Exercício físico e composição corporal em mulheres pós-menopáusicas
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2016-05-06
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Objetivos: A presente dissertação procurou analisar o efeito isolado e interativo de um programa de exercício de step/musculação/flexibilidade com a natureza da menopausa e com a terapia hormonal na composição corporal e na taxa metabólica basal de mulheres pós-menopáusicas.
Métodos: Cento e sessenta e nove mulheres (56,80 ± 6,47 anos) foram selecionadas de forma randomizada para os grupos de exercício (GE, n = 91) e de controlo (GC, n = 78). O GE realizou sessões trissemanais de exercício, com 60 minutos de duração cada, envolvendo step (40% a 75% da frequência cardíaca de reserva), treino de força muscular (70% a 80% de 1 repetição máxima, 8 a 12 repetições, 2 séries) e flexibilidade.
A avaliação da história clínica e reprodutiva foi realizada no início do estudo, permitindo a verificação dos critérios de inclusão na amostra e as medições foram realizadas antes e após 12 meses de intervenção. A composição corporal foi avaliada com a bioimpedância ocotopolar InBody 720, sendo consideradas as seguintes variáveis: peso (P), massa gorda (MG), massa isenta de gordura (MIG), massa isenta de gordura e de osso (MIGO) total e regional, área de adiposidade visceral (AAV), massa muscular esquelética (MME) e taxa metabólica basal (TMB). O índice de massa muscular esquelética foi calculado (IMME = [MME / P] × 100) e o método de registro alimentar foi utilizado. A análise estatística incluiu testes t e ancovas (controlo da idade), sendo considerado um grau de significância estatística de 5%.
Resultados: Não foram registadas diferenças entre as médias das variáveis entre os dois grupos no início do estudo, exceto para a idade. Na comparação das taxas de modificação do grupo de exercício (GE) com o grupo controle (GC), foram notadas mudanças significativas para as variáveis da composição corporal e TMB, exceto P e MG. Para as variáveis, MME, MIGO (com exceção para os membros inferiores) e TMB, as reduções no grupo de exercício (GE) foram significativamente menores quando comparadas com o GC. A altura (p<0,01) e a MIGO dos membros inferiores (MIGOMI) revelaram um aumento no GE. O tratamento estatístico revelou também uma redução da AAV no GE (- 0,17 ± 13.15) e o incremento desta variável no GC (4,17± 11.96), sendo a diferença entre as taxas de modificação desta variável nos dois grupos de 4,34% (p=0,04).
A análise do efeito isolado e interativo do exercício com a natureza da menopausa revelou que o primeiro influenciou de forma significativa e isolada a taxa de modificação da altura (p=0,034), MME (p=0,000), IMME (p=0,042) e MIGO total (p=0,015), dos membros superiores (MIGOMS, p=0,017) e do tronco (MIGOT, p=0,018). A natureza da menopausa afetou a taxa de modificação da MME, MIGOT e da MIGOB. Nas mulheres com menopausa natural, o exercício influenciou a variação da altura (p≤0,05), AAV (p≤0,05), MME (p≤0,01), IMME (p≤0,01) e MIGOMS e MIGOMT (p≤0,05). Para as mulheres cuja menopausa ocorreu de forma induzida, o exercício teve impacto apenas na MME (p≤0,01).
Independentemente da terapia hormonal (TH), o exercício influiu (p≤ 0.03) a variação da altura, AAV, MME, IMME e MIGO (excepto MIGOMI), com um R2 Ajustado entre 0,7% e 11,3%. Nas mulheres que documentaram o uso de TH, as do GE apresentaram uma redução mais atenuada da MIGOMS (-2,60%, p<0,05), MIGO, MIG e IMME (-0,03, p <0,05, 0,03, p <0,01), tendo melhorado a altura (1,89% no GE e -1,54% no GC, p <0,01). Os resultados também demonstraram diferenças da MME entre o GE e o GC, nas mulheres que documentaram o uso e o não uso de TH.
Conclusão: Os resultados sugerem que o programa de exercício foi efetivo na atenuação do aumentos dos níveis de adiposidade total e central e na perda de massa muscular das mulheres pós-menopáusicas, com possíveis benefícios na autonomia funcional das mesmas.
A composição corporal foi mais influenciada pelo exercício do que pelas características da menopausa analisadas (natureza da menopausa e terapia hormonal).
