pires, Flávio de Oliveira
Tipo
Tese de doutorado
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ISSN da Revista
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Resumo
Objetivos: Esta tese conduziu três estudos para investigar os efeitos do pré-resfriamento sobre o desempenho físico em exercícios realizados em ambiente temperado. Os estudos 1 e 2 verificaram a aplicabilidade e possíveis mecanismos da massagem com gelo local sobre o desempenho de endurance. Para tanto, foi aplicada massagem com gelo nos músculos da panturrilha previamente à realização de teste de corrida contrarrelógio de 4km (TT4Km) e teste de função muscular em contração isométrica voluntária submáxima (CIVS). No estudo 3, uma revisão sistemática com metanálise (RSMA) analisou a qualidade metodológica, o nível de evidência e o tamanho do efeito de diferentes estratégias de pré-resfriamento sobre o desempenho físico em diferentes tipos de exercício. Métodos: No estudo 1, 14 participantes foram submetidos ao TT4KM em uma pista de atletismo de 400 m em ambiente temperado (23.3 ± 1.7º C), com e sem massagem com gelo aplicada previamente à corrida. O tempo de corrida, PSE e percepção de dor foram registrados a cada 400 m. No estudo 2, 11 participantes foram submetidos a três CIVS até a falha, em ambiente de laboratório com condições climáticas controladas (21 – 22º C). Os sujeitos foram submetidos à condição controle (sem massagem) e massagem com gelo aplicada previamente ao teste. Medidas de desempenho (tempo até a falha), eletromiografia (EMG) e eficiência neuromuscular (ENM) dos músculos vasto lateral (VL) e reto femoral (RF), além de PSE e percepção de dor foram obtidas durante a CIVS. Uma RSMA foi realizada de acordo com as normas da Cochrane em 5 bases de dados sem restrição de idioma. O risco de viés foi analisado por meio da ferramenta Rob2 e a certeza da evidência pelo GRADE. Ademais, foi realizada metanálise de tamanhos de efeito em modelo de efeitos aleatórios. Resultados: o pré-resfriamento local com massagem com gelo aumentou a velocidade média (~ 5.2%, p = 0.03) e diminuiu o tempo para completar o TT4KM (~ 5.5%, p = 0.03), além de reduzir a percepção de dor (p = 0.028), mas não a PSE durante o TT4KM (p = 0.32). A massagem com gelo aumentou o tempo até a falha (220.9 ± 89.1 vs 173.7± 89.3 J; p = 0.006), reduzindo a ENM do VL (p = 0.003) e a PSE (p = 0.020) durante CVIS, porém sem efeito na ENM do RF, EMG dos músculos VL e RF e percepção de dor. Resultados da RSMA evidenciaram um efeito pequeno e significante do pré-resfriamento sobre o desempenho de endurance (p < 0.01), embora nenhum efeito tenha sido observado sobre o desempenho físico nos dados agrupados [Z = - 0.07; SMD = - 0.01 (IC95% -0,20 – 0,19); p = 0,94], no desempenho em resistência de força (p = 0,77) ou em salto (p = 0,77), ou nos dados separados pela modalidade de resfriamento (p > 0,59). A literatura desta área apresenta algum tipo de viés, com moderada certeza da evidência. Conclusão: o pré-resfriamento local com massagem com gelo aplicada na panturrilha e nos músculos VL e RF melhorou o desempenho de endurance durante exercício de grande massa muscular (TT4KM) e em teste de função muscular (CIVS) realizado em ambiente temperado, provavelmente por seus efeitos benéficos à função neuromuscular (ENM) e respostas perceptivas (PSE e dor). Entretanto, tais efeitos parecem não ser estendidos ao desempenho de resistência de força e salto, ou a outras modalidades de resfriamento. Alguns riscos de viés como a randomização e cegagem dos participantes comprometem a qualidade das evidências da literatura desta área.
