Efeitos do treinamento muscular inspiratório no controle autonômico: revisão sistemática
DOI:
https://doi.org/10.1590/1809-2950/17015425032018Palavras-chave:
Exercícios Respiratórios, Exercício, Sistema Nervoso Autônomo, FisiopatologiaResumo
A disfunção do sistema nervoso autônomo tem papel importante na fisiopatologia de diversas doenças. Uma possível maneira de melhorar o controle autonômico é o treinamento muscular inspiratório (TMI), sendo o objetivo deste estudo revisar sistematicamente a literatura disponível sobre os efeitos desta modalidade. Dois revisores buscaram ensaios clínicos controlados e randomizados nas bases de dados MEDLINE, PEDro, SciELO e LILACS, avaliando também sua qualidade metodológica (escala de PEDro). Foram encontrados 181 artigos e, após verificar os critérios de elegibilidade, foram incluídos quatro pesquisas que avaliaram o efeito do TMI sobre o controle autonômico de participantes com fatores de risco para doenças cardiovasculares, por meio da variabilidade da frequência cardíaca (VFC) e dos níveis plasmáticos de noradrenalina. O TMI melhorou o controle autonômico em três estudos, reduzindo a atividade nervosa simpática (níveis plasmáticos de noradrenalina; LF u.n. – VFC) e aumentando a atividade nervosa vagal (HF u.n. – VFC). Conclui-se que o TMI parece ser uma alternativa terapêutica para melhorar o controle autonômico.
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Referências
Wehrewin EA, Orer HS, Barman SM. Overview of the anatomy,
physiology, and pharmacology of the autonomic nervous
system. Compr Physiol. 2016;6(3):1239-78. doi: 10.1002/cphy.
c150037
Zygmunt A, Stanczyk J. Methods of evaluation of autonomic
nervous system function. Arch Med Sci. 2010;6(1):11-8.
doi: 10.5114/aoms.2010.13500
Liao D, Cai J, Barnes RW, Tyroler HA, Rautaharju P, Holme
I, et al. Association of cardiac autonomic function and the
development of hypertension: the ARIC study. Am J Hypertens.
;9(12):1147-56. doi: 10.1016/S0895-7061(96)00249-X
Phillips JK. Autonomic dysfunction in heart failure and renal
disease. Front Physiol. 2012;3:219. doi: 10.3389/fphys.2012.00219
Jyotsna VP, Singh AK, Deepak KK, Sreenivas V. Progression
of cardiac autonomic dysfunction in newly detected type 2
diabetes. Diabetes Res Clin Pract. 2010;90(1):e5-6. doi: 10.1016/j.
diabres.2010.04.009
Pantoni CBF, Reis MS, Martins LEB, Catai AM, Costa D,
Borghi-Silva A. Study of heart rate autonomic modulation at
rest in elderly patients with chronic obstructive pulmonary
disease. Rev Bras Fisioter. 2007;11(1):33-8. doi: 10.1590/
S1413-35552007000100007
Martinez DG, Nicolau JC, Lage RL, Toschi-Dias E, Matos LD, Alves
MJ, et al. Effects of long-term exercise training on autonomic
control in myocardial infarction patients. Hypertension.
;58(6):1049-56. doi: 10.1161/HYPERTENSIONAHA.111.176644
Lazzeroni D, Castiglioni P, Bini M, Faini A, Camaiora U, Ugolotti
PT, et al. Improvement in aerobic capacity during cardiac
rehabilitation in coronary artery disease patients: is there a role
for autonomic adaptations? Eur J Prev Cardiol. 2017;24(4):357-
doi: 10.1177/2047487316681341
Barği G, Güçlü MB, Arıbaş Z, Aki ŞZ, Sucak GT. Inspiratory muscle
training in allogeneic hematopoietic stem cell transplantation
recipients: a randomized controlled trial. Support Care Cancer.
