Avaliação cardiovascular, muscular e da mobilidade funcional de adolescentes com síndrome de Down atendidos na Equoterapia e Fisioterapia

Abstract

Introduction: Cardiovascular diseases are the major cause of mortality in the world population and individuals with Down syndrome have a markedly increased risk of developing these diseases. Some of the factors that contribute to cardiovascular events are high blood pressure, sedentary lifestyle, low adaptive heart rate response and blood pressure during physical activities. Muscular hypotonia, characteristic of Down Syndrome, compromises functional mobility, muscular strength and consequently muscular electrical activity. Objectives: To evaluate the effects of Hippotherapy and physiotherapy on the values of the cardiovascular, muscular and functional parameters of adolescents with Down syndrome. Materials and Methods: The study included 14 subjects with Down syndrome divided into two groups: nine (six male and three female) in the Hipotherapy group and five (three male and two female) in the Physiotherapy group, mean age 13.2 ± 2.2) and 14.2 (± 3.1) years, respectively. A total of 30 sessions of each treatment modality were performed with a duration of 30 minutes each, once a week. Blood pressure, heart rate and peripheral oxygen saturation were collected before, during and after the interventions (initial rest 1 and 10 min, during 1, 15 and 30 min of activity, and at final rest 1 and 10 min). The surface electromyographic collections of the lower limbs, the Timed Up and Go (TUG) and 30 Seconds Chair Stand (30 CST) tests were performed before and after the 30 sessions. Results: The systolic blood pressure analysis presented significant differences (p <0.001) in the 30th session in the physiotherapy group. In the heart rate of both groups there were significant differences in moments 1, 15 and 30 minutes of the activities compared to the initial and final rest, however, the group Hippotherapy presented lower values compared to the physiotherapy group. In the 30 CST test, no significant results were observed in the comparisons between pre and post interventions in both groups. In the electromyographic analyzes in the time domain, no significant results were observed when comparing pre and post intervention in both groups. However, in the frequency domain the results were significant in the right vastus lateralis muscle (p = 0.049) and right biceps femoris (p = 0.005) in the hippotherapy group; and right femoral muscle (p = 0.050), right vastus lateralis (p= 0.035), right femoral biceps (p = 0.017) and left medial vastus (p =0.006) in physiotherapy. In the 30 CST test, no significant results were observed in the comparisons between pre and post interventions in both groups. In the TUG test, we observed statistically significant differences (p = 0.006) in the Hippotherapy group, comparing the pre and post intervention (1st and 30th sessions). Conclusion: Hippotherapy did not significantly alter the behavior of blood pressure after the sessions, as well as heart rate and oxygen saturation. However, it provided an improvement in functional mobility and reduced risk of fatigue when compared to Physiotherapy. Physiotherapy promoted a reduction in systolic blood pressure values after a period of intervention and greater risk of fatigue. However, both interventions are safe practices for the cardiovascular parameters of adolescents with Down syndrome.