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Title: Risco cardiovascular em pessoas vivendo com HIV/AIDS: avaliação do padrão alimentar, da capacidade funcional e efeitos do treinamento físico
Authors: Deresz, Luís Fernando
metadata.dc.contributor.advisor: Dal Lago, Pedro
Issue Date: 2015
Keywords: Doenças Cardiovasculares
Risco
Treinamento Físico
Estresse Oxidativo
Desempenho Funcional
HIV
Síndrome de Imunodeficiência Adquirida
[en] Cardiovascular Diseases
[en] Risk
[en] Exercise
[en] Oxidative Stress
[en] Physical Functional Performance
[en] Acquired Immunodeficiency Syndrome
Abstract: O risco e a prevalência das doenças cardiovasculares apresentam-se elevados em pessoas vivendo com o vírus da imunodeficiência humana (HIV) e síndrome da imunodeficiência adquirida (AIDS) – PVHA. Esta tese teve com objetivo contribuir para o melhor entendimento sobre este tema e para isso foram desenvolvidos três trabalhos: um ensaio clínico que investigou o efeito do treinamento físico em marcadores de estresse oxidativo em PVHA; e dois estudos transversais, um que o avaliou capacidade funcional e a eficiência ventilatória por meio do teste de exercício cardiopulmonar (TECP) e outro que avaliou o padrão de consumo alimentar relacionado aos fatores de risco cardiovascular em PVHA. No estudo 1, denominado de “Exercise training decreases oxidative stress in people living with HIV/AIDS – A pilot study” foram avaliados os efeitos do treinamento físico (treinamento aeróbio (n=3), de força (n=3) e combinado (n=2)) em marcadores de estresse oxidativo e na capacidade funcional e força muscular em 8 PVHA (5 mulheres). Os resultados deste estudo piloto indicam que o treinamento físico (24 sessões em oito semanas de protocolo) reduz o estresse oxidativo, verificado pela diminuição nos níveis da razão glutationa oxidada, glutationa reduzida e espécies reativas ao ácido tiobarbitúrico. Além disso, o estudo reforça a eficácia do treinamento aeróbio para a melhora da capacidade aeróbia e do treinamento de força no componente neuromuscular. Os resultados combinados reforçam a inclusão do treinamento físico como estratégia coadjuvante ao tratamento medicamentoso para a redução do risco cardiovascular em PVHA. O estudo 2, intitulado de “Functional capacity and ventilatory efficiency are preserved in well-controlled people living with HIV/AIDS” foi desenvolvido para avaliar a capacidade funcional e a eficiência ventilatória em PVHA. Neste estudo, variáveis obtidas TECP como o pico do consumo de oxigênio, frequência cardíaca máxima, pulso de oxigênio, limiares ventilatórios, eficiência ventilatória do consumo de oxigênio, eficiência ventilatória para a produção de dióxido de carbono, recuperação da frequência cardíaca e do consumo de oxigênio de 9 PVHA com a doença bem controlada foram avaliadas e comparadas com as obtidas em um grupo de indivíduos não portadores do HIV (também 9 participantes). Na comparação entre os grupos não foram verificadas diferenças nas variáveis avaliadas sugerindo que com a doença bem controlada há preservação da capacidade funcional e da eficiência ventilatória. Adicionalmente, os resultados obtidos indicam que o TECP pode ser uma ferramenta útil para a avaliação da capacidade funcional, assim como para a obtenção de variáveis utilizadas na prescrição de exercícios aeróbios na população em estudo. O estudo 3, denominado “Consumo alimentar inadequado e risco cardiovascular em pessoas vivendo com HIV/AIDS” foi elaborado para obter informações sobre o consumo alimentar e fatores de risco cardiovascular em PVHA. A amostra, composta por 45 PVHA (27 mulheres), teve o consumo alimentar avaliado através de questionário de frequência alimentar anual, dividido em alimentos protetores e não protetores para doença cardiovascular. Também foram verificados os fatores de risco para doença cardiovascular (perfil bioquímico e antropométrico). Os resultados mostraram que o consumo de alimentos não protetores para o risco de doença cardiovascular é maior do que o consumo de alimentos protetores. Além disso, constatou-se elevada prevalência de síndrome metabólica e dislipidemia tanto nos homens quanto nas mulheres, sendo que as últimas também apresentam maior prevalência de obesidade central quando comparadas aos homens. Diante disso, reforça-se a necessidade de orientação nutricional especialmente direcionada para o risco cardiovascular nessa população. Combinados, os resultados dos três estudos indicam que o padrão de consumo alimentar é inadequado e que com a doença controlada a capacidade funcional e a eficiência ventilatória estão preservadas nas PVHA. Complementarmente, o treinamento físico emerge como uma estratégia adicional ao tratamento medicamentoso para reduzir o estresse oxidativo e melhorar a capacidade funcional nessa população.
