http://bibliotecatede.uninove.br/handle/tede/32 Sun, 05 Apr 2026 06:39:12 GMT 2026-04-05T06:39:12Z http://bibliotecatede.uninove.br/handle/tede/3916 Título: Reprodutibilidade e validação da versão português do Brasil do questionário duke activity status index para uso em pacientes com hipertensão pulmonar. Autor: Teles, Stephanny Nascimento Primeiro orientador: Jorge, Luciana Maria Malosa Sampaio Abstract: Introduction: Pulmonary hypertension (PH) is characterized by increased pressure in the pulmonary circulation, causing symptoms such as dyspnea, fatigue, and chest pain. People with PH face challenges related to worsening functionality and consequently in adapting to and maintaining a good quality of life. Therefore, an interdisciplinary treatment approach is necessary, with interventions not only related to the medical treatment of the disease but also to the functional capacity and rehabilitation of these patients. Functional assessment tests, while useful, have limitations regarding cost, time, the need for qualified professionals, and health risks, especially in patients with more severe cases. Thus, simple and safe instruments, such as questionnaires, become promising alternatives for evaluating and developing a therapeutic plan aimed at the rehabilitation of people with PH. Methods: This was an observational, cross-sectional validation study including 50 adults diagnosed with PH. Participants completed demographic and clinical questionnaires, the International Physical Activity Questionnaire (IPAQ), and the DASI. The most recent six-minute walk test (6MWT) result was also collected. Results: The sample consisted predominantly of women (88%), with a mean age of 40.38 ± 11.64 years. The most frequent PH etiologies were idiopathic (58%) and congenital heart disease (22%). The mean 6MWT distance was 391.68 ± 190.03 m, and the mean DASI score was 25.26 ± 13.91 METs. There was a good correlation between DASI and 6MWT (r = 0.523), a weak correlation between 6MWT and IPAQ (r = 0.153), and a moderate correlation between DASI and IPAQ (r = 0.282). Cronbach’s alpha was 0.841, and the intraclass correlation coefficient was 0.998, indicating excellent internal consistency and reproducibility. Conclusion: The DASI demonstrated adequate psychometric properties for assessing functional capacity in patients with pulmonary hypertension, proving to be a valid, reliable, and easily applicable tool for clinical practice. Instituição: Universidade Nove de Julho Tipo do documento: Dissertação Thu, 04 Dec 2025 00:00:00 GMT http://bibliotecatede.uninove.br/handle/tede/3916 2025-12-04T00:00:00Z http://bibliotecatede.uninove.br/handle/tede/3915 Título: Efeitos da gamificação na reabilitação cardiopulmonar na qualidade de vida, nível de atividade física e capacidade funcional: uma revisão sistemática e meta-análise Autor: Luiz, Rodrigo Pereira Primeiro orientador: Dias, Raphael Mendes Ritti Abstract: Introduction: Patients with cardiopulmonary diseases often require cardiopulmonary rehabilitation to improve physical activity levels, functional capacity, and quality of life. However, lack of adherence to the training program, increased healthcare costs with these programs, and inequality in access to healthcare resources have been important challenges for participation in conventional rehabilitation programs. Gamification, defined as the use of game design elements in non-game contexts, has been used in studies that used remote rehabilitation programs. Objective: To synthesize the evidence on the effects of gamification applied in cardiopulmonary rehabilitation on the quality of life, physical activity level, and functional capacity of patients with cardiopulmonary diseases. Methods: Systematic review with meta-analysis with research up to May 11, 2025, in the electronic databases: MEDLINE via PubMed, Web of Science, Embase, Cochrane Library, PEDro, Scopus, and Trip Data Base. The PICO strategy was used, which included studies with patients with cardiopulmonary diseases, adults and elderly people of both sexes, in rehabilitation or post-cardiopulmonary rehabilitation with Gamified interventions, compared to a placebo group or no intervention, which evaluated the outcomes of physical activity level, quality of life and functional capacity. Studies involving patients with other diseases or healthy populations, with virtual reality interventions, exergames, active video games and motion detection technologies were excluded. The screening, separation and analysis of the studies were performed by two independent reviewers. The methodological quality was assessed using the PEDro scale, the risk of bias of the studies using the Cochrane ROB2 and the quality of the evidence using the GRADE methodology. The data were synthesized and presented in tables and