Modulação metabólica pelo exercício e manejo de recursos ergogênicos na doença pulmonar obstrutiva crônica
DOI:
https://doi.org/10.33233/fb.v12i1.603Resumo
Introdução: A Doença Pulmonar Obstrutiva Crônica (DPOC) é um dos focos dos projetos de saúde pública cursando com alta incidência e prevalência em adultos e idosos. A abordagem terapêutica a DPOC compreende o entendimento das vias moleculares de inflação, degradação proteica e hipertrofia. Objetivo: Discutir as vias de sinalização para hipotrofia/hipertrofia adjuntas as diferentes suplementações para o paciente com DPOC compensada. Método: Foram cotejados e analisados artigos publicados em revistas presentes na base de dados da PubMed, utilizando-se palavras em inglês como: amino acids supplementation, COPD, hypertrophy pulmonary rehabilitation em diferentes combinações, mas sempre com a palavra COPD presente. Resultados: O exercício é um estressor metabólico que aumenta a mobilização de aminoácidos e a inflamação local e aguda com sinalização para síntese proteica. Diferentes peptídeos de produção rápida estão envolvidos neste mecanismo com modulação no status muscular, sendo a intensidade e a velocidade de execução do exercício os principais mediadores do processo. A suplementação nutricional e hormonal associadas a um programa de exercícios são estratégias que aumentam a força e resistência muscular e reduzem o risco de internação e êxito letal. Conclusão: O exercício é uma intervenção não farmacológica efetiva no tratamento de pacientes com doença metabólica subsequente a DPOC. A utilização de fármacos e suplementos nutricionais é factível na terapêutica cotidiana do profissional de saúde com a finalidade de aumentar massa magra e resistência física.
Palavras–chave: caquexia, suplementação, aminoácidos, hipertrofia, catabolismo, reabilitação.
Referências
Man WD, Kemp P, Moxham J, Polkey MI. Exercise and muscle dysfunction in COPD: implications for pulmonary rehabilitation. Clin Sci (Lond) 2009;117(8):281-91.
Jardim Junior OJ, Nascimento O. Consenso Brasileiro Sobre Doença Pulmonar Obstrutiva Crônica – DPOC. Brasil: Sociedade Brasileira de Pneumologia e Tisiologia; 2006.
Ward S, Casaburi R. 21st century perspective on chronic obstructive pulmonary disease. Respiration 2001;68(6):557-61.
Wagner PD. Possible mechanisms underlying the development of cachexia in COPD. Eur Respir J 2008;31(3):492-501.
John M, Hoernig S, Doehner W, Okonko D, Witt C, Anker S. Anemia and inflammation in COPD. Chest 2005;127(3):825-9.
Aliverti A, Macklem PT. The major limitation to exercise performance in COPD is inadequate energy supply to the respiratory and locomotor muscles. J Appl Physiol 2008;105(2):749-57.
Engelen MP, Wouters EF, Deutz NE, Does JD, Schols AM. Effects of exercise on amino acid metabolism in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;163(4):859-64.
Vogiatzis I, Simoes DC, Stratakos G, Kourepini E, Terzis G, Manta P, et al. Effect of pulmonary rehabilitation on muscle remodelling in cachectic patients with COPD. Eur Respir J 2010;36(2):301-10.
Engelen MP, Deutz NE, Mostert R, Wouters EF, Schols AM. Response of whole-body protein and urea turnover to exercise differs between patients with chronic obstructive pulmonary disease with and without emphysema. Am J Clin Nutr 2003;77(4):868-74.
Creutzberg EC, Schols AM, Weling-Scheepers CA, Buurman WA, Wouters EF. Characterization of nonresponse to high caloric oral nutritional therapy in depleted patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;161(3 Pt 1):745-52.
Creutzberg EC, Wouters EF, Mostert R, Pluymers RJ, Schols AM. A role for anabolic steroids in the rehabilitation of patients with COPD? A double-blind, placebo-controlled, randomized trial. Chest 2003;124(5):1733-42.
Faager G, Söderlund K, Sköld C, Rundgren S, Tollbäck A, Jakobsson P. Creatine supplementation and physical training in patients with COPD: a double blind, placebo-controlled study. Int J Chron Obstruct Pulmon Dis 2006;1(4):445-53.