metadata.dc.description.abstract-en: The risk and prevalence of cardiovascular diseases are elevated in people living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) – PLWHA. The purpose of this thesis was to contribute to the better understanding of this subject and in order to do this, three studies were developed: one clinical trial that investigated the effects of exercise training on oxidative stress in PLWHA; and two cross-sectional studies, one that evaluated functional capacity and ventilatory efficiency through cardiopulmonary exercise testing (CPX) and another which evaluated the patterns of food intake related to cardiovascular risk factors in PLWHA. In the first study, titled, “Exercise training decreases oxidative stress in people living with HIV/AIDS – A pilot study” it was evaluated the effects of exercise training (Aerobic (n=3), Resistance (n=3) and Concurrent Training (n=2)) in oxidative stress markers, functional capacity and muscular strength in 8 PLWHA (5 women). The results of this pilot study showed that the exercise training (24 sessions in an 8-week protocol) decreased the oxidative stress, observed in lower levels of oxidized to reduced glutathione ratio (GSSG/GSH) and thiobarbituric acid–reactive substances (TBARS). Furthermore, this study reinforces the aerobic training efficacy in increasing the aerobic capacity and resistance training in neuromuscular outcomes. The combined results reinforce the use of exercise training as a support strategy for medical treatment to reduce cardiovascular risk among PLWHA. The second study, titled “Functional capacity and ventilatory efficiency are preserved in well-controlled people living with HIV/AIDS”, was developed to evaluate the functional capacity and ventilatory efficiency in PLWHA. In this study, the CPX variables: peak oxygen uptake (VO2peak), maximal heart rate (HRmax), oxygen pulse, gas exchange threshold (GET), respiratory compensation point (RCP), oxygen uptake efficiency slope (OUES), VE/VCO2 slope, heart rate recovery (HRR) and half-time of recovery maximal VO2 (T½ VO2) were analyzed in 9 well-controlled PLWHA and were compared with the findings from the healthy subjects (also with 9 participants). No differences were found when comparing the two groups, suggesting that in patients with well-controlled disease there is preserved functional capacity and ventilatory efficiency. Additionally, the results pointed that CPX could be a useful tool in the evaluation of functional capacity, as well as to prescribe aerobic exercise in this population. The third study, titled “Inappropriate dietary intake and cardiovascular risk in people living with HIV/AIDS”, was done in order to obtain information about food intake and cardiovascular risks in PLWHA. The sample was composed of 45 PLWHA (27 women). Food intake was obtained by the annual food frequency questionnaire, separated into two groups, healthy and unhealthy food related to cardiovascular disease. The traditional cardiovascular risk factors were also evaluated. The results showed that the intake of unhealthy foods for cardiovascular risk was greater compared to the intake of healthy foods. Moreover, it was observed a higher prevalence of metabolic syndrome and dyslipidemia in both men and women. Women also showed a higher prevalence to visceral obesity when compared to men. The results found reinforce the necessity of nutritional advice especially focused on the cardiovascular risks in this population. Combining the results of these three studies, it can be concluded that food patterns are inappropriate and that with controlled disease, functional capacity and ventilatory efficiency are preserved in PLWHA. In addition, exercise training seems to be and additional strategy to medical treatment in order to reduce oxidative stress and improve functional capacity in this population.
