Relação entre os marcadores inflamatórios e força muscular periférica em pacientes com asma moderada a grave: ensaio clínico controlado e randomizado dos efeitos do treinamento resistido associado a fotobiomodulação

Abstract

Asthma is a bronchial inflammation of the lower airways and among the drugs recommended for the maintenance treatment are inhaled corticosteroids and with its regular use an overall improvement of the disease occurs with less frequent and lower intensity attacks. Prolonged use of corticosteroids can lead to disorders such as chronic myopathy, causing muscle weakness, including effects on the peripheral muscles in their use at higher doses. Among the non-pharmacological treatments is pulmonary rehabilitation, consisting of 3 types of exercise: aerobic, resisted and combined, with the main objective of reducing muscle fatigue during exercise and during daily activities. Therefore, before starting rehabilitation programs, it is necessary to evaluate the functional and physical capacity of these patients to choose the best mode of exercise during rehabilitation. Functional tests such as the Incremental Shuttle Walk Test, which are easy to apply and inexpensive, are commonly used to evaluate the functional capacity of pre and post-pulmonary rehabilitation programs, but their reliability in the population of difficult-to-control asthma Was not very well delimited so far, considering the importance of the continuous evaluation of its clinical and therapeutic condition. In addition to the exercise modalities found in the literature, electro-physical methods have been used in conjunction with pulmonary rehabilitation, showing good results in improving muscle fatigue and increasing peripheral muscle strength. Objectives: This study aims to evaluate the reliability of the incremental controlled walking test of patients with difficult-to-control asthma, the acute effects of light-emitting diode (LEDT) therapy on muscle function and systemic inflammatory mediators in patients with Moderate to severe asthma during isometric exercise and the chronic effects of the application of LED phototherapy associated with resistance training in the peripheral muscle function of patients with moderate to severe asthma. Methods and Results: Study I: For the reliability of the test, 45 patients with mean age of 47 ± 13.8 were selected who performed the Shuttle Walk Test twice with a 20-minute resting period between them. As results we did not find statistical difference between the average distance traveled between the first and second test (330.5 and 336.3 meters respectively). In the analysis of the two tests revealed an average difference of -12.7 meters, with a confidence interval of 37.9 to -63.2 meters. Study II: For the evaluation of the acute effects of LEDT on peripheral muscle function during isometric exercise, 11 38 ± 10 were selected, underwent a single LEDT application in the dominant femoral quadriceps limb (cluster with 50 LEDs λ = 850 nm, 50 MW, 15 sec; 37.5 J), 48 h cross-over. Before and after the application of LEDT and sham, patients underwent an isometric resistance test (60% of maximal voluntary isometric contraction), up to the simultaneous recording tolerance limit of two-point surface electromyography (rectus femoris and vastus Medial) and collection of a blood sample for the identification of systemic inflammatory mediators. For the evaluation of the responses, the differences between the variables of contraction time for exhaustion and the effect of LEDT irradiation. Sham irradiation were compared using two-factor ANOVA. There were no statistically significant differences between the groups at the time of contraction (before 41 ± 14 vs. 44 ± 16 s, after 46 ± 12 vs. 45 ± 20 s) during the isometric contraction test and in the inflammatory markers before and after one Single application LED. Study III: 30 patients were randomized into two resistance training groups, one of which was associated with LED phototherapy. As a result, we found statistically significant differences with an increase in the 1-RM variables of all muscle groups submitted to LED irradiation associated with resistance exercise after the training period, as well as an increase in the variables of functional capacity VO2 AT, VO2 max And DSWT compared to the group receiving LED-Placebo. Conclusion: Thus, we can conclude that the walk test with incremental controlled speed is reliable for individuals with difficult to control asthma and can be used in the evaluation of functional capacity and also the applications of acute LEDT did not differ in the time of response to fatigue In asthmatic patients and in systemic inflammatory mediators, however, the long-term application of this technique has shown an increase in strength compared to the group that received phototherapy by LED-Placebo, making it a useful tool for the use associated with pulmonary rehabilitation protocols.