Engelen MP, Schols AM, Does JD, Wouters EF. Skeletal muscle weakness is associated with wasting of extremity fat-free mass but not with airflow obstruction in patients with chronic obstructive pulmonary disease. Am J Clin Nutr 2000;71(3):733-8.
Maltais F, LeBlanc P, Whittom F, Simard C, Marquis K, Bélanger M, et al. Oxidative enzyme activities of the vastus lateralis muscle and the functional status in patients with COPD. Thorax 2000;55(10):848-53.
Remels AH, Schrauwen P, Broekhuizen R, Willems J, Kersten S, Gosker HR, et al. Peroxisome proliferator-activated receptor expression is reduced in skeletal muscle in COPD. Eur Respir J 2007;30(2):245-52.
Doucet M, Russell AP, Leger B, Debigare R, Joanisse DR, Caron MA, et al. Muscle atrophy and hypertrophy signaling in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007;176(3):261-9.
Brault J, Jespersen J, Goldberg A. PGC-1{alpha} or PGC-1{beta} (peroxisome proliferator-activated receptor {gamma} coactivator 1{alpha} or 1{beta}) overexpression inhibits muscle protein degradation, induction of ubiquitin ligases, and disuse atrophy. J Biol Chem 2010;285(25):19460-71.
Vogiatzis I, Stratakos G, Simoes DC, Terzis G, Georgiadou O, Roussos C, et al. Effects of rehabilitative exercise on peripheral muscle TNFalpha, IL-6, IGF-I and MyoD expression in patients with COPD. Thorax 2007;62(11):950-6.
O'Donnell D, McGuire M, Samis L, Webb K. General exercise training improves ventilatory and peripheral muscle strength and endurance in chronic airflow limitation. Am J Respir Crit Care Med 1998;157(5 Pt 1):1489-97.
Vogiatzis I, Williamson A, Miles J, Taylor I. Physiological response to moderate exercise workloads in a pulmonary rehabilitation program in patients with varying degrees of airflow obstruction. Chest 1999;116(5):1200-7.
Engelen MP, Schols AM, Does JD, Gosker HR, Deutz NE, Wouters EF. Exercise-induced lactate increase in relation to muscle substrates in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;162(5):1697-704.
Reid WD, Rurak J, Harris RL. Skeletal muscle response to inflammation--lessons for chronic obstructive pulmonary disease. Crit Care Med 2009;37(10 Suppl):S372-83.
Benton C, Holloway G, Han X, Yoshida Y, Snook L, Lally J, et al. Increased levels of peroxisome proliferator-activated receptor gamma, coactivator 1 alpha (PGC-1alpha) improve lipid utilisation, insulin signalling and glucose transport in skeletal muscle of lean and insulin-resistant obese Zucker rats. Diabetologia 2010;53(9):2008-19.
Nader G. Molecular determinants of skeletal muscle mass: getting the "AKT" together. Int J Biochem Cell Biol 2005;37(10):1985-96.
Cai D, Frantz JD, Tawa NE, Jr., Melendez PA, Oh BC, Lidov HG, et al. IKKbeta/NF-kappaB activation causes severe muscle wasting in mice. Cell 2004;119(2):285-98.
Léger B, Senese R, Al-Khodairy A, Dériaz O, Gobelet C, Giacobino J, et al. Atrogin-1, MuRF1, and FoXO, as well as phosphorylated GSK-3beta and 4E-BP1 are reduced in skeletal muscle of chronic spinal cord-injured patients. Muscle Nerve 2009;40(1):69-78.
Lin J, Wu H, Tarr P, Zhang C, Wu Z, Boss O, et al. Transcriptional co-activator PGC-1 alpha drives the formation of slow-twitch muscle fibres. Nature 2002;418(6899):797-801.
Ochi E, Hirose T, Hiranuma K, Min SK, Ishii N, Nakazato K. Elevation of myostatin and FOXOs in prolonged muscular impairment induced by eccentric contractions in rat medial gastrocnemius muscle. J Appl Physiol 2010;108(2):306-13.
Rutten EP, Engelen MP, Wouters EF, Schols AM, Deutz NE. Metabolic effects of glutamine and glutamate ingestion in healthy subjects and in persons with chronic obstructive pulmonary disease. Am J Clin Nutr 2006;83(1):115-23.
Rutten EP, Engelen MP, Gosker H, Bast A, Cosemans K, Vissers YL, et al. Metabolic and functional effects of glutamate intake in patients with chronic obstructive pulmonary disease (COPD). Clin Nutr 2008;27(3):408-15.
