A VARIABILIDADE DA FREQUÊNCIA CARDÍACA PODE SER USADA PARA ESTIMAR O LIMIAR VENTILATÓRIO EM INDIVÍDUOS COM LESÃO MEDULAR?
DOI:
https://doi.org/10.63330/armv1n9-003Palavras-chave:
Tetraplegia, Paraplegia, Limiar ventilatório, Limiar da variabilidade da frequência cardíaca, Consumo de oxigênioResumo
Pessoas com lesão medular (LM) apresentam maior risco de desenvolver doenças cardiometabólicas do que pessoas sem LM. A prescrição de exercícios aeróbios tem sido recomendada para a prevenção e tratamento dessas doenças. Como padrão ouro para prescrição da intensidade deste tipo de exercício estão os limiares ventilatórios, que para serem medidos são necessários equipamentos sofisticados e profissionais especializados. Por isso, novos métodos para identificar o primeiro limiar ventilatório têm sido criados. Dessa forma, um dos objetivos do estudo foi avaliar a confiabilidade do limiar da variabilidade da frequência cardíaca (LiVFC) em estimar o primeiro limiar ventilatório (LV1) em indivíduos com LM. O outro objetivo foi comparar os valores referentes ao LV1 nas populações estudadas. Este é um estudo seccional com a participação de 17 indivíduos com LM, 09 com tetraplegia, 08 com paraplegia e 10 sem LM. Foi realizado um teste cardiopulmonar em esforço progressivo (TCPE) em cicloergômetro para membros superiores, com carga inicial de 20W, incrementos sucessivos de 2W ou 5W para tetraplégicos, e 5W para os indivíduos paraplégicos e sem LM, a cada minuto, com ciclagem entre 50-60 rpm. Foram consideradas as variáveis: VO2pico absoluto e relativo, valores de VO2, do percentual do VO2 de reserva (%VO2), da FC, do percentual da FC de reserva (%FCr) e da potência (W) referentes ao LV1. Foram realizadas comparações entre os subgrupos do estudo (Kruskal Wallis com post hoc de Bonferroni) e a verificação da validade das medidas foram verificadas pelo coeficiente de correlação intraclasse (ICC2,1) e pela abordagem gráfica de Altman e Bland. O nível de significância estatística foi de 5%. Nos tetraplégicos foi observado uma confiabilidade excelente (ICC>0,75) no VO2 e na potência no ponto do LV1. Nos paraplégicos o ICC foi excelente quanto à potência e aceitáveis quanto ao VO2 e a potência (ICC>0,40). Os indivíduos sem lesão apresentaram maiores valores quanto ao VO2 e potência no ponto de LV1 do que os indivíduos com LM (p<0,01). Dado o exposto, verificou-se que o LiVFC parece ser um método válido para prescrever a intensidade do exercício aeróbio em pessoas com LM.
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ALMEIDA, Marcos B.; ARAÚJO, Gil S. Efeitos do treinamento aeróbico sobre a freqüência cardíaca. v. 9, p. 104–112, 2003.
AU, Jason S. et al. Assessing Ventilatory Threshold in Individuals With Motor-Complete Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation, v. 99, n. 10, p. 1991–1997, 2018.
BAUMGART, Julia Kathrin; BRUROK, Berit; SANDBAKK, Øyvind. Comparison of peak oxygen uptake between upper-body exercise modes: A systematic literature review and meta-analysis. Frontiers in Physiology, v. 11, n. May, p. 1–12, 2020.
BLAND, J. Martin; ALTMAN, Douglas G. Measuring agreement in method comparison Studies. Statistical Methods in Medical Research, v. 8, n. 2, p. 135–160, 1999.
BRUNETTO, Antônio Fernando et al. Limiar de variabilidade da freqüência cardíaca em adolecentes obesos e não-obesos. Revista Brasileira de Medicina do Esporte, v. 14, n. 2, p. 145–149, 2008.
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CASSIRAME, Johan et al. Heart rate variability to assess ventilatory threshold in ski-mountaineering. European Journal of Sport Science, v. 15, n. 7, p. 615–622, 2015.
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IWRF. Manual de classificação da IWRF, 3a edição, revisado 2011. Disponível em: https://worldwheelchair.rugby/wp-content/uploads/2022/11/2021-Wheelchair-Rugby-International-Rules-Portugues-1.pdf.
KANG, Jie et al. Regulating exercise intensity using ratings of perceived exertion during arm and leg ergometry. European Journal of Applied Physiology and Occupational Physiology, v. 78, n. 3, p. 241–246, 1998.
