Avaliação do impacto do treinamento resistido progressivo na melhoria da capacidade funcional de pacientes com artrite reumatóide
Data
2015-02-26
Tipo
Dissertação de mestrado
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Resumo
Introdução: A artrite reumatoide (AR) é uma doença inflamatória crônica que acomete pequenas e grandes articulações de forma simétrica, acarretando destruição da cartilagem e sinovites, podendo ocorrer o ?pannus?. Nos casos agressivos e não tratados pode ocorrer deformidade e incapacidade. As articulações mais frequentemente acometidas são mãos, punhos, interfalângicas proximais, metacarpofalângicas, metatarsofalangicas, joelhos, cotovelos, tornozelos, ombros e quadris. Antigamente, acreditava-se que os exercícios eram benéficos para a amplitude de movimento (ADM) e força muscular (FM), mas os mesmos podiam causar prejuízos. Atualmente, vários estudos comprovam que os exercícios são seguros e benéficos para o condicionamento aeróbio na AR, mas com relação à atividade da doença, habilidade funcional, dor e qualidade de vida os estudos são inconclusivos. Estudos sobre a efetividade do treinamento resistido progressivo global em AR são escassos. Por isso, torna-se necessário realizar um ensaio clínico que busque avaliar o impacto do treinamento resistido progressivo global em pacientes com AR. Objetivo: Avaliar a efetividade do treinamento resistido progressivo global na melhoria da capacidade funcional, qualidade de vida, dor e FM de pacientes com AR. Tipo de estudo: Ensaio clínico controlado e randomizado com avaliador cego. Material e métodos: Foram incluídos 60 pacientes classificados com AR pelos critérios do ACR (1988), com idade entre 18-65 anos, com medicação estável, que não estavam realizando atividade física, não tinham outra doença osteomuscular e ausência de contraindicação para realizar atividade física. Foram contatados cento e treze pacientes (113) e apenas sessenta (60) foram incluídos. Os pacientes foram randomizados em dois grupos. O grupo intervenção (GI) realizou o programa de fortalecimento durante 12 semanas, duas vezes por semana. O grupo controle (GC) não realizou exercícios de fortalecimento, recebendo apenas tratamento medicamentoso estabelecido pelo médico reumatologista. O programa de fortalecimento resistido progressivo (PFRP) consistia de exercícios para os seguintes grupos musculares: flexores e eretores de tronco, adutores e flexores do ombro, flexores e extensores do joelho, adutores e abdutores do quadril,flexores e extensores do cotovelo, elevadores do ombro e flexores e extensores dos punhos, todos realizados com 50% e 70% de uma Repetição Máxima (1RM), utilizando máquinas de fortalecimento muscular específico para cada grupo muscular e halteres. A carga foi reavaliada após seis e 12 semanas da avaliação inicial. A atividade da doença (DAS 28) foi avaliada por uma médica reumatologista e a avaliação da capacidade funcional (HAQ), qualidade de vida (SF-36), força de preensão (dinamômetro), força muscular (RM), quantidade de medicamento consumida e avaliação de dor (END) foram realizadas no início do estudo, na 6ª e na 12ª semana por um avaliador cego. Resultados: Dos 60 pacientes incluídos neste estudo, 33 foram alocados para o grupo controle e 27 pacientes para o grupo intervenção. Na análise intergrupos usando o ANOVA de medidas repetidas, foram encontrados melhores resultados para o grupo intervenção no HAQ (p=0,001), em alguns domínios do SF-36 (capacidade funcional: p<0,001; dor: p=0,002 e aspectos sociais: p=0,049), no END (p=0,035) e na força muscular (preensão da mão direita: p<0,001; preensão da mão esquerda: p<0,001; flexores do joelho direito: p=0,001; flexores do joelho esquerdo: p=0,003; extensores do joelho direito: p=0,009; extensores do joelho esquerdo: p=0,032). Contudo, não foi observada diferença estatisticamente significante no que diz respeito ao consumo de medicamento entre os grupos (p>0,05). Conclusão: Por meio dos resultados obtido neste estudo, foi possível concluir que o treinamento resistido progressivo é efetivo para a melhora da capacidade funcional de pacientes com artrite reumatoide avaliado pelo HAQ. Além disso, o treinamento resistido progressivo melhorou a dor, a qualidade de vida de acordo com o SF-36 (capacidade funcional, dor, vitalidade, aspectos sociais, aspectos emocionais e saúde mental) e a força muscular de alguns grupos musculares exercitados.
Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects small and large joints symmetrically, resulting in destruction of cartilage and synovitis, and there may be the "pannus". In aggressive and untreated cases can occur deformity and disability. Studies on the effectiveness of the global progressive resistance training in AR are rare. Therefore, it is necessary to conduct a clinical trial that seeks to assess the impact of global progressive resistance training in patients with RA. Objective: To evaluate the overall effectiveness of progressive resistance training in improving functional capacity, quality of life, pain and MS in patients with rheumatoid arthritis. Type of study: Randomized controlled trial with blind assessor. Material and methods: 60 patients with RA classified by the ACR criteria (1988), aged 1865 years, with stable medication were included. They were not doing physical activity, didn’t have other musculoskeletal disease and no contraindications for physical activity. One hundred and thirteen patients (113) were contacted and only sixty (60) were included. Patients were randomized into two groups. The intervention group (IG) conducted the strengthening program for 12 weeks, two times a week. The control group (CG) did not perform strengthening exercises, receiving only drug treatment established by a rheumatologist. The program of progressive resistance strengthening (PFRP) consisted of exercises for the following muscle groups: flexors and extensors of the trunk, abductors of the shoulder and elbow flexors, flexors and extensors of the knee, adductors and abductors of the hip, flexors and extensors of the elbow, the abductors of the shoulders and flexors and extensors of the wrist all performed at 50% and 70% of one repetition maximum using specific machines for muscle building and muscle weights for each muscle group. The load was reassessed after six and twelve weeks of initial assessment. Disease activity (DAS28) was assessed by a rheumatologist, and the assessment of functional capacity (HAQ), quality of life (SF36), grip strength (dynamometer), muscle strength (RM), amount of drug consumed and pain (VAS) were performed at baseline, at the 6th and 12th weeks by a blinded evaluator. Results: Of the 60 patients included in this study, 33 were allocated to the control group and 27 in the intervention group. In the intergroup analysis using ANOVA for repeated measures, better results were found for the intervention group in HAQ (p = 0.001), in some domains of the SF36 (functional capacity: p <0.001; pain: p = 0.002 and social aspects: p = 0.049), for pain (p = 0.035) and for muscle strength (right hand hold: p <0.001; left hand hold: p <0.001; flexors right knee: p = 0.001; flexors left knee: p = 0.003; right knee extensors: p = 0.009; left knee extensors: p = 0.032). However, there was no statistically significant difference with regard to drug use among groups (p> 0.05). Conclusion: Through the results obtained in this study, it was concluded that progressive resistance training is effective for improvement of the functional capacity of patients with rheumatoid arthritis assessed by HAQ. In addition, progressive resistance training improved pain, quality of life according to the SF36 (functional capacity, pain, vitality, social functioning, emotional and mental health) and muscle strength of some exercised muscle groups.
Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects small and large joints symmetrically, resulting in destruction of cartilage and synovitis, and there may be the "pannus". In aggressive and untreated cases can occur deformity and disability. Studies on the effectiveness of the global progressive resistance training in AR are rare. Therefore, it is necessary to conduct a clinical trial that seeks to assess the impact of global progressive resistance training in patients with RA. Objective: To evaluate the overall effectiveness of progressive resistance training in improving functional capacity, quality of life, pain and MS in patients with rheumatoid arthritis. Type of study: Randomized controlled trial with blind assessor. Material and methods: 60 patients with RA classified by the ACR criteria (1988), aged 1865 years, with stable medication were included. They were not doing physical activity, didn’t have other musculoskeletal disease and no contraindications for physical activity. One hundred and thirteen patients (113) were contacted and only sixty (60) were included. Patients were randomized into two groups. The intervention group (IG) conducted the strengthening program for 12 weeks, two times a week. The control group (CG) did not perform strengthening exercises, receiving only drug treatment established by a rheumatologist. The program of progressive resistance strengthening (PFRP) consisted of exercises for the following muscle groups: flexors and extensors of the trunk, abductors of the shoulder and elbow flexors, flexors and extensors of the knee, adductors and abductors of the hip, flexors and extensors of the elbow, the abductors of the shoulders and flexors and extensors of the wrist all performed at 50% and 70% of one repetition maximum using specific machines for muscle building and muscle weights for each muscle group. The load was reassessed after six and twelve weeks of initial assessment. Disease activity (DAS28) was assessed by a rheumatologist, and the assessment of functional capacity (HAQ), quality of life (SF36), grip strength (dynamometer), muscle strength (RM), amount of drug consumed and pain (VAS) were performed at baseline, at the 6th and 12th weeks by a blinded evaluator. Results: Of the 60 patients included in this study, 33 were allocated to the control group and 27 in the intervention group. In the intergroup analysis using ANOVA for repeated measures, better results were found for the intervention group in HAQ (p = 0.001), in some domains of the SF36 (functional capacity: p <0.001; pain: p = 0.002 and social aspects: p = 0.049), for pain (p = 0.035) and for muscle strength (right hand hold: p <0.001; left hand hold: p <0.001; flexors right knee: p = 0.001; flexors left knee: p = 0.003; right knee extensors: p = 0.009; left knee extensors: p = 0.032). However, there was no statistically significant difference with regard to drug use among groups (p> 0.05). Conclusion: Through the results obtained in this study, it was concluded that progressive resistance training is effective for improvement of the functional capacity of patients with rheumatoid arthritis assessed by HAQ. In addition, progressive resistance training improved pain, quality of life according to the SF36 (functional capacity, pain, vitality, social functioning, emotional and mental health) and muscle strength of some exercised muscle groups.
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Citação
LOURENZI, Felipe Martinelli. Avaliação do impacto do treinamento resistido progressivo na melhoria da capacidade funcional de pacientes com artrite reumatóide. 2015. 94 f. Dissertação (Mestrado em Reumatologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.