;24(2):647-59. doi: 10.1007/s00520-015-2825-3
Mello PR, Guerra GM, Borile S, Rondon MU, Alves MJ, Negrão
CE, et al. Inspiratory muscle training reduces sympathetic
nervous activity and improves inspiratory muscle weakness
and quality of life in patients with chronic heart failure: a clinical
trial. J Cardiopulm Rehabil Prev. 2012;32(5):255-61. doi: 10.1097/
HCR.0b013e31825828da
Hermes BM, Cardoso DM, Gomes TJ, Santos TD, Vicente
MS, Pereira SN, et al. Short-term inspiratory muscle training potentiates the benefits of aerobic and resistance training in
patients undergoing CABG in phase II cardiac rehabilitation
program. Rev Bras Cir Cardiovasc. 2015;30(4):474-81.
doi: 10.5935/1678-9741.20150043
Corrêa AP, Ribeiro JP, Balzan FM, Mundstock L, Ferlin EL,
Moraes RS. Inspiratory muscle training in type 2 diabetes
with inspiratory muscle weakness. Med Sci Sports Exerc.
;43(7):1135-41. doi: 10.1249/MSS.0b013e31820a7c12
Ferreira JB, Plentz RD, Stein C, Casali KR, Arena R, Lago
PD. Inspiratory muscle training reduces blood pressure and
sympathetic activity in hypertensive patients: a randomized
controlled trial. Int J Cardiol. 2013;166(1):61-7. doi: 10.1016/j.
ijcard.2011.09.069
Kaminski DM, Schaan BD, Silva AM, Soares PP, Lago PD.
Inspiratory muscle training in patients with diabetic neuropathy:
a randomized clinical trial. Clin Auton Res. 2015;25(4):263-6.
doi: 10.1007/s10286-015-0291-0
Vranish JR, Bailey EF. Inspiratory muscle training improves sleep
and mitigates cardiovascular dysfunction in obstructive sleep
apnea. Sleep. 2016;39(6):1179-85. doi: 10.5665/sleep.5826
Witt JD, Guenette JA, Rupert JL, McKenzie DC, Sheel AW.
Inspiratory muscle training attenuates the human respiratory
muscle metaboreflex. J Physiol. 2007;584(3):1019-28.
doi: 10.1113/jphysiol.2007.140855
Jones CU, Sangthong B, Pachirat O, Jones DA. Slow breathing
training reduces resting blood pressure and the pressure
responses to exercise. Physiol Res. 2015;64(5):673-82.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting
items for systematic reviews and meta-analyses: the PRISMA
statement. PLoS Med. 2009;6(7): e1000097. doi: 10.1371/journal.
pmed.1000097
Besnier F, Labrunée M, Pathak A, Paw-Le Traon A, Galès C,
Sénard JM, et al. Exercise training-induced modification in
autonomic nervous system: an update for cardiac patients.
Ann Phys Rehabil Med. 2017;60(1):27-35. doi: 10.1016/j.
rehab.2016.07.002
Montemezzo D, Fregonezi GA, Pereira DA, Britto RR, Reid
WD. Influence of inspiratory muscle weakness on inspiratory
muscle training responses in chronic heart failure patients: a
systematic review and meta-analysis. Arch Physic Med Rehabil.
;95(7):1398-407. doi: 10.1016/j.apmr.2014.02.022
Basso-Vanelli RP, Di Lorenzo VA, Labadessa IG, Regueiro EM,
Jamami M, Gomes EL, et al. Effects of inspiratory muscle
training and calisthenics-and-breathing exercises in COPD
with and without respiratory muscle weakness. Respir Care.
;61(1):50-60. doi: 10.4187/respcare.03947
Zeren M, Demir R, Yigit Z, Gurses HN. Effects of inspiratory
muscle training on pulmonary function, respiratory muscle
strength and functional capacity in patients with atrial
fibrillation: a randomized controlled trial. Clin Rehabil.
