Elisa Corrêa Marson

Glucose control can be similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: A randomized clinical trial

OBJECTIVES To compare the effects of two aerobic training methods in water and on dry-land on glycemic, lipid, inflammatory, hormonal, cardiorespiratory, and functional outcomes in patients with type 2 diabetes. DESIGN Randomized clinical trial. METHODS Thirty-five patients with type 2 diabetes were randomly assigned to aquatic aerobic training group (n=17) or dry-land aerobic training group (n=18). Exercise training interventions had duration of 12 weeks, performed in three weekly sessions (45min/session), with intensity progressing from 85% to 100% of heart rate of anaerobic threshold during interventions. All outcomes were evaluated at baseline and 12 weeks later. RESULTS Patients were 56.7±7.9 years old. Decreases in glycated hemoglobin were observed in both groups (AT: -0.42±0.28%, DLT: -0.35±1.8%). Total cholesterol, high density lipoprotein, low density lipoprotein levels, plasma renin activity, angiotensin II concentrations, C-reactive protein, systolic blood pressure, resting heart rate, and timed up and go test performed at the usual speed also decreased in both groups in response to both interventions (p<0.05), without between-group differences. Both groups increased the ratio between oxygen uptake at the anaerobic threshold and oxygen uptake of peak (p=0.01). CONCLUSIONS Aerobic training in an aquatic environment provides effects similar to aerobic training in a dry-land environment in patients with type 2 diabetes.

Effects of aerobic, resistance, and combined exercise training on insulin resistance markers in overweight or obese children and adolescents: A systematic review and meta-analysis

OBJECTIVE To assess the associations of aerobic, resistance, and combined exercise with changes in insulin resistance, fasting glucose, and fasting insulin in children and adolescents who are overweight or obese. DATA SEARCHES MEDLINE via Pubmed, Cochrane-CENTRAL, SPORTDiscus, and LILACS. STUDY SELECTION Randomized clinical trials of at least six weeks of duration that evaluated the ability of exercise training to lower at least one of the following outcomes: insulin resistance-HOMA, fasting glucose, and fasting insulin in children and/or adolescents classified as obese or overweight. DATA EXTRACTION AND ANALYSIS Two independent reviewers extracted data and assessed the quality of the included studies. Differences (exercise training group minus control group) in the outcomes evaluated were analyzed using a random effects model. RESULTS Of 1853 articles retrieved, 17 studies were included. The meta-analysis showed that physical training in general was not associated with a reduction in fasting glucose levels compared to the control, but it was associated with reductions in fasting insulin levels (-3.37μU/ml; CI 95%, -5.16μU/ml to -1.57μU/ml; I2, 54%, p=0.003) and HOMA (-0.61; CI 95%, -1.19 to -0.02; I2, 49%, p=0.040). In addition, each modality (aerobic, resistance, and combined) was compared to the control group. Aerobic exercise was associated with declines in fasting insulin levels (-4.52μU/ml; CI 95%, -7.40 to -1.65; I2, 65%, p=0.002) and in HOMA (-1.33; 95% confidence interval, -2.47 to -0.18; I2, 73%, p=0.005). CONCLUSIONS Exercise training, especially aerobic training, is associated with the reduction of fasting insulin levels and HOMA in children and adolescents with obesity and overweight, and may prevent metabolic syndrome and type 2 diabetes.

Quality of life and sleep quality are similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: A randomized clinical trial

OBJECTIVES To compare the effects of two aerobic training models in water and on dry-land on quality of life, depressive symptoms and sleep quality in patients with type 2 diabetes. DESIGN Randomized clinical trial. METHODS Thirty-five patients with type 2 diabetes were randomly assigned to aquatic aerobic training group (n=17) or dry-land aerobic training group (n=18). Exercise training length was of 12 weeks, performed in three weekly sessions (45min/session), with intensity progressing from 85% to 100% of heart rate of anaerobic threshold during interventions. All outcomes were evaluated at baseline and 12 weeks later. RESULTS In per protocol analysis, physical and psychological domains of quality of life improved in both groups (p<0.05) without between-group differences. Overall quality of life and sleep quality improved in both groups (p<0.05), without between-group differences in per protocol and intention to treat analysis. No changes on depressive symptoms were observed in both groups at follow-up. CONCLUSIONS Aerobic training in an aquatic environment provides similar effects to aerobic training in a dry-land environment on quality of life, depressive symptoms and sleep quality in patients with type 2 diabetes. Clinical trial reg. no. NCT01956357, clinicaltrials.gov.

GLYCEMIC THRESHOLD AS AN ALTERNATIVE METHOD TO IDENTIFY THE ANAEROBIC THRESHOLD IN PATIENTS WITH TYPE 2 DIABETES

Purpose: To analyze the agreement between the velocity, heart rate, and oxygen uptake values corresponding to second ventilatory threshold and glycemic threshold in patients with type 2 diabetes. Methods: Twenty-four untrained patients (55.1 ± 8.9 years) were evaluated. Three different parameters of training intensity corresponding to anaerobic threshold, one mechanical (velocity) and two physiological (heart rate and oxygen uptake) parameters, were identified by a classical method (second ventilatory threshold) and by an alternative method (glycemic threshold). To determine the threshold values, patients performed an incremental treadmill test, with an initial velocity of 3 km.h-1 for 3 min, that was then increased by 1 km.h-1 every 2 min. Comparisons between mean values and the degree of agreement between second ventilatory threshold and glycemic threshold were analyzed using the paired t-test and Bland-Altman test, respectively. Results: All patients performed the tests appropriately, and no adverse effects were recorded. Patients demonstrated similar mean velocity (p = 0.25), heart rate (p = 0.97) and oxygen uptake (p = 0.71) between the ventilatory threshold (6.4 ± 0.6 km.h-1, 130.1 ± 18.7 bpm, 15.2 ± 3.5 ml.kg.min-1) and the glycemic threshold (6.2 ± 0.9 km.h-1, 130.2 ± 12.8 bpm, 15.0 ± 3.8 ml.kg.min-1). Conclusion: The present study indicates an agreement between the glycemic and second ventilatory methods in determination of the anaerobic threshold of patients with type 2 diabetes; and thus, either method may be used for these patients.