Avaliação da oxigenação tecidual nos músculos periféricos e da capacidade funcional em crianças e adolescentes com fibrose cística após um programa de telereabilitação

Abstract

Cystic Fibrosis is a multisystemic disease that affects the exocrine glands and hinders the secretions elimination. Fibrocystic individuals have progressive complications with worsening lung function, reduced muscle mass and functional capacity, which contribute to inactivity and social isolation, frequently observed, in this group of individuals. The aims of this thesis were to evaluate the peripheral muscles tissue oxygenation and the functional capacity in volunteers with Cystic Fibrosis and compare with healthy volunteers; to evaluate the effect of a telerehabilitation program on functional capacity and peripheral muscle tissue oxygenation in fibrocystic volunteers and to verify the association between the behavior of peripheral muscle tissue oxygenation and performance before and after the program. The study was divided in two stages: cross-sectional, observational, exploratory and quasi-experimental study. Children and adolescents aged six to 18 years old with cystic fibrosis and paired healthy children and adolescents were selected. The variables related to functional capacity, peripheral muscle tissue oxygenation and hemodynamic response were assessed using the modified shuttle test (MTS), near-infrared spectroscopy (NIRS), spirometry, and effort scale. The volunteers with cystic fibrosis who participated in telerehabilitation performed daily activities, for 30 minutes, for three months. During this period, they received every two weeks calls and messages with information and recommendations about the activities. Every three months, two follow-ups were reassessed. In the cross-sectional study 124 volunteers participated, they were divided in: Cystic Fibrosis group (GFC) and healthy group (CG). The GFC walked less (p = 0.001), with worse distances (p = 0.001), greater delta deoxyhemoglobin (p = 0.001) and less time until reaching the worst tissue oxygen saturation (p = 0.037). The participants of CFG presented lower values of respiratory (p = 0.001) and heart rate (p = 0.001) at the end of the test, with a worse heart rate recovery time after test (p = 0.005). The GFC consumed more oxygen more quickly with a slower recovery, reflecting worse dynamics of muscle oxygen extraction. The functional capacity of the GFC was worse and associated with a worse hemodynamic recovery (r =0.528). In the quasi-experimental study 62 individuals with Cystic Fibrosis participated. The delta deoxyhemoglobin decreased significantly (p = 0.040) between the beginning and the end of the program. There were no significant differences in walking (p = 0.819) and metabolic (p = 0.219) efficiency defined as the relationship between the distance covered in the MST and the delta of heart rate and the relationship between the distance covered in the MST and the delta of tissue oxygen saturation respectively, or in reoxygenation rates (p = 0.212 and p = 0.627).The program did not obtain results in peripheral musculature and functional capacity. The adherence stratification, in the first follow-up, demonstrated that the low adherence group had worse initial tissue saturation than the high adherence group. The deoxygenation rate was also worse in this group compared to the moderate and high adherence groups, reflecting a change in the available and consumed oxygen. The association between peripheral muscle tissue oxygenation and MST in the evaluation moments was weak and inversely proportional to the deoxygenation rate and performance in the first evaluation (r = -0.323). In the first and second follow-ups this association was lost possibly due to the fact that the participants showed clinical improvement.