graphs. Results: From the initial search, 1.427 articles were identified. Of these, 160 duplicates were excluded and, after screening by title and abstract, 24 studies were selected for full reading, 16 studies were then excluded, leaving eight articles for the review. The included studies totaled 2.734 participants, 50.5% of whom were male, aged 18 to 80 years, with cardiopulmonary diseases. Physical activity was assessed by steps per day, daily minutes of moderate to vigorous physical activity, wearable device as an activity tracker, total physical activity by metabolic equivalent, self-report, smartphone accelerometers and movement regimen. For the meta-analysis, data related to steps per day were used, with an overall result in favor of gamification in relation to the control group (SMD 0.39, 95% CI 0.26 - 0.52), with moderate certainty of evidence. Functional capacity was assessed by two studies and quality of life by only one study, identifying a clinically and statistically significant increase in functional status and improvement in quality of life in relation to baseline levels. Conclusion: Our results suggest that gamification has a beneficial effect on cardiovascular rehabilitation in relation to the level of physical activity, however there is a gap in the literature regarding the use of gamification in quality of life and functional capacity in cardiopulmonary rehabilitation. Instituição: Universidade Nove de Julho Tipo do documento: Tese Tue, 17 Jun 2025 00:00:00 GMT http://bibliotecatede.uninove.br/handle/tede/3915 2025-06-17T00:00:00Z http://bibliotecatede.uninove.br/handle/tede/3914 Título: Efeito do treinamento isométrico com handgrip na pressão arterial ambulatorial e modulação autonômica cardíaca de hipertensos: um estudo multicêntrico Autor: Melo, Paulo Henrique de Primeiro orientador: Dias, Raphael Mendes Ritti Abstract: Evidence has suggested that isometric handgrip training (IHT) is an effective strategy for promoting reductions in resting blood pressure (BP). However, the effects and underlying mechanisms of this modality on ambulatory BP, a superior predictor of cardiovascular risk compared to resting BP, remain uncertain. The aim of this study was to analyze the effects of IHT on ambulatory BP and cardiac autonomic modulation in hypertensive adults. A randomized, controlled clinical trial was conducted in four Brazilian cities, including medicated, sedentary, non-smoking, non-diabetic hypertensive adults with no other cardiovascular diseases, who were randomized into two groups: IHT or Control (CG). The IHT group performed four 2-minute sets at 30% of maximal voluntary contraction, with 1-minute rest intervals between sets and alternating hands, three times per week for 24 weeks. The CG performed the same protocol in a sham manner using a stress ball. Resting BP, ambulatory BP (24-hour, daytime and nighttime), nocturnal dipping, morning surge, and cardiac autonomic modulation were assessed before, and after 12 and 24 weeks of intervention. The study included 139 hypertensive participants (IHT = 70; CG = 69), analyzed by intention to treat. After 12 weeks, resting systolic BP decreased by −7.0 ± 1.2 mmHg compared with pre-intervention in the IHT group and remained reduced after 24 weeks (−7.2 ± 1.6 mmHg). After 24 weeks, the CG also showed a reduction (−7.2 ± 1.6 mmHg). Resting diastolic BP did not decrease in either group (p > 0.05). Ambulatory systolic BP and 24-hour mean BP, as well as daytime diastolic BP, were reduced after 12 and 24 weeks compared with pre-intervention in the IHT group, with no statistically significant changes observed in the CG. Between-group comparisons showed that 24-hour mean BP was lower in the IHT group compared with the CG after 24 weeks. No significant changes were observed in morning surge, nocturnal dipping, or heart rate variability in either group (p > 0.05 for all). In conclusion, IHT elicits a time-dependent response, and in the long term, it does not produce additional reductions in resting systolic BP; however, the initial reductions are maintained. On the other hand, IHT was effective in reducing ambulatory systolic BP, 24-hour mean BP, and daytime diastolic BP in hypertensive adults. Nonetheless, it did not modify nocturnal dipping, morning surge, or cardiac autonomic modulation. Instituição: Universidade Nove de Julho Tipo do documento: Tese Tue, 02 Dec 2025 00:00:00 GMT http://bibliotecatede.uninove.br/handle/tede/3914 2025-12-02T00:00:00Z http://bibliotecatede.uninove.br/handle/tede/3913 Título: Avaliação da relação entre cinesiofobia, autoeficácia e desvio dos padrões de movimento em pessoas com dor femoropatelar Autor: Leite, Otávio Henrique Cardoso Primeiro orientador: Lucareli, Paulo Roberto Garcia Abstract: Introduction: Musculoskeletal pain is a global public