Nelson Sousa

Exercise prescription for patients with type 2 diabetes—a synthesis of international recommendations: narrative review

Background Physical activity is a cornerstone of type 2 diabetes treatment and control. Aim We analysed and synthesised the guidelines and recommendations issued by scientific organisations, regarding exercise prescription for patients with type 2 diabetes. Method A systematic bibliographic search in Pubmed, Web of Science and Scopus databases was conducted. Clinical guidelines from major international scientific organisations in the field of diabetology, endocrinology, cardiology, public health and sports medicine were also considered. 11 publications were selected. Results Published guidelines recommend a weekly accumulation of a minimum of 150 min of aerobic exercise at moderate-to-vigorous intensity spread over a minimum of 3 days per week. Resistance exercise for muscle strengthening is also recommended at least 2 days a week. Flexibility exercises may complement other types of exercise. Combining aerobic and resistance exercise within the same exercise session is recommended by most guidelines. Conclusions Exercise prescription for individuals with type 2 diabetes should include specific information on the type, mode, duration, intensity and weekly frequency. The exercise strategies must be adapted for each individual, based on comorbidities, contraindications and realistic personal goals.

A randomized 9-month study of blood pressure and body fat responses to aerobic training versus combined aerobic and resistance training in older men.

This randomized study evaluated the impact of different exercise training modalities on blood pressure and body fat responses in apparently healthy older men. Forty-eight elderly men (aged 65-75 years) were randomly assigned to an aerobic training group (ATG, n=15), a combined aerobic and resistance training group (CTG, n=16), or a control group (n=17). Both exercise training programs were moderate-to-vigorous intensity, three days/week for 9-months. Strength, aerobic endurance, body fat and blood pressure were measured on five different occasions. The data were analyzed using a mixed-model ANOVA, and the independence between systolic blood pressure (SBP), diastolic blood pressure (DBP) and group was tested. A significant main effect of group (p<0.001) was observed in strength and aerobic endurance, with higher performance observed in the CTG. A significant main effect of group (p<0.001) and time (p=0.029) was observed in body fat percentage, with a 2.3% decrease in CTG. A significant main effect of time was observed in SBP (p=0.005) and in DBP (p=0.011) for both ATG and CTG. Mean decreases in SBP and DBP, respectively, were 15 and 6 mmHg for ATG and 24 and 12 mmHg for CTG. There was a significant association for SBP (p=0.008) and DBP (p=0.005) in the CTG, with significant individual BP profile modifications. Both exercise-training programs reduce resting blood pressure. However, only the combined exercise training was effective at reducing body fat percentage; consequently, there were larger changes in blood pressure, which result in a significant reduction in hypertensive subjects.

Effectiveness of combined exercise training to improve functional fitness in older adults: A randomized controlled trial

The present randomized controlled trial evaluated the impact of different exercise training modalities on functional fitness responses in apparently healthy older men.

Long‐term effects of aerobic training versus combined aerobic and resistance training in modifying cardiovascular disease risk factors in healthy elderly men

The purpose of the present study was to compare different modes of exercise in chronic modification of cardiovascular diseases risk factors.

Physiological Responses to Treadmill and Cycle Exercise

This study aimed to identify differences in the acute cardio-respiratory, metabolic and perceptual responses between exercise performed on the treadmill and on the cycle ergometer at several intensities. The sample comprised of 20 voluntary male participants (age=22.5 ± 1.8 years; height=177.7 ± 7.0 cm; body mass=72.6 ± 7.9 kg; fat mass=7.87 ± 1.3%) that performed 5 submaximal 8 min exercise bouts, interspersed with a 10 min period of passive recovery. Exercise intensity used on the treadmill was 10, 12, 14, 15 and 16 km/h (0% gradient), and 80, 120, 160, 180 and 200 W on the cycle ergometer (65-70 rpm). There was a significant mode effect and also mode×intensity interaction in oxygen uptake and heart rate with higher values in the treadmill protocol (F=32.0 p=0.000, η2=0.65 and F=132.0 p=0.000, η2=0.88, respectively). The respiratory exchange ratio and blood lactate concentrations were not different across modes (F1, 18=1.9 p=0.183 and F1, 17=0.1 p=0.964, respectively) and rate of perceived exertion values were higher in the cycle ergometer (F1, 12=1.2 p=0.288). Generally, results showed a larger exercise mode effect on the cardio-respiratory variables with higher response patterns on the treadmill, differing according to exercise intensity.

Prevention of exercise-related injuries and adverse events in patients with type 2 diabetes

Physical activity is widely recommended as an essential non-pharmacological therapeutic strategy to the prevention and control of type 2 diabetes and cardiovascular risk. Microvascular and macrovascular complications associated with the natural progression of the disease and typical age and anthropometric profile of individuals with type 2 diabetes may expose these patients to an increased risk of injury and acute adverse events during exercise. These injuries and adverse events can lead to fear of new injury and consequent physical inactivity. Preventative measures are essential to reduce risk, increase safety and avoid the occurrence of exercise-related injuries in people with type 2 diabetes. This population can exercise safely if certain precautions are taken and if exercise is adapted to complications and contraindications of each individual. Conditions such as diabetic foot, diabetic retinopathy, diabetic nephropathy, diabetic autonomic neuropathy, cardiovascular risk factors, musculoskeletal disorders, hypoglycaemia, hyperglycaemia, dehydration and interactions between medication and exercise should be taken into consideration when prescribing exercise.