Objectives: This thesis conducted three studies to investigate the effects of pre-cooling on physical performance during exercise in temperate environments. Studies 1 and 2 examined the applicability and potential mechanisms of local ice massage on endurance performance. Ice massage was applied prior to a 4-km time trial (TT4Km) and a submaximal isometric voluntary contraction (CIVS) muscle function test. Study 3 comprised a systematic review and meta-analysis (RSMA) to evaluate the methodological quality, level of evidence, and effect size of various pre-cooling strategies on physical performance across different exercise types. Methods: In Study 1, 14 participants performed the TT4Km on a 400-m outdoor track in a temperate environment, with and without prior ice massage. Running time, rating of perceived exertion (PSE), and pain perception were recorded every 400 m. In Study 2, 11 participants performed three CIVS to failure in a laboratory with controlled conditions (21–22°C). Participants underwent a control condition (no massage) and ice massage prior to testing. Performance measures (time to failure), electromyography (EMG), and neuromuscular efficiency (ENM) of the vastus lateralis (VL) and rectus femoris (RF) muscles, as well as PSE and pain perception, were assessed during CIVS. The RSMA was conducted following Cochrane guidelines across five databases without language restrictions. Risk of bias was evaluated using the Rob2 tool, and evidence certainly was assessed using the GRADE approach. Additionally, random-effects meta-analysis was performed to assess effect sizes. Results: Local pre-cooling with ice massage increased average speed (~5.2%, p = 0.03) and reduced time to complete the TT4Km (~5.5%, p = 0.03), while decreasing pain perception (p = 0.028) but not RPE during the TT4Km (p = 0.32). Ice massage increased time to failure (220.9 ± 89.1 vs. 173.7 ± 89.3 J; p = 0.006), reduced VL ENM (p = 0.003), and lowered PSE (p = 0.020) during CIVS, but had no effect on RF ENM, VL or RF EMG, or pain perception. The RSMA revealed a small but significant effect of pre-cooling on endurance performance (p < 0.01), although no significant effects were observed on aggregated data for overall physical performance [Z = -0.07; SMD = -0.01 (95% CI: -0.20–0.19); p = 0.94], strength-endurance (p = 0.77), or jumping performance (p = 0.77), nor when stratified by cooling modality (p > 0.59). The literature in this field shows some degree of bias with moderate certainty of evidence. Conclusion: Local pre-cooling with ice massage enhanced endurance performance in large muscle mass exercises (TT4Km) and muscle function testing (CIVS) conducted in temperate environments, likely due to its beneficial effects on neuromuscular efficiency (ENM) and perceptual responses (PSE and pain). However, these effects do not appear to extend to strength-endurance or jumping performance, nor to other cooling modalities. Some risk of bias compromises the quality of evidence in this area.
Objectives: This thesis conducted three studies to investigate the effects of pre-cooling on physical performance during exercise in temperate environments. Studies 1 and 2 examined the applicability and potential mechanisms of local ice massage on endurance performance. Ice massage was applied prior to a 4-km time trial (TT4Km) and a submaximal isometric voluntary contraction (CIVS) muscle function test. Study 3 comprised a systematic review and meta-analysis (RSMA) to evaluate the methodological quality, level of evidence, and effect size of various pre-cooling strategies on physical performance across different exercise types. Methods: In Study 1, 14 participants performed the TT4Km on a 400-m outdoor track in a temperate environment, with and without prior ice massage. Running time, rating of perceived exertion (PSE), and pain perception were recorded every 400 m. In Study 2, 11 participants performed three CIVS to failure in a laboratory with controlled conditions (21–22°C). Participants underwent a control condition (no massage) and ice massage prior to testing. Performance measures (time to failure), electromyography (EMG), and neuromuscular efficiency (ENM) of the vastus lateralis (VL) and rectus femoris (RF) muscles, as well as PSE and pain perception, were assessed during CIVS. The RSMA was conducted following Cochrane guidelines across five databases without language restrictions. Risk of bias was evaluated using the Rob2 tool, and evidence certainly was assessed using the GRADE approach. Additionally, random-effects meta-analysis was performed to assess effect sizes. Results: Local pre-cooling with ice massage increased average speed (~5.2%, p = 0.03) and reduced time to complete the TT4Km (~5.5%, p = 0.03), while decreasing pain perception (p = 0.028) but not RPE during the TT4Km (p = 0.32). Ice massage increased time to failure (220.9 ± 89.1 vs. 173.7 ± 89.3 J; p = 0.006), reduced VL ENM (p = 0.003), and lowered PSE (p = 0.020) during CIVS, but had no effect on RF ENM, VL or RF EMG, or pain perception. The RSMA revealed a small but significant effect of pre-cooling on endurance performance (p < 0.01), although no significant effects were observed on aggregated data for overall physical performance [Z = -0.07; SMD = -0.01 (95% CI: -0.20–0.19); p = 0.94], strength-endurance (p = 0.77), or jumping performance (p = 0.77), nor when stratified by cooling modality (p > 0.59). The literature in this field shows some degree of bias with moderate certainty of evidence. Conclusion: Local pre-cooling with ice massage enhanced endurance performance in large muscle mass exercises (TT4Km) and muscle function testing (CIVS) conducted in temperate environments, likely due to its beneficial effects on neuromuscular efficiency (ENM) and perceptual responses (PSE and pain). However, these effects do not appear to extend to strength-endurance or jumping performance, nor to other cooling modalities. Some risk of bias compromises the quality of evidence in this area.
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Citação
ALVARENGA, Paulo Estevão Franco. Desempenho físico em ambiente temperado: eficácia, mecanismos e aplicabilidade do pré-resfriamento local. 2024. 88 f. Tese (Doutorado em Ciências do Movimento Humano e Reabilitação) - Universidade Federal de São Paulo, Instituto de Saúde e Sociedade, Santos, 2025.
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