health issue with significant impacts on individuals’ quality of life and functionality. Among these conditions, patellofemoral pain (PFP) is one of the most prevalent complaints in young adults, especially women, and is characterized by anterior knee pain during activities that increase joint load. Although historically considered self-limiting, recent evidence shows that PFP can persist and result in long-term functional limitations. Current literature emphasizes the importance of a multifactorial approach to chronic pain, addressing not only biomechanical aspects but also cognitive-behavioral factors such as kinesiophobia, pain catastrophizing, and self-efficacy, which directly influence the pain experience and motor behavior. The motor response, in turn, may reflect both adaptive and maladaptive learned strategies. Dynamic assessment methods, such as the Lateral Step-Down (LSD) test, allow for a more sensitive analysis of movement responses to nociceptive stimuli compared with traditional retrospective measures. Therefore, it is essential to investigate cognitive-behavioral, functional, and motor factors in an integrated manner among individuals with PFP, aiming to develop more effective, individualized, and patient-centered therapeutic strategies. Objectives: The main objectives of this thesis are: 1) To evaluate the associations between kinesiophobia, cognitive-behavioral factors, pain, and functional domains in individuals with patellofemoral pain (PFP). 2) To determine which self- reported pain measure: (a) average pain over the past 15 days, (b) pain at baseline (upon arrival for assessment), or (c) pain during each movement set, shows the strongest association with the Movement Deviation Profile (MDP) during the Lateral Step-Down (LSD) test in people with PFP. Methods: 1)This is a cross-sectional study involving 66 individuals with PFP, who underwent kinematic assessment during the Lateral Step-Down (LSD) test, concomitantly with cognitive-behavioral evaluation. To examine angular kinematics during the LSD, the Movement Deviation Profile (MDP) was used. The cognitive-behavioral assessment was conducted using scales designed to measure fear of movement (Tampa Scale for Kinesiophobia), the individual’s confidence in performing activities despite pain (Pain Self- Efficacy Scale – PSEQ-10 and Chronic Pain Self-Efficacy Scale – CPSE), and the negative emotional and behavioral impact associated with coping with pain (Pain Catastrophizing Scale). Before the main analyses, data normality and homogeneity were verified to ensure the adequacy and consistency of subsequent statistical procedures. A statistical model was then built to identify the factors most associated with kinesiophobia, using automatic variable selection and model quality criteria. 2) This is a cross-sectional study including 66 individuals with PFP who underwent kinematic evaluation during 12 cycles of the LSD test, concomitant with pain assessment using the Numerical Pain Rating Scale. To analyze angular kinematics during the LSD, the MDP was used. For pain assessment, the numerical pain rating scale was applied at six different time points: initially, considering the 15 days prior to data collection; then, before starting the single-leg squat; and subsequently, after every four repetitions of the exercise. The study employed a generalized linear model to analyze the evolution of variables across multiple series, considering possible interactions between variables and estimating regression coefficients and existing associations. Results: 1) Kinesiophobia decreased by 0.31 points for every one-point increase in the Pain Self-Efficacy Questionnaire (PSEQ-10) score. Conversely, the MDPmean variable showed a directly proportional effect, with a 0.24-point increase in kinesiophobia for every one-degree increase in movement deviation. 2) The analysis showed that none of the pain indices, whether retrospective, baseline, or task-induced, presented a statistically significant association with movement deviation. The direction of the coefficients indicated a weak and positive trend between higher pain and higher MDP values, particularly for pain during movement; however, these trends did not reach conventional statistical significance. Conclusion: 1) The findings highlight that self-efficacy, measured by the PSEQ- 10, and the MDP are important variables for explaining kinesiophobia, demonstrating its multifactorial nature. 2) The results of this study indicated that movement deviation over four sets of single-leg squats was not associated with any pain measure, whether retrospective or experienced during exercise. Instituição: Universidade Nove de Julho Tipo do documento: Tese Fri, 14 Nov 2025 00:00:00 GMT http://bibliotecatede.uninove.br/handle/tede/3913 2025-11-14T00:00:00Z