Diabetes em Movimento®-programa comunitário de exercício para pessoas com diabetes tipo 2: efeitos no controlo glicémico, fatores de risco cardiovascular e aptidão física
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2014-11-11
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A atividade física é reconhecida como uma estratégia terapêutica não farmacológica fundamental para o controlo da diabetes tipo 2 e do risco cardiovascular associado. No entanto, a maioria dos diabéticos tipo 2 não pratica exercício de forma regular, quer por uma consciência insuficiente sobre os potenciais benefícios do exercício, quer pela falta de conhecimentos específicos sobre as suas recomendações atuais. Quais são então as recomendações de prescrição de exercício para pessoas com diabetes tipo 2? De que forma se podem prevenir as lesões e eventos adversos agudos associados à prática de exercício nesta população? Será o treino intervalado de alta intensidade (TIAI) um método seguro e eficaz no controlo glicémico agudo? Será um programa comunitário de exercício combinado, de elevada aplicabilidade, e desenvolvido com recursos materiais mínimos e de baixo custo, capaz de induzir benefícios no controlo glicémico, nos principais fatores de risco cardiovascular, e na aptidão física em pessoas com diabetes tipo 2? Para responder a estas questões foram realizados vários estudos: uma revisão sistemática das recomendações internacionais de prescrição de exercício para pessoas com diabetes tipo 2; uma revisão crítica sobre as principais medidas preventivas de lesões e eventos adversos agudos associados ao exercício nesta população; um estudo cruzado, randomizado e controlado sobre os efeitos agudos do TIAI no controlo glicémico em pessoas com diabetes tipo 2; e um estudo longitudinal sobre os efeitos de nove meses do Diabetes em Movimento®, um programa comunitário de exercício combinado, direcionado para pessoas com diabetes tipo 2, de elevada aplicabilidade, e desenvolvido com recursos materiais mínimos e de baixo custo, no controlo glicémico, nos principais fatores de risco cardiovascular modificáveis, e na aptidão física de um grupo de pessoas com diabetes tipo 2. Tendo em consideração os resultados dos estudos, os diabéticos tipo 2 devem seguir as recomendações de atividade física e exercício para a população geral. Contudo, a prescrição de exercício deve incluir recomendações para a prevenção e controlo de complicações como o pé diabético, retinopatia diabética, nefropatia diabética, neuropatia autonómica diabética, risco cardiovascular, patologias musculoesqueléticas, hipoglicemia, hiperglicemia, desidratação e interações entre os medicamentos e o exercício. O TIAI parece ter aplicabilidade em pessoas com diabetes tipo 2, e demonstrou ser um método seguro e mais eficaz no controlo glicémico agudo imediato do que o treino contínuo de intensidade moderada. Nove meses do programa Diabetes em Movimento® melhoraram de forma significativa os níveis da hemoglobina glicada, da glicose plasmática em jejum, do colesterol total, do colesterol HDL, do colesterol LDL, dos triglicerídeos, da pressão arterial sistólica, da pressão arterial diastólica, o índice de massa corporal, o perímetro abdominal, o risco de doença das artérias coronárias a 10 anos, a aptidão aeróbia, a força muscular, a agilidade/equilíbrio, e a flexibilidade de um grupo de pessoas com diabetes tipo 2.
Physical activity is recognized as a major non-pharmacological therapeutic strategy for the control of type 2 diabetes and related cardiovascular risk. However, the majority of type 2 diabetics do not regularly engage in exercise, either by insufficient awareness of the potential benefits of exercise, either by lack of specific knowledge about their current recommendations. What are the recommendations for exercise prescription for people with type 2 diabetes? How injury and exercise-related acute adverse events can be prevented in this population? Is high intensity interval training (HIIT) a safe and effective method in acute glycemic control? Can a community-based combined exercise program, with high applicability, and developed with minimum and low cost material resources, be capable of inducing benefits on glycemic control, major cardiovascular risk factors, and physical fitness in people with type 2 diabetes? To answer these questions several studies were conducted: a systematic review of international recommendations for exercise prescription in people with type 2 diabetes; a critical review study about the main preventive measures for exercise-related injuries and adverse events in this population; a randomized controlled crossover study on the acute effects of HIIT on glycemic control in people with type 2 diabetes; and a longitudinal study about the effects of nine months of Diabetes em Movimento®, a community-based combined exercise program designed for people with type 2 diabetes, with high applicability, and developed with minimum low-cost material resources, on glycemic control, major modifiable cardiovascular risk factors, and physical fitness in a group of people with type 2 diabetes. The results of the studies suggest that type 2 diabetics should follow the recommendations for physical activity and exercise for the general population. However, exercise prescription should include recommendations for the prevention and control of complications such as diabetic foot, diabetic retinopathy, diabetic nephropathy, diabetic autonomic neuropathy, cardiovascular risk, musculoskeletal disorders, hypoglycemia, hyperglycemia, dehydration and interactions between medication and exercise. HIIT seems to have applicability in people with type 2 diabetes, and demonstrated to be a safe and a more effective method in the immediate acute glycemic control than moderate intensity continuous training. Nine months of Diabetes em Movimento® program significantly improved the levels of glycated hemoglobin, fasting plasma glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, abdominal circumference, 10 years risk of coronary artery disease, aerobic fitness, muscular strength, agility/balance, and flexibility in a group of people with type 2 diabetes.
Physical activity is recognized as a major non-pharmacological therapeutic strategy for the control of type 2 diabetes and related cardiovascular risk. However, the majority of type 2 diabetics do not regularly engage in exercise, either by insufficient awareness of the potential benefits of exercise, either by lack of specific knowledge about their current recommendations. What are the recommendations for exercise prescription for people with type 2 diabetes? How injury and exercise-related acute adverse events can be prevented in this population? Is high intensity interval training (HIIT) a safe and effective method in acute glycemic control? Can a community-based combined exercise program, with high applicability, and developed with minimum and low cost material resources, be capable of inducing benefits on glycemic control, major cardiovascular risk factors, and physical fitness in people with type 2 diabetes? To answer these questions several studies were conducted: a systematic review of international recommendations for exercise prescription in people with type 2 diabetes; a critical review study about the main preventive measures for exercise-related injuries and adverse events in this population; a randomized controlled crossover study on the acute effects of HIIT on glycemic control in people with type 2 diabetes; and a longitudinal study about the effects of nine months of Diabetes em Movimento®, a community-based combined exercise program designed for people with type 2 diabetes, with high applicability, and developed with minimum low-cost material resources, on glycemic control, major modifiable cardiovascular risk factors, and physical fitness in a group of people with type 2 diabetes. The results of the studies suggest that type 2 diabetics should follow the recommendations for physical activity and exercise for the general population. However, exercise prescription should include recommendations for the prevention and control of complications such as diabetic foot, diabetic retinopathy, diabetic nephropathy, diabetic autonomic neuropathy, cardiovascular risk, musculoskeletal disorders, hypoglycemia, hyperglycemia, dehydration and interactions between medication and exercise. HIIT seems to have applicability in people with type 2 diabetes, and demonstrated to be a safe and a more effective method in the immediate acute glycemic control than moderate intensity continuous training. Nine months of Diabetes em Movimento® program significantly improved the levels of glycated hemoglobin, fasting plasma glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, abdominal circumference, 10 years risk of coronary artery disease, aerobic fitness, muscular strength, agility/balance, and flexibility in a group of people with type 2 diabetes.
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Tese de Doutoramento em Ciências do Desporto
Palavras-chave
Atividade física , Aptidão física , Diabetes tipo 2 , Intervenção comunitária , Controlo glicémico , Fatores de risco cardiovascular