Purpose: This dissertation aimed to analyze the isolated and interactive effect of an exercise program including body step, weight training and flexibility exercises in relation to the nature of menopause and hormone therapy on body composition and basal metabolic rate of post-menopausal women. Methods: One hundred and sixty-nine women (56.80 ± 6.47 years old) were randomly selected for the exercise (EG, n = 91) and control groups (CG, n = 78). The EG performed exercises thrice a week, in 60-minute long sessions, involving body step (50% to 84% of the heart rate reserve), muscular strength training (70% to 80% of one-repetition maximum, 2 sets of 8-12 repetitions), and flexibility training. The evaluation of the participants’ medical and reproductive history was done at the beginning of the study, thus allowing the verification of the inclusion criteria in the sample. Measurements were made before and after 12 months of intervention. Body composition was evaluated by InBody 720 octapolar bioimpedance, with the following variables being considered: weight (W), fat mass (FM), fat-free mass (FFM), soft lean mass – total (SLMT) and regional (SLMR) –, visceral fat area (VFA), skeletal muscle mass (SMM), and basal metabolic rate (BMR). The skeletal muscle mass index was calculated (SMMI = [SMM/W] × 100), and a food record method was used. Statistical analysis included t-tests and ANCOVA (age control), with a 5% level of statistical significance. Results: No differences were found between the averages of the variables in both groups at baseline, except for age. By comparing the rate of change in the exercise group (EG) with the control group (CG), significant changes were observed for the variables of body composition and basal metabolic rate, except for weight and fat mass. For the variables SM, SLM (except for lower body) and BMR, reductions in the exercise group (EG) were significantly lower when compared to the control group. Height (p<0.01) and lower body SLM (SLMLB) showed an increase in the EG. Statistical treatment also showed a reduction in the VFA in the EG (-0.17 ± 13.15) and an increase in this variable in the CG (4.17± 11.96), with a 4.34% (p=0.04) difference in the rates of change in both groups. The analysis of the isolated and interactive effects of exercises in relation to the nature of menopause revealed that the former influenced significantly and isolatedly the rate of change of height (p=0.034), SMM (p=0.000), SMMI (p=0.042) and total SLM (p=0.015), of the upper body (SLMUB, p=0.017) and of the trunk (SLMT, p=0.018). The nature of menopause affected the rates of change of the SLMT and of the SLMA. In women with natural menopause, the practice of exercise influenced the height variation (p≤0.05), VFA (p≤0.05), SMM (p≤0.01), SMMI (p≤0.01), and SLMUB and SLMLB (p≤0.05). For the women whose menopause had been induced, exercise had an effect only on SMM (p≤0.01). Regardless of hormone therapy (HT), exercise influenced (p≤0.03) height variation, VFA, SMM, SMMI and SLM (except for SLMLB), with an R² adjusted between 0.7% and 11.3%. In women who reported the use of HT, those in the EG presented a more attenuated reduction in the SLMUB (-2.60%, p=0.04), SLM, FFM and SMMI (-0.03, p<0.01), achieving height improvement (1.89% in the EG and -1.54% in the CG, p<0.01). The results also showed differences in SMM between the EG and the CG in women who reported the non-use of HT. Conclusion: Our results suggest that the exercise program was effective in attenuating the increases in total and central fat, and in the loss of muscular mass in post-menopausal women, with possible benefits to their functional autonomy. Body composition was more influenced by exercise than by the analyzed characteristics of menopause (the nature of menopause, and hormone therapy).
Purpose: This dissertation aimed to analyze the isolated and interactive effect of an exercise program including body step, weight training and flexibility exercises in relation to the nature of menopause and hormone therapy on body composition and basal metabolic rate of post-menopausal women. Methods: One hundred and sixty-nine women (56.80 ± 6.47 years old) were randomly selected for the exercise (EG, n = 91) and control groups (CG, n = 78). The EG performed exercises thrice a week, in 60-minute long sessions, involving body step (50% to 84% of the heart rate reserve), muscular strength training (70% to 80% of one-repetition maximum, 2 sets of 8-12 repetitions), and flexibility training. The evaluation of the participants’ medical and reproductive history was done at the beginning of the study, thus allowing the verification of the inclusion criteria in the sample. Measurements were made before and after 12 months of intervention. Body composition was evaluated by InBody 720 octapolar bioimpedance, with the following variables being considered: weight (W), fat mass (FM), fat-free mass (FFM), soft lean mass – total (SLMT) and regional (SLMR) –, visceral fat area (VFA), skeletal muscle mass (SMM), and basal metabolic rate (BMR). The skeletal muscle mass index was calculated (SMMI = [SMM/W] × 100), and a food record method was used. Statistical analysis included t-tests and ANCOVA (age control), with a 5% level of statistical significance. Results: No differences were found between the averages of the variables in both groups at baseline, except for age. By comparing the rate of change in the exercise group (EG) with the control group (CG), significant changes were observed for the variables of body composition and basal metabolic rate, except for weight and fat mass. For the variables SM, SLM (except for lower body) and BMR, reductions in the exercise group (EG) were significantly lower when compared to the control group. Height (p<0.01) and lower body SLM (SLMLB) showed an increase in the EG. Statistical treatment also showed a reduction in the VFA in the EG (-0.17 ± 13.15) and an increase in this variable in the CG (4.17± 11.96), with a 4.34% (p=0.04) difference in the rates of change in both groups. The analysis of the isolated and interactive effects of exercises in relation to the nature of menopause revealed that the former influenced significantly and isolatedly the rate of change of height (p=0.034), SMM (p=0.000), SMMI (p=0.042) and total SLM (p=0.015), of the upper body (SLMUB, p=0.017) and of the trunk (SLMT, p=0.018). The nature of menopause affected the rates of change of the SLMT and of the SLMA. In women with natural menopause, the practice of exercise influenced the height variation (p≤0.05), VFA (p≤0.05), SMM (p≤0.01), SMMI (p≤0.01), and SLMUB and SLMLB (p≤0.05). For the women whose menopause had been induced, exercise had an effect only on SMM (p≤0.01). Regardless of hormone therapy (HT), exercise influenced (p≤0.03) height variation, VFA, SMM, SMMI and SLM (except for SLMLB), with an R² adjusted between 0.7% and 11.3%. In women who reported the use of HT, those in the EG presented a more attenuated reduction in the SLMUB (-2.60%, p=0.04), SLM, FFM and SMMI (-0.03, p<0.01), achieving height improvement (1.89% in the EG and -1.54% in the CG, p<0.01). The results also showed differences in SMM between the EG and the CG in women who reported the non-use of HT. Conclusion: Our results suggest that the exercise program was effective in attenuating the increases in total and central fat, and in the loss of muscular mass in post-menopausal women, with possible benefits to their functional autonomy. Body composition was more influenced by exercise than by the analyzed characteristics of menopause (the nature of menopause, and hormone therapy).
Descrição
Tese de Doutoramento em Ciências do Desporto
Palavras-chave
Composição corporal , Exercícios físicos , Pós-menopausa , Natureza da menopausa , Terapia hormonal