The risk and prevalence of cardiovascular diseases are elevated in people living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) – PLWHA. The purpose of this thesis was to contribute to the better understanding of this subject and in order to do this, three studies were developed: one clinical trial that investigated the effects of exercise training on oxidative stress in PLWHA; and two cross-sectional studies, one that evaluated functional capacity and ventilatory efficiency through cardiopulmonary exercise testing (CPX) and another which evaluated the patterns of food intake related to cardiovascular risk factors in PLWHA. In the first study, titled, “Exercise training decreases oxidative stress in people living with HIV/AIDS – A pilot study” it was evaluated the effects of exercise training (Aerobic (n=3), Resistance (n=3) and Concurrent Training (n=2)) in oxidative stress markers, functional capacity and muscular strength in 8 PLWHA (5 women). The results of this pilot study showed that the exercise training (24 sessions in an 8-week protocol) decreased the oxidative stress, observed in lower levels of oxidized to reduced glutathione ratio (GSSG/GSH) and thiobarbituric acid–reactive substances (TBARS). Furthermore, this study reinforces the aerobic training efficacy in increasing the aerobic capacity and resistance training in neuromuscular outcomes. The combined results reinforce the use of exercise training as a support strategy for medical treatment to reduce cardiovascular risk among PLWHA. The second study, titled “Functional capacity and ventilatory efficiency are preserved in well-controlled people living with HIV/AIDS”, was developed to evaluate the functional capacity and ventilatory efficiency in PLWHA. In this study, the CPX variables: peak oxygen uptake (VO2peak), maximal heart rate (HRmax), oxygen pulse, gas exchange threshold (GET), respiratory compensation point (RCP), oxygen uptake efficiency slope (OUES), VE/VCO2 slope, heart rate recovery (HRR) and half-time of recovery maximal VO2 (T½ VO2) were analyzed in 9 well-controlled PLWHA and were compared with the findings from the healthy subjects (also with 9 participants). No differences were found when comparing the xii two groups, suggesting that in patients with well-controlled disease there is preserved functional capacity and ventilatory efficiency. Additionally, the results pointed that CPX could be a useful tool in the evaluation of functional capacity, as well as to prescribe aerobic exercise in this population. The third study, titled “Inappropriate dietary intake and cardiovascular risk in people living with HIV/AIDS”, was done in order to obtain information about food intake and cardiovascular risks in PLWHA. The sample was composed of 45 PLWHA (27 women). Food intake was obtained by the annual food frequency questionnaire, separated into two groups, healthy and unhealthy food related to cardiovascular disease. The traditional cardiovascular risk factors were also evaluated. The results showed that the intake of unhealthy foods for cardiovascular risk was greater compared to the intake of healthy foods. Moreover, it was observed a higher prevalence of metabolic syndrome and dyslipidemia in both men and women. Women also showed a higher prevalence to visceral obesity when compared to men. The results found reinforce the necessity of nutritional advice especially focused on the cardiovascular risks in this population. Combining the results of these three studies, it can be concluded that food patterns are inappropriate and that with controlled disease, functional capacity and ventilatory efficiency are preserved in PLWHA. In addition, exercise training seems to be and additional strategy to medical treatment in order to reduce oxidative stress and improve functional capacity in this population.
Description: Tese (Doutorado)-Programa de Pós-Graduação em Ciências da Saúde, Fundação Universidade Federal de Ciências da Saúde de Porto Alegre.
metadata.dc.rights: Atribuição-NãoComercial-CompartilhaIgual 4.0 Internacional
metadata.dc.relation.requires: Adobe Reader
metadata.dc.date.date-insert: 2016-10-17
metadata.dc.type: Tese
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