Differences in Maximum Upper and Lower Limb Strength in Older Adults After a 12 Week Intense Resistance Training Program

Differences in Maximum Upper and Lower Limb Strength in Older Adults After a 12 Week Intense Resistance Training Program The purpose of this study was to identify differences in maximum strength after an intense strength training program, contrasting muscle groups from upper limbs versus lower limbs. The sample consisted of 10 healthy elderly males (age 73±6 years) with independent living. The training program lasted 12 weeks (3 × week, 50 to 80% of 1RM, 2-3 sets, 6 to 12 repetitions). Two muscle groups were analyzed: LOWER (sum of average values of three exercises for the lower limbs) and UPPER (sum of average values of four exercises for the upper limbs). Measurement of 1RM was performed at intervals of 4 weeks by direct methods. Repeated measures ANOVA identified significant differences in muscle groups (F=8.1, p=0.006), time (F=730.0 p=0.000) and also their interaction (F=4.4, p=0.014). The gains in 1RM values were higher for upper limbs. These results may suggest that the muscles of the lower limbs are elicited more frequently and therefore, have a smaller potential to gain strength at older age. The muscles of the upper limbs are in accelerated muscle atrophy and their trainability is probably higher.

Physical exercise and functional fitness in independently living vs institutionalized elderly women: a comparison of 60- to 79-year-old city dwellers

Purpose To compare functional fitness (FF) levels among independent-living (IL) and day care (DC) elderly women of different age groups and to analyze changes in FF after 8 months of participation in an exercise program intervention for the IL elderly women. Materials and methods A total of 674 elderly women were divided into four IL groups with age in the range of 60–64 years (IL60–64, n=149), 65–69 years (IL65–69, n=138), 70–74 years (IL70–74, n=135), and 75–79 years (IL75–79, n=83), and four DC groups with age in the range of 60–64 years (DC60–64, n=35), 65–69 years (DC65–69, n=34), 70–74 years (DC70–74, n=47), and 75–79 years (DC75–79, n=53). The intervention consisted of a multimodal exercise training, 3 days per week for 8 months. Senior Fitness Test battery performances were obtained at baseline and after 8-month intervention. Results Significant differences were identified between all IL groups and DC groups in all FF tests (P<0.001), except between IL70–74 and DC70–74 in the chair sit-and-reach. Analysis of covariance (ANCOVA) identified significant improvements in all FF tests between pre- and posttests in the IL groups (P<0.001), except in the chair sit-and-reach for the IL70–74. ANCOVA also showed a significant declining performance in all FF tests for DC groups (P<0.001), except in the chair sit-and-reach for the DC70–74 and DC75–79. Conclusion IL women are more fit than institutionalized DC elderly women. The multimodal training was effective in improving all FF components related to daily living activities, in all age groups. In contrast, institutionalized elderly showed a clear tendency to worsen their FF over the time.

Thermography: a technique for assessing the risk of developing diabetic foot disorders

Development of diabetic foot disorders is one of the most serious and costly complications of diabetes mellitus.1 Foot ulcers and amputations are major causes of morbidity and disability in this population. The identification of patients at risk for diabetic foot should be the first step in preventing such complications.2 Diabetic foot clinical examination involves a 10-g Semmes-Weinstein monofilament test, palpation of peripheral arterial pulses, subjective assessment of skin temperature, as well as the observation of structural and dermatological characteristics of the feet. However, this protocol is greatly dependent of observer knowledge and experience. Digital infrared thermal imaging based thermography is able to quantify small temperature asymmetries in order to monitor some physiological conditions. This technique has great portability and poses no risk to …

Short-Term Effects of Complex Training on Agility with the Ball, Speed, Efficiency of Crossing and Shooting in Youth Soccer Players

Abstract Complex training (CXT) is the result of a combination of strength and plyometric exercises in the same session. This method has recently been used in the preparation of athletes of different sports. The aim of the present study was to observe the acute effects of a CXT program of 6 weeks: i) on agility with the ball, sprinting and the efficiency of crossing and shooting in youth soccer players; ii) and the influence of the number of CXT sessions per week (one vs. two). Sixteen youth male soccer players were randomly divided into three groups: a group that performed one weekly CXT session (GCT1, n = 5, age: 13.80 ± 0.45 years); or a group that performed two weekly CXT sessions (GCT2, n = 5, age: 14.20 ± 0.45 years); or a control group that did not perform the CTX (n = 6, age: 14.20 ± 0.84 years). All groups maintained their regular soccer training sessions. No significant interactions were found between GCT1 and GCT2 in all variables. Significant statistical differences were identified (F = 1139, p = 0.02, μp2 = 0531) in the pre-test versus post-test, for both experimental groups, in shot effectiveness. In conclusion, the CXT program proved to be an effective method in boosting abilities and motor skills associated with soccer among young athletes, particularly in increasing shot effectiveness.