RESUMO
BACKGROUND: Chronic venous insufficiency (CVI) causes pathophysiological changes in the lower-limb muscles, particularly the calf muscles, and limits ankle range of motion (ROM). These changes reduce functional activities and decrease quality of life (QOL). Although several studies have shown the benefits of exercise (strengthening the calf muscles to improve calf-muscle pumping and QOL) in patients with CVI, few studies are randomized controlled trials. This has led to a weak indication of exercise for the treatment of patients with CVI. The aim of this study is to analyze the effects of a supervised exercise program to improve calf-muscle endurance as well as QOL in patients with CVI. METHODS/DESIGN: This is an evaluator-blind, randomized clinical trial with an 8-week duration and a follow-up evaluation at week 16. A pilot study with subjects with a CVI diagnosis will be performed to calculate sample size. The participants will be randomly allocated (1:1) into a treatment or a control group (usual care/no intervention). The treatment intervention consists of a bi-weekly supervised exercise program of the lower limbs that will include aerobic training, strengthening and cardiovascular exercises. The participants from both groups will participate in a health education lecture. Primary outcomes are changes in calf-muscle endurance and QOL score. Secondary outcomes are changes in exercise capacity, ankle ROM, electrical muscle activity and cardiac output. The first statistical comparison will be performed after 8 weeks' intervention. DISCUSSION: Patients with CVI may have an impaired calf-muscle pump and decreased exercise capacity. A randomized controlled trial evaluating a supervised exercise program should provide much needed information on the management of CVI to promote health and independence. TRIAL REGISTRATION: This study was registered on the Brazilian Clinical Trials Database (REBEC) (RBR-57xtk7). The results will be disseminated at scientific events, presentations, and publications in peer-reviewed journals.
Assuntos
Terapia por Exercício , Perna (Membro)/irrigação sanguínea , Músculo Esquelético/irrigação sanguínea , Insuficiência Venosa/terapia , Articulação do Tornozelo/fisiopatologia , Brasil , Doença Crônica , Humanos , Músculo Esquelético/fisiopatologia , Projetos Piloto , Pletismografia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Resultado do Tratamento , Insuficiência Venosa/fisiopatologiaRESUMO
Introdução: A síndrome da fragilidade, bastante comum em pessoas de idade avançada, consiste em um conjunto de sinais e sintomas no qual estão presentes critérios como perda de peso corporal não intencional em um ano (aproximadamente 5%), diminuição na velocidade da marcha, níveis baixos de atividade física,exaustão subjetiva e diminuição de força muscular. Os consequentes efeitos dessas mudanças relacionadas à idade, que incluem sarcopenia, disfunção imunológica e desregulação neuroendócrina, aumentam a vulnerabilidade do organismo ao estresse, reduzindo a habilidade de adaptar, compensar ou modular esses estímulos.Diferentes intervenções têm sido propostas para atenuar esse processo, sendo o exercício resistido(ER) uma das opções estudadas. Objetivo: Realizar uma revisão bibliográfica averiguando os efeitos dos ER na fisiopatologia da síndrome da fragilidade. Materiais e métodos: Foi realizada uma revisão bibliográfica do período de 2004 a 2010, por meio das bases de dados LILACS, MEDLINE e PubMed. Resultados: Por meio das análises dos estudos, foram observadas alterações nos sistemas hormonal e imune, atuando de forma sistêmica na reversão ou minimização dos efeitos da sarcopenia exercendo influência positiva na síndrome da fragilidade. Conclusão: O ER deve ser indicado como opção terapêutica para idosos frágeis ou pré-frágeis que não apresentem contra indicações para realização desta modalidade de exercício
INTRODUCTION: Fragility syndrome, very common in elderly people, consists of a set of signals and symptoms in which is present criteria such as not intentional weight loss (approximately 5%) in a year, reduction in the walking speed, low physical activity levels, subjective exhaustion and muscular strength reduction. The increasing effect of these changes related to age, which include sarcopenia, immunity functional disorder and neuroendocrinous misconduct, increase the vulnerability of the organism to stress, reducing the ability to adapt, compensate or modulate these stimuli. Several intervention proposals have been made to attenuate this process, and resistance exercises (RE) was one of the options studied. OBJECTIVES: To evaluate the effects of RE on the physiopathology of fragility syndrome. MATERIALS AND METHODS: A bibliographic review of the period 2004-2010 was made based on the data of LILACS, MEDLINE and PubMed. Results: Changes in the hormonal and immune systems were observed acting in a systemic way by reverting or minimizing the effects of sarcopenia.CONCLUSION: Resistance exercises should serve as therapy to those elderly who are fragile and do not present any health problems.