Engelen MP, Schols AM, Does JD, Deutz NE, Wouters EF. Altered glutamate metabolism is associated with reduced muscle glutathione levels in patients with emphysema. Am J Respir Crit Care Med 2000;161(1):98-103.
Ferreira IM, Brooks D, Lacasse Y, Goldstein RS. Nutritional support for individuals with COPD: a meta-analysis. Chest 2000;117(3):672-8.
Steiner MC, Barton RL, Singh SJ, Morgan MD. Nutritional enhancement of exercise performance in chronic obstructive pulmonary disease: a randomised controlled trial. Thorax 2003;58(9):745-51.
Engelen MP, Rutten EP, De Castro CL, Wouters EF, Schols AM, Deutz NE. Supplementation of soy protein with branched-chain amino acids alters protein metabolism in healthy elderly and even more in patients with chronic obstructive pulmonary disease. Am J Clin Nutr 2007;85(2):431-9.
Kutsuzawa T, Shioya S, Kurita D, Haida M. Plasma branched-chain amino acid levels and muscle energy metabolism in patients with chronic obstructive pulmonary disease. Clin Nutr 2009;28(2):203-8.
Fuld JP, Kilduff LP, Neder JA, Pitsiladis Y, Lean ME, Ward SA, et al. Creatine supplementation during pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax 2005;60(7):531-7.
Deacon SJ, Vincent EE, Greenhaff PL, Fox J, Steiner MC, Singh SJ, et al. Randomized controlled trial of dietary creatine as an adjunct therapy to physical training in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008;178(3):233-9.
Vieira RP, Duarte AC, Claudino RC, Perini A, Santos AB, Moriya HT, et al. Creatine supplementation exacerbates allergic lung inflammation and airway remodeling in mice. Am J Respir Cell Mol Biol 2007;37(6):660-7.
Vieira RP, Duarte AC, Santos AB, Medeiros MC, Mauad T, Martins MA, et al. Exercise reduces effects of creatine on lung. Int J Sports Med 2009;30(9):684-90.
Burdet L, de Muralt B, Schutz Y, Pichard C, Fitting JW. Administration of growth hormone to underweight patients with chronic obstructive pulmonary disease. A prospective, randomized, controlled study. Am J Respir Crit Care Med 1997;156(6):1800-6.
Ferreira IM, Verreschi IT, Nery LE, Goldstein RS, Zamel N, Brooks D, et al. The influence of 6 months of oral anabolic steroids on body mass and respiratory muscles in undernourished COPD patients. Chest 1998;114(1):19-28.
Casaburi R, Bhasin S, Cosentino L, Porszasz J, Somfay A, Lewis M, et al. Effects of testosterone and resistance training in men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004;170(8):870-8.
Lewis MI, Fournier M, Storer TW, Bhasin S, Porszasz J, Ren SG, et al. Skeletal muscle adaptations to testosterone and resistance training in men with COPD. J Appl Physiol 2007;103(4):1299-310.
Ferreira I, Verreschi I, Nery L, Goldstein R, Zamel N, Brooks D, et al. The influence of 6 months of oral anabolic steroids on body mass and respiratory muscles in undernourished COPD patients. Chest 1998;114(1):19-28.
van Balkom RH, Dekhuijzen PN, van der Heijden HF, Folgering HT, Fransen JA, van Herwaarden CL. Effects of anabolic steroids on diaphragm impairment induced by methylprednisolone in emphysematous hamsters. Eur Respir J 1999;13(5):1062-9.
Yeh SS, DeGuzman B, Kramer T. Reversal of COPD-associated weight loss using the anabolic agent oxandrolone. Chest 2002;122(2):421-8.
Akerstrom T, Krogh-Madsen R, Petersen A, Pedersen B. Glucose ingestion during endurance training in men attenuates expression of myokine receptor. Exp Physiol 2009;94(11):1124-31.
Broekhuizen R, Wouters EF, Creutzberg EC, Weling-Scheepers CA, Schols AM. Polyunsaturated fatty acids improve exercise capacity in chronic obstructive pulmonary disease. Thorax 2005;60(5):376-82.
Downloads
Publicado
Edição
Seção
Licença
Autores que publicam nesta revista concordam com os seguintes termos:
Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution 4.0 que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
Autores têm autorização para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.