;30(12):1165-74. doi: 10.1177/0269215515628038
Dempsey JA. New perspectives concerning feedback influences
on cardiorespiratory control during rhythmic exercise and
on exercise performance. J Physiol. 2012;590(17):4129-44.
doi: 10.1113/jphysiol.2012.233908
St Croix CM, Morgan BJ, Wetter TJ, Dempsey JA. Fatiguing
inspiratory muscle work causes reflex sympathetic
activation in humans. J Physiol. 2000;529(2):493-504.
doi: 10.1111/j.1469-7793.2000.00493.x
Archiza B, Simões RP, Mendes RG, Fregonezi GAF, Catai
AM, Borghi-Silva A. Acute effects of different inspiratory
resistive loading on heart rate variability in healthy elderly
patients. Braz J Phys Ther. 2013;17(4):401-8. doi: 10.1590/
S1413-35552013005000100
Plentz RDM, Silva VG, Dipp T, Macagnan FE, Lemos LC, Tartari
JLL, et al. Treinamento (entrenamiento) muscular inspiratório
para o controle (el control) autonômico de indivíduos saudáveis
(sanos). Salud(i)ciência. 2014;21(1):28-34.
Jaenisch RB, Hentschke VS, Quagliotto E, Cavinato PR,
Schmeing LA, Xavier LL, et al. Respiratory muscle training
improves hemodynamics, autonomic function, baroreceptor
sensitivity, and respiratory mechanics in rats with heart
failure. J Appl Physiol. 2011;111(6):1664-70. doi: 10.1152/
japplphysiol.01245.2010
Shepherd JT. The lungs as receptor sites for cardiovascular
regulation. Circulation. 1981;63(1):1-10. doi: 10.1161/01.CIR.63.1.1
Dempsey JA, Sheel AW, St Croix CM, Morgan BJ. Respiratory
influences on sympathetic vasomotor outflow in humans.
Respir Physiol Neurobiol. 2002;130(1):3-20. doi: 10.1016/
S0034-5687(01)00327-9
Neff RA, Wang J, Baxi S, Evans C, Mendelowitz D. Respiratory
sinus arrhythmia: endogenous activation of nicotinic receptors
mediates respiratory modulation of brainstem cardioinhibitory
parasympathetic neurons. Circ Res. 2003;93(6):565-72.
doi: 10.1161/01.RES.0000090361.45027.5B
Pei J, Tang W, Li LX, Su CY, Wang T. Heart rate variability
predicts mortality in peritoneal dyalisis patients. Ren Fail.
;37(7):1132-7. doi: 10.3109/0886022X.2015.1061729
Compostella L, Nicola R, Tiziana S, Caterina C, Fabio B. Autonomic
dysfunction predicts poor physical improvement after cardiac
rehabilitation in patients with heart failure. Res Cardiovasc
Med. 2014;3(4):e25237. doi: 10.5812/cardiovascmed.25237
Danilowicz-Szymanowicz L, Suchecka J, Niemirycz-Makurat
A, Rozwadowska K, Raczak G. Autonomic predictors of
hospitalization due to heart failure decompensation in
patients with left ventricular systolic dysfunction. PLoS One.
;11(3):e0152372. doi: 10.1371/journal.pone.0152372
Schwartz PJ, Billman GE, Stone HL. Autonomic mechanisms
in ventricular fibrillation induced by myocardial ischemia
during exercise in dogs with healed myocardial infarction: an
experimental preparation for sudden cardiac death. Circulation.
;69(4):790-800. doi: 10.1161/01.CIR.69.4.790
Triposkiadis F, Karayannis G, Giamouzis G, Skoularigis J,
Louridas G, Butler J. The sympathetic nervous system in heart
failure: physiology, pathophysiology, and clinical implications.
J Am Coll Cardiol. 2009;54(19):1747-62. doi: 10.1016/j.
jacc.2009.05.015
Gourine A, Gourine AV. Neural mechanisms of cardioprotection.
Physiology. 2014;29(2):133-40. doi: 10.1152/physiol.00037.2013
Bocchi EA, Marcondes-Braga FG, Bacal F, Ferraz AS,
Albuquerque D, Rodrigues D, et al. Atualização da
diretriz brasileira de insuficiência cardíaca crônica: 2012.
Arq Bras Cardiol. 2012;98(1 Suppl 1):1-33. doi: 10.1590/
S0066-782X2012000700001
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