KARAPETIAN, Gregory K.; ENGELS, H. J.; GRETEBECK, R. J. Use of heart rate variability to estimate LT and VT. International Journal of Sports Medicine, v. 29, n. 8, p. 652–657, 2008.
KRAUSE, James S.; CAO, Yue; DIPIRO, Nicole. Psychological factors and risk of mortality after spinal cord injury. Journal of Spinal Cord Medicine, v. 0, n. 0, p. 1–9, 2019.
KYRIAKIDES, Athanasios et al. The effect of level of injury and physical activity on heart rate variability following spinal cord injury. Journal of Spinal Cord Medicine, v. 42, n. 2, p. 212–219, 2019.
LAUGHTON, G. E. et al. Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord, v. 47, n. 10, p. 757–762, 2009.
LAVELA, Sherri L. et al. Males aging with a spinal cord injury: prevalence of cardiovascular and metabolic conditions. Archives of Physical Medicine and Rehabilitation, v. 93, n. 1, p. 90–95, 2012.
LEICHT, C. A. et al. Blood lactate and ventilatory thresholds in wheelchair athletes with tetraplegia and paraplegia. European Journal of Applied Physiology, v. 114, n. 8, p. 1635–1643, 2014.
LEICHT, C. A.; BISHOP, N. C.; GOOSEY-TOLFREY, V. L. Submaximal exercise responses in tetraplegic, paraplegic and non spinal cord injured elite wheelchair athletes. Scandinavian Journal of Medicine and Science in Sports, v. 22, n. 6, p. 729–736, 2012.
LIMA, Jorge Roberto Perrout; KISS, Maria Augusta Peduti Dal’Molin. LIMIAR DE VARIABILIDADE DA FREQÜÊNCIA CARDÍACA. Revista Brasileira de Atividade Física e Saúde, v. 4, n. 1, p. 10, 1999.
MATSUDO, S. et al. Questionário Internacional De Atividade Física (Ipaq): Estupo De Validade E Reprodutibilidade No Brasil. Revista Brasileira de Atividade Física & Saúde, v. 6, n. 2, p. 5–18, 2012.
MAUNDER, E. et al. Exercise intensity regulates the effect of heat stress on substrate oxidation rates during exercise. European Journal of Sport Science, v. 0, n. 0, p. 1–23, 2019.
MCNARRY, Melitta A.; LEWIS, Michael J. Heart rate variability reproducibility during exercise. Physiological Measurement, v. 33, n. 7, p. 1123–1133, 2012.
MILLET, Gregoire P.; VLECK, V. E.; BENTLEY, D. J. Physiological differences between cycling and running: Lessons from triathletes. Sports Medicine, v. 39, n. 3, p. 179–206, 2009.
MITCHELL, Jere H. Cardiovascular control during exercise: Central and reflex neural mechanisms. The American Journal of Cardiology, v. 55, n. 10, 1985.
NAKAMURA, Fábio Yuzo; MOREIRA, Alexandre; AOKI, Marcelo Saldanha. Monitoramento da carga de treinamento: a percepção subjetiva do esforço da sessão é um método confiável? Revista da Educação Física/UEM, v. 21, n. 1, 2010.
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NOVELLI, Fabiula Isoton et al. Reproducibility of Heart Rate Variability Threshold in Untrained Individuals. International Journal of Sports Medicine, v. 40, n. 2, p. 95–99, 2019.
ORR, J. L. et al. Cardiopulmonary exercise testing: Arm crank vs cycle ergometry. Anaesthesia, v. 68, n. 5, p. 497–501, 2013.
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SIMÕES, Rodrigo P. et al. Use of heart rate variability to estimate lactate threshold in coronary artery disease patients during resistance exercise. Journal of Sports Science and Medicine, v. 15, n. 4, p. 649–657, 2016.
SOUZA, Lívia Victorino de et al. Cardiac autonomic modulation in healthy subjects with a family history of chronic kidney disease. Jornal brasileiro de nefrologia : ’orgão oficial de Sociedades Brasileira e Latino-Americana de Nefrologia, v. 35, n. 1, p. 42–47, 2013.
ACSM. Diretrizes do ACSM para os testes de esforço e sua prescrição. 10a ed. Rio de Janeiro: [S.n.].
ALMEIDA, Marcos B.; ARAÚJO, Gil S. Efeitos do treinamento aeróbico sobre a freqüência cardíaca. v. 9, p. 104–112, 2003.
AU, Jason S. et al. Assessing Ventilatory Threshold in Individuals With Motor-Complete Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation, v. 99, n. 10, p. 1991–1997, 2018.
BAUMGART, Julia Kathrin; BRUROK, Berit; SANDBAKK, Øyvind. Comparison of peak oxygen uptake between upper-body exercise modes: A systematic literature review and meta-analysis. Frontiers in Physiology, v. 11, n. May, p. 1–12, 2020.
BLAND, J. Martin; ALTMAN, Douglas G. Measuring agreement in method comparison Studies. Statistical Methods in Medical Research, v. 8, n. 2, p. 135–160, 1999.
BRUNETTO, Antônio Fernando et al. Limiar de variabilidade da freqüência cardíaca em adolecentes obesos e não-obesos. Revista Brasileira de Medicina do Esporte, v. 14, n. 2, p. 145–149, 2008.
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GASKILL, S. E. et al. Validity and reliability of combining three methods to determine ventilatory threshold. Medicine and Science in Sports and Exercise, v. 33, n. 11, p. 1841–1848, 2001.
GATER, David R. Obesity After Spinal Cord Injury. Physical Medicine and Rehabilitation Clinics of North America, v. 18, n. 2, p. 333–351, 2007.
GINIS, M. et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: An update and a new guideline. Spinal Cord, v. 56, n. 4, p. 308–321, 2018.
GOOSEY-TOLFREY, Victoria L. et al. Development of scientific exercise guidelines for adults with spinal cord injury. British Journal of Sports Medicine, v. 52, n. 18, p. 1166–1167, 2018.
GRANNELL, Andrew; VITO, Giuseppe De. An investigation into the relationship between heart rate variability and the ventilatory threshold in healthy moderately trained males. p. 1–7, 2017.
GRIGOREAN, Valentin Titus et al. Cardiac dysfunctions following spinal cord injury. Journal of medicine and life, v. 2, n. 2, p. 133–145, 2009.
GUPTA, N.; WHITE, K. T.; SANDFORD, P. R. Body mass index in spinal cord injury - A retrospective study. Spinal Cord, v. 44, n. 2, p. 92–94, 2006.
HAENNEL, Robert G.; LEMIRE, Francine. Physical activity to prevent cardiovascular disease. How much is enough? Canadian Family Physician, v. 48, n. JAN., p. 65–71, 2002.
HOLMLUND, Tobias et al. Intensity of physical activity as a percentage of peak oxygen uptake, heart rate and Borg RPE in motor-complete para- And tetraplegia. PLoS ONE, v. 14, n. 12, p. 1–13, 2019.
HOPMAN, Maria T. et al. The Effect of Varied Fractional Inspired Oxygen on Arm Exercise Performance in Spinal Cord Injury and Able-Bodied Persons. Archives of Physical Medicine and Rehabilitation, v. 85, n. 2, p. 319–323, 2004.
HOWLEY, E. T.; BASSETT, D. R.; WELCH, H. G. Criteria for Maximal Oxygen Uptake: Review and Commentary. Med Sci Sports Exerc, v. 27, n. 9, p. 1292–1301, 1995.
IWRF. Manual de classificação da IWRF, 3a edição, revisado 2011. Disponível em: https://worldwheelchair.rugby/wp-content/uploads/2022/11/2021-Wheelchair-Rugby-International-Rules-Portugues-1.pdf.
KANG, Jie et al. Regulating exercise intensity using ratings of perceived exertion during arm and leg ergometry. European Journal of Applied Physiology and Occupational Physiology, v. 78, n. 3, p. 241–246, 1998.
KARAPETIAN, Gregory K.; ENGELS, H. J.; GRETEBECK, R. J. Use of heart rate variability to estimate LT and VT. International Journal of Sports Medicine, v. 29, n. 8, p. 652–657, 2008.
KRAUSE, James S.; CAO, Yue; DIPIRO, Nicole. Psychological factors and risk of mortality after spinal cord injury. Journal of Spinal Cord Medicine, v. 0, n. 0, p. 1–9, 2019.
KYRIAKIDES, Athanasios et al. The effect of level of injury and physical activity on heart rate variability following spinal cord injury. Journal of Spinal Cord Medicine, v. 42, n. 2, p. 212–219, 2019.
LAUGHTON, G. E. et al. Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord, v. 47, n. 10, p. 757